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yet another reason to exercise personal discretion

July 30, 2009

i pause for a moment to consider Health Care Reform.  well, actually, it’s taking much more than a moment because it’s damn near impossible to understand what exactly is in this  “robust” “reform.” these words are being used everywhere, aren’t they?  …headlines, water cooler discussions, party line editorials…  none of which are of any use to my understanding.  what exactly is this “reform” everyone has an opinion about?   i can’t possibly have an opinion without understanding the issue, can i?   no, i cannot.  dammit.

think i’ll start with the basics, i.e. Wiki:

Wikipedia offer these sound bytes about Reform:

Reform means beneficial change, or sometimes, more specifically, reversion to a pure original state.

Reform is generally distinguished from revolution. The latter means basic or radical change; whereas reform may be no more than fine tuning, or at most redressing serious wrongs without altering the fundamentals of the system. Reform seeks to improve the system as it stands, never to overthrow it wholesale.

During the Philadelphia Convention of 1787, for example, the New Jersey Plan would have reformed the existing constitution, the Articles of Confederation. By contrast, the Virginia Plan proposed to completely rewrite the nation’s fundamental charter, and create a new constitution. Virginia’s more revolutionary approach prevailed and resulted in the U.S. Constitution.

ooh, i like.  what else, Wiki?  let’s try Wiktionary:

Reform [noun] – Amendment of what is defective, vicious, corrupt, or depraved; reformation;


Reform [verb]

1.  To put into a new and improved form or condition; to restore to a former good state, or bring from bad to good; to change from worse to better; to amend; to correct; as, to reform a profligate man; to reform corrupt manners or morals.

2.  To return to a good state; to amend or correct one’s own character or habits; as, a person of settled habits of vice will seldom reform.

amend corruption… how interesting. 

to characterize the above definitions as my starting point on understanding the [insert most fear inciting adjective] health-care reform would not be fair.  being all wrapped up in my personal life for a few weeks left me in the dust as far as keeping up with breaking news over the two week health care hot topic explosion.  is it me or has this happened inordinately fast?   my first spot on the catch up train was to start asking for opinions of those around me.  a well intended approach that left me with little more than an angry party driven reaction.  then i turned to The Week magazine, who summarized the procedural aspects of what was going on in congress to get reform passed but offered little by was of substance.  um-he-llo, it’s the substance i’m after, people.

a good friend blasted “SOCIALISM” at me when i asked for her thoughts.  she’s incredibly thoughtful and similarly holds an undergraduate degree in economics.  she’s also currently reading Atlas Shrugged which, for reasons largely based on a bad dating experience, i absolutely refuse to pick up.  well, that and the simple fact that i’m uber tired of criticizing the government, and the populous unrealistic shortsighted self-serving expectations of government.  my reaction:  it’s easy to sit on the couch and criticize, but i digress…

regardless of how i react to Atlas Shrugged, because i probably would like it if i were ever in that mood to actual read it and think about what it says, i shudder when i hear the words “socialism” and “nationalism.”  i can’t help it, right?  i’m an economist for goodness sake.  socialism?  EEK!  see, it’s compulsive.  and then i start to feel republican, Marching Free Capitalist, with a reaction!!!  (hehe).  again i say, eek, really?  

when Mr. O said “the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care.” i agreed.  the president who won my vote wants to socialize health-care?  hmmm…  rather than curl my lip in a snarl of disgust, i wonder why he wants to do that and i set out on some research.  is it socialism you want, Mr. O?  if so, why?  help me understand what’s going on.

what i loved about the study of economics was theory.  i loved this about law school too.  [geek alert!]  i remember talking about how you could plan the most beautiful diagram about how a market should operate under perfect conditions – mainly, meaning without human behavior.  ha!  you see, that’s the sometimes the problem with Laissez-faire.  a free market relies on profitability of acting in self interest.  this is exactly why our existing system of health care is a failed market.   i will explain below but you don’t have to take it from me.  i also urge you to read this excellent article about costs of health care and the reasons doctors run more tests and use less discretion in McAllen, Texas (oh yes, and feel awfully close to home).

the Economist offers us these sad points:

1.  Even though one dollar in every six generated by the world’s richest economy is spent on health—almost twice the average for rich countries—infant mortality, life expectancy and survival-rates for heart attacks are all worse than the [] average.  [translation: our health care is more expensive and is NOT exactly better]

2.  [A] big distortion is that most doctors in America work on a fee-for-service basis; the more pills they prescribe, or tests they order, or procedures they perform, the more money they get—even though there is abundant clinical evidence that more spending does not reliably lead to better outcomes.  [translation:  failed market]

3.  The trouble is that many Americans are understandably happy with all-you-can-eat health care, which allows them to see any doctor they like and get any test that they are talked into thinking they need. [translation:  unless you like being a guinea pig (say no to animal testing!!! hehe) and USED in the doctors/insurers get rich game, personal discretion might be useful]

it makes me sad to consider that the free market has changed the practice of medicine for many doctors, who now consider the profitability of ordering unnecessary  procedures.  don’t we need our doctors to be able to recommend treatment based on what is medically necessary or recommended and not what (how many things) a patient’s insurer will pay for?  when my stomach hurts, i don’t want to have to see 3 different specialists, have 17 tests run and possibly take a visit to the hospital so that everyone gets paid the most possible amount for my stomach ache.  call me a socialist but i prefer the least intrusive course of treatment.  at the same time, i want my doctor to be adequately compensated for his time and his enormously valuable opinion.  you see, i like doctors, it’s insurers that can suck it.

my gut instinct to healthcare reform was “we need health INSURANCE reform.”  this was my smell test reaction.  i wasn’t entirely sure why Insurers are The Devil but something says they are the biggest offender here.  in looking at it further, the problem is two-fold (and the answer isn’t that some lazy asshole wants another hand out) and both point to the Insurer.   again, insurance is a failed market.  it’s not profitable to insure older people or unhealthy people because they actually need expensive medical treatments and long term, expensive care, as opposed to the young who can be put through the ringer on occasion and go on about healthy life.  hence the Public Option being proposed to provide for those who need insurance to get the treatment they need at prices they can afford.  

my opinion, subject to change at any time, is that Mr. O is right about the necessity of healthcare reform.  the reform needs to address the rising costs of health care (which will not stop under the current system) and those who are unable to secure  private health insurance at a reasonable price.  i’m still fairly clueless on what the current Robust Reform says or how it is intended to operate.  the politics, the fear, and the rush to create a bill and demonstrate a reaction are still in the way.  maybe we should have a tea party.  at our tea party i would suggest we start by reform the title of our health care reform.  we should pick something we can all agree on whether we’re red, blue, purple, green, whatever.  something like, FOR THE GREATER GOOD OF ALL AMERICANS – ROBUSTLY SEND AIG, ET AL. TO HELL, REFORM.

 oh, and slow down guys.  taking time to figure this out does not indicate failure to me.  and, in the words of the Great FDR who also dealt with worldwide economic crises and war:  The only thing we have to fear is fear itself.

and for now, i will step off of my soapbox.

2 Comments leave one →
  1. fortheloveofguava permalink
    August 3, 2009 12:47 pm

    Mmm… well said as usual lady. I definitely get what you’re saying about feeling overwhelmed with someone screaming in each ear… and I too think that clearly something needs to be changed but I haven’t the slightest clue as to how/what will make it right… and it’s becoming increasingly apparent that those that have the expertise in the area and are getting paid to figure it out don’t always have the most benevolent or clear cut set of intentions. What I do know is that healthcare is scary… I’ve had some really ridiculous experiences.. and I’m relatively healthy! I can’t imagine having anything more serious and walking into the doctor’s office with the same suspicion that I do like I’m walking on to a used car lot… eck…

    **head explodes**


  1. more about Health Insurance Reform « think outside the cage

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