Death Panels

Filed under: by: Hey Doc Wait

I'd like to find the actual wording of the health reform bill that describes the "death panels" and tattoo it on my forehead, or be in on the secret meeting where Obama and Pelosi discuss the final solution to get rid of anyone over the age of 65 or without perfect health.

Oh wait...

I'm reiterating what many have said before, but people, come on. It's totally awesome to have a rational debate about healthcare reform, and to hold opposing viewpoints, and to disagree with a public option, or to worry about rationing of care. What is not awesome is reading a debunked chain email with all the veracity of a Nigerian bank fraud and then screaming that you'd better not let the government mess with Grandma's Medicare!

I did like this post at Movin' Meat: the message is that if you don't think health care is rationed, that's because it hasn't happened to you yet.

I understand if utilitarianism isn't your thing. It's a way of approaching the situation, but it isn't necessarily the best way. It is, however, useful to approach the situation by acknowledging that healthcare resources are finite. Even if there were an abundance of livers available, not every American could get a liver transplant if they needed one today, because the cost is astronomical. The surgery takes hours, the pre-op testing takes weeks, the post-op recovery takes weeks, and then you go on immunosuppressive meds for years. So, then, how to decide who gets a liver? Right now, we do it in several ways, often based on money. If you're a VA patient, you have to meet their service connection criteria, or no liver for you. You'd better have insurance or cash if you are a civilian. If you're a patient in a large county system without Medicare or Medicaid, and you're unable to cough up the dough, then you don't get the liver. Today, this is considered fair--by those who have insurance or cash, who don't like to think about the person without. Or they say, this person is likely unemployed and therefore doesn't deserve a liver. Isn't that a form of utilitarianism, though, to judge a person's worth to society by saying they're uninsured, therefore they're unemployed and a burden to society and don't deserve treatment?

Ahem. Sorry for the soapboxing. What I'm getting at, though, is utilitarian principles may help to distribute limited resources among the population. In our country, we don't act like health care is a limited resource. That is a big part of our problem. If you go to a fancy private hospital for treatment because you have good insurance or good money, it's easy to ignore the plight of the patient in the huge county system, waiting 7 hours to be seen in clinic or >24 hours to be seen in the ER. I am lumped in this category, so I'm including myself in my criticism.

The way I see it, though, our whole health care system is a giant pyramid scheme. There are real fixed costs in health care (although these are buried under a morass of billing schemes created by insurance, Medicare, clinics, doctors, and hospitals) that require payment. If you crash your car and you are uninsured, who pays your hospital bills? If you cannot pay, the hospital eats the cost of your care. The doctors who saw you, if they bill by procedure or hour of consultation, do not get paid for that care; in essence they are paying for it.

Those who have insurance are counting on paying less in premiums than they will rack up in costs should they get seriously ill. This is how all insurance works. The insurance companies are counting on you not getting ill, but if you do they might just cut you off as a "pre-existing condition" or raise your premium so high you cannot afford it.

Medicare refuses to pay for certain things that should be covered, like known complications of being sick (under guise of the "never event" policy). Medicare, Medicaid, and private insurance ALL play billing games, denying claims for a misplaced comma in the hopes the hospital or clinic won't refile the bill, so they won't have to pay the claim; this in turn leaves the cost on the hospital or clinic, who then attempt to make the patient pay, which may or may not happen.

Everyone is trying to get someone else to pay. It's a mad scramble, as we use more and more health care but seemingly have fewer people actually paying for it. What ends up happening is the burden of paying for people who cannot pay ends up spread over the paying patients (increased fees for Tylenol in the hospital, increased insurance premiums), insurers (who aren't currently hurting, because they can raise their rates), hospitals (who often collect less than 50% of what they bill), doctors, and ultimately the government. As our health care costs spiral out of control, and consume more of our GDP, money that could have gone to other things is sucked into health care.

One reason I support universal coverage (not single payer, or truly socialized care) is that it spreads the burden over more people, hopefully more equally than we do now. The young, healthy person who forgoes health insurance may not cost the system anything initially, but if they become seriously injured or very sick we all end up paying for them anyway. The key is that they didn't put anything in to pay for themselves or anyone else. The system will take care of them anyway, but they had no skin in the game; they bet on the system providing for them even though they paid it nothing.

Of course, if we don't drive down the costs in health care, all of this discussion may be moot, but I'm tired now, so that will be another post...


On August 13, 2009 at 12:37 PM , TB said...

If someone thinks that our healthcare system isn't flawed, than they are either selfish, ignorant, or blind.

I have heard enough from O about that. For the last year whenever he talks about healthcare he talks about how it needs his "change". I'd like a lot more open discussion about what he is trying to push through and a lot less about what is wrong. How are his "changes" going to fix the problems we have today?

If he is creating a government plan that doesn't reject based on pre-existing conditions, a few more people who can't get private insurance (like myself) who don't have a job that provides insurance (unlike myself) than some more people will be covered.

But what about the 20-something who thinks they don't need it. What about the unemployed who can't afford it. Who pays for them when they get in a wreck or cut off their fingers trying to unclog the lawnmower? I hear a lot of talk about the number of millions of uninsured, but how many are uninsured by choice?

Healthcare is expensive for a lot of reasons. There is medicolegal risk, there is defensive medicine to prevent that risk, there is abuse of self-referral, there are large back-end operating costs, and there is a large cohort of non-payers. If any hospital approached your suggestion of collect 50% of what they bill then they would be collecting more than double what most hospitals do.

How about we fix the abuse of litigation (which is going to be hard considering most senators and congressman are lawyers). How about we fix back end costs of pharmaceuticals, medical grade equipment, and billing departments. How about we fix the waste of defensive medicine. How about we fix medicare/medicaid abuse in self-referral of unnecessary procedures.

Once those are done and the cost of providing healthcare is reduced, it might be an easier feat to then fix the problem of who actually pays for whose care.

On August 17, 2009 at 8:43 PM , Hey Doc Wait said...

One quick point, because I couldn't remember the actual number I'd heard about hospital billing--it's actually like 20% or below usually, isn't it? And often the big county systems don't collect anything for the majority of their patients...