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April 04, 2009 05:42 PM UTC
27 Comments
but I hope it’s Ok if I bring it up and ask other people to weight in on it. Here’s my opinion on it:
I have no problem with the institutional changes it makes. My only problem is that they cannot possibly fund it properly with only private contributions. It sets up all the things we’d need to have to create state-provided health care, but it’s incredibly vague on the funding.
I see two possible solutions to that problem: either raise taxes, or wait until Washington figures something out. The former is much more preferable, because health care reform at a federal level is still years away.
I would hate to put this in place, have people rely on it, and then not be able to fund it properly. If we’re creating a safety net, let’s make sure it does its job. The only way to do that is to make sure there is a dedicated source of funding every year.
First off, I don’t know what 09-1273 does.
Can we have the state set up a state-run plan which handles medicare, medicaid, and is open for any business, family, or individual to join? You would get a lot of businesses using it if they could just point employees to it and write a check monthly – and there’s some of your funding.
It passed in committee on a near party line vote (one Dem voted no).
Here’s the summary:
it creates single-payer health care which will be administered by an authority that is separate from the government. They have to reach a certain funding level–from grants, gifts and donations–by 2011 or it won’t take effect.
Put it to TABOR and make it a business head tax of some kind. For companies like mine it just changes where the check I write monthly for health insurance goes.
You could probably get 80% of the CEOs in this state behind something like this.
Hey Pols,
Yesterday was my birthday, so I missed this discussion of the very thing on which I have been working since August.
HB1273 first creates a Health Care Authority and a Trust Fund. The Authority–whch is separate from the state–will have a large board that will design a health care system for the whole state. The operation of the Authority during this design phase will be done with no money appropriated from the state; we’ll need to raise $1.2M to run the thing.
The Authority will operate according to a set of elements/constraints built into the bill. If you favor single payer, then the elements look like they ought to be more tightly directed toward single payer. If you are an opponent of single payer, then the elements of the bill that direct the Authority in the design of the system will look stridently single payer to you.
Once the Authority designs the system, the the legislature has to approve it before implementation. In this way, HB1273 really should not be threatening to anyone. The goal is to have a system that is separate from state-government. (More distinct than, say, Pinnacol 😉
How might the Authority design and pay for the system? Well, the first insight is that we spend enough on health care in this state to pay for everyone’s care if we spend it efficiently. The Lewin analysis of the 208 Commission proposals showed that the CSHP plan could save $1.4B annually and cover everyone.
Drawing with a broad brush here, put the Medicare and Medicaid money into a pot. Collect a premium of 6+or-% on payroll. Collect from individuals a premium based on income. The Authority would set the amount. (Note that we’d no longer pay health insurance premiums). Add all that money together, spend it without the 20-30 administrative overhead costs now, and we have enough money to cover everything.
Note, though, that the elements of the plan are loose enough that the design might look very different.
Is federal law too great a straitjacket? In a word: No. I got a call from Rep. Kucinich’s office the other day. His staff is working with the staffs of Rep. Conyers and Sen. Sanders to craft legislation that would help the four states in the lead on this idea (CO, CA, IL, and PA) with the waivers, federal changes, and maybe a little money that is needed. They want a letter from Colorado, which letter I should be writing now. That’s not a guarantee yet, but it’s a start.
HB1273 has made it through House Business Affairs and Labor and through House Appropriations. The Bill is likely to be on the House floor tomorrow. See: http://www.healthcareforallcol… for what you can to help.
Throughout this process, everyone involved has sought to create a health care system that is not run by the government. Instead, the idea is the state can use its power to facilitate a solution that collects private and public money and allows delivery to still be in the hands of private providers–Kaiser, Rocky Mountain Health Plans, Dr. Welby, etc.–or public ones–Denver Health. The big change is in financing. (So, don’t bother calling me a socialist.)
Also, Canada has never been the model so don’t bring up our neighbor the north, eh?
I see this whole thing as very western Democratic. As a state, we can solve the health care problem. We don’t need to rely on Washington DC to solve this problem, although we do some waivers. We also don’t need to rely on a bunch of mostly eastern insurance companies. We have the wherewithal if we work together and maybe even give a damn about each other.
That, in a nutshell, is what HB1273 is about. If there are errors and typos above, I apologize, I am working on 13 different things simultaneously today.
Tom Russell
VP, Health Care for All Colorado
trussell@HealthCareforAllColorado.org
And for putting up your e-mail so people can call with questions. I’ll be one of them 🙂
I thought it had died last year and was still comatose. I’m pretty familiar with the ideas due to a Friend, Eldon V.
Maybe I’ll have to return to CO before I’m 65 after all!
The three top concerns for any health care delivery system are Cost, Quality and Access. Obviously the current “system” is broke on numbers 1 and 3. Only about 55% of Americans can afford health care, so are denied easy, efficient and effective access.
The two most important factors, which IMHO do the most damage, are insurance companies that have a diabolical and adverse motivation. In other words, they just want to take your premium dollars in, and do as little as possible paying them out. Their motivation isn’t your health, it’s their bottom line.
Second, there is a misplaced glamor element which leads to both those that manufacture the hardware (from needles, heart monitoring equipment, to expensive full body scanning dsevices), to those that deliver healthcare, always pushing for more expensive and flashy (thus, marketable) technologies.
There are many other factors, especially an over priced pharmacology, too little attention paid to prevention, and yes, a blinders on approach to alternative treatments.
There’s so much money in the game, that it will be very difficult to achieve substantial changes to the comprehensive subject of health and health care delivery in this generation….by that I mean 25 years.
Futile Medicine. I’m with those who believe in assisted suicide (an upcoming trend…..assisted suicide for couples?). Our inability to let the old and sick die without the expensive, life extending technology is a sickness in and of itself.
In fact, I was thinking about that as I posted my response to your first post. Part of our problem with distributing our resources fairly and efficiently is that we have saddled ourselves with an absurd morality that requires huge investments to impose continued suffering on those who no longer wish to endure it, taking those resources away from, for instance, a young child who could have been saved and allowed to live a long and healthy life. What insanity! It is cruel to both the terminally ill person who would rather die gracefully and without unnecessary torment, and to the child who is condemned to death in order to finance that unwanted torment.
Liability insurance, I vividly discovered, is a way in which not only to be prepared to bear the moral and ethical responsibility to make a person whom you accidentally harm whole again, but also a way to minimize that responsiblity and try to low-ball those whom you have wronged. I had my reliable old car, which had only recently had maintenance work done on it in Mexico (for which I had no receipts), totalled by a drunk driver while it was parked outside a friends house where my wife and I stayed when we first moved to Colorado. The insurance company refused to pay me more than $1000, though there was no way I could have replaced the car for that amount of money. In effect, they were imposing on my the costs of uncertainty that are involved in buying an unknown car for that amount of money that I had not born in regard to the car that had been totalled (and there was almost no chance that any car I bought for that amount of money would have been as reliable as the one I had had).
Morally and ethically, the drunk driver who totals your legally parked car while you’re asleep bears 100% of the responsibility for insuring that you bear no costs or inconveniences whatsoever. But insurance companies, which supposedly sell the service of meeting that moral and ethical responsibility when it arises, are businesses that are trying to maximize profits in part by minimizing costs, and so rather than ask themselves “what will it take to meet the moral and ethical responsibility we have contracted to meet,” they ask themselves “what is the least we can get away with paying?”
Similarly, in health insurance, insurers who contract clients to meet their medical needs as they arise, do not ask themselves “what do we have to do to fulfil the letter and spirit of the contract we made,” but rather “what, on average, is the least we can pay, such that our total costs, including legal costs when sued, are the least possible?”
One of the challenges of social institutions is avoiding the institutionalization of cost-benefit analyses which undermine the institution’s motivations for accomplishing the task to which it is supposed to be dedicated. While we do live in a world of limited resources such that not everyone can get what they want or need whenver they want or need it, we do not currently frame the production and distribution of those resources within a system which most fairly and efficiently accomodates the just wants and needs of the members of society.
Markets are great, but it is of vital importance to internalize the externalities, including the externalities that take the form of institutionalized injustices.
When doctors recommend a healthier diet, exercise, and relaxing activities, is this the “noise” you were discussing?
But in all seriousness, I wholeheartedly agree that various options in treatment from different perspectives of medicine would benefit most of these schools of thought and subsequently benefit prospective patients, as long as all perpsectives are competent and logically based, rather than holistically, or worse, religiously based (we already have christian psychology, somebody will attempt to effect christian medicine). It’s unlikely there would be a difference between religious medicine and traditional medicine initially, excepting the regular accompaniment of a prayer session with your doctor, but the shift from logically-based diagnoses and treatment to instinctually religious treatment would be disastrous. Perhaps grants would be given to research gene therapy to “cure” homosexuality.
But I digress. The FDA, currently stands as the ultimate judge as to what medical treatments and strategies are acceptable and it keeps the reigns pretty tight on cultural directions in medicine. Health care is already heavily regulated, and the institutionalization of cultural beliefs is the consequence of that. If health insurance is also regulated, any government-regulated insurance system will undoubtedly view other cultures’ medical treatments as downright cosmetic. Any chance at legitimacy in the American mind these options had will be squelched long before maturity. Which is worth more? Diverse thought flourishing in medicine or guaranteed coverage?
Whatever it is, you’re paying too much.
What does “cultural directions in medicine” mean? What is wrong with “holistically” based treatment modalities? The rest of your post is babble.
Thank you for your astute critique. Sorry I wasn’t clear- the term “western health care” carries a cultural weight to it. As in, a style of medicine that originates from western cultures.
Direction refers to the nature of our medical future.
When I combined the two, I meant to imply that there was a chance that western healthcare could change in its natural culture, or adopt aspects of other cultures. My apologies for the cryptic method of saying so.
Prove that “holistically” based treatment modalities work, and there’s absolutely nothing wrong with them.
I basically agree that western approaches to healthcare can evolve and change. In my opinion that would have to start with a renewed focus on just how we view and define health.
Currently, an annual physical will include blood lab work to measure cholesterol, check organ function, inspect the eyes, ears, nose and throat areas, a check of blood pressure, and if your over 50 the inevitable recommendation for an invasive technique to check for cancerous polyps in your prostate. The lungs are focused on, especially if one smokes.
More traditional cultures would define health as obtaining and maintaining a balance of all aspects of the self – mental, emotional, spiritual and physical – with and through the help and involvement of the family and the community.
With the change in definition, there clearly is a change in how illness is approached and treated. The latter is a holistic approach, and yes, holistic treatment modalities do work.
For an excellent treatment of this subject, one should read Planet Medicine by Richard Grossinger. From my favorite on line book seller, Abe’s Books:
http://www.abebooks.com/servle…
Thank again.
It comes from “holism,” which is the theory that the universe is more than the sum of its parts, in other words, a systemic whole. It is applied to other systems within that overarching one as well. As applied to medicine, it means the treatment of the human organism as a systemic whole rather than as a mere collection of parts.
The proof that this is, at least in theory, a better informed approach comes primarily from the phenomonal strides made by dynamical systems analysis (which includeds its popularized version, “Chaos Theory”). There is increasing evidence that most phenomena in nature is non-linear, characterized by complex cybernetic loops that create iterative and often self-amplifying effects. The common metaphor is “the butterfly effect,” suggesting (with only slight exaggeration) that a butterfly flapping its wings over China today might “cause” (ie, be an indispensible contributing variable to the emergence of) a hurricane in the Caribbean next month.
In fact, an increasing amount of technologies and mathematical models employ complex dynamical systems analysis, including many medical technologies. Some precede the theory, such as a defibrulator (the underlying reason fro its working not being fully understood until complex dynamical systems analysis developed an understanding of how “strange attractors,” or complex dynamical equilibria, function).
Of course, simply applying the label “holistic” doesn’t tell us whether a technique or concept is well-founded or useful. Labelling, by itself, in general only tells us that someone managed to attach that label to that thing. But the concept of holism itself is very well established as a mathematically and scientifically legitimate and essential component in our understanding of the funcitoning of complex systems. Living systems and living organisms are the archetypical example of such complex dynamical systems, and so the notion that medicine should be holistic to be most effective is almost axiomatic to those with an extensive scientific and mathematical understanding of how living systems operate.
As in “Yes oui can!” and “Change oui can believe in!”
It’s pronounce “Wee-duh.”
Just a few months back we ran into another Ouida at a doctor’s waiting room. She says that she has always told people she is the “Yes!” Yes!” girl. First in French, then in Russian.
That old woman has spent her life implying that she wouldn’t say “No.”
It addresses everything you’ve tried to say here. It defines the distinction between noise and signal in terms of accuracy of causal conclusions, something that is testable. It addresses the need to clinically test medical techniques generated from non-western or ancient traditions, thus incorporating those that are effective rather than discarding them. Your post contributes nothing to the discussion by only re-muddling the lines that I had so clearly drawn.
Furthermore, you open your post asking whether the diet and exercise that I suggested should be the corner of our health care system is the “noise” to which I referred. Obviously not, since the causal relationship between diet and exercise on the one hand, and health on the other, is very well established by western research techniques. And I believe that these should be fully institutionalized and incentivized, especially considering that those who do engage in good dietary and exercise regimes bear the medial intervention costs of those who don’t, while saving those who don’t similar costs in return. As much as possible, people should bear the benefits of those choices which produce positive externalities, and bear the costs (within reason) of those choices which produce negative externalities.
You have offered a muddled, imprecise, assumption-laden response to a clear, precise, logically constructed presentation. I just don’t see the point.
Now, if you want to argue that prevalent cultural assumptions in the United States would create obstacles to even clinically tested and verified “exotic” medical treatments, such an argument would at least be reasonable, if not, probably, accurate (once clinically tested, people no longer care about the origins of the idea). But you don’t make that step.
You mention the “insititutionalization of cultural beliefs” as the cause of heavy regulation. First, all beliefs are cultural beliefs, including scientifically tested and supported beliefs. Second, regulations are based on the combination of values and clinically tested beliefs: We value insuring that our health care system provides what it purports to provide, does so with some degree of fairness and humanity, and have a fairly well-constructed set of ideas about what that entails. The error is not over-regulation, but rather under-regulation, because, despite our wealth, we leave a very large portion of our population without access to health care services, something (I believe) no other developed country does. And we do it at far greater expense per capita than any other country!
1) The FDA is the food and drug administration, and is the regulatory agencies which applies the relevant legislation regarding food and drugs, not the ultimate judge of anything (their decisions are appealable in the courts, where, not surprisingly, both the intermediate and ultimate judges are found), nor even regulators of “medical treatments and strategies” in general. The American Medical Association, which is a non-governmental professional licensing organization, plays that role, and does so, historically, more in order to limit entry and competition than to regulate the quality and safety of the professional practices (regulating quality and safety became the way in which professional organizations were able to successully establish themselves in order to limit entry and thus competition, and so, as often happens, ended up performing a vital, though skewed, public service in futherance of their self-interested agenda).
2) “Logic” is not a state of being so much as a procedural guideline. To determine what is logical, one must apply logic. Reducing concepts and practices to those which are logical and those which are not without bothering to demonstrate that logical steps which so designated them is merely the cooptation of the venerated word “logic” in furtherance of a process which is fundamentally polemical (ie, judgmental rather than logical).