Open Wide For A Preview

If, as anticipated, the Supreme Court rules the Affordable Care Act unconstitutional, then according to experts there is a real possibility that the entire healthcare system will be thrown into financial chaos. Why? An NPR report says,

One reason is that the law (the ACA) changed the payment rates for just about every type of health care professional who treats Medicare patients. Every time Medicare sets a payment rate, it needs to cite a legal authority. And for the past two years, says Rosenbaum, that legal authority has been the Affordable Care Act.

So if the law is found unconstitutional, she says, every one of those changes “doesn’t exist anymore because the law doesn’t exist.”

And the result? “You have agencies sitting on two years of policies that are up in smoke,” she says. “Hospitals might not get paid. Nursing homes might not get paid. Doctors might not get paid. Changes in coverage that have begun to take effect for the elderly, closing the doughnut hole might not happen. We don’t know.”

And many of those facilities serve not just Medicare patients but the rest of the population, too. Hence, the spillover could affect the health care system as a whole.

If in fact the government’s part of healthcare is removed or its payments reduced,

Cervical decay on a premolar

Cervical decay on a premolar (Photo credit: Wikipedia)

what will it then look like? I believe I have found a preview in a report by ABC News. Some dental care is covered by Medicaid, the program for the poor, but its rates are not competitive in the market. As you can see in the ABC 4-minute clip, the journalist called ten pediatric dentists’ offices in four Florida counties and did not find a single dentist willing to see a Medicaid child patient in need of immediate care. Dental care is fee for service – it’s about the money and its up to the patient to foresee that dental health is vital to one’s overall health, including not just appearance and nutrition but even affecting the heart. That takes foresight and commitment, things not always a high priority when you’re young.

It would be easy to take the position that families ought to prioritize their finances, save up and take care of this responsibility. Right. And that would apply to so many other things as well, things like regular healthcare, life insurance, and just plain savings for example. But the simple fact is that people don’t do many things they should, especially when those things require long-range planning.

When I was working, there were things I knew I should do but didn’t because I rationalized there wasn’t time. I didn’t work out every day because I was too tired. I didn’t brush my teeth after breakfast or lunch, even though that would have taken only a couple of minutes. I don’t have that excuse now, so I do those things, but it still takes an effort, a mental commitment. What I’m trying to say here is that for-profit medicine is too expensive and too neglectful of preventive public healthcare. Under a public option you would get the preventive process and you would get it for about 40% of the up-front cost of how we do it now, and further savings by not having to treat neglect as emergencies.

What, me worry?

There is a general public prejudice against government-provided healthcare in this country. Some even consider the idea anti-American. That needs to change because healthcare under the current system, even under the ACA, is centered around money and patient through-put. It ought to be a public service supported by taxes. If we don’t change our delivery system and the Supreme Court kills the Affordable Care Act,  American healthcare could soon look like dental care in Florida, or maybe like healthcare in Pakistan. (The rich there are doing just fine, thank you – the others, not so hot.)

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About Jim Wheeler

U. S. Naval Academy, BS, Engineering, 1959; Naval line officer and submariner, 1959 -1981, Commander, USN; The George Washington U., MSA, Management Eng.; Aerospace Engineer, 1981-1999; Resident Gadfly, 1999 - present. Political affiliation: Independent, tending progressive as the GOP recedes from its Eisenhower roots.
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13 Responses to Open Wide For A Preview

  1. hlgaskins says:

    “There is a general public prejudice against government-provided healthcare in this country.”
    I suspect that’s the intended public perception that healthcare profiteers so effectively bank-on. It’s a sad statement on American education and culture that we allow ourselves to be so easily manipulated and deceived. “There is a general public prejudice against government-provided healthcare,” because that’s the intent of those who control how it’s provided.

    Like

  2. ansonburlingame says:

    To all,

    There are two issues in this blog it seems to me.

    Fiirst is the issue of the consequences of deeming ACA unconstitutional. My reaction to that is the same as when I heard, “We won’t know what is in the law until we pass it”!. No one will be able to predict how we untangle the consequences of ruling ACA unconstitutional until it is stricken from the books as a constitutional law.

    My very simple approach, with no legal research or background to support it, would be to say that acitons taken under ACA up to the DATE that it is declared unconstitutional, would in fact have been legal under the law at that time. But moving forward from that date, say in June 2012, just get out the law books and enforce the old laws that were present prior to implementation of ACA. Any bureaucrat that can read should be able to do so, it would seem to me.

    But of course the other issue is “What should the country do given no ACA”.

    Again, legislatively that seems like a very “simple” answer. We reset the debate back to 2009 when implementing HC reform under what became ACA first started. Put up all the pictures one likes of “bad teeth”. You could have posted the same in 2009.

    But for SURE, such legislative and Executive Branch difficulties are NOT the concern of SCOTUS. Their ONLY concern should be whether ACA is in fact constitutional, yes or no, simple as that. What then flows from that LEGAL edict is AGAIN not in the realm of required action by SCOTUS.

    Consider this folks, on the right or the left. Most folks on the left see ACA as merely a stepping stone towards some form of public option or universal HC. Fine. Restart your HC reform debate and push to “leap” to REAL HC reform based on what you really want to see happen, legislatively.

    NOW there is a campaign platform that you should stand firmly upon assuming June 2012 is the date of deeming ACA unconstitutional. Campaign as hard as you like on that new approach to HC reform without the “baggage” of ACA to defend. Make good enough arguments to win the election and you might just get your way.

    I on the other hand would be FORCED to campaign on MY plans for HC reform, given no ACA. All my side has done so far, really, is say they will “kill ACA” legislatively if they win. That won’t satisfy American voters if SCOTUS strikes down ACA. The GOP will then have to put up or shut up.

    Anson

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  3. Jim Wheeler says:

    I wouldn’t say that the profiteers are controlling the system so much as they are taking full advantage of the opportunity, HL. Like the big firms of the military industrial complex, big Pharma and others in the medical industrial complex take out expensive, slick ads promoting not their competitive costs but their public image as perfect high-tech providers for whatever might ail you, never mind that medical errors and rampant profiteering are all part of the mix. Image trumps facts in our society. Hmm. Maybe that is “controlling”.

    It’s nice to hear from you, HL. Glad you’re still around – I’ve missed your insights.

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  4. ansonburlingame says:

    “Image trumps facts in our society”

    Is that not the basis of almost all political campaigns as well?

    Who for example in modern day America took over an economically flailing government, achieved extraordinary growth in two years and long term, sustained high economic growth for years thereafter. That is a simple FACT and you all know who it was.

    But the response from the left is “trickle down economics” (meaning I suppose high growth in GDP), “does not work”. Is that an “image” or a “fact”. And if it is a fact, why is Obama trying to achieve high growth in GDP, or is that too on Obama’s part simply an “image”.

    Anson

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  5. Jim Wheeler says:

    AN OFF-TOPIC NOTICE FOR MY READERSHIP. The Joplin Globe has informed me that they are discontinuing their sponsorship of the Joplin Globe Community Bloggers as of the end of April, 2012. The reason given is that even the small remuneration the Globe paid us was too unproductive of online traffic on the Globe web site – most readers subscribe directly once the sites were found. However, I plan to continue blogging from this same site whenever inspiration strikes. Thanks to my readership for our continuing discourse. – Jim Wheeler

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  6. Dion USNA88 says:

    What qualifies as “rampant profiteering”? The net margins for most of the healthcare industry participants are less than 10%, many less than 5%. This is a fraction of the profitability enjoyed by the software industry and many technology firms (pick most any example: http://www.sec.gov/edgar/searchedgar/webusers.htm).

    Two simple facts:
    Healthcare services will be delivered for a profit or they won’t be delivered at all (providers need to feed their families).

    The industry is highly competitive with relatively slim margins and costs generally being pushed higher by governmental requirements and impediments on innovation.

    Let’s hope the experts are correct and ACA is deemed unconstitutional.

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    • Jim Wheeler says:

      Sorry, Dion, but I just can’t agree. Like so many you have bought into the notion that “the best healthcare system in the world” charges more only because it’s worth it. It isn’t so. The systems of Canada and some European countries deliver results just like ours for about 40% of the cost, and in many cases they have fewer medical errors, something that in our system is a national disgrace. But our system does have more modern buildings and nice machines with flashing lights and displays. And the bottom line, no pun intended, is that healthcare cost is the primary reason for our out-of-control national debt. We can not afford it.

      I also offer this previous post for more on the matter.

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  7. ansonburlingame says:

    Modern buildings and flashing light machines! Hmmmm,

    How many Americans are willing to go into a “dump” for HC? Should we ignore say just MRI’s, a “flashing light machine” and go back to just X-rays? Exactly what “new machines” with or without flashing lights would you abandon, Jim?

    Two reasons, big reasons that I see for increased costs for HC. One, the really big one for at least Medicare is EOL care. We have agreed on that point before, as I recall. Older Americans and their families DEMAND state of the art HC to extend the lives of older Americans and it costs a fortune that we do not have, privately or publicly.

    Now go read my recent blog, a real anecdote on pallative care versus aggressive care for terminal illnesses.

    The other reason is American demands for state of the art HC for “hang nails” by everyone. Go out into the general public today and count the number of “knee braces” being worn by some. Do you know what those suckers cost? About $550 buck a pop.

    I have had sprained knees, ankles, etc and guess what I wore. Ace Bandages that cost about $5 dollars and my knees and ankles healed just fine, long ago.

    Care to check out the cost of a motorized wheel chair for folks, some of whom weigh about 300 lbs and wear oxygen masks.

    Government cannot force people to accept pallative care vs agressive care. If a “modern knee brace” is available, government cannot force people to wear just an Ace bandage. Americans would not stand for such treatment if “state of the art” treatment is available. And the American public that I listen to all the time will not STAND to wait for six months to get an appointment with a doctor to check out either a failing heart or a “hang nail” as well.

    You paint a picture of some kind of utopia with universal, government funded HC. In fact that picture you paint is in my view something Americans will not stand for unless they are forced to accept it, either by individual choices or government force.

    In the past we have let individuals make those tough decisions. Now you call for government force to do so and blame it on “greedy” HC providers or insurance companies. Those “greedy” providers are providing that which Americans DEMAND today. Until you change that demand, the supply is going to cost more than any of us have, publicly or privately.

    Anson

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  8. Jim Wheeler says:

    @AB,

    Nobody, least of all I, has suggested that our hospitals should be “dumps”, nor did I suggest doing away with necessary equipment. You are resorting to your familiar technique of setting up straw men of course, and then offering your “simple” solutions to them. Nothing I say will persuade you of anything, but for other readers, what I was trying to express was that the current system emphasizes appearance over substance, concentrating on infrastructure and through-put while neglecting efficiency and medical errors. One symptom of this is excessive testing, and I think you would at least agree with that based on previous commentary.

    Then, you proceed to complain about the costs of braces and wheel chairs while ignoring that such things would not have such excessive costs except for the broken system we have now. As for waiting “six months” for a doctor’s appointment, that is obvious and unsupported hyperbole.

    No, I am not picturing a government “utopia”, I am picturing a system that would be structured for common-sense treatment and preventive care. However, I grant that you and most other citizens will not stand for changing the system and will continue to believe in the current fantasy, that you are getting what you pay for, even as Big Pharma puts their emphasis on Viagra, cholesterol drugs and the like, while neglecting things like vaccines, antibiotics and medicine for very serious but less-common afflictions. Most people are being skinned by the system, but as military retirees you and I of course have the best of both worlds. Makes it easy to argue for the status quo, doesn’t it?

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  9. ansonburlingame says:

    Jim,

    We occassionally have reasonable discussions on HC. But when you accuse me of strawman arguments, they degenerate. My “knee brace” point is an anectodte, not a strawman, and it points out a fundamental flaw in our current system. People want the best possible but are unwilling to pay for the best. They expect others to pay for it.

    As for “waiting periods” to see a doctor in Canada and Europe, I have read many anecdotal comments reflecting exactly that situation. I have talked to Europeans and Canadians expressing such views as well. They are real views from real people living under such a system. Yet again you disregard such views as “strawmen”.

    Again, that is NOT a strawman view, it is a fundamental view, at least in my opinion. When 51% demand that 49% pay for their “needs” legitimate or not, then bad things start to unfold and we see it today in our HC arguments.

    No go read Whitford’s column in today’s Globe. The situation he describes is in fact a HC problem with “Dave”. Now how do you “fix” Dave and the millions like him in America today. By millions I do NOT mean just the homeless drunk as well. I mean those folks that demand others to pay for their needs. Will you at least agree that such foks are a burden on society and must be treated, effectively to mitigate that burden, a burden for which we cannot pay for, publicly or privately.

    Anson

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    • Jim Wheeler says:

      I didn’t say your knee brace or waiting periods either were straw men. What I said was that your accusations about hospital equipment and building infrastructure were straw man arguments. See, that’s the problem I have in trying to discuss anything with you and I’m sure it’s a major factor in why Duane has stopped doing so. You don’t want to have a discussion, you want to wage and win verbal war as a self-appointed knight-defender of freedom, justice and the American way (as defined by yourself). No, “waiting periods” is not a strawman argument, it is as you say anecdotal. What you can’t seem to abide is any hint that such views might be skewed.

      Whitford’s column is indeed powerful and points to a significant problem with food stamps and other aid, i.e. that such aid can stand as an obstacle to remediation of social problems, particularly those complicated with addictions. I agree that privacy is over-rated in social programs. Personally I would like to see food stamps replaced by some form of direct help because the program is obviously being seriously abused, but how to do that is problematic. I might suggest that aid recipients who are documented as having addictions should be relegated to other options than food stamps, options like soup kitchens. I’d like to hear Whitford’s opinion on such.

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    • Jim Wheeler says:

      I didn’t say your knee brace or waiting periods either were straw men. What I said was that your accusations about hospital equipment and building infrastructure were straw man arguments. See, that’s the problem I have in trying to discuss anything with you and I’m sure it’s a major factor in why Duane has stopped doing so. You don’t want to have a discussion, you want to wage and win verbal war as a self-appointed knight-defender of freedom, justice and the American way (as defined by yourself). No, “waiting periods” is not a strawman argument, it is as you say anecdotal. What you can’t seem to abide is any hint that such views might be skewed.

      Whitford’s column is indeed powerful and points to a significant problem with food stamps and other aid, i.e. that such aid can stand as an obstacle to remediation of social problems, particularly those complicated with addictions. I agree that privacy is over-rated in social programs. Personally I would like to see food stamps replaced by some form of direct help because the program is obviously being seriously abused, but how to do that is problematic. I might suggest that aid recipients who are documented as having addictions should be relegated to other options than food stamps, options like soup kitchens. I’d like to hear Whitford’s opinion on such.

      Like

  10. ansonburlingame says:

    Jim,

    I believe you “double pumped” your comment above, perhaps out of frustration with me.

    OK, let’s focus on “dumps and machines with flashing lights”. I recall full well the pictures of HC services in the former Soviet Union. Of course the conditions were abhorrent for anyone, Russian or American. But that was the reality of communist, unviersal HC. I have not been to public clinics in Europe, but again I have heard about them. Drab, dingy rooms with very long waiting lines.

    Sort of reminds me of the “unversal HC” my family received long ago in military facilities. I didn’t particularly like it then and did my best to use home remedies before going to such facilities, facilities with young and relatively inexperienced doctors as well, by and large. When in Hawaii my wife had a few days of hospitalization in Castle Hospital, a private, non-government hospitat. In the early 70’s the difference was “night and day” different in terms of facilities, standards of care, etc. You probably saw the same, long ago as well.

    As well all of those “machines” we routinely expect to see used on us or our loved ones are very expensive machines and the training to operate them properly costs a lot as well. I did not say they were unneeded but did ask you which ones should be NOT used if we went to a universal HC system.

    My guess is today an X-ray costs in the few hundred dollar range and an MRI cost in the low thousands, at least as charged. Any doctor today will order an MRI at the drop of the hat instead of an X-ray. Now if I as the patient was worried about the cost I for sure would ask WHY? But I don’t do that today. I simply go with what the doctor orders because I am “covered”.

    Solutions to all of these things are very, very complex, for sure and I do NOT have any simple solutions. BUT the cause of such problems at a fundamental level is easy at least for me to see. The demand of the best possible HC, all the time, whatever the illness, has far outstripped our ability as individuals and collectively as a nation to supply such services cost effectively.

    When demand outstrips supply, we all know the fundamental outcome. You think you can fix it with controlls on the supply side. I disagree. Instead I seek humane ways to limit demand.

    But the nuances of each approach is very complex for sure and we will never solve them on a blog.

    Anson

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