Friday, September 30, 2011

The good and bad of Obamacare

Tooth Extraction DayImage by Rev Dan Catt via Flickr
I had a patient at my place of employment who went to the dentist recently.  He had been a lawyer, and had a stroke afterwards while still young.  He could no longer read or write, and had reduced sensation and movement in half of his body, precluding walking. His voice took on a bit of a slur due to muscle weakness.  He could no longer be a lawyer, although his mind was intact.  He then got a job at about minimum wage, with no insurance.  He has had some other negative health events, due entirely to the stroke.  His stroke also caused him to neglect the weak half of his body.  He forgets about it, as many stroke patients do.  For example, wheeling himself through a door, he quite often hits his weak sided foot against the door frame, not noticing that he's crushing his foot against it.  Naturally his tooth brushing suffered as he forgets to take care of half of his mouth.  He had rotting teeth, and went to the dentist... but wait, his health care plan won't cover it.  So he has some teeth that need work, and no way to get them taken care of.  Rotting teeth (especially the upper rear molars) involve bacteria, and often cause clots that break away and travel to the brain... causing strokes.  Another stroke in his case.  He hasn't had it, but if and when he does, it will cost a lot more than a dental visit.  And he will suffer even more permanent damage, and maybe this time he will have significant cognitive deficits.  As far as I can tell, if Obamacare was fully in effect, he would have had insurance, and I could help him relearn to read and write without wondering about his unecessarily increased stroke risk.  I couldn't help but think today that if we were in Canada, or England, or another of a whole list of countries, he would have gotten his rotting teeth pulled and had root canals and crowns or whatever he needs.

Obamacare attempts to cover everyone. Jeffrey Anderson claims that Universal coverage will not reduce costs, and will probably increase them. I don't think that it will for three reasons. First, because the healthcare system will no longer have to charge higher prices to cover all those people that don't pay for ER visits etc. and secondly because in most markets, when you increase the size of the market, costs per individual units decrease. Car prices would be a lot higher if only half of everyone had one. Fewer cars sold means fewer cars made means less variety and higher per unit production costs. Thirdly, as noted in the case of my friend where I work, universal healthcare includes universal preventive care, which will mean less major healthcare costs and healthier people.

On the other hand, it may be true that universal healthcare would mean increased demand in some areas, which might increase costs.

I think it should be noted that Obamacare will reduce the federal deficit. I think democrats have their numbers and republicans have theirs, and they contradict almost completely. The Congressional Budget Office seems to be objective though, and it says that the deficit will be decreased.

Additionally, it should be noted that this is not government health care. State exchanges are set up, and all the private insurers are on them, and people choose a private company to go through for their health insurance. I encourage the Obamacare haters to read the cbs news article above. It gives a summary of the law, and their's actually a lot to like in it.

There are some negatives though. The law doesn't take on increasing healthcare costs. As a person that has worked with computer programs used by health care organizations, worked with insurance coverage for healthcare, worked as a Nursing Aid, a Therapy Aid, and now as a Speech Therapist, I feel like I have a pretty good idea of some of the areas that represent overspending or inefficiencies that cost money. I don't know everything, but I know a good amount about multiple areas.

To reduce costs, a good starting point is to standardize healthcare information. There are hundreds of programs, thousands of record forms, and an extreme amount of complexity in dealing with such issues as figuring out which insurance pays what, how records are kept, which records can and can't be used together, how information is transferred, who is or isn't covered for any given procedure on any given insurance, how much people have to pay and when, what and who can and can't be included when exchanging information, etc.

Having a complete record of our own medical history is practically impossible without hours of records requests and work. A single format for medical records, with each being shared only be consent of the individual and only under previously decided upon circumstances, would save lives, and a whole lot of money. Standardized language and formatting for insurance coverage information would save a lot of time and money. These are things that Obamacare doesn't do, and things that the Republicans don't want to do either, due to concerns of information privacy or government 'regulations.' If every system could communicate with each other when it should in an efficient and easy manner, billions of dollars would be saved. It might mean that some people can't lie about conditions... but one of the benefits of Obamacare is that insurance companies can't discriminate on the basis of conditions anymore anyway, so it shouldn't matter in most cases.

Another major inefficiency is the waste of material products involved in Healthcare. The amount of garbage produced by hospitals is amazing. I would guess more than half of it is necessary, but I think there's at least 20% and possibly a lot more that is monetarily inefficient.

Another major cost of healthcare waste is when doctors overtreat patients. Apparently 42% of Doctors think that they're overtreating patients. Something I found interesting from the article is that just about all doctors agree that multiple doctors would prescribe different things for the same patient with the same symptoms.

Increasing the length of schooling and the intensity of programs to become doctors, nurses, or other specialists ends up in higher demand, therefore more pay for their services.  I think the whole educational system for all of these areas needs to be revamped.  As a specialist, I know my area of speech therapy, but still must ask for MD orders to do things my patients need.  Things that the doctors know little or nothing about.  MDs are both specializing in certain areas and playing the role of directing others' specialties as well.  I think either is fine, but both is kindof silly. 

One other problem that has a major role in the increased cost for healthcare is increased unhealthiness of the American people.  We're the fattest people on the planet. 

Something that I don't see mentioned is that medical technology is advancing, and the numbers of specialists are increasing, and what they can do is increasing, but higher technology, more specialists and more treatments mean paying more money, period. The interdisciplinary team that sees my patients includes multiple doctors, Speech, Occupational and Physical Therapies, Nursing staff, case workers, social workers, and other specialists as needed. It wasn't like that 100 years ago. People are living longer today.  In this article, it reviews European taxes on unhealthy foods.  WE NEED TAXES ON UNHEALTHY FOODS!!!! Paul Ryan's ideas seem to be valid in several respects regarding lowering health care costs. He is right that Obamacare doesn't directly attempt to lower costs. It's more about getting healthcare for everyone. Additionally, he talks about increasing the efficiency of Medicare and Medicaid. Their cost increases have been about twice as much as the cost increases of private insurance. I especially like the call for transparency and greater ability to compare insurance coverages and allow competition for consumers. I don't think his ideas are an all encompassing solution to the healthcare problem. Like Obamacare, I think most of what he talks about is needed.

I don't see the two plans as oppositional. In the case of encouraging competitive bidding, they are similar.

Universal health careImage via Wikipedia

Countries with Universal Health Care
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1 comment:

graham said...

This was great! You were very thorough and objective and in my opinion unbiased. Thanks!