Wednesday, October 8, 2008

Health Train Derailed

Last night’s debate was rather lackluster and uninspiring. Neither of the candidates revealed themselves to be ‘leaders’ and proponents for a glowing American rebound and future. Neither of them painted a picture of creative thought. Rather it was more like a cabinet meeting of officials discussing nickel-dime instructions on how to rescue our country from decline and mediocrity.

McCain’ plan for health reform made universal payer look highly desirable. He totally ignored the issues of escalating health care cost, the uninsured and underinsured.

He ignored public health, children’s health, and geriatric health and no mention about Medicare reform. There was no mention of the burdens of unnecessary bureaucracy and redundant process.

The idea of removing employers from the equation is a double edged sword. The most negative thing about is that many people would not obtain health insurance if it is not a benefit. Who would pick up the vacuum? The tax credit is inadequate and adds another level of complexity, another attempt to manipulate citizen behavior with more tax codes. It does not address the unemployed, either acutely or chronically. In our present system, employers also analyze health insurance plans and offer a menu of plans analyzed by human resources. Would individuals be able to navigate this morass? On the other hand it removes the employer as a negotiating agent in the marketing war of insurers. Individuals would negotiate directly with the insurers. This would change the playing field.

The campaign has drifted away from ‘the measure of the man’. I tend to like some of Obama’s ideas, but am very uncomfortable with the measure of him. Yes, he did some worthwhile work in Chicago with community development, but where does that work leave the ‘rest of us’.

As in healthcare, the economic rescue plan very much depends on details. Without careful thought and advice from those in the system it will be doomed to failure.

In addition to these factors, the financial world seems to have lost all sense fiduciary responsibility, captivated by profit, greed, and golden parachutes. Many of these ‘captains of industry’ should be indicted for fraud and prosecuted to the full extent of the law.

I and many of my colleagues feel a deep sense of resentment when the financial industry can function in a manner that we cannot. If my medical practice acted in this manner, my doors would be closed. I look at Washington Mutual, Wachovia, and others who have been rescued (for the time being) with open doors, doing business as usual. I think their doors should be shuttered. FDIC can insure the depositors, but these banks should no longer be operating. The employees can work for other financial institutions. However to allow them to keep operating under the same name is a travesty of unbelievable proportions.

It seems harsh, but those who lose money will be much more attentive to the banks with which they do business. Obviously leaving this up to regulators who do not regulate has not worked.

If you have made it down to this point in my diatribe, I will close with the following.

Obviously you and I who have practiced in the system for say 5,10,20 years or more no nothing about healthcare, nor how to reform it (at least that is how the politicians, pundits, and allied personel look at it).

image (from Distractible Mind..thanks)

I am no expert.....that is woefullly apparent from comments I have received from others.  I will pontificate in other areas. Healthcare is in the ICU, intubated, and without  ADVANCE DIRECTIVES. with no means of ''pulling the plug".


Medical futility.
Who has the power to decide?

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