OK, I've already explained my view that healthcare is more of a privilege than a right, and should be treated as such. However, while I don't believe it's a right, I do believe it's important that it be affordable for all Americans. I do believe, as a nation, we're doing our citizens a disservice if we do not make healthcare available to everyone. At the same time, while it would be ideal to be able to provide some level of care to everyone, I also think that Americans should at least have the ability to purchase superior care if they have the means. Yes, I'm talking about a tiered healthcare system.
It's like housing, food, clothing, or any of the other basic necessities of American citizens. While we can all agree that everyone should have access to all of those things, not everyone has access to the same quality or quantity. Just because Oprah lives in a multi-million dollar mansion, it doesn't mean we all need one. Just because there are some people who eat at Morton's Steakhouse every week, we can't expect to provide that to everyone. Understand?
Healthcare, like every other commodity, is just that -- it's a commodity. It has a real value attached to it, and certain things are more expensive than others. For instance, I have some patients who have health insurance which pays for whichever medication or test I order. Others require prior authorization for almost everything. To those who don't understand exactly what that means: prior authorization means if I want Jane Doe to take Crestor for her cholesterol, I need to call her insurance company and explain to some nurse/clerk (i.e., a nurse unqualified to actually take care of patients, so she works as a telephone operator) why I want her on this drug. The nurse asks me a series of questions off a computer screen including, "Have you tried the patient on simvastatin or pravastatin yet?" If the answer is no, or if the patient hasn't been tried on BOTH of those cheaper generic alternatives yet, then the prior authorization is denied. If the patient HAS been tried on both drugs, then they better have had a very bad reaction to both of them for the insurance company to approve the more expensive Crestor. So, it's not just a matter of me calling and getting approval. The insurance company is literally deciding for me which drug is best for Jane Doe.
In a "National Healthcare System," we would all be reduced to this lowest common denominator. In other words, people who can afford more expensive drugs or services will still be denied. A "one size fits all" approach to medicine and healthcare. In contrast, a multi-tiered system would allow patients to sign up for the "free" national healthcare, a relatively inexpensive healthcare plan, a more expensive plan, or the supreme plan (for example). While some of you might argue how unfair this is, consider that this is essentially what we have today, though it just doesn't work efficiently. The poorest people are on state-run Medicaid. The problem with it is that many doctors don't accept it, it only pays for the cheapest generic drugs, and you often have to wait a long time before seeing a specialist (because so many doctors don't take it). The wealthiest people generally have fee-for-service insurance which basically either charges very high premiums, or charges patients a lot of money for each service or medication as they go. But, they can see anyone they want whenever they want, they can fill any prescription and they can get any test done -- while never having to ask permission from an insurance nurse/clerk.
To those who I know will tell me how unjust it is to have a tiered healthcare system, I ask you why is it unjust? Isn't this a free country? Shouldn't people have the freedom to buy whichever kind of healthcare they'd prefer for themselves? In Canada they deny people the freedom to seek out private healthcare. That would be equivalent to denying people in the US the right to send their children to private schools.
If the government wants to control healthcare costs, this is the solution. Let the government pay for a minimalist system which offers the ability to take care of anyone who wants it, but provides less bells and whistles. People who NEED it, will sign up for it. People who'd prefer to have higher quality, will pay for it out of their pockets. So, what I'm basically suggesting is a national Medicaid system for anyone who wants it (not just the poor), but provides only Medicaid-like service and care. Meanwhile, use this to replace the current Medicare system, and allow the citizens to choose between this and private insurance. Lower costs, healthcare for all Americans, and freedom for people to choose whatever healthcare they'd prefer. Once the Liberals get past the concept of a tiered system (which, in a free country, is a fact of life in every industry), then I think even they would have to admit it would work.
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I find it difficult to disagree with this. I think many conservatives and libertarians will have a problem with providing ANY type of basic, bottom-tier care.
ReplyDeleteYou're right, PAL. After I wrote this, I realized, "Oh my God! I'm starting to sound like a Liberal!" But actually, I view it as more of a compromise. I recognize that the government is going to be involved in healthcare whether we like it or not. It simply has too much history and momentum to stop it. What I'm suggesting is that they REDUCE the level of care they provide, but expand the opportunity to everyone. Therefore, in my opinion, once people realize how restrictive a national healthcare system is, most who can afford it would opt out for a private alternative.
ReplyDeleteAdditionally, what I didn't mention, is that I think there should be a tax break to people who opt out, since they will be costing the government less money as a result of them not taking from the system. Therefore, there would actually be an INCENTIVE for working and taxpaying individuals to seek out their own private insurance.
It's kind of like offering "vouchers" for healthcare. Let the people spend them as they see fit. If they'd rather use the relatively small amount of money to pay for their national health insurance, so be it. If others would rather take that same amount of money in the form of a tax break, then all power to them. I think that might appeal to the more conservative and libertarian crowd.
But don't kid yourself, PAL. Many Liberals would actually NOT like this kind of plan, since a tiered system theoretically provides "lesser" services and care to some than to others. A true Socialist or Marxist would not like that at all, which is why I'd be surprised if President Obama would favor a system providing that kind of freedom to the people. If I read him correctly, I would predict that he would want ALL PEOPLE to be dependent on HIS SYSTEM, like the Canadian system.
let's remember, despite what you may have been told...
ReplyDelete"liberal" =/= "socialist"
Seems based on the comments I read here your audience is pretty myopic. Liberal=socialist, socialist/marxist. listening to the right bets boring after a while. But that said I agree with your tiered approach and do believe that this is the intention of the government. Obama has said repeatedly he does NOT favor a single payer Canadian system and prefers a European approach, which allows people to have their own private insurance.
ReplyDeleteI also find it interesting that you are a doctor and as such your interests are best served by a tiered system so you can charge those patients a higher rate than what a government might impose on you should you choose to care for government patients.
So there you have it, a liberal who agrees with you. I wish your other readers could leave the rhetoric and name calling to one side and discuss the issues.
Thanks, Dennis. Actually, PalMD is my Liberal partner in my medical practice. We're just giving each other a hard time and kidding around in a public forum.
ReplyDeleteThanks for your input. And yes, you are right that as a physician, I would stand more to gain from a tiered system. But, I also feel I would stand more to gain as a patient (which all of us are at some time or another). I hope you are right about what you said about Obama. But I am concerned about the national health care system having controls over the industry, like the Rationing Board in the United Kingdom. Let the people have what they want. The government simply needs to decide what it can afford, and pay for those services/drugs/tests ONLY. Enough to guarantee basic care to anyone who needs it, but not so much as to give people unlimited choices free of charge. We'll see how it all pans out. But it absolutely MUST move away from the dysfunctional Medicare system we currently have.