A letter to Senator Kennedy
Feb. 6th, 2009 02:52 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
teddywolfBefore I go to anything else - Mr. Kennedy, I hope your tumor is completely gone and that you have many active years left ahead of you.
To the heart of the matter: we need single payer health care in the US. Our neighbor to the north, Canada, has such a system. They pay about 60% of what we do per capita, last I heard, and they are generally pleased with their health care aside from some long waits. Considering some of the waits I've had for a simple PCP visit, though, I don't think theirs could be worse. Moreover, I have heard that with a bit more funding - bringing them to 65% of our cost - they would have much-reduced waits.
Right now, 30% of every health care dollar spent in the US goes to insurance companies, according to a report by Frontline (PBS). These companies are effectively middlemen, and most of them operate on a for-profit basis. More money is spent at the hospitals just to have people who are trained in insurance company paperwork. By removing the middlemen and streamlining the paperwork we could not only cut costs for medical care, we could give better care to people who need it.
My family is struggling. My employer offers what is considered adequate health-care for employees, but co-pays went up this year. Drug co-pays are $15. Doctor visits are $20, up from $15. Our co-pays for emergency room visits are $75, up from $50. These co-pays are in addition to paying my share of the insurance coverage, which amounts to over 10% of my income before taxes. I am in a low-to-median wage job, $14 an hour. My wife earns more, $21 an hour, but she is working half-time. Include the co-pays we incur for medicine, for doctors visits for the children and for us, and it's just way too much money. We pay for a minimum of 3-4 prescriptions a month, a baseline of 5 doctor visits a month, and Heaven help us when we have to visit the ER - which we did twice last month. I pay about $250.00 a month for health care, my contribution; add the co-pays and it's more like $400.00. If I were working full time at the company this would work out to $2.50 an hour that I am paying for health care, or coming close to 20% of my income. As I work more like 32 hours a week, well... the health care costs don't go down, but the percentage of my income it eats up goes up. That's over $3.00 an hour I'm paying for health care, somewhere around 22% of my base wage. Factor in my wife's income and it still comes to over 11% of our income. If I were single I wouldn't have to pay for the family plan, but I do have a family - and the government says it wants strong and healthy families, right? The government should put its money where its mouth is, and those family-values Republicans doubly so.
We have applied for MassHealth; I hope we get it, because we need it.
There are a lot of other families out there struggling like mine. Single-payer health care would save money, arguably cutting costs at least as much as in Canada, while giving people better care and taking a great deal of stress off of overcrowded and overburdened emergency rooms. It would reduce the cost of prescription drugs as well.
Single payer is not the only thing which would be important for keeping down costs, however.
The abomination known as Medicare Part D should be changed to single payer. Mr. Bush's argument about competitive pricing doesn't hold water when one of the largest companies in the US, WalMart, frequently dictates how much it will pay to its suppliers. Lots of little plans don't have that muscle. One big plan does.
Medical staff, like truckers, should have a maximum number of hours they can work in a day. Even the world's best specialist doesn't do particularly well on 24 hours without rest; less skilled physicians and nurses can face similar difficulties. This could reduce accidental treatments or lack of treatment caused in part by medical staff fatigue. We worry about a truck going off the road and killing regular drivers; we should have the same consideration in hospitals.
One more item that would be useful in keeping down costs: capping or government control of malpractice insurance. Even with caps on the amount somebody can get in court for malpractice, the cost of the insurance has gone through the roof - and I don't mean the roof of my apartment, I mean the roof of that new skyscraper hotel in Dubai. Many if not most doctors are paying premiums that are considerably more than the average family's wages. This more than anything else has led to the demise of the small-office family practitioner.
I would suggest another point as well: dental insurance and vision insurance should be made part of overall health plans. Teeth are important. Losing them is bad. Current dental plans have an annual cap on how much treatment you can get, and if you need a major set of dental work it will easily overwhelm that annual cap. No other kind of health care does this. It's managed care, but it comes at a price of a person's health - and that is not acceptable.
I feel there will still be a place for private medicine and private insurance; but it should be for optional treatments, such as unnecessary reconstructive surgery, or for doctors who work outside the single-payer plan by providing concierge-doctor service. The Constitution does not say anywhere that any particular business has the right to exist.
We have some excellent health care in the US, but we have a mediocre and haphazard way of delivering it. The emergency room should not be used for primary care. It should not even be suggested for primary care, but that's what the last President did. The ER is the most expensive kind of care given. Move some of that over to doctor's offices and the cost of care goes down - again.
To sum up:
*single-payer health care for all Americans, not just seniors and government workers;
*revise Medicare Part D to single payer;
*include vision and dental as part of overall health;
*government regulation of malpractice insurance, or government taking it over like it does for flood insurance in some areas; and
*a cap on hours worked by medical workers to ensure a higher level of care.
This is a whole plan, and I feel that all together it is a workable one. Piecemeal implementation of it would be better than none, but this is the time to finally get this through. The families of Massachusetts want this, Senator. Many nurses and doctors I've talked with want this. More to the point, the hard-working families of this nation *need* this.
I do not have access to the GAO but I believe your office does. I believe my suggestions would save money and provide better care, but I admit I do not *know* this 100% - I am not a trained economist or number cruncher. However, I think running these suggestions by them might give a good comprehensive picture of what the costs would look like.
I do worry about your health, Senator. You are a lion of the Senate and your voice is a very strong one. Please stay healthy.
So - aside from Libertarian arguments about government, does my reasoning seem sound to you?
To the heart of the matter: we need single payer health care in the US. Our neighbor to the north, Canada, has such a system. They pay about 60% of what we do per capita, last I heard, and they are generally pleased with their health care aside from some long waits. Considering some of the waits I've had for a simple PCP visit, though, I don't think theirs could be worse. Moreover, I have heard that with a bit more funding - bringing them to 65% of our cost - they would have much-reduced waits.
Right now, 30% of every health care dollar spent in the US goes to insurance companies, according to a report by Frontline (PBS). These companies are effectively middlemen, and most of them operate on a for-profit basis. More money is spent at the hospitals just to have people who are trained in insurance company paperwork. By removing the middlemen and streamlining the paperwork we could not only cut costs for medical care, we could give better care to people who need it.
My family is struggling. My employer offers what is considered adequate health-care for employees, but co-pays went up this year. Drug co-pays are $15. Doctor visits are $20, up from $15. Our co-pays for emergency room visits are $75, up from $50. These co-pays are in addition to paying my share of the insurance coverage, which amounts to over 10% of my income before taxes. I am in a low-to-median wage job, $14 an hour. My wife earns more, $21 an hour, but she is working half-time. Include the co-pays we incur for medicine, for doctors visits for the children and for us, and it's just way too much money. We pay for a minimum of 3-4 prescriptions a month, a baseline of 5 doctor visits a month, and Heaven help us when we have to visit the ER - which we did twice last month. I pay about $250.00 a month for health care, my contribution; add the co-pays and it's more like $400.00. If I were working full time at the company this would work out to $2.50 an hour that I am paying for health care, or coming close to 20% of my income. As I work more like 32 hours a week, well... the health care costs don't go down, but the percentage of my income it eats up goes up. That's over $3.00 an hour I'm paying for health care, somewhere around 22% of my base wage. Factor in my wife's income and it still comes to over 11% of our income. If I were single I wouldn't have to pay for the family plan, but I do have a family - and the government says it wants strong and healthy families, right? The government should put its money where its mouth is, and those family-values Republicans doubly so.
We have applied for MassHealth; I hope we get it, because we need it.
There are a lot of other families out there struggling like mine. Single-payer health care would save money, arguably cutting costs at least as much as in Canada, while giving people better care and taking a great deal of stress off of overcrowded and overburdened emergency rooms. It would reduce the cost of prescription drugs as well.
Single payer is not the only thing which would be important for keeping down costs, however.
The abomination known as Medicare Part D should be changed to single payer. Mr. Bush's argument about competitive pricing doesn't hold water when one of the largest companies in the US, WalMart, frequently dictates how much it will pay to its suppliers. Lots of little plans don't have that muscle. One big plan does.
Medical staff, like truckers, should have a maximum number of hours they can work in a day. Even the world's best specialist doesn't do particularly well on 24 hours without rest; less skilled physicians and nurses can face similar difficulties. This could reduce accidental treatments or lack of treatment caused in part by medical staff fatigue. We worry about a truck going off the road and killing regular drivers; we should have the same consideration in hospitals.
One more item that would be useful in keeping down costs: capping or government control of malpractice insurance. Even with caps on the amount somebody can get in court for malpractice, the cost of the insurance has gone through the roof - and I don't mean the roof of my apartment, I mean the roof of that new skyscraper hotel in Dubai. Many if not most doctors are paying premiums that are considerably more than the average family's wages. This more than anything else has led to the demise of the small-office family practitioner.
I would suggest another point as well: dental insurance and vision insurance should be made part of overall health plans. Teeth are important. Losing them is bad. Current dental plans have an annual cap on how much treatment you can get, and if you need a major set of dental work it will easily overwhelm that annual cap. No other kind of health care does this. It's managed care, but it comes at a price of a person's health - and that is not acceptable.
I feel there will still be a place for private medicine and private insurance; but it should be for optional treatments, such as unnecessary reconstructive surgery, or for doctors who work outside the single-payer plan by providing concierge-doctor service. The Constitution does not say anywhere that any particular business has the right to exist.
We have some excellent health care in the US, but we have a mediocre and haphazard way of delivering it. The emergency room should not be used for primary care. It should not even be suggested for primary care, but that's what the last President did. The ER is the most expensive kind of care given. Move some of that over to doctor's offices and the cost of care goes down - again.
To sum up:
*single-payer health care for all Americans, not just seniors and government workers;
*revise Medicare Part D to single payer;
*include vision and dental as part of overall health;
*government regulation of malpractice insurance, or government taking it over like it does for flood insurance in some areas; and
*a cap on hours worked by medical workers to ensure a higher level of care.
This is a whole plan, and I feel that all together it is a workable one. Piecemeal implementation of it would be better than none, but this is the time to finally get this through. The families of Massachusetts want this, Senator. Many nurses and doctors I've talked with want this. More to the point, the hard-working families of this nation *need* this.
I do not have access to the GAO but I believe your office does. I believe my suggestions would save money and provide better care, but I admit I do not *know* this 100% - I am not a trained economist or number cruncher. However, I think running these suggestions by them might give a good comprehensive picture of what the costs would look like.
I do worry about your health, Senator. You are a lion of the Senate and your voice is a very strong one. Please stay healthy.
So - aside from Libertarian arguments about government, does my reasoning seem sound to you?
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no subject
Date: 2009-02-06 04:30 pm (UTC)Another argument for single-payer coverage is, in fact, the cost of malpractice insurance. Note: in the following paragraphs, I'm talking about monetary awards to the victims of genuine medical malpractice. I'm not talking about people suing over an unfavorable outcome, not caused by malpractice, in the hopes that the malpractice insurer will pay out because it's still cheaper than contesting the case in court. And I'm only talking about awards for support - not punitive damages, and especially not "pain and suffering".
As I understand it, a significant portion of those exorbitant malpractice settlements is intended to provide lifetime medical care for the individual injured by the malpractice, especially in cases where the injury leads to employment-preventing disability. Because, in our current system, unless they're either a) still employable, and employed, and covered through an insurer [and don't fall afoul of preexisting condition exclusions], or b) covered by Medicare or Medicaid, they're not only uninsured but uninsurable. Which currently is spelled SOL. So they need insane amounts of money to pay for their medical care for the rest of their life.
If we go single-payer, then they're covered anyway, just as they were before the malpractice happened, so the 'support' portion of the malpractice award only needs to cover lost income. Which is still a large chunk of change, but a much smaller one than is necessary under the current system.
no subject
Date: 2009-02-06 11:28 pm (UTC)no subject
Date: 2009-02-07 02:37 pm (UTC)no subject
Date: 2009-02-08 03:03 am (UTC)no subject
Date: 2009-03-13 11:25 am (UTC)