Health Care Reform: Tired of talking about this, but

August 31, 2009 at 11:46 AM (Uncategorized) (, )

Kennedy’s gone….

and I feel the need to dissect Krauthammer, so as Keith Olbermann says, “Here we go,”

First read his whole article…Then, I have a few points I’ll make up front.

Our present private healthcare system stands between patient and doctor with a labyrinthine system of denials, appeals, denials, angry letters to the CEO, denials, letter to a legislator, some last minute heat and denial, or possible final payment while the patient’s condition worsens… or the patient’s death.

“Futile Care” laws, already on the books in places like Texas (Passed under GWB ) already deny care, most notably end of life, to uninsured patients…Death Panel anyone?

We have rationed care on an economic basis in this country *right now,* brought to you by the policies of the private insurers, the shortage of primary care physicians, inability to get insurance due to preexisting conditions, bloated specialty practices and overburdened hospitals.

Krauthammer makes his (nearly credible) claim about Medicare first.

You don’t need a PhD to see that the promise to expand coverage and reduce costs is a crude deception, or that cutting $500 billion from Medicare without affecting care is a fiction.

Medicare Advantage Plans, administered for the government by the private carriers can sometimes make more money than they pay out in claims, and that extra (while now the fee for administering said plans,) leftover, part of the private companies profits is really taxpayer money ….that needs to stop, and is one of the ideas the administration has spoken about…
Waste, fraud and abuse only need smart savvy watchdogs and electronic records to be cut down…. I’ll let Mr. Krauthammer quibble over the amount that can be saved, but it would be a significant number, and needs to be done, not glossed over as ‘fiction.”

Soft-pedal the idea of government committees determining “best practices.” President Obama’s Federal Coordinating Council for Comparative Effectiveness Research was sold as simply government helping doctors choose the best treatments. But there are dozens of medical journal review articles that do just that. The real purpose of such councils is ultimately to establish official criteria for denying reimbursement to less favored (because presumably less effective) treatments — precisely the triage done by the NICE committee in Britain, the Orwellian body that once blocked access to a certain expensive anti-blindness drug until you went blind in one eye. (NICE: the National Institute for Health and Clinical Excellence.) “

Smaller versions of these councils exist now in all the private carriers and have particularly strong ‘veto power’ over medications in their formularies (approved drug lists) or both meds and treatments in a ‘closed HMO’ system (Where you go to only one hospital and see only the doctors and specialists at the companies own clinics.) Patients are being directed to older tried medicines *right now* because of these sorts of boards or panels…sometimes it does prove beneficial and cost saving because the cheaper meds *do* work just as well…and sometimes a private carrier will deny a medicine it knows to be efficacious on the basis of cost alone even when other meds for the same condition have been tried and found ineffective. [the carrier will give some bullsh!t reason and cite studies that they don’t happen to have a copy of on hand, but the result is the same] If you have money you can pay cash for the prescription (or find an outside doctor to write it, and you pay cash) but if you don’t have the cash then forget it. Economic rationing for you.

Apparently since Krauthammer cannot recognize economic rationing if it is in front of his own nose, he cleverly unveils time-rationing as the last scary result of *any* attempt at changing the current system, even one that he posits Republicans would vote for.

Isn’t there a catch? Of course there is. This scheme is the ultimate bait-and-switch. The pleasure comes now, the pain later. Government-subsidized universal and virtually unlimited coverage will vastly compound already out-of-control government spending on health care. The financial and budgetary consequences will be catastrophic.

The rest of the quote makes clear he’s speaking about time-rationing, but the same paragraph needs to apply to the real catch – The one Krauthammer left out.

I’ve said this before, but I’ll say it slowly this time, so maybe some Blue Dogs can go strolling to their nearest clue shop and purchase a few.

Both the public option plan and the non public option plan limit out of pocket expenses (this is a good thing), do not deny care based on preexisting conditions (also a good thing) and will hopefully have language in them re the private carriers that they cannot drop an individual if they have an illness or event that proves costly. (The third good thing)

Here’s the catch that Krauthammer described, while oddly leaving it out of his essay:

There is no mechanism in the bill to stop community rating blocks premium pricing to rise and rise and rise for an entire group (geographic ) of people, if the carriers can get their rates past the Insurance Commissions in the states, something auto and homeowners insurers seem to have no problem doing. I believe pricing by age group will also be permitted in both plans, yet another way for the private carriers to retain some or all of the money they would lose by not being able to drop individuals, create plans with obscene out of pocket responsibility or deny coverage…

So, none too accurate.

Irrespective of being right or left, please research health insurance as it exists today before you open your mouth about it, even in an opinion piece, because ‘informed opinons’ are the only ones that make us think.


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