Responding to Six Confusing Claims: A Doctor Makes Sense of the Health-Care Debate, Part 2

by Arthur Jones 09-02-2009

The second issue has to do with the impact of health-care costs on the fiscal health of our country. Health-care costs continue to rise at more than twice the rate of inflation. This trend has not only negatively impacted our competitive position in the world economy, it is simply nonsustainable. An ever-increasing portion of an employee’s total compensation package (salary and fringe benefits) is spent on health care.

The proportion of both federal and state budgets spent on health care continues to escalate, draining dollars from other important areas of government responsibility. Massachusetts implemented the changes recommended above and eliminated almost all of its uninsured. Unfortunately, they did little to control health-care costs, which threaten the entire program.

I believe the most crucial part of the current health-care debate has to do with the public option. It would allow employers and individuals to choose the government-sponsored health insurance option just like they could choose a private insurance option. The public option should compete fairly and live off its insurance premium dollars without additional supplementary funds from the federal government. Medicare and most state Medicaid programs operate with a 3 to 4% administrative cost. Private insurance companies generally take 15 to 20% of the premium. Many health insurance markets in this country are controlled by one or two companies and have an inadequate incentive to reduce health-care costs. If private insurance companies cannot reduce their costs to compete with the public option, we would eventually move to a single-payer system that characterizes most other westernized countries.

Who stands to benefit the most from such a change in our health-care system? Clearly the 47 million medically uninsured Americans would. As health-care costs become curtailed under such a competitive system, most of the rest of us would benefit as well. Who stands to lose? The health insurance industry would for sure, but the medical profession, hospital, pharmaceutical, and medical device industries would as well. The latter would find it increasingly more difficult to bargain rate increases from a public option more concerned about keeping coverage affordable than padding the affluent working within the health care industry.

In addition, if the government would remove the malpractice system out of the tort legal system and replace it with panels charged with decided compensation for medical error, the legal system may experience a drop in revenue as well. As a result, you will hear claims such as the following from those representing the interests of those who stand to lose from the creation of a public option.

1. You may lose your current health insurance carrier and may not be able to see your current doctor.

It is true, especially if your current doctor refuses to contract with the public option. It is true with our current system also, as many employers change health insurance carriers almost yearly in a scramble to contain escalating costs.

2. The government will set up “death panels.”

This is in reference to the plan to reimburse doctors for actually having a discussion of end-of-life issues with their patients so that patient wishes are followed. All too often, this discussion never takes place and patients are subjected to “heroic” efforts to squeeze a little more life out of them before they die. Some of these patients would never have agreed to such care had they been given an opportunity to express their wishes ahead of time.

3. The government will mandate government funding of abortions.

The current White House administration has stated that this is not their intent but there is no guarantee that this could not change in the future. Doesn’t God call us, however, to be just as ardent about the pro-life position of inadequate access to health-care services as we are about the abortion issue?

4. The government will make treatment decisions that should only be made between a patient and his/her doctor.

It is true that in countries with a single-payer system, decisions are made about the cost-effectiveness of certain treatments before they are made available. Private insurance companies as well as CMS, which controls Medicare and Medicaid, are already doing that.

5. There will be long lines of people waiting to get medical services just as there are now in Canada, Great Britain, and other countries where government controls much of the health-care system.

The lines are exaggerated, as are the claims that Canadians are flooding the borders to enter the U.S. to get access to our health-care system. The reality of our current system is that it is the poor and medically uninsured that wait in the long lines and Americans are traveling to India and Southeast Asia to get access to health care they can’t afford in our own country. The length of any lines is more related to how much of a country’s GNP is spent on health care and how efficiently those funds are spent.

6. The government option will move us into socialized medicine.

This is a direct reference to communist countries that adopted government-run health-care services. That red scare technique has been used to stamp out health-care reform in this country since 1917. It is being used again right now. Surveys show that a large majority of Americans are dissatisfied with our current health-care system. We have been in that position several times before in the last 65 years. Public opinion has repeatedly been turned against reform as those who stand the most to benefit from the status quo convince us to look at this from a self-interested standpoint and invoke fear that we may personally be better off just as things are.

Will the church stand up and be counted among those advocating for those who suffer under our current health-care system? History says we will stay silent. Will we?

Arthur Jones, M.D., is a founding physician at Lawndale Christian Health Center.

Categories: Health

Lord_Voldemort

Taking this point-by-point:

1. Conservatives have sometimes exaggerated this -- there's nothing the market or the government can do if your current doctor retires -- but the important question is, when it's time to choose a new doctor, who makes the choice? In a market the patient has more control over the long haul.

2. Again, the death panels were a bit of an exaggeration, but as Dr. Charles Krauthammer pointed out, the end-of-life counseling certainly could "nudge" patients towards foregoing treatment and that should give people pause.

3. Dr. Jones asks: "Doesn’t God call us, however, to be just as ardent about the pro-life position of inadequate access to health-care services as we are about the abortion issue?" The answer is no, he doesn't. He calls us all to do different things and gives us different experiences and allows us to reach different conclusions. Dr. Jones is allowed his sense of priorities, and pro-lifers are allowed theirs.

4. Again, the doctor has a point, but he misses ours. Unless you're literally paying out of your own pocket there will be someone else, either an insurer or a government program, with a say. But with private insurance the patient has more of a say as to who that third person will be. That doesn't guarantee good care but all else being equal it does improve the odds.

5. We can argue about the length of the lines, but there's no point in denying they exist. A few years ago a court in Quebec ruled that the wait for some treatments was unacceptably long and the head of the nation's health service has warned that the system could collapse. Dr. Brown asserts that the severity of the problem is exaggerated, but provides no facts to prove what he's saying.

6. While a public option wouldn't automatically usher in a government health system, you'd have to set things up just so -- if the public option is too poor nobody will want to use it, if it's too generous then it will undercut private insurers -- in effect a back door nationalization. Barney Frank is on record saying that public option is the best way politically to bring about nationalized health care, and Obama is on record supporting nationalized health care in principle. I find it very likely plausible that he will be willing to risk running private insurers out. You can call it a "Red Scare" all you want, that doesn't mean there isn't a real problem here.

LV

SisterMarie

This is the same Dr. Charles Krauthammer who wrote:

"When my father was dying, my mother and brother and I had to decide how much treatment to pursue. What was a better way to ascertain my father's wishes: What he checked off on a form one fine summer's day years before being stricken; or what we, who had known him intimately for decades, thought he would want? The answer is obvious."

So for you Americans who thought you had settled those questions when you sat down with your loved ones and prepared a Living Will, not so fast. Dr. Krauthammer knows what's best for you. Just throw out that paper that you signed! It's worthless. We're just going to keep pumping stuff into your body and we'll decide what's best for you.

Lord_Voldemort

Dr. Krauthammer has a point: nobody can anticipate all the things that might happen to him or her. Having a form that determines how you'll be treated sounds fine in theory, in practice you really might be better off letting close family decide. Sarcasm aside Dr. Krauthammer doesn't claim to "know what's best for you", that's why he's consulting with the people who know you best. Is that really so shocking?

At any rate, this is a red herring. Living wills exist now. There's no reason to think that the government will be any more likely to respect the wishes of a near-dead and unconscious patient than his or her relatives would be. Government bureacracies have their own incentives that might be contrary to the desires of the terminally ill, and there are lots of places in government office buildings in which to hide inconvenient documents.

LV

SisterMarie

"...in practice you really might be better off letting close family decide."

Lord, I need some help here. How should I revise my advance directive/living will so that my wishes are respected and that close family members do not decide? Do either you or the good doctor have some ironclad language that I can insert so that my intentions override those of those gathered at my bedside?

justintime

'Death with dignity' allows you to claim your right to die in case of a terminal illness.
If your state doesn't have it you can work to achieve death with dignity legislation.
Or you could move to Washington or Oregon.

jdquest

I think it might depend on who you trust with your living will. My parents had a living will on file with their doctor. When my husband (who did not have a living will) was terminally ill, the doctors seemed to be rushing us to move him on out of here. When I told them this, they took their wills back from the doctor and gave it to family members. That may not be a legal way of handling it in all states but it worked for us.

SisterMarie

"Sarcasm aside Dr. Krauthammer doesn't claim to "know what's best for you", that's why he's consulting with the people who know you best."

I don't consider it to be sarcasm when I question the credentials of an individual who you cited in your original contribution. If I decide on "one fine summer's day" when I am totally healthy and lucid that I don't want a lot of tubes keeping me alive, I don't want my loved ones to follow Dr. Krauthammer's advice to keep me plugged in. By the same token, if my choice on that summer day was to keep the stuff coming through the feeding tube and keep me drugged up on pain-killers, then I would not want my loved ones to contravene that decision either. No one knows me better than me despite what you and Dr. Krauthammer say. And yes, to suggest otherwise really is shocking.

Lord_Voldemort

"No one knows me better than me despite what you and Dr. Krauthammer say. And yes, to suggest otherwise really is shocking."

The problem is, *you* are not available, *you* are unconscious or at any rate not lucid. If you were conscious and aware of what was going on the doctor wouldn't worry about pieces of paper or the guesses of your relatives, he'd ask you directly.

With you unfortunately unavailable what the doctor has is a document bearing your signature that may or may not adequately address the condition you are in. That's assuming the government agent hasn't misplaced it. If your precious document isn't clear or something comes up that you didn't anticipate, then the doctor's back to talking with your relatives.

I don't know your family so I can't say what they might do or if they might respect your wishes. If you really fear that they will mistreat you then you have my pity. As for me, I know my family, and I know the government. In a situation like this, I trust my wife and kids. They know me better and they care about me more.

That's really the question here. Living wills serve their purposes and if they are drafted well they can be valuable -- if nothing else they can tough decisions easier -- but a living will is only as good as the people who apply it. There's nothing magical about a piece of paper that guarantees it will be followed.

Someday I may decide to leave some advance directives of my own. If I do, I'll leave my family a copy, not because I want them to decide everything, but because I expect they will understand and respect my wishes. I'm less convinced of that as far as the government is concerned.

Now, does *that* shock you?

LV

SisterMarie

Lord,

I'm not sure that I fully understand your code that you used in your last sentence. Is there some sort of secret handshake that only Limbaugh worhsippers understand? Does *that* convey some special meaning that only insiders understand, or is that just a fancy way of adding expletives that will not be deleted by Sojo?

Nevertheless, there's a lot of faulty logic in your post and I'll do my best to respond to them in terms that you can understand.

"That's assuming the government agent hasn't misplaced it."
The government agent does not have a copy of my advanced directive. There's a copy on file with my family physician and with the hospital in which I have been treated several times, but not with the "government agents."

"I know my family, and I know the government." The primary reason for an advanced directive is to keep the government out of those end of life decisions. Nowhere was this issue more adequately demonstrated than the case of Terrri Schiavo in which George Bush and Jeb Bush thought that they knew more than Terri's doctors and Dr. Bill Frist provided a long-distance diagnosis on the basis of video footage. That case alone resulted in me and millions of other Americans writing advanced directives to prevent the kind of government intrusion that you so eloquently lament.

So when you do prepare an advance directive, do leave a copy with your family, your doctor, and the hospital where you would expect to be treated in case of an emergency. But don't mail a copy to the government.

letjusticerolldown

1. The number of payers, or lack thereof, or who they are may or may not impact proviider choice. I don't believe different sides of argument about how to get more universal access and cost-control have an inherent advantage on this point. I do believe there needs to be fundamental value placed on the value of individual control and one aspect of that is control of relationship with a primary provider. Those things are not very present now and are not guaranteed by reform.

2. Death Panels: I think cost controls and our fundamental values are the risk here; not whether physicians discuss care options with patients. These choices get made everyday. It is part of life and death. A hospital today has both the capacity to unduly ram care down a patient's throat and can make it abundantly clear they think the plug should be pulled. There is no perfect way. But the time to give the patient a bit of power, knowledge and say so is not when their life is on the line, when they are unconscious, or in unbearable pain, or burning through their last asset--and with a smile ask if we should pull the plug. Yes the issue is real. But "no" in this context the reality of what was in the bill was not of concern and subtracts greatly from the legitimacy of those who chose to exploit fears.

3. Yes everyone has a right to priorities. I think his attempt is to not to try to play one issue against the other. Let's acknowledge we can attempt to address a multiplicity of issues in a bill and not all threaten to walk away from governing because one issue isn't exactly what we want. Tony Perkins (for example) cannot legitmately say he wants to address issues of access; but only if abortion funding is dealt with in a certain way. Either we are going to work together to increase access, outcomes, and reduce costs or we are not. If we do not work together the thing will fail because the values and issues of many sides need to accomodated. They are not accomodated through compromise but through wisdom.

4. Treatment decisions: The goal is to maximize the patient's health supported by patient's healthcare choices in consultation with provider of their choice--placing appropriate value on varied treatments (treatment can kill as well as save). I think we have to fight for this goal. I don't think the choice of third-parties is a plus or minus on this. It is how he payer functions. I think presenting the "public option" as expanding the field of competition is wrong. It may do so. But it may not. The point is to be clear on what we are after when we advocate for any changes. If you and I are after the same fundamental goals--we can be clear on that. If we are after different things--that is OK.

5. Lines. You agree with Dr Jones. Lines exist. What is our goal here?? I would think we want people to make good decisions about what lines to get in and when to get in them; allow them to get in line freely; and make them as short as possible. So let's work to that end and agree to neither obfuscate or exaggerate the line issues in the US or other countries.

6. Is anyone proposing or desiring a "Federally Funded National Clinic" with government doctors? No.

I believe Obama would like a universal single payer. This might take us there. Dr. Jones states that. That is not a national clinic and the fear language implying such is the case is wrong. And again by playing on this the opponents seriously dilute the full range of serious concerns about even heavier federal involvement in healthcare. There are too many serious issues here to cloud the air with false issues.

justintime

Well reasoned points, ljrd.
I think the "portability" feature of health care reform, as described by Obama, is essential.
When you change jobs or get laid off, you keep your plan and your doctor.

xfree9

Gee, imagine that. A libertarian idea of not tying jobs to health insurance, and letting the consumer/patient decide his/her plan... you might have a single libertarian bone in your body, justintime!

justintime

That's another trait of libertarianism -- claim the ideas of others and
long dead patriots as your own. Thomas Paine is rolling over in his
grave on the publication of Glenn Beck's "Common Sense".

If you were to stop looking at the world through the lens of
libertarianism, xfree, you might discover the real world.

xfree9

Did you read Beck's book? I have a progressive friend who disagrees with the book, but at least read it.

Eric77

I'm going to repost something I posted in another thread:

If anyone is interested in a good analysis of the current problems with our health care system I'd encourage you to read this article in the Atlantic entitled "How American Health Care Killed My Father". I think it does a good job of presenting the problems with the current system and proposes some solutions at the end.
http://www.theatlantic.com/doc/200909/health-care

If you choose to read it, let me know where you think his logic is faulty or what he gets right. I'm no expert on this issue, but the author makes a lot of sense to me.

lumens

In general, he gets the issue right. He is oversimplifying the logistical issue facing health care IT. The problem, and providers are investing considerable amount of time and labor addressing it, is that there is no one platform on which the various technologies can operate.

Between updated software, OEM devices, and aging technology, it is nearly impossible to put together a system that can seamlessly integrate the various images, records, past prescriptions etc... This is especially problematic since most patients are elderly, and therefore have long medical histories.

One answer is to streamline care via the insurer, forcing people to choose doctors within particular networks, which can then share data. This proved unpalatable in an era of employer-provided coverage, but in a free market, it would be very appealing to have a doctor who was intimately familiar with your medical history.

Unfortunately, none of his proposed fixes (or identified challenges, for that matter) can be condensed into a political slogan.

justintime

This is an excellent article!
It will get you thinking in different ways about our broken health care system.
Makes a lot of sense to me as well.

justintime

2. The government will set up “death panels.”
This is in reference to the plan to reimburse doctors for actually having a discussion of end-of-life issues with their patients so that patient wishes are followed. All too often, this discussion never takes place and patients are subjected to “heroic” efforts to squeeze a little more life out of them before they die. Some of these patients would never have agreed to such care had they been given an opportunity to express their wishes ahead of time.
.............................................................................................................................
I think it's a good idea for doctors to be compensated for discussing end-of-life issues with their patients. Ultimately it's the patient's call on measures to be taken to prolong life in terminal illnesses. It's best if patients make end-of-life decisions based on professional medical consultation and doctors who provide this consultation should be fairly compensated, which many, if not most, private insurers refuse.

Many patients forgo "heroic" measures by signing 'advance health care directives', also known as 'living wills'. These documents are often not honored by health care providers, who routinely administer "heroic" measures against the patient's wishes because they know they will be compensated. I haven't found any data on the costs for unwanted "heroic" health care in end-of-life situations, but I'm sure it represents a substantial unnecessary cost to our health care system.

I also support "Death with Dignity" legislation otherwise known as "Doctor assisted suicide". Two states, Washington and Oregon, have death with dignity statutes. Anyone who has attended a loved one's death from terminal cancer, as I have, will give serious consideration to death with dignity legislation.

I'm curious what courageous, free will, libertarians have to say about end-of life counseling and death with dignity.
I suspect they're participating, along with the Sarah Palin, Charles Krauthammer conservatives, in spreading unwarranted fear among the afraid-to-die in America.

Jackafuss

1). Holding up "reforms" passed in Massachusetts as an example of what we can expect tells us all we need to know.

2) There has never been a publicly financed health system that did not lead to rationing of care. Can you imagine the horror of the 65 year olds in England who were denied admission to ICU after surgery?

letjusticerolldown

1. He holds up reforms in MA to clarify what we need to work towards (including what it did not accomplish). Do you think the goals ought be different?

2. I agree every publicly financed system allocates care. Is there a system that does not??