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Most experts feel that a comprehensive health care reform package that contains universal coverage for all Americans and focuses on prevention and primary care would actually save money over the long haul. There is way too much uncoordinated care done today and the patchwork system leaves way too many outside the loop.
The Robert Wood Johnson Foundation did a study a few years ago and concluded that the cost of treating the uninsured actually exceeds what it would cost to cover the uninsured. This is because most uninsured (and underinsured also) postpone any treatment until it is in a more advanced stage where treaatment is more costly and because many uninsured do not have a personal physician and use the hospital emergency room instead. The uncompensated care of the uninsured is reflected in what those with insurance do pay since those costs are shifted to the sector that has the ability to pay. In esscence, those who do pay (whether through insurance, government or out of our own pockets) are subsidizing the care of the uninsured (which is normally more costly).
What Massachussetts learned with their health insurance program is that because so many previously uninsured people now get covered, they get treatment that they would not otherwise be receiving and that increases the cost of the program dramatically in the early years. I am amazed that myself, with no accounting background or experience, could realize that while the people in charge could not anticipate this. As time goes by, the cost of the program should stabilize as those previously uninsured are receiving care and treaatment (very often that is less costly and more effective) and the emphasis on prevention and primary care reduces the incidences of more costly and serious treatment.
The Medicare drug benefit is so flawed that it should be re-written completely. Who thought of the brilliant idea of having the 'donut hole' should be shot. The Medicare drug benefit is what happens when we allow the pharmacutical and insurance lobbyists to write legislation and then it is presented to a republican congress that is also in the pockets of thsoe lobbyists. My father and my doctor both concurred long ago (before any Medicare drug benefit was on the radar) that the prescriptions being prescribed to many people actually kept them out of the hospital. My doctor would tell me that so many Medicare patients without drug coverage would refuse to get their prescriptions filled or would split pills to make them last longer and then wind up back in the hospital because their condition had made it so. The increased cost is because so many people are now getting their prescriptions filled and have access to prescriptions that they didn't have before. In time, that will have the effect of reducing the more costly hospital stays and emergency room usage.
They also both agreed that we are an overmedicated society. The USA consumes more prescription drugs per capita than any other nation inthe world, even those nations with universal health care and 'free' drig coverage. We have become so dependent on a 'magic pill' to cure our ills when in many other nations, they don't rely on medication. Pharmaceutical companies now advertise direct to consumers and most of the drugs they promote are the most expensive (and profitable) drugs out there. Most treat conditions that are largely preventable or can be treated by less costly means. I get a kick out of watching the commercials for druge to treat 'erectile dysfunction' sandwiched between the beer commercials on football games. If some of those guys would get off the couch and play some sports instead of watching it all the time and drank less beer, perhaps they wouldn't need a drug for 'erectile dysfunction'.
A few years ago i was at a benefit fair for a large company and had a table next to their pharmacy benefit manager. Durina a slow time, she said that the drug usage in that group was very high and was a major contributor to the 20% increase inthe health insurance cost from the previous year. She also said that most of the drug usage was for anti depressants which accounted for the largest catagory of drug usage in that group. I suggested that perhaps that company (which was paying over 80% of the health insurance premium) should re-examine their work environment.
We have become an overworked and overstressed society in this country. I don't see that in Europe. There workers get an automatic four week vacation every year and even though many Europeans live in big cities, they don't seem to be as stressed out as we are here inthe USA. The same also applies north of the border in Canada. Canadians normally receive three weeks paid vacation each year regardless of where they work or how long they have been on the job. Are Americans that more productive than Canadians or Europeans? I don't think so.
My father worked as a sales and marketing analyst for a tool manufacturer. He got (and took) at least three weeks paid vacation every year and one year when i was in high school back in the 1960s, we took a whole month off and took a driving vacation out to the Rocky Mountains (think of those Chevy Chase movies) where my brother and myself got to spend a week backpacking at a scout ranch in New Mexico. My mother was a nurse at a large hospital in OB-GYN and she was also to get the time off. How many middle management people could take a whole month off for a family vacation today and still have a job when they returned? My father's job was also rather stressful and his answer to work stress was a 45 minute drive home and a manhattan when he got there. Usually my mother would join him for 'happy hour'. He never got drunk or would drink and drive. Perhaps we should rethink our work culture and enjoy 'happy hour' after work rather than popping pills.
I agree with you about the flawed medicare drug bill. The donut hole provision boggles the mind.
I think the place where we disagree is that you believe the democrats and the repubilicans are different from each other in the way they write and pass legislation. I don't. It's not that one party is flawed or "owned" by corporate interestests. Both parties are. The problem, as Chris Dodd pointed out, is the way campaigns are financed. The system is flawed, not the political parties.
In creating legislation to provide healthcare reform, democrats will be subject to the same pressures republicans were subject to when they passed the medicare drug bill, only more and bigger because more money is involved.
If you think we're over medicated now, just wait till health care reform passes, and pharmaceutical companies are able to more accuratey track which doctors prescribe their medications, and apply more pressure to doctors to prescribe, and more pressure to patients to comply.
It's not surprising that Massachusettes has seen an increase in the cost of medical care since implementing more universal coverage. They may expect that cost to come down, but on what basis? The same thing could happen nationally when healthcare reform passes. We really don't know what the impact to cost will be.