Letter to the Editor: The reality of health care
Two weeks ago we debated LD 882 in the Maine House. The bill would simply bring Maine's Health Care mandates in line with those required by the Affordable Health Care Act (ObamaCare). Maine currently has many more mandates than even this 2,000-page bill requires. We know from a recent Gorman study that Maine's private insurance rates are projected to rise 38 percent when the federal law is implemented. During the speech, I ridiculed the idea that my 20-year-old son should be required to buy health insurance mandating pap smears. As a result the Maine People's Alliance is attacking me for being anti-women. The point was not about women's issues for my son or prostate exams for my daughter, or anything of the sort. The point was why would Maine require more extravagant mandates than the federal government. A pap smear exam should be part of any annual check up for any women of the appropriate age as determined by between her and her doctor, not determined by government mandate.
As a result I find I have to respond to a storm of criticism. The good news is that no one has actually argued that young men should be covered for pap smear examinations, so I don’t have to provide a short lesson in basic anatomy.
I’m being damned for suggesting that there could or should be any restrictions on the cost of health care. We are hearing that you can’t put a price tag on a human life and that everyone has a “right” to complete health care coverage without regard to cost.
I have doubts about any new-found rights which are claims on other people’s income, but that’s not the thing about these hostile reactions, which is most interesting. The thing which really puzzles me is the belief that there must never, ever be restrictions on the cost of health care.
This may be a nice sentiment, but it’s a fantasy that has no place in the real world. Health care always runs into limits. Governments either rations it (a limit and burden on the patients) or imposes price controls (a limit and burden on the care-givers).
Private citizens confront the same reality. If old age ever brings me to the point where my children have the choice of prolonging my life in a coma for another six months at the cost of their homes, their savings and their credit, I hope and expect they will have the sense to tell the doctors to pull the plug. I believe that almost everyone would do the same, given the choices. That may be a cold thing to say, but reality is often cold. In the end, reality will always prevail over sentiment.
I know not everybody likes to hear these things. My only answer is that I did not invent reality. It’s not my responsibility. It existed before I was born and will continue after I die. Anyone objecting has to argue that yes, governments are willing to use up all their revenues on health care. With the current demographic picture we face in the western world any attempt to add excessive mandates to insurance plans will by nature disproportionately force the cost ever downward to the young. Leaving them with two bad choices: paying ever more expensive cost for health insurance, much for which they have no use for, or going without. Unfortunately this is the current state in Maine. The bill debated sought to offer some choice where we can to those who are under the heavy yoke of Maine's burdensome insurance mandates.
Lance Harvell
Farmington
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I have been wondering why the liberals were so upset about this. Now I know Lance ridiculed their great health care dreams. He is pretty spot on in his explanation. Hard to argue with reality.
Being a young person I can say I am glad to see someone is trying to make sure the cost does not end up totally upon our shoulders. Thanks Lance
One of the most thoughtful letters I've seen by a public official on this topic.
Thank you Lance for giving us a dose of reality. The false philanthropy of government programs vexes me.
What is wrong with imposing price-control for caregivers? One of the major problems with raising health care cost is that we continue to subscribe to a fee-for-service system, which means that doctors have an incentive to overtreat. If we paid doctors a salary or paid by patient then this incentive would disappear and costs would go down. Also, if the government imposed price-controls for drugs, medications would become more affordable.
If you don't like this idea, please don't tell me that no one would wanted to be a doctor without fee-for-service. Even with more reasonable reimbursements structures, doctors could still get rich compared to the rest of us.
"We know from a recent Gorman study that Maine's private insurance rates are projected to rise 38 percent when the federal law is implemented"
Say no more Lance!
Does this hit home with anyone, anyone, hello anyone home!
Everyone should be picking up the phone and calling there reps and senators and tell them on a daily basis to get rid of this legislation!!
I whole heartedly agree with you, Lance. I would like to see cost/benefit studies of life enhancing programs being made available, especially when one has to make those tough decisions. As you pointed out, too often we are prone to spend the family's future to extend life a few short months. I have no problem with a family making the hard decision to attempt to extend life, but if the risk is high, then allow the family to take on the financial burden if they need the procedure, not force the collective to take on that cost (rising health insurance). The cost/benefit becomes reality when it comes out of one's own pocket. This whole discussion would not be brought up if health insurance was affordable.
I relate this to how I might spend money. When I am on a cash basis, I tend to be frugal, but when I use plastic, I think I can afford anything (kind of like the Federal budget).
"Gnatty" has a point in that there needs to be some type of oversight on medical costs. What that should look like, I really don't know. It seems though that government oversight rarely works.
Thanks for stating your premise so clearly.
Thanks for sharing.....
Thank you Lance for your interest in controlling health care costs. Any sensible person looking at the fact that health care accounts for 20% of GDP in the USA would say that these expenditures are not sustainable. However, reducing coverage by reducing mandates would be pretty low on my list of things to do. This would bring us to the level of Alabama and Mississippi in terms of coverage. All industrialized countries with the exception of the USA provide comprehensive coverage to all their citizens at half the cost or less. I think that our closest rival is Switzerland. The problem is in the way that the health care system is structured and the fact that intrenched interests want to keep it as it is. My challenge to you is to find out how other countries manage to do it and why we don't. Also I could not find the Gorman study you refer to in a quick search. I suspect that it is rather difficult to predict the outcome of 2000 pages of regulations with any accuracy.
Ed: Other countries ration health care or use price control, which rations. We do here to some extent the question is who will do this you or the government. Will you as a citizen with your doctor and insurance company come up with a system or will the state mandate it all?
I'm one of the lucky American workers who has health insurance. However, there are millions of people who work and earn a living but do not have health insurance simply because their employer doesn't offer a plan or they can't afford the high cost of health insurance premiums. Furthermore, what about the millions of workers who are currently unemployed and without health care?
Of course, people who are not covered by a health care plan do NOT see a doctor regularly, if at all. If there is a medical emergency or a need that cannot be ignored any longer, where do they go? The answer is to the emergency room. My prediction is that more and more people are making use of emergency rooms since they have no other choice. There should be another choice, though.
In my opinion, all Americans should have access to basic health care and pain relief. Let's go after corporate greed. Let them feel the pain for a while.
Insurance companies have a strong vested interest in the system as it is now. Angela Braley CEO of Wellpoint Corp. (Anthem) in 2009 received a compensation package of 13.1 million dollars. Cigna and Aetna CEO's were not far behind. Healthcare in America is rationed now, providers spend much of their time justifying their decisions to bureaucrats at insurance companies and 45 million have no health care at all. Many more people have inadequate coverage. An MRI costs 100$ in Japan and $1500 in the US.
If you can show me how I can come up with a system with my doctor I'll go for it but right now I don't have a clue as to how I would do that.
Lance I like your common sense. My question is how does the government expect those unemployed or on state medical care to pay for insurance? Sometimes things just don't make sense at all. I think our government needs to start paying the same rates that the little guy pays and then maybe they wont be so quick to shove ridiculous legislation at the American people all the time. Just saying.
@Ed Miller, based on the quality of my japanese car, I will take the US $1500 MRI please.
Compared to the Pontiacs and Oldsmobiles I drove in the past, my Japanese cars have run like a dream. Poor Dave must have bought a lemon.
But if he wants to pay 15 times more for a Pinto or Gremlin than for a Camry or Civic, then by all means...
Dave, Making a decision based on a sample size of one is not likely to yield good results. Statistically, Japanese cars are as good if not better than American made and so are their MRI's. The quality of Japanese health care based on outcomes is also better. Their average life expectancy is considerably higher than ours. We spend more and get less. The answer is not simply to limit coverage as Lance suggests, but rather it lies in focusing on quality outcomes while controlling costs.
Ahem,,,,Rhonda Sue needs to LOOK UP and see what's happening with OUR Cars compared to theirs lately..
@ Rhonda Sue,,
It's not 1970 anymore,,,Hello.
Our cars are beating them (except the race to bust thru the back wall of your garage when the throttle sticks,,we let Toyota win that one,,,,haha).
Why would it not please an american citizen that our cars have rebounded and are beating them.
BTW,,,we didn't steal anybody elses designs like "some other countries do to us ...
Maybe find a more worthy cause to stick your neck out for Rhonda..
What does this have to do with the article,,,,,,very little,,,She just p - - - - - me off.
Thank You For Listening.
Ed: coverage will be limited always is. My in-laws from Holland and their friends all buy supplemental insurance. The question I posed was who does the limiting?
Good luck with your union made,overpriced,taxpayer financed Detroit clunkers,Ed. I'll keep my Honda and Toyota and you have fun with your Edse.......I mean, Chevy Volt!
Ahem yourself.
You've got a punctuation problem (not to mention a bit of a temper).
"What does this have to do with the article,,,,,,very little,,," It just made me laugh.
Lance, in the bill LD882 it appears that the government will be reducing the coverage that insurance companies must offer. In my experience I have never had a say in what coverage my insurance plan would offer except through contacting my state Representative. The decision was made by my employer. If I didn't like it, I could go somewhere else. You don't know what your plan really covers until you get sick and have to use it and by then it is too late. Many people have plans now that say they coverage but when they try to use them they have deductibles of $5000 or more and when they reach the deductible they have a copay of 50%. Again, the USA spends at least 50% more than other industrialized countries and gets some of the worst outcomes in terms of the health of it's citizens. Where is all the money going and what is it being used for? Answer that question and you will begin to understand how to make meaningful changes instead of making slogans.
Well,laughing is a start,Rhonda. :)
Workers of the world unite, overthrow the corporate greedy elites, form collectives, give free education and healthcare to the masses. Oh, hold on, that was tried in other places and it failed.
Japan does indeed have a much greater life expectancy than we do, however, I dispute the idea that this is due solely to differences in the two health care systems. We need only look at a few other statistics to see a possible problem with that theory. For example, the obesity rates in the US are the highest throughout the world at over 30% while Japan is at around 3%. Japan also has a lower overall crime rate than we do. We cannot base judgement about "quality of care" on life expectancy alone.
@gnatty.................. I don't really have alot to argue on this site, because it just goes round and round with no solution. That said, I paid $10K out-of-pocket in 2011 for health/pharmcacy insurance in Maine....................and it went up 34% this year. I have since popped-over into Medicare with a less expensive supplement. That said, I think my question is worth asking given your response, partiularly since I helped put a boy through college(Colby) and medical school (Tufts) in the 1980's. How MUCH did YOU spend on your after-high-school education? How much debt are you paying off? You ask the question as if every doctor is somehow guilty of becoming immediately "RICH" because of an "MD" beside their name. Am not sure you realize that many/most of them spend years and years paying off a hundred thousand +++ dollars of debt and are far from being 'rich'. If they finally get out of hock and have trained and worked their butts off to make some serious money.............well, they've earned it!
I consider ObamaCare a form of welfare.
Basically, welfare poses a fundamental philosophical question which must be answered before assessing any economic argument: is it morally right to force a person to cede wealth to someone else for the other's benefit? Some believe that what they earn should stay theirs, and others believe that supporting other people when they struggle is moral, and thus, the only way to go. I believe this question must be answered in the negative, because no matter how well intentioned you are, forcing someone to give wealth to someone else is wrong, and there will ALWAYS be abuses, miscalculations, arbitrary requirements, and a violation of personal rights and freedoms in doing so.
Private property is a basic requirement for a free society to truly have liberty and rights. When private property can be seized from a person for any reason at all without the person's consent, then freedom is nothing more than an illusion in such a society. This (allegedly) is a FREE COUNTRY, so when you have programs such as this you're slapping people who feel anything is possible in the face.
As seen through recent history, capitalism possesses the power to lift the masses out of poverty. The expansion of productivity and wealth brought on by the free market has already saved countless people from needing welfare in the first place, and in an unhampered situation without force redistribution which exacerbates the problem, capitalism could indeed help many of those on welfare permanently become independent. Unfortunately with welfare, many become unable to escape the system for various reasons, and instead of helping them the welfare system begins to support these people and even encourages more to join the system or make personal decisions they normally would not have made (such as not looking for a job, staying at an unproductive and low paying job, having a family without the proper support, abstaining from school and training, etc).
In the end, redistribution such as welfare drags everyone down (including the people it assists) while violating property rights and personal freedoms that erode liberty and open the door for further authoritarian programs for the good of certain people at the expense of other people.
I believe that welfare and similar programs have the ability to keep people satisfied enough with their lot in life to prevent them from reaching out for more. If people were truly desperate, than we would see true change in this nation. Social unrest leading to revolution. Power to the people. Welfare gives the those at the bottom enough to have something to lose. When people have nothing, that is when they can risk everything.
If a "greedy" CEO has 500,000 clients and makes $20,000,000 a year, how greedy are they?
I think "a la carte" health care would be wonderful. Pick your choices every January. Want a Pap this year, take that option. Think you might want to have a bone density scan? Pay a little more. Here's another thought-why does a spouse on my health insurance cost SO much, yet I can add a bazillion kids all for one low price? I guarantee you my children are going to be utilizing the insurance more than my spouse.
CEOs of the world unite, subjugate the uppity workers who made you wealthy, form country clubs, deny free education and healthcare to the masses. Oh, hold on, that was tried right the heck here... and it failed worse.
Being 'rich' is a matter of perspective. I don't believe you need money to be 'rich'.
BTW, we should all buy American. And for those that choose American made products....thank you!
Health care or no health care? That is the question. Actually, it's not the question, it's the choice. Now...do I drive a $30,000 vehicle and make $700/mo payments on that to impress my neighbors/friends, or do I drive a 10 year old vehicle and pay health insurance premiums? Do I live in a house that might need paint or use a washer that is second hand? But pay for health insurance for my kids?
In the 46 years we've been married, we have ALWAYS had health insurance (except for the first 6 months when we were trying to get our acts together). Did either of our employers provide it? Nope. Did I ever drive a fancy car instead of paying for health insurance? Nope. It's choices! And we made ours. Did we pay through the nose? Not in the beginning, but in the later years, definitely! But we paid. It was that important to us. But with the costs these days, I certainly can understand why people can't afford insurance. But because insurance doesn't pay like it used to, our co-pays are extremely high, and what isn't paid for really mounts up. It kills me to have to pay for insurance, then pay for all the rest out-of-pocket when there are so many people getting everything for FREE. And now I have no choice...the Gov't took it away.
To CA Pike, I was using Japan as an example.I think that everyone could have low cost access to comprehensive health care at much lower cost for the same or greater benefit. The fact that the USA ranks 30th in life expectancy right behind Portugal and just above Albania is a rather poor showing in terms of the dollars spent versus the results. http://www.worldlifeexpectancy.com/world-rankings-total-deaths I would also agree that there are many factors that effect life expectancy besides the kind of health care and that most of these are related to behavior, for example, smoking or poor diet. Most insurance companies have little interest in maintaining the health of their patrons because they know that the average person switches insurance every 4 years and by the time the worst effects show up coverage will be provided by Medicare. An exception to this is Anthem, in conjunction with Maine State Employees who established a program which rewards participants for good health behaviors.
Nancy:
You’re not talking about health care. You’re talking about making a continuous lifelong bet with an insurance company that you’ll get sick or injured. Insurance companies do not provide medical assistance, they bet against it. Insurers win if you’re healthy and making payments. Congratulations, you’re a winner when you get sick or injured. Insurers are able to get folks to place these bets because everyone gets sick or injured sooner or later and most people are unable to finance one major health problem on their own.
Insurance companies could get even more people to place these bets if medical treatment were provided based solely on the ability to pay. The initial cautionary examples of poor investment choices would create near universal coverage. You may notice an increase in hitch-hikers and food bank lines, but choosing to walk and miss a meal or two may also create healthier consumers. Insurers could advertise their policies using the pain-wracked bodies of the untreated. The specter of untreated disease and injury may not increase the bargaining power of the policy holder, so premiums may not initially fall. Faith in the free market shall sustain you through these times. If requiring payment for treatment doesn’t lower the premiums of more worthy citizenry, more radical approaches may be offered. In addition to drug screening and spot police inspections, the uninsured could be required by law to purchase minimum coverage that would enlarge the pool of risk and presumably make everyone’s bet a little less costly. The Supreme Court may even weigh in soon, or punt. Would guaranteed insurance customers by need or by law automatically decrease average premiums ? Where is the free market incentive to lower premiums if basic coverage is required by all? This is not car insurance. Is it really gambling if you’re forced to bet?
Medicare for all I say, with no giveaways to the pharmaceutical industry. Nationalize the basic health insurance industry and put everyone in the same insurance pool with no profit motive. Your welcome.
It seems that Rep. Harvell’s only conceivable reality is a stoic acceptance of the current market-based rationing of care that prices people out. This rather than accept the possibility of a government based healthcare solution which may control cost. If conservatives like Rep. Harvell truly cared about free riders they would take a harder look at the existential legitimacy of the health insurance industry as profit-motivated middlemen between doctor and patient instead of the thousand points of light of the invisible hand they aspire to be if just left alone with their bettors. That reality should be part of a legislator’s responsibility.
The reality of health care here in the US is that it could be tonnes better and not cost US any more
There are any number of models in place in the civilized and industrialized that do just that!
The Swiss health care system has been mentioned in this Bulldog “thread” as being quite expensive which it is in terms of GNP and the cost of coverage, not quite as much as here
The Swiss do pay quite a bit but they do get a positive result and they have made the decision to pay the tab in the national interest
In the not so distant past (mid 80’s maybe) Swiss insurance companies were copying the American model re health insurance for profit by acquiring non profit companies and converting them to “for profit” insurance companies
The predictable results were the no coverage for pre existing conditions, denied claims, increasing uninsured population, bankruptcies; and *enhanced profits for the insurers*
That is what is going in this country currently
I think that the current Swiss health care program dates only from the late 90’s
In the current Swiss system as approved by the majority of the population the decision was made that access to affordable health care by its citizens was somewhat an essential “right”
Every Swiss citizens buys their basic health insurance coverage from any number of private insurance companies of their choice; what is in the “basic coverage” is set by the government; health care insurance is not employer related
It is this aspect of the Swiss system, the same basic policy for all citizens is that expand the “pool” and keeps the insurers solvent
Insurers can not make a profit on the basic coverage; if there are funds left over, they are used to reduce future premiums
Insurers do compete for non essential and enhanced elective/selective procedures, etc and the like, and do make a profit
Every Swiss citizen is covered and all claims for all prescribed procedures and treatments are simply paid
As J Antonucci, MD commented on another Bulldog “thread” on 2/14/12
“Everyone is entitled to health care Until we find the political will to fix a horribly broken system in this country things will only get worse.Much much worse than this”
It is simply not going to get any better in this country until those “in power” muster the intestinal fortitude to take on the insurance industry and make them part of the solution and NOT the major cause of the problem as they currently are
The harping, past and present, re death panels, rationing, socialized medicine, bloated governmental bureaucracies etc are by and large simple scare tactics for those opposing any meaningful change/reform of the mess we currently are in
I certainly agree that the health care system is broken in this country, and my feeling is that we need to get rid of the special interest groups, lobbiests, and provide universal health care for all. Other countries do it with good results and if the politicians pockets were not being lined they might be able to come together and figure something out that would benefit everyone.
An interesting case study that will not catch on here is Canada's system of National Health Insurance
A progressive Prime Minister in Saskatchewan after WWII "set up" the Province's "single payer" model that was so successful that other provinces began clamoring for something similar
Canada's "single payer" system pioneered in a single province, Saskatchewan, was adopted in the early 60's
Detractors of the Canadian system carp/harp and complain about long lines, alleged rationing, but essential and needed treatment is available for all citizen when its needed, all citizen are treated the same
There is some truth to the waiting for selective/elective non emergency/essential proceedures, which *are* covered in Canada