You can go here to see John McCain's proposals on Healthcare reform for the US. Aircav over at ABP has decided that I'm an asshole because I was making fun of McCain, saying I didn't realize he had a plan beyond saying if you don't have health insurance don't plan on getting it anytime soon.
So here is John McCain's plan as posted on his website:
Bringing costs under control is the only way to stop the erosion of affordable health insurance, save Medicare and Medicaid, protect private health benefits for retirees, and allow our companies to effectively compete around the world.
File this under the heading 'No shit, Sherlock'
Families should be in charge of their health care dollars and have more control over their care. We can improve health and spend less, while promoting competition on the cost and quality of care, taking better care of our citizens with chronic illness, and promoting prevention that will keep millions of others from ever developing deadly and debilitating disease.
So it begs asking, how many of you don't have control over your own care right now? Are you prevented from researching different options, going to see the doctor you want, and otherwise price shopping? No? What this really means is that Republicans want people to bare the costs of Healthcare so that they will ration how much they consume, not based upon educated assessments of what value the treatment has but rather based upon costs. Patients can't make truely informed decisions about Healthcare simply because they don't have all of the education necessary to really determine what the best treatment options are. Doctors study for years to make those determinations, if their judgement can be analyzed by the average car mechanic, why do we even need doctors? Perhaps later we'll read about how McCain is proposing to send every person in the US to med school.
While we reform the system and maintain quality, we can and must provide access to health care for all our citizens - whether temporarily or chronically uninsured, whether living in rural areas with limited services, or whether residing in inner cities where access to physicians is often limited.
Another for the 'NSS' file.
America's veterans have fought for our freedom. We should give them freedom to choose to carry their VA dollars to a provider that gives them the timely care at high quality and in the best location.
Rough translation. Privatize VA hospitals.
Controlling health care costs will take fundamental change - nothing short of a complete reform of the culture of our health system and the way we pay for it will suffice. Reforms to federal policy and programs should focus on enhancing quality while controlling costs:
Promote competition throughout the health care system - between providers and among alternative treatments.
Promote competition throughout the healthcare system? Is there a doctor's cabal out there we're unaware of? Doctors and Hospitals do compete for patients now. The problem goes back to the fact that consumers do not have the requisite amount of information to make informed decisions between treatments. This is why HMOs and Managed Care options were formed, to provide on the consumer side a party who could evaluate the treatment options and make the determination based upon medical training whether a treatment was valid or worthwhile. Ofcourse that didn't work because the doctors employeed by the HMOs and MCs options found themselves pressed to work in the best interests of the Insurance Company and not necessarily the best interests of the consumer of healthcare.
Make patients the center of care and give them a larger role in both prevention and care, putting more decisions and responsibility in their hands.
Restating the same. How do you put the responsibility in the hands of patients for their care if they don't have the necessary information to make those decisions? Hey Mr. Jones you have chronnic heart failure. Here are a couple of pamphlets documenting some treatment options. When you decided which treatment option is best for you, please call the nurse and set up an appointment and we'll get you fixed right up. Make sense? Not in the least.
Make public more information on treatment options and require transparency by providers regarding medical outcomes, quality of care, costs, and prices.
Providers are happy to provide you with a listing of their prices already. Pooled insurance is able to negotiate better prices. The quality of care issue is a good thought. Zagut ratings for doctors maybe? Medical outcomes is a far more sticky subject, reporting on that would interfere with patient confidentiality.
Facilitate the development of national standards for measuring and recording treatments and outcomes.
Sounds like a good idea. But doesn't do anything to provide insurance to those who don't have it.
Reform the payment systems in Medicare to compensate providers for diagnosis, prevention, and care coordination. Medicare should not pay for preventable medical errors or mismanagement.
What does this even mean? Medicare should not pay for medical errors or mismanagement?
Dedicate federal research on the basis of sound science resulting in greater focus on care and cure of chronic disease
Are we presently dedicating federal research on the basis of unsound science? If so I agree that should change.
Give states the flexibility to, and encourage them to experiment with: alternative forms of access; risk-adjusted payments per episode covered under Medicaid; use of private insurance in Medicaid; alternative insurance policies and insurance providers; and, different licensing schemes for medical providers.
This says to allow the states to have power to use different licensing schemes for medical providers.
Build genuine national markets by permitting providers to practice nationwide.
This says states shouldn't be able to set licensing restrictions for people practicing in their state. So which is it.
Promote rapid deployment of 21st century information systems.
Promoted by whom? The Government? And what exactly is preventing this from happening now?
Support innovative delivery systems, such as clinics in retail outlets and other ways that provide greater market flexibility in permitting appropriate roles for nurse practitioners, nurses, and doctors.
Again, what exactly is preventing this from happening now? Pharmacies are starting to put in retail clinics. As far as permitting the appropriate roles for nurse practitioners, doctors and nurses. Do the states not already have this power?
Where cost-effective, employ telemedicine, and community and mental health clinics in areas where services and providers are limited.
Where cost-effective? How about this, we allow it where it is outcome-effictive? And dial-a-doc sounds like such a great policy. Getting diagnosed and treated by somebody who has never met you, seen you, run test on you, or hell, even gone so far as to take your blood pressure sounds like such a great way to conduct business. Just like getting Viagra over the internet.
Foster the development of routes for safe, cheaper generic versions of drugs and biologic pharmaceuticals. Develop safety protocols that permit re-importation to keep competition vigorous.
Another that makes no sense. The reason we don't have these routes now is that it isn't very profitable to research and test a drug for 10 years simply to allow your competitors to market it as soon as it is deemed acceptable for market. And developing safety protocols that permit re-importation? Dubya isn't going to be happy about that. And I thought this was supposed to be the personal responsibility plan? How about we just allow re-importation?
Pass tort reform to eliminate frivolous lawsuits and excessive damage awards. Provide a safe harbor for doctors that follow clinical guidelines and adhere to patient safety protocols.
Don't you like this system? You are responsible for your own medical treatment not your doctor, and when your doctor fucks up that treatment, well, you are responsible for that too.
Protect the health care consumer through vigorous enforcement of federal protections against collusion, unfair business actions, and deceptive consumer practices. John McCain believes that insurance reforms should increase the variety and affordability of insurance coverage available to American families by fostering competition and innovation.
Is he admitting that the current administration isn't vigorously enforcing the federal protections against collusion, unfair business actions and deceptive consumer practices? Well I applaud him for that.
Reform the tax code to eliminate the bias toward employer-sponsored health insurance, and provide all individuals with a $2,500 tax credit ($5,000 for families) to increase incentives for insurance coverage. Individuals owning innovative multi-year policies that cost less than the full credit can deposit remainder in expanded health savings accounts.
$2500 per indiviual and only $5000 per family? So a family of 4 is credited the same amount as an unmarried couple? A unmarried couple with 2 kids would qualify for $7500 in tax credits but a married family with 2 kids would only qualify for $5000. Somehow I don't think James Dobson is gonna like that.
Families should be able to purchase health insurance nationwide, across state lines, to maximize their choices, and heighten competition for their business that will eliminate excess overhead, administrative, and excessive compensation costs from the system.
So states should be required to try innovative insurance methods, but should have no control over who practices in their state.
Insurance should be innovative, moving from job to home, job to job, and providing multi-year coverage.
What the hell does this mean? Job to home? Multi-year coverage?
Require any state receiving Medicaid to develop a financial "risk adjustment" bonus to high-cost and low-income families to supplement tax credits and Medicaid funds.
'Risk adjustment' bonus? Again I not sure what this means, but I have a feeling it means that we should provide health insurance to poor people but find a way to punish them for using it.
Allow individuals to get insurance through any organization or association that they choose: employers, individual purchases, churches, professional association, and so forth. These policies will be available to small businesses and the self-employed, will be portable across all jobs, and will automatically bridge the time between retirement and Medicare eligibility. These plans would have to meet rigorous standards and certification. John McCain Believes in Personal Responsibility
Again, what is preventing this from happening now? Is there some form of law that prevents churchs from offerning health insurance? And you can get insurance that isn't related to your job, the problem isn't availablity it is cost. Large employers get volumn discounts for buying insurance. If you make each man an island in the health insurance game, you eliminate that pooled buying power thus making it easier for insurance companies to charge higher prices. Honestly, who do you think gets the better deal when buying a new car, you with your little Blue Book, or Hertz Rentacar?
We must do more to take care of ourselves to prevent chronic diseases when possible, and do more to adhere to treatment after we are diagnosed with an illness.
More of a lecture than a solution. This is implementable how?
Childhood obesity, diabetes and high blood pressure are all on the rise. We must again teach our children about health, nutrition and exercise - vital life information.
Public health initiatives must be undertaken with all our citizens to stem the growing epidemic of obesity and diabetes, and to deter smoking.
Like implementing food qualities laws?
So my overall impression of the McCain plan is as follows. In order to fix our healthcare system the solution is the exempt employers, doctors, and insurance companies from any responsibility in the system. Doctors shouldn't be required to direct treatment or be responsible for their medical errors, insurance companies shouldn't be responsible for providing good service while controlling prices, and we shouldn't have employer paid health insurance.
On its face is says that McCain belives with no regard to history or economics, that individuals acting in the market place would be able to negotiate better prices than any pooled conumer group. But that is just the selling angle really, the same as the $2500/$5000 tax credit. They realize that some form of healthcare reform is going to happen, and all this plan really says is that the way to change it is to convince people to limit their own consumption of healthcare to what they can personally afford to pay for.
It is the height of modern Movement Conservative thought process. No problem can be solved through direct action. Instead problems can only be solved though a combination of dancing around the problem, cutting taxes, and elimating the responsibility of business to be a part of the solution. And you guys say McCain isn't a Conservative. Funny.
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3 comments:
First let me say that I disagree with your assessment of McCain's assessment on most points. I also want to add that I'm looking at it from a different perspective (ie medical student/future doctor) although the military health system is markedly different than anything found in the civilian sector or anywhere in the world.
First, a few points...
When McCain talks about Veteran's taking their care elsewhere, I don't think he's talking about privitization (although having worked at several VAs, that might not be a bad idea), he's talking about giving patients choices to go to other facilities in the sense that Tri-care prime gives military members stationed where there is no MTF (military treatment facility) the option to receive care at local facilities which the VA does not allow currently (rather than forcing someone to drive long distances to receive care at a VA facility).
With regards to your complaints about insurance deregulation, McCain is saying (I believe) that insurance companies have to tailor plans to states and cannot provide plans in some states because of laws which prevent this. He is asking for deregulation of the insurance industry in the sense that there can be true competition for consumers to choose their plans. Competition breeds lower prices (I'm pretty sure this is ECON 101).
With regard to your criticisms about portability and multi-year plans, the point is that you can bring your insurance with you if you change/loose your job and that you can pay years in advance (for lower costs and for continuity purposes). Thus people don't have gaps in health insurance and they don't have to wait a day at an ER for primary care.
With regard to telemedicine, it is used frequently and effectively and should be used more often. There are still people at these telemed centers that takes vitals signs, labs, etc, but it allows people to receive care or at least be triaged to a care provider if necessary. The beauty of medicine is that 80% of patients are diagnosed during the history/interview (not the physical or labs... bet you didn't know that did you?) so a lot of people can benefit from this.
"Build genuine national markets by permitting providers to practice nationwide."
States issue licenses but the licensing exams are actually done on a national level with (for lack of a better word) addendum exams for laws specific to the state you choose to practice in. Furthermore, many states have reciprocity agreements, why shouldn't all states? The problem with the licensing mess is that neither states nor the federal government have complete control (there are laws at all levels of government controlling licensure).
Finally, with regards to chronic disease (the last two statements), people cannot expect unlimited care if they do not care for themselves. If you look at the models on which the democratic plans are likely based (Canada and European systems), those plans sometimes disqualify people with certain conditions (ie people who eat themselves diabetic or smoke themselves to death). The problem here is that our society is a society of excess and therefore this requires a fundamental change in our mindset as a country. If federally-mandated universal coverage or some form of socialized medicine is chosen as the MO, then tough choices are going to be made and people are going to be denied treatment (or would be placed at the end of a long line in some instances) for conditions based solely on their lifestyle choices. People need to realize that not adhering to reasonable treatment plans and not making lifestyle modification drastically increase the cost of health care. This is going to involve a hefty dose of education (from childhood onward) as well as some tough love (discontinuing care).
Any way, what is your solution to the problem of health care? I'm for prenatal and child health care for all and health care for vets and elderly with some general catastophic coverage for all. However, socialized medicine/ObamaClinton care are flawed because they don't mesh well with our country's lifestyle and they actually lead to substandard care beyond the primary care provider level.
The whole VA thing is typical right wing political posturing. It is the same philosopy that they've applied to all government programs, slowly defund them until they can't meet basic needs and then complain that they are failing and thus represent a failing of government. It is why the Bush tax cuts were so important to them, and why even during a time of war they've been unwilling to back off of any of them in spite of massive deficit and enormous growth of the national debt. If the government isn't running a deficit then it is hard to make a case that government is bankrupting America.
My dad has repeatedly used the VA system for everything from a quadruple bypass to a cataract surgury and he has always gotten decent treatment at a fair price even though he has had to travel 100 miles to do so.
As far as letting insurance companies practice across state lines, I suspect that the reason they are prohibited from doing so now has to do with the Interstate Commerence clause of the constitution. If Insurance companies are allowed to practice across state lines it takes away the ability of the states to regulate insurance as it then becomes interstate commerence.
That is one of the biggest problems of the McCain plan. It looks like he went to the Healthcare industry and got from them a wish list. This isn't designed to make treatment better from a patient perspective, most of it is meant more to make the business climate more favorable for insurance companies, doctors and hospitals.
Take away state regulation, take away doctor's liability, make the patient responsible for things doctors should be deciding.
Competition providing efficiency in the market is part of econ 101, but so is the definition of what competition means and what an efficient market really means. And you can not have an efficient market when the supply side has an information advantage over the demand side, and that is what the training of doctors is. As I repeatedly noted, patients do not have the information available to make a determination of what is the best treatment for them, if they did they wouldn't need doctors. Doctors have a virtural monopoly on medical information and have an absolute monopoly on treatment and prescription ability. To have true competition there have to be low barriers to entry and exit to the market, but med-school and residency, along with a very limited supply of medical schools is one hell of a barrier to entry into the medical care market.
They derive this monopoly from the government which says you need med school and training to practice medicine and as such the government has the responsibility to monitor and regulate them to ensure they are using the power the state has granted them in the best interests of the community. Taking this regulation power away from the states gives too much power to the doctors.
If you are going to promote a medical market based upon free market competition and expect it to act like free market theory, then you need to go all of the way and take away the monopolistic aspects of the market.
I do agree with you to an extent about supply issue with doctors. That said, it's the same AMA (the closest we have to a doctor's union and an organization of which I'll never be a member) that advocates increasing access to care at the same time encouraging medical schools to keep the number of students down while working to limit the scope of PAs and NPs (both of which, by the way, have prescriptive/treatment authority in many states now... check your facts).
My problem with the VA system isn't the people who have to drive 100 miles. My uncles uses it all the time and my dad used it as well. But there are people who have to travel much greater distances to obtain care (keep in mind that I'm from Texas and 100 miles is not necessarily considered a long distance). Furthermore, it often less expensive for the government to farm out certain areas of care in some types of specialties rather than maintaining the staff/equipment necessary for that particular specialty; it is thus an economy of scale issue. The military does this with some specialties currently (and effectively I might add).
Listen, I do not disagree with you on one fundamental thing... that the government should not give tax breaks to people during a time of war when we do not really know the total costs of a war. I supported them in 2001 but in 2003, the tax cuts seemed a little absurd.
Finally, I think you misunderstand the notion of the doctor/patient relationship in the 21st century. This is no longer the era (for better of worse) when doctor knows best; the model is now that of a partnership and patients often need to decide things on their own or with doctor's counsel.
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