I host a radio talk show" The Living Well Hour" on WBAP, News/Talk 820. One of the themes of the show is that , as a nation, we can no longer afford to be sick. I am very impressed by Gov. Mike Huckabee's recent comments on the health care issues. The benefit of Michael Moore's movie, "Sicko", is that the movie brings health care issues to light. The first issue that needs to be addressed with regards to health care is whether health care is a commodity that you can have access to if you can afford it, or is health care a right that we have as Americans and that it fits in a category under "Life, Liberty and the Pursuit of Happiness".
I do feel that we have a health care crisis with regards to cost and access to care.
I invite Gov. Huckabee to be a guest on " The Living Well Hour" to discuss these health care issues.
Dr. Milinda
www.drmilinda.com
3 comments:
On my own blog today (August 27, 2007 at http://camp2008victorya.blogspot.com, I offer some good advice to Gov. Huckabee on how he can advance his standing in the race for the Republican nomination and the presidency. I'd love to hear your comments (and get your support for my suggestions). Thanks.
steve maloney
ambridge, pa
national coordinating team Palin 4 VP
I think most people involved with the health care system would agree that it is a complicated process with many complicated problems. Some systems (e.g. Medicare) simply have not adapted to the growing availability of treatment options and technology that were not available say 10 or 15 or 20 years ago. Many people with disease are living longer (some living longer and maintaining their productivity, some not). When there is a medical success in general it results in an aggregate additional cost to society. Economics and health care ethics are not optimizable together -- it is more economical to let the elderly succumb to their disease than to continue to provide health care -- this is reality and it is immediately riddled with emotion. People bristle when we talk about "rationing" health care and emotionally we all desire maximal health care for everyone at all times. Let's keep everyone alive for as long as possible... it is an automatic response built-in to the American psychi. Yet, it becomes distorted with all the implemented health care policies and bureaucratic implementations. I personally have countless examples of failed attempts by insurance companies trying to hold down costs by not approving an MRI of the brain or a blood test. Where does self responsibility and good personal behavior play into all of this? Obesity, smoking, poor diet, poor compliance and inappropriate behavior play an enormous modifying role in the cost of an individual (and therefore societies') health care. With a policy of "A Few Patients Left Behind" Act we could bring force upon the individual an underlying element to the health care problem - your own personal responsibility plays a significant role in the incidence and severity of disease -- it's development and subsequent treatment (and outcome). The solution arises in a shared Group HSA with raised allowances for contributions, raise the deductionables (to say $10,000 per individual), diminish the role of insurance companies and incorporate higher income individuals with lower income individuals within the Group HSA allowing for differential contributions and yet equalized access to the fund for health care costs. This has the advantage of an HSA, the advantage of pooled risk, places a slightly higher burden on individuals with higher incomes and reduces the role of for-profit insurance companies but also allows for more direct consumer-driven health care... Also, raise the age of eligibility for Medicare to say age 72 for individuals with net worth less than $2 million. If the net worth of an individual is an excess of $2 million they are ineligible for Medicare benefits until their net worth is reduced to below $2 million. Once an individual dies their holdings on the Group HSA are maintained within the Group HSA and new member as incorporated. The concept of a health care endowment becomes manifest in this financial structure. On the reimbursement side bonus doctors a large sum -- say $5,000/year for every yet that an obese patient maintains their ideal body mass index or for every year a previous smoker does not smoke. Members of a Group HSA will be assigned randomly by a computer system - and groups could vary in size from say 1,000 members to 10,000 members -- some large number to stratify risk and demographics. Let higher income earners contribute more and let them deduct more - BUT if they die the money is held in the account for others' use within the existing Group HSA. Members will not know the identity of the other members. The account will be invested in various investment options just as in a 401(k) or IRA with the exception that say 30% must be held in liquid form -- say T-bills or CDs. Individuals that invest more play a proportionately greater role in the investment decision process modified by a deduction from their draw from the account -- healthier, wealthier people control the investment allocations. The investment community would like this vehicle as it would bring more capital to the market, banks would like it as it would encourage savings, doctors would like it since patients would be paying cash (less transaction costs), computer companies would like it since it would require more software engineering and transaction processing, consumer-driven health care advocates would like it since there is nothing like a choosy, cash-paying patient. It does place a greater burden on wealthier, more successful people. But we need to stop insulating individual patients from the true cost of their disease to themselves and to society.
How about the super, red-hot, never talked about most controversial topic in health care that is the single most expensive line item? Last Illness.
Last Illness - the last 90 days or so of an individual's life accounts for over 20% of the total health care cost for the entire life of the person! And yet the outcome is universally bad -- death. In a pay-for-performance model I would say this outcome is unacceptable. Why perform elective surgery on a terminal patient? Why continue with chemotherapy or radiation therapy? Why continue expensive dialysis? The list goes on and on. This topic is so taboo, so controversial that it rarely enters the health care debate. What would happen if we created a health care system that paid in arrears by say 110 days but upon termination of the patient -- the last 90 days of health care was not paid at all? Our so-called health care crisis would evolve into a debate of who is to pay for expensive treatments that ultimately failed. Pay-for-Performance would work best if implemented on Last Illness scenario. Have a private conversation with an oncologist or a nephrologist on how they are pressured by family members to apply aggressive treatments to a terminally ill patient. But why did the patient develop cancer or end-stage kidney disease to begin with ? Smoking? Uncontrolled hypertension? Obesity? Poor compliance in taking medication? Not wearing sunscreen?
Personal responsibility has been a hallmark of the American way of life. It is time that we move the debate of the so-called "Health Care Crisis" back to the origins of what made America great - self-sacrifice, hard work, personal determination, self determination, a recognition that we are free -- free to make our own way and enjoy or suffer the consequences of those choices as individuals. Developing any system with a "blank check" with no negative feedback loop or eventually spiral into non-sustainability. The current health care system as it is presently implemented is not sustainable - I think we can all agree to this. Keep the concept of sustainability in mind when trying to design and develop a new system.
Keep in mind that Gov Huckabee is for the "fairtax" which taxes all purchases, rent, services -- even medical care.
Read that again, don't gloss over it.
Medical care -- ALL medical care, would have to pay this 30% fairtax.
It would actually be much higher than 30% -- because many people couldnt pay it, so the tax on those of us who COULD pay it, will have to go up.
Anyway -- how do you tax cancer victims? Will Gov Huckabee really send a tax bill of 70,000 dollars to the parents of a leukemia victim, for their spending to keep their child alive?
How will you tax nursing home patients, exactly?
Huckabee might say the right things, but essentially he is selling a free lunch.
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