Commentary 23- Wego Health

Message Boards»Mental Health»Mental Health»Discussion
1 of 2 1 2 Next

Ah, the American Health Care System Un-subscribe from this discussion


BarbaraPosted: 15 January 2008 01:38 PM Report Ignore Usually, when I talk about the American Health Care system, I say BarbaraAnne Rant #4968, so we can get it over with in 5 seconds and have a cup of tea.

But today, I have to tell the whole story of what it’s like for someone with low-functioning bipolar disorder to get his medication out of the pharmacy in the new year, when that medication is the difference between pain, brain torture, rage and delusions and calm with the real human being being able to emerge as he really is.

It seems that James was changed automatically to a different health plan this new year. United Healthcare didn’t want to bear the cost of his medication, which is $1300 per month, so he was changed to AARP Medicare Rx Saver Plan. Since he has the Medicaid Supplement to Medicare Part D, he pays $2.15 for generic drugs and $5.35 for brand name drugs. This allows us to eat, and might I say pay our vet bills, which with 8 princes and princesses are very interesting documents which you’d need heart medication before looking at them, since I am a Jewish mother to my pets.

OK.

So I go into the pharmacy last night at around 4:00 pm. His prescriptions did not go through. I went home. I called the insurance company. They gave me new RxBin, RxGroup, and Rx PCN Numbers. I went back to the pharmacy. These didn’t work. The pharmacy said the cobra numbers, which link their database to James’s insurance information were bringing up someone who was born in 1923. James was there and proceeded to do his old lady voice and offered to come back with a grey halloween costume witch’s wig, which made everyone crack up laughing, but I told him I didn’t think that was going to work.

So I called the insurance company from the pharmacy and had the insurance company agent speak to Jay, a lovely man, and the agent couldn’t find the cobra numbers. So we went home, and I called the insurance company again. This time, a man answered, and he did find the cobra numbers. So I went back to the pharmacy, and asked them to try these new cobra numbers. They didn’t work.

So we went home, and I called the insurance company again! This time, someone said, “Oh, I know what the problem is.” James hadn’t been updated in the insurance company’s computer system. This update would take 20 minutes to 2 hours they said. So I called the pharmacy and told them that, and the girl said she’s run it tomorrow morning to see if it went through.

This morning the girl at the pharmacy called the insurance company because I had left my official letter from them confirming that James was covered under the AARP Medicare Rx Saver plan, and what that meant for the cost of his medicine with all the numbers we had gotten last night.

It seems that when they updated him in the system, all his numbers changed.

His RxBin Number, his RxGroup Number, and his RxPCN number were different than what I was given last night. So when he was updated, and the pharmacy put in the correct numbers, James’s insurance went through and his $1300 worth of medication was paid for. They called me this morning. I’m going to buy them a box of chocolates and give it to the people at CVS. I might even write a letter to CVS corporate telling them how helpful they were to me in this dire situation because James had 2 days of medicine left.

AND, when I found out in December that his doctor would be on vacation all January, I ran James into see him for an extra appointment so Dr. Paidi could give us the written prescription for January 3 weeks before it was due, so James would have it while the doctor was in India visiting his family.

I have to tell you, I am the difference between life and death for this man.

But my point about this nightmare is that it takes a computer-savvy tenacious advocate, who is not mentally disabled, to negotiate the bureaucracy of the American health care system.

Before I came into James’s life, he used to go to the pharmacy in Monterey, bang his fists on the counter and yell “Drugs for Mason,” at the top of his lungs. What chance in hell do you think the pharmacist would choose to make the effort to figure out the mistakes between the insurance company computer systems and the pharmacy computer systems. In Monterey, they often didn’t have James’s full prescription, so when I went to get the rest of it, the insurance company wouldn’t pay because the pharmacy computer automatically refilled at the previous rate, which was incorrect. So I had to negotiate between pharmacy and insurance company computer systems talking to each other then.

What chance does any brain damaged person have of doing this? NONE. That’s what. NONE. And if their advocates are not educated—I see a lot of very intelligent, but unwired rural people here—they have no chance either.

And I think this complexity is built into the system as a money saver.

We have no right to use the term “medical ethics” in this country, when the system is built to save money and let the severely mentally ill go without medication to either cost the taxpayer hundreds of thousands of dollars because they have to be unnecessarily locked up, or in jail, or screaming on the streets homeless, or dead.

And it is absolutely, positively disgusting to me because when you calm and stabilize a serious mental illness, the human being that comes out is worth having in this world, and their voice is worth hearing in this world, and society’s expectations can go to hell at this point, the way I feel today.

Signature
Barbara
Moderator, WEGO Mental Health Communities

Original Referenced Post


My Commentary:


ZemackPosted: 04 March 2008 03:07 PM # 16 Part 1

Before we rush off into the medical nightmare of government-run health care, we owe it to ourselves to understand fully how the current health care financing crisis came about and what the real alternatives are. It is generally believed by more and more people that the free market in healthcare has failed, and that the solution is to place medicine under state control.

But the truth is, no free healthcare market exists in America today, except in bits and pieces here and there, having been strangled long ago by government controls, regulations, and intrusions. To understand the current crisis (and it is a crisis), I urge you to read this excellent essay from the Objective Standard. It is rather lengthy, but again we owe it to ourselves to make an informed, objective judgement based on all sides and facts of this crucial issue.

The choice, then, is not between the status quo and socialized medicine (or “universal healthcare”). The status quo is clearly unsustainable. The real choice is between a free market and government control…i.e., between taking control of your own healthcare decisions, or relinquishing that control to state bureaucrats with coercive power.

The free market means that patients, doctors, healthcare product manufacturers, and insurance companies are free to act according to their own judgement and self-interest, with their rights protected by government. All participants deal with each other by voluntary, uncoerced agreement, to mutual advantage. The immutable law of supply and demand determines all prices.

Here is a brief outline of the necessary reforms and what a free market would look like:

1. Remove all government-imposed insurance mandates. These are requirements dictating the content and terms of policies and imposed by federal and state fiat, at the behest of a myriad of special interests. There are currently over 1900 such mandates nationwide.

2. End insurance trade barriers between the states. Many people may not realize that a policy offered in one state cannot be sold in another, thanks to the different sets of state mandates (see above). This would open up nationwide interstate competition.

3. End the third-party-payer system of health insurance by switching all tax preferences, deductions, and exclusions from employers to individuals (or families). Each individual would purchase his health policy directly from insurance companies (which would be tax free under our current tax regime). The insurance industry, liberated from government mandates and restrictions and able to compete nationwide, would reorient its policies toward the individual market, tailoring its health insurance products according to the requirements and choices of the individual customer…i.e., the market.

4. Repeal EMTALA, the 1985 law that requires (i.e., forces) hospitals and their doctors and specialists to treat all people regardless of their ability or willingness to pay. This outrageous law amounts to slavery. It has led to large-scale closings of hospitals and emergency rooms. Hospitals and doctors have the sole right to determine when and how to offer charitable care, on a voluntary basis.

These initial steps would need to be followed up. In a free market (i.e., capitalism), there is no government-imposed “charity”. Each is free to decide when and how to assist others according to his own values and affordability. Tax-funded (i.e., coerced) “charity”, like tax-funded religion, is a violation of individual rights and is thus immoral. Likewise, everyone would be responsible for saving for his own retirement health care needs. No one would be forced to pay for the health needs of others in exchange for a promise from politicians of benefits in some distant future.

The insurance hassles like the ones cited by others in this thread are real. But a crucial fact needs to be grasped here. The root of the problem is, once again, the government-imposed third-party-payer system of health insurance. When you are dealing with your employer-hired insurance company, remember that you are not the customer, your boss is. The insurance company, in other words, is beholden to the employer, and rightfully so. It is true that your health insurance is part of your compensation. But, in essence, the employer purchases the insurance on your behalf, with your money, but according to his best interest. This is the inherent contradiction of our system. When you purchase homeowners insurance, a car, a pencil, a computer or a box of nails, you are both the consumer and the buyer. Not so in healthcare, with our absurd third-party-payer system. The conflict disappears with the direct purchase of insurance by the individual. By being beholden to the individual (the customer) rather than a third party, the insurer runs the risk of losing a customer for poor service, since the individual has the sole authority to drop one insurer for another that offers better service. In a fre market, the insured is also the customer, and thus has the power. Just like with any other product.

I have one final point, and it is the most important one, I think. Who is the person never mentioned in any discussion of “universal healthcare”? Who is it that is never given even a passing thought? Who is it that those seeking the “free lunch” of socialized medicine never bother to consider? It is the person without whom there would be no healthcare debate…the person in whose hands you will be placing your and your families medical well-being into…the doctor. When the government controls the entire healthcare industry, it controls the careers, the judgements, and the lives of the doctors.

When your doctor’s judgement about what mode of treatment is best for his patient (this means you) conflicts with the arbitrary, budget-centered edicts of some faraway state bureaucrat, who do you think will win…you or the bureaucrat? This article offers a real-life, all-to-common example of what happens when a government bureaucrat comes between the patient and his doctor. This article critical of Britain’s National Health Service appeared in, of all places, the New York Times…not exactly a bastion of pro-capitalist sentiment.

In Ayn Rand’s novel Atlas Shrugged, Dr. Hendricks, a surgeon who retires when medicine is placed under state control, says in protest:

“I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind… Let them discover the kind of doctors their system will now produce. Let them discover…that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it- and even less safe, if he is the sort who doesn’t.”

If you think that this is only fiction and irrelevant to real life, then consider this from the Objective Standard essay cited above:

“According to a recent survey of doctors, ‘30 to 40 percent of practicing physicians would not choose to enter the medical profession if they were deciding on a career again, and an even higher percentage would not encourage their children to pursue a medical career.’ “ (“Physician Burnout And Stress Now Reaching Critical Levels,” Medical News Today, April 18, 2007.) The doctor shortages, the long waits for routine medical procedures, the denial of cutting-edge treatments… these are all common to state-run medicine.

The increasingly unaffordable health insurance in America has reached crisis proportions. Don’t blame the free market…it doesn’t exist. Don’t blame the heavily regulated medical insurance industry… it has become a quasi-branch of the government. The crisis has been a long time coming. The steady breakdown of the system has paralleled the steady growth of government involvement in medicine. Yet the statists, banking on we the people not discovering the real cause, are now demanding that we swallow a full glass of the poison that has been killing us in small, steady doses.

Well, it is government programs and controls that have failed. It’s time for the government to get out of our way.

Healthcare is shaping up to be the domestic issue of the 2008 presidential campaign. Though my comments here are by no means exhaustive, I hope my posts have contributed to a better understanding of the stakes involved. The choice is either a free market or government control…freedom or statism…the individual or the state. It is either/or. If you choose government-imposed “universal healthcare”, do so with full knowledge of what you are giving up. If you choose free markets, i.e., your individual rights, welcome aboard.


Other Commentary:


Sarah_LizPosted: 11 March 2008 09:02 PM Report Ignore # 18 Barbara - I’m sorry to hear about your struggles with James’ insurance. I’m thankful, however, that you were able to get things sorted out and that your thin, young self was there to help out the situation. I would agree that it’s frustrating and sad to see that medications are being denyed to those who are unable to secure them. “So much for the sanctity of marriage. So much for the worship of capitalism.” Oh yeah ... but it’s the same way with homosexual marriage, too. Gotta keep the money flowing ... who cares about love, right? ; )

Kori - “I really wish our country would get it together and get us some decent affordable health care.” I agree. I have more to say about this, but am working on my response!

TheUnspecified1 - growing up I was uninsured, too. My parents are also self-employed and it was a scary thing applying for college knowing that. Sorry to hear that your mom had to struggle so much after her injury - as if struggling when well is easy. “I don’t know what the solution is, but right now the only people who are doing well are the insurance companies. as they say on the internets....EPIC FAIL.” Oh how that made me want to give you a high five!

Debbie - in your draft you mentioned a “cap on medicine.” I assume that you mean a prescription drug cap, and I would have to agree with you on that idea. It happens elsewhere, and many countries work with pharmaceutical companies to keep their drug costs down. I don’t know why the US can’t see that it’s not hurting the other countries - they’re just saving money!

Sue - “Once you have kids and can no longer have kids, why do you need OB coverage?” What happens if you get cancer? There are many things that can happen within your reproductive system that might need an OB surgeon for. (Just sayin’, since your opinion is going to get me going!)
“Socialized medicine will just give total control of our health care needs over to the federal government.” Kinda. I am going to talk more about the actual definition of socialized health care and how we can attain universal healthcare without it being 100% socialized.
“But in other socialist countries, it’s the elderly who are left out in the cold.” Can I ask you for an example of this? I don’t know that I quite agree with the statement.
“No one has the right to force me to pay for someone else’s health care.” But you pay for my police & fire coverage along with the public school education I got.
I can’t get to the link you included about health care not being a right, but as a strong opponent to that idea, I’d love to see the link.
“Jobs, health care, homes are all man made and therefore are not inalienable rights.” Would you say the same thing about education then, too?
I see the point of a lot of what you’re saying, but I just have to ask questions when they come up! LOL

Zemack - I was frustrated by #4 your outline. “Hospitals and doctors have the sole right to determine when and how to offer charitable care, on a voluntary basis.” *sigh* What hospital is going to OFFER to give money away? That was why EMTALA was instilled in the first place ... people who were dying were being turned away. EMTALA in and of itself has not been the only fac tthat “has led to large-scale closings of hospitals and emergency rooms.” There are many factors involved - not just charity care.
“The choice is either a free market or government control…freedom or statism…the individual or the state.” No, not really. There are in betweens. Grey areas. Other countries have other options, and we could mimic their ideas.

~*~*~*~
And just a thing in general to everyone about socialized health care. I think the words scare people and that it isn’t quite clear whether health care for certain nations is socialized.

Canada, for instance, does NOT have socialized health care. Many people use the words “socialized health care” to mean “health care for everyone”. “To say that something is “socialized” means that the government not only RUNS whatever it is but OWNS all the “capital” involved and EMPLOYS all the personnel. Translating that into terms of the health care delivery system means that the government has total control over all the resources - it owns all the buildings (hospitals, doctors’ offices, clinics); and assumes all administrative tasks (sets the budget and determines how many people to hire, what services to hire, where the offices should be located).” This describes the UK’s National Health System, not Canada’s program. Canada only receives 73% of it’s health care funding from the federal level; the other funding is out of pocket and from the provinces.

There is no fix-all cure for America’s health care system. Even if everyone could agree and we decide tomorrow that (true) socialized health care is the way to go, it wouldn’t be immediate, wouldn’t happen TOMORROW. Health care change will be a slow process in order to work people in without overwhelming any new set up!


My Commentary:


ZemackPosted: 18 March 2008 04:47 PM # 20 Sarah Liz. Thank you for your response.

Part 1

The primitive rule of brute force keeps resurfacing in various forms. From Plato’s Philosopher King, to the medieval rule of the Church, to the tribal chief, to the monarchy, to the feudal lord, to the rule of the Islamic theocracies, etc., force has been the dominant element in mankind’s social evolution. Today’s primary version is socialism…the subordination of the individual to the group…i.e., the collective. It can take the form of Communism (Soviet Russia), Fascism (Mussolini’s Italy), National Socialism (Hitler’s Germany), Welfare Statism (Bismarck’s Germany), or various forms of Social Democracy (unlimited majority rule).

What all of these examples have in common is that they are all variants of statism-collectivism, the doctrine that holds that the individual has no value and no rights, and that his only justification for being is service to some group, as represented by the state. Whether the state represents the proletariat, the race, the nation, society, the majority, or the “common good” is immaterial. It can be violent or non-violent. It can be democratic or one-party rule.

Your analysis of what is or is not “socialism” is a distinction without a difference. It makes no difference who “owns” property or capital under the rule of a government that has omnipotent control over its citizenry. To own property, whether material or intellectual, means to have the right of its use and disposal. To “own” property that the government controls is to have no property rights, thus making “ownership” a sham.

“The party is all-embracing…” said Adolf Hitler upon taking power, “Each activity and each need of the individual will thereby be regulated by the party as the representative of the general good…This is Socialism- not such trifles as the private possession of the means of production. Of what importance is that if I range men firmly within a discipline they cannot escape. Let them own land or factories as much as they please. The decisive factor is that the State, through the party, is supreme over all, regardless of whether they are owners or workers…Our Socialism goes far deeper…[the people] have entered a new relation…What are ownership and income to that? Why need we trouble to socialize banks and factories? We socialize human beings.” (From Herman Rauschning’s The Voice of Destruction, as quoted in The Ominous Parallels, by Leonard Peikoff, page 231-232.)

So, whether you are talking about government ownership (Communism), government control (Fascism), or some mixture of the two, you are essentially talking about the same thing. Socialism is Socialism. Tyranny is Tyranny. And the rule of physical force by some men over others is the rule of physical force.

There is only one alternative to all of the above…the banishment of force from human relationships. (I am talking here about the initiation of, or threat of the initiation of, physical force. Force in self-defense…i.e., protection against domestic criminals or foreign enemies…is certainly legitimate.) And there is only one social system that accomplishes this…Capitalism. Only Capitalism is based on individual rights, with a government that protects, not violates, those rights. Under Capitalism (which doesn’t exist today, except as part of the deteriorating “gray” mixture of freedom and statism...i.e., the mixed economy), there is a separation of state and economics. Which means that no person or group can impose its economic agenda on the rest of the country through governmental force. Under Capitalism, people can deal with one another only by voluntary association to mutual advantage, each according to his own self-interest. Capitalism, born of the Enlightenment, ends the rule of force by men over men.

There is no “gray” area between the two. Either voluntary persuasion and logic govern human relationships, or force does. Reason or guns. White or black. It’s either-or. By accepting the “gray” premise that one’s freedom of action (individual rights) can be overridden by the coercive will of others, you are accepting force as a legitimate means of human interaction. When you accept this premise, you obliterate the concept of inalienable rights. Freedom means freedom from physical force, governmental or otherwise, and nothing else. Like cancerous cells destroy healthy cells if not eliminated, force destroys freedom. There are only two basic choices…the rule of force under Statism, or the elimination of force under Capitalism.


ZemackPosted: 18 March 2008 05:49 PM # 21 Part 2

When you say “What hospital is going to offer to give money away? That was why EMTALA was instilled in the first place”, you are hitting the “gray” nail on the head. If the doctors and hospitals are not acting according to the will of the state, you are saying, then the state will force them to act according to its dictates. They are deprived of their right to think and act according to their own judgement and in their own best interest, by force of government. If one’s rights are conditional, one is not free. Force destroys freedom. It’s either-or.

EMTALA’s coercive “charity” (i.e., the initiation of physical force by government against the doctors and hospitals), is the black side of the “gray” equation. It is Marxism, not freedom. It is not “gray”. It is force. “From each according to his ability, to each according to his need.” What attribute do the doctors and hospitals possess that makes their rights expendable? The ability to treat and heal the sick. They are being punished for the value they offer the sick and injured, by people who offer no such value, but who demand their unpaid services to the needs of anyone who cannot or will not pay. “From each according to his ability, to each according to his need.” It’s a moral inversion. EMTALA is a violation of individual rights. EMTALA is not “gray”. It is force.

This is the kind of government coercion that is destroying American healthcare and is leading to a healthcare dictatorship…i.e., socialized medicine. It was never consciously chosen by Americans. The deterioration of the healthcare system has proceeded in lockstep with the steady, piecemeal growth of government intrusion and controls over a period of some 75 years. In the “gray” area between Capitalism and Socialism in American healthcare…between freedom and force…force (the cancerous cells) is destroying freedom (the healthy cells). And this has far-reaching ramifications for America’s future.

Ideas move human history. It is only ideas that move human history. When we accepted, through EMTALA, the idea that government can compel the involuntary servitude of so much as one hour of one doctor’s life in a hospital emergency room, we have accepted the idea that the government has the right to enslave. If a doctor’s “vital” service justifies his enslavement, even partially, then so do the “vital” services of teachers, plumbers, airline pilots, homebuilders, food and energy producers, and clothing manufacturers justify their eventual enslavement. This is why it is so important to oppose EMTALA. There is no “gray” here. Either the state has the power to enslave, or it doesn’t. It’s either-or.

The fact that so many Americans can so casually and flippantly demand the violation of the rights of the very people…the hospitals, doctors, pharmaceutical companies, among others…that are the most needed to keep us healthy is a real danger signal. It means that the philosophical-moral base of totalitarian socialism, collectivism-altruism, is permeating the culture. And collectivism’s antitheses, individualism…the doctrine that holds that each person has the right to exist for his own sake, to pursue his own welfare and happiness and which is the philosophical-moral base of Capitalism and America’s founding, is losing whatever grip it has.

Politicians and policymakers run from the term “Socialism”, because they know that they can never explicitly sell it to America. But by accepting the sacrifice of the individual to the needs of “society”, collectivism, Americans have embraced a lethal contradiction. This contradiction is leading not to the overt socialism of Communism, but to the back door version which is covertly taking root in America with each new government control, regulation, and welfare-state program. Fascism, with its veneer of private ownership, is the direction in which we are headed.

The “gray” that you advocate, Sarah, is really a battle between the two extremes of Capitalist freedom and Socialist tyranny…between freedom and force. Healthcare is currently the central front in this battle. Either we choose Capitalism with its consequence of ever lower prices and rising quality available uncoercively to more and more people or we choose Socialism with its consequence of soaring cost, deteriorating quality, loss of freedom by doctors, patients, drug and medical device makers, etc., and rationing. It is imperative that American voters be presented with the clear, bold, comprehensive free market alternative to “universal healthcare”, because the outcome of this battle has far-reaching consequences for us. Power-lust is insatiable. Statism will not stop at healthcare. Today neither party is picking up the free market challenge, and Americans are being denied a real choice.


ZemackPosted: 18 March 2008 06:18 PM # 23 Part 3

As a sidebar, your question “What hospital is going to offer to give money away?” is a straw man. It’s not about giving money away, but about charitable health services to those unable to pay. The fact is that Americans, including healthcare providers, are the most generous people in the world. In 2002, according to the latest available figures, Americans’ voluntary charitable giving was $241 billion, or 2.3% of GDP. In another survey, the highest per-capita giving of any European country was 122 euros, compared to 278 by Americans-more than twice as much (figures are in euros because this is a European study). These charity figures do not take into account volunteer services…time…donated by Americans. I provide these charity figures only to make a point that options are available for the truly indigent. If any healthcare provider decided not to offer one minute of his time to charitable care, it would be his inalienable right. Offering one’s services or products after years of training and/or research and development to others for payment (i.e., in trade on the free market) is an honorable and moral undertaking. No one in a free society can be considered an unpaid servant of others…not the doctor to his patient any more than the unskilled laborer to his employer. But the fact is that doctors, hospitals, and pharmaceutical companies have a long tradition of offering their products and services free of charge to people unable to pay. But only those who have made the lifelong commitment to treat the sick and the injured have a right to decide if, when, and how to offer charitable care.

To help the sick, one should recognize the value of the healthcare providers. This means to respect their freedom, lives, and achievements. The issue, then, is not charity or no charity. It is voluntary charity vs. coercive “charity” (slavery). It is not “gray”. It is freedom or force. It is either-or.



per capita giving

total US charitable giving in 2002