Friday, December 6, 2013

Obamacare and the Rose-Colored Glasses

It's time to pause in my cheerleading for Obamacare and entertain a little reality check.  Yes, Obamacare is better than nothing, but is it right that here in 2013 that should continue to be the mantra of the U.S. healthcare movement?

Once upon a time, on Long Island, I was a psychologist.  As has been my pattern in my life, I was in the right place at the wrong time.  The year I began my private practice, managed care was threatening to take over, promising false promises of great savings in healthcare costs and improved treatment.  Psychology stood in the front lines of the managed care firing squad.  By the time they were done with me, I had decided the only moral choice for me was to quit the couple of remaining groups I was in and just accept sliding fee scale payments.  After that disastrous cut in income, I could afford to retire my practice and move south, and with relief left the field I once loved behind.

What I learned was that the insurance industry would always find a way.  The government was always too many steps behind, and had too many naifs on one side and too many corrupt on the other.  Medicare eventually was plundered to the point where there are now premiums, co-pays and in the end requires supplemental private insurance, a sweet deal for private insurers.  Doctors and hospitals did not sit innocently by back in the Medicare heyday.  If they could raise costs and collect more from Uncle Sam, they quickly did.

Medicaid has never, not ever, been more than a band-aid, and one that doesn't quite cover the wound.  Back in my psychologist days, when private practitioners were charging up to $100 per 45 minute hour, Medicaid was paying out $20 and requiring a full 60-minute session.  Along with the time it took to do bookkeeping and note-taking, and resubmitting all the claims that they had screwed up, lost, or otherwise refused to pay out.  The end result of that, for me, was that I had my pick of patients, because no one else could be bothered.  Hard work for little pay, just like Walmart and McDonald's.

So when President Obama and I insist that we must expand Medicaid, at least one of us knows that this is an insufficient solution to providing health care to Americans.  And when we all scream about protecting our Medicare, our backsides are still unprotected from the insurance industry that has made additional coverage necessary.

As long as we in this country are unwilling to agree that health care is not a for-profit enterprise, we will continue to have inadequate, too expensive protection.  And even when the government pays out, our tax dollars are going toward the fat and inefficient health care machine.

Do doctors make enough money?  I don't know.  I do know that on my insurance claim statement, the same Blue Cross that Congress has access to, the amount billed is considered the fantasy charge.  Since the days of managed care, the insurance industry has been free to invent its own "customary charge" which sometimes reflects a more realistic amount, and sometimes is taken from billing structures from ancient history.

Do hospitals charge too much?  It seems to me that a well run hospital is going to cost a lot of money, but what we have today is hospitals that cost a lot of money to run with inadequate staff on one side and ridiculous waste on the other.

The only reason that medical tests, medical instruments and pharmaceuticals cost as much as they do is because they can.  Our government watches helplessly, when they are not colluding with all kinds of medical corporate interests, as industry gouges doctors, hospitals and consumers.  They parrot lame excuses about the cost of research that don't seem to apply to most other consumer products, where research and competition go hand in hand.  Our government resists providing much needed oversight and regulation for the same lame reasons.

So where does that leave us?  With too many uninsured and the hope that we can at least let them have a band-aid for their troubles.

What should we do?  Strong and common sense federal regulation has to happen for costs to go down.  We have to get private industry out of health care.  I believe that health care will work best on the state level, where there is real concern for the health and well-being of its citizens.

Vermont is taking the challenge.  They have approved a single payer plan to be fully operational by 2017.  Everyone covered, no premiums, co-pays or deductibles.  A slight rise in taxes.

Cynical as I tend to be, I am feeling hopeful about this solution.  This small state has its heart in the right place.  They have Independent Bernie Sanders in the US Senate, and he is as progressive, outspoken, and uncorruptible as they come.  When that works, I know that other states will be quick to come on board.  Not my state, but still, it's a start.

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