The US health care reform continues to create torrent of criticism in conservative circles, including one of my good friends "A". Since I didn't ask her permission to use her side of our recent e-mail exchanges, I am only giving excerpts from my responses to her. Although the US health care reform has been a subject of earlier blog entries on this side, I think that during our discussion with "A", enough new thoughts surfaced to readdress the issue from my side.
A:
she brought up concerns about the immigrants receiving free emergency medical care. She referred to this as "full medical coverage."
My response to this:
The illegal immigrants’ health care is of marginal significance in the bigger picture of no-or-under insurance of legal US citizens. Since you brought it up, let me remind you: you pay tax for your health care, the illegal immigrants pay for the privilege of being treated in the ER with their dirt cheap work. This way, they end up paying far higher insurance fee than you ever will under any kind of health insurance law.
Additionally, you may have overlooked this important point: they don’t have "full health care": they get treated in the ER free of charge. As a physician you know that emergency medical care is far from "full health care". When one gets a free emergency transfusion for anemia in the ER for his/her bleeding colon cancer, it is not the same as discovering the colon cancer on time, before it bleeds, and before it spread over the body; discovering it with colonoscopy at a stage when complete cure is highly likely.
Illegal immigration is a far broader social problem in the US than its health care aspects. I’m not against taxing illegal immigrants after they get some kind of official position in the country - temporary worker, citizien, etc. - Remember that, on the first place, they came here illegally because they could get illegal work from legal Americans, who in turn provide legal services to the rest of the legal Americans!
A: is concerned about who makes decisions about health care in the trenches under the new health care reform.
My response to this:
For your question about who makes the decision about health procedures/treatments, etc.: there is nothing in the new health care law that would make me think that the administrators of this health care would be less qualified than those who today’s insurance companies put next to their “precertification” telephone lines.
In an earlier message, my response was the following for her similar concern:
On the side, about 90% of the procedures I perform or testing that I order - short of routine tests - need to be preauthorized, i.e. a low level administrator reads through a handbook and tells me if the test/procedure can be done or not. Currently I am in argument with one of these administrators about genetic testing for a patient of mine whose diagnosis of polycystic kidney disease would require this test. We are into our 2nd months of back-and for messages with this administrator and no end is in sight.
A: expresses uneasiness about the end-of life consulation in the new health law.
My response to this:
The end of life consultation is just that: like my wife being consulted whether or not she wants chemotherapy or not. So, what's the problem with it?
This same question came back on a second time and my response was this:
Killing yourself is not recommended in the new health care law (and no, nobody wants to kill your grandmother either!). You sound much like Sarah Palin here:) It seems that unlike you, many people are interested in dignified death and not rotting away on respirators, surrounded by IV and feeding tubes. This however remains your choice under the new health care bill.A: brought up her concerns about the Government seeing her health documents.
My response to this:
As to the privacy issue you brought up, today it is the insurance companies who have your health story. When the Government becomes your insurance company, it will be their designated agents who'll have access to your health information.
I have no less trust in them honoring my privacy than I have in today’s insurance companies, but I admit that this is a subjective matter. Here we’re coming back to high school graduates working on barely above minimum wage who handle my health information. These people are employed by profit-hungry insurance companies. Under the new health care law, it will be the same kind of people who would be hired by the Government. The only difference will be that at least I'll have the reassuring, though far-fetched hope, that the decisions about my health will not be made based on how much golden parachute the insurance CEO requested, but possibly on the Government’s wisdom who, under ideal circumstances, may actually value me as a productive citizen.
A: finally expressed her agreement with me that everyone deserves "full medical care," but the new health reform is worse than the old stand-still status of health care.
My response to this:
I’m glad that your Christian believes finally met my socially conscious desire to provide universal health care! You don’t like the current law, but cannot propose a new one. Well, think about it and when you have a better solution, let the people of the US know it and vote for it - this is how democracy is supposed to work, isn’t it? -. Until then, let’s take care of all the sick ones, as Jesus, or the simple non-religious compassion, not the one the GOP preaches about, would expect us to do.
– You have to admit that over decades of its existence, this richest of all countries didn’t even get to the point of acknowledging that health is a universal right and not the privilege for a selected majority. Remember how the GOP killed Clinton’s health care proposal in the early 90s without ever coming up with their own plan although they had 8 hard years to do that after Clinton and twelve years before him - between Carter and Clinton. -
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A couple points: Illegal worker are taxed: sales taxes, fees for licenses and services; most pay SS taxes because they have forged SS cards (a must for "legal employers") and this money goes into SS fund but the illegal workers will never see a cent, etc.
ReplyDeleteWe already have government health care that works reasonably well. It is called medicare, federal employee health care, military health care, and medicaid. According to a late Gallup poll 30% of Americans are already on government health care (www.gallup.com/.../nearly-insured-government-coverage-2008.aspx). None of the teapartiers or right wing blowhards or congress persons, or veterans, or federal retirees, or those over 65 are fomenting rebellion because of the awful fate of being on government health care programs. They thank God they are covered. Tea Party members aren't burning their medicare cards, or if they are, it is being done very quietly. Why? Because it works.
Third, the debate is not about health care (or more accurately disease care), it about fairness and about money. People on the right worry about people getting something for nothing, a valid concern. People on the left care more about compassion, also a valid concern. Meanwhile, the people making money or our current system (Insurers, pharma, medical technologists, many physicians, etc) do not want to kill the goose laying the golden egg. So they whip opposition to what ever threatens their goose. A goose in the pot is worth two in Affordable Health Care Act. If Jesus Christ, Gautama and Confucius did a world tour and touted Health Care Reform in the US, people profiting from the current system would accuse these souls of such foulness so as to embarrass anyone with unimpaired commonsense...(insert here a Rush Limbaugh rant).
Your points are well taken Doug. It seems that way too many people here in the US lack a minimal dose of necessary common sense for long term survival. The country is big and can limp along with short term mistakes, such as "repelling" the Obama care without viable counteroffer, but even the US will regret these short-sighted mistakes in the not too far future, when the sh.. hits the fence - again, see the Occupy movement as a beginning -.
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