Thursday, June 09, 2005

Nothing like old news

With all the activity on the site yesterday, you might have missed this column in the Daily News. It looks like Gov. Ed Rendell and the legislature are going to try and balance the budget on the backs of poor people. And what's worse, they're going to do it on the backs of poor sick people.
This year there's a plan to limit services to 1.7 million Pennsylvanians eligible for state and federal medical aid, many of them working poor, many of them miserably poor, many elderly, sick and poor.

The limits cut prescriptions to six per month for some, three for others; add co-pays; limit hospital admissions to two per year for some, one for others; cap doctor visits to 18 per year; reduce ambulance service, X-ray service and more.

And you might think, well heck, we're helping 1.7 million folks already, and who needs 18 trips to the doctor or two trips to the hospital and, as Gov. Ed repeatedly says, at least we're not lopping people off.

If you think this way, you're qualified to serve in the state House.

Think it through.

Who needs more than six prescriptions a month or more than 18 doctor visits a year or more than two hospital admissions?

The chronically ill, that's who, poor people with cancer and heart disease, the sickest, most disabled, most vulnerable. And that's where we want government to save money?

And not cutting people off? Well, if you keep the people who need the most care from getting the most care, aren't you eventually cutting them off?


I just find it maddening that the place politicians look to save money is so often the very the place society is most noble in spending it.
Go read the whole thing. And then get the pitchforks ready.


At 11:36 AM, Blogger DanielUA said...

Certainly, this is an issue that can unite us all.

Our, part-time, very well paid state legislators are going to raise their salaries while poor people with cancer will not be able to afford basic medicine?

Are you kidding me? We need every State Rep to be shouting at the top of their lungs about this. Every one.

At 5:17 PM, Blogger Dumplingeater said...

Not to mention the fact that cutting custodial care for the chronically ill, will make really sick people, really, really, really sick people, thereby increasing the long-term cost burden of medical care.

Along those lines, read the interesting article in from which the following excerpt has been lifted:

What's more, the dread socialized medicine of the continent is actually cheaper than America's public/private mishmash. The French government spends about $1,000 less per capita on health care than does the U.S. government, despite the fact that the France covers everyone, needs to deal with a more elderly population, and has a higher life expectancy than we do. On top of that, France spends far less on private sector health care, freeing up resources for consumers to spend on other things.

At 6:33 PM, Blogger Eric Loeb said...

From my own experience as a long-term cancer patient/survivor I've often thought that we could save many billions in accounting costs if we would just clean up this mish mash mess.

Every hospital has their own system and so does every insurance company. The net result is a whole lot of accountants shuffling a whole lot of paperwork.

And none of these per-capita-cost estimates account for the time the individual patients must spend trying to decypher their cryptic medical bills and insurance statements.

At 12:49 AM, Blogger Charles said...

I think that Dumplingeater makes a great point. Speaking as a professional in Healthcare technology and actually flagging these cases and looking at them with clinicians, I can tell you that if we spend a little more money on Disease Management (which means more drugs, most of the time), then we can save a mint in the long run. Do we really want people who have Diabetes and Asthma to stop taking their meds? I don’t think so. Not only will they go to the ER and the Hospital more, but they will get worse conditions in the future such as CHF, High Blood Pressure, Renal Failure, you name it. We also need to cut the waste, like people taking the sexy thousand dollar drugs far longer than therapeutically necessary when they should just be on iron or a multi-vitamin. It happens way more than you would think.

Where I disagree with most Liberals is on a National Healthcare system. I think that everyone in this country should be guaranteed Healthcare, and I think that the best way to do that is to have Government pay for it and regulate it, but have private insurers, like Medicaid HMOs, provide it. The Insurance industry is too big to take on. And even if it wasn’t, we would still be in the hole. Even if tomorrow, the government decided to socialize medicine, then we would just be switched to being slaves to the Drug Companies and Pharmaceutical Benefit Managers.

I see two scenarios happening. One, people can get whatever they want whenever they want it, no matter how much it costs or how effective it is. This, of course is not sustainable, considering that if your prescription benefit only goes up 7% (over twice the rate of inflation) a year, you are doing a kick ass job. The other scenario will be legislators trying to cut services in a useless rule of thumb manner, like they are here. And that will not help either.

I hear people quote a stat saying that private insurers spend 40% on administration while Government only spends 1%. I don’t know where it comes from. Can anyone shed some light on this? All I can say is that it is easy to cut admin costs when you are not administering that much. When there is Carte Blanche, there is no need for a lot of administration. But at the end of the day, if HMO’s can provide Healthcare at a cheaper rate with less inflationary costs, then do I really care that they have more administration?

Isn’t the American spirit one of innovation and entrepreneurialism? Why not as liberals, can we say that you can have your cake and eat it to? We are so busy with what we think is “good” and “getting the profit out of” this or that. Why can’t we show people that you can do things the right way, provide Healthcare for everyone, and there will be enough money to go around to people who do a good job at it? Not only do I think that it is a better sell, but I think that it is a better way.

At 11:31 PM, Blogger Dumplingeater said...

Not quite the statistical details you wanted, but information relevant to your post nonetheless, from a Paul Krugman editorial:

The intellectually serious debate is between those who believe that the government should simply provide basic health insurance for everyone and those proposing a more complex, indirect approach that preserves a central role for private health insurance companies.

A system in which the government provides universal health insurance is often referred to as "single payer," but I like Ted Kennedy's slogan "Medicare for all." It reminds voters that America already has a highly successful, popular single-payer program, albeit only for the elderly. It shows that we're talking about government insurance, not government-provided health care. And it makes it clear that like Medicare (but unlike Canada's system), a U.S. national health insurance system would allow individuals with the means and inclination to buy their own medical care.

The great advantage of universal, government-provided health insurance is lower costs. Canada's government-run insurance system has much less bureaucracy and much lower administrative costs than our largely private system. Medicare has much lower administrative costs than private insurance. The reason is that single-payer systems don't devote large resources to screening out high-risk clients or charging them higher fees. The savings from a single-payer system would probably exceed $200 billion a year, far more than the cost of covering all of those now uninsured.

Nonetheless, most reform proposals out there - even proposals from liberal groups like the Century Foundation and the Center for American Progress - reject a simple single-payer approach. Instead, they call for some combination of mandates and subsidies to help everyone buy insurance from private insurers.

Some people, not all of them right-wingers, fear that a single-payer system would hurt innovation. But the main reason these proposals give private insurers a big role is the belief that the insurers must be appeased.

That belief is rooted in recent history. Bill Clinton's health care plan failed in large part because of a dishonest but devastating lobbying and advertising campaign financed by the health insurance industry - remember Harry and Louise? And the lesson many people took from that defeat is that any future health care proposal must buy off the insurance lobby.

But I think that's the wrong lesson. The Clinton plan actually preserved a big role for private insurers; the industry attacked it all the same. And the plan's complexity, which was largely a result of attempts to placate interest groups, made it hard to sell to the public. So I would argue that good economics is also good politics: reformers will do best with a straightforward single-payer plan, which offers maximum savings and, unlike the Clinton plan, can easily be explained.

We need to do this one right. If reform fails again, we'll be on the way to a radically unequal society, in which all but the most affluent Americans face the constant risk of financial ruin and even premature death because they can't pay their medical bills.


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