Healthcare veteran says systemic reform is critical

Tue, 07/14/2009 - 3:24pm
By: Letters to the ...

I feel compelled to respond to the healthcare reform editorials published in last week’s Citizen.

Kimberly Learned made several excellent points in support of federally funded universal healthcare. Her statement that “Our politicians enjoy taxpayer-funded healthcare” was declared “flat wrong” by another writer, Donald Clack, who pointed out that the federal employees health benefit program is not “free.”

True, but we taxpayers do fund approximately 75 percent of these healthcare premiums. And members of Congress receive extra perks, including their own pharmacy, physicians and nurses, at an additional cost of $2 million per year to the taxpayers. That’s a pretty hefty benefit package, in my book.

All of this is tangential to the primary issue: the urgent need for a national healthcare system that will meet at least the basic needs of all citizens.

The U.S. spends far more per capita than any other nation in the world (an estimated $8,300 per person in 2009), yet is the only wealthy industrialized nation lacking some form of universal healthcare.

We are now spending more on healthcare every year than we spend on educating our children, building roads, even feeding ourselves.

Forty-five million Americans have no health insurance; another 25 million are underinsured. Half of Americans say they have cut back on healthcare in the past year due to cost concerns and one in five say they have not filled a medical prescription. Lack of preventative care — and timely care — is contributing to higher and higher costs.

If we do nothing about this issue, healthcare costs are projected to soar to $13,000 per person annually within the next eight years, according to the Congressional Budget Office. The number of uninsured will rise accordingly.

Tying health insurance to employment is crippling American business. Escalating health insurance premiums are bankrupting businesses as well as families across this nation. Many sobering statistics can be found in well researched articles on the internet and elsewhere, so I need not quote them here.

We can all point to problems and complaints with healthcare systems in other countries. All are evolving, all are imperfect. But very few citizens of Canada, the UK, France, Norway, or Australia say they would like to trade their system with what we currently have — or should I say DO NOT have — in the U.S.A.

We can’t turn back the clock — although I admit that, as a retiree, I sometimes wish that were possible.

My parents raised five children during the 1940s and ‘50s with minimal medical expenses and no health insurance. When there was a broken leg, a case of pneumonia, or an attack of appendicitis, one could always work out a reasonable payment plan with the doctor or hospital, which might involve selling a cow or a couple of fattened lambs.

But we live in different times. Costs and services have increased dramatically; our systems and philosophies have not kept pace.

I have worked for 28 years in hospitals and medical clinics, witnessing the mushrooming waste and inefficiency in our healthcare delivery system. I could write volumes about my first-hand knowledge of human misery related to this issue.

I have known several families bankrupted by healthcare costs, even when they were “covered” by medical insurance. I have had to turn tourists with sick children away from clinics in Florida, sending them to expensive, crowded emergency rooms because they did not have acceptable insurance or payment in hand.

I have participated in countless administrative meetings with the purpose of designing “economic credentialing” programs — a process that rewards physicians for utilizing expensive new diagnostic equipment, increasing surgical procedures or patient admissions.

In one extreme case I witnessed a body radiated “one last time” before death was officially pronounced, due to this brand of economic pressure.

I remember following an elderly couple down the long administrative corridor lined with offices. “What do you suppose they are all doing in there?” the wife asked her husband. He shook his head and said he couldn’t imagine.

And I couldn’t imagine how one would help them understand the bureaucratic maze they were negotiating on their way to the admissions office. How do you explain the clerical army stationed behind all those desks?

How do you describe the repetitive medical staff credentialing process, the utilization review, quality assurance and risk management functions, the coding and billing, transcription of illegible manual records, the tangle of insurance filing and re-filing and appeals, the receivables, collections, marketing and community relations, patient advocacy, and discharge planning for patients who are still too ill to function on their own?

All of it could go a long way in explaining why a single aspirin can cost $30 when administered in a hospital. But then I would have to explain the concept of cost-shifting, which makes no sense to anyone.

Regarding the RATIONING of care (a “scare word” employed by Gregory West in his editorial): Surely we all recognize that healthcare is currently being rationed in this country.

The private insurance industry does a pretty good job of rationing by excluding pre-existing conditions, by requiring complex “pre-authorizations,” and through an arbitrary process of review and denial.

We might also ask the millions of uninsured and underinsured, if they don’t feel their care is rationed by economics.

I suspect that — to use Mr. West’s own phrasing — they may well feel that “life is no longer under their own control.”

Anyone who believes that only the lazy, degenerate and irresponsible are outside the healthcare system in this country has been isolated by privilege, or is simply not paying attention.

We must also recognize that the latest and greatest high-tech treatments do not correlate with improved health and longevity. Some basic cost/benefit reasoning must be applied to healthcare, as it is in any other industry.

If this is “rationing,” it is certainly preferable to the current situation that punishes the most vulnerable.

Americans, as a society, will have to recognize that quality of life is a legitimate consideration and that the end of life is inevitable for everyone — young and old, rich and poor alike. No amount of money will buy us out of the human condition.

Oh, yes, we need reform. Healthcare in the United States of America has become an unaffordable privilege — not a right — for many. That is not my idea of democracy.

The debate will continue. Do we amputate? Design a whole new limb? Apply a tourniquet or a Band-Aid? Or utilize a whole arsenal of poorly coordinated treatments that could further complicate an already complex problem?

I have to believe that, working together, we will meet this challenge. Citing the numerous problems in other countries — or in the state of Massachusetts — cannot be our excuse for failing to tackle healthcare reform. We must use their experience to help us craft an American system that will control costs, improve quality and provide at least a baseline standard of healthcare for all.

Sara DeLuca

Peachtree City, Ga.

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Submitted by smile on Fri, 07/17/2009 - 2:50am.

You make excellent points. You also wrote very well about the behind the scenes side of healthcare that most people don't think about. I know I didn't until I worked in a hospital and saw it all myself. I wish healthcare was more about compassion and care than a business, but I don't trust the gov't to do any better than the private sector. Maybe I am just too jaded by what I have seen.

S. Lindsey's picture
Submitted by S. Lindsey on Thu, 07/16/2009 - 4:33pm.

This debate is starting to sound like a Dire Straits song.. Everyone wants something for nothing.. New Flash people it will not be FREE..
Employers with 5 or more employees will be forced to provide Healthcare... or will have to pay up to 8% of their salary as a tax..
Hmmm....conform or be taxed now where have I heard that before..??

What do you think Employers will do?? Hire more people? Expand? Give Raises? Tell me... although I know already.. They will be forced to adjust salaries and/or let someone go to pay for that FREE healhcare..


Answer one question.. If a homeless drug addict has a heart attack
on the street.. does he die right there or are they taken to the nearest hospital given life saving drugs and every effort to save their life taken?
If the answer is yes.. and the answer IS YES... then there is no Healthcare CRISIS.. Everyone has some type of coverage.. may not be the absolute best.. but then once we get rationed care then none of us will get the absolute best.. WE will get what we are given.. EQUALITY.. is what is sought here.. So you and I will get the same treatment as a drug addict.. This is what we are headed for and this is what they (Progressives) want.

"When the person who in possession of a government, shall say to a nation, I hold this power in 'contempt' of you, it signifies not on what authority he pretends to say it is..but an aggravation to a person in slavery"..Thomas Paine

Cyclist's picture
Submitted by Cyclist on Thu, 07/16/2009 - 4:46pm.

According to the Vice Perpetrator, drug companies recognize the potential profits in extending coverage to nearly 50 million Americans without health insurance.

I wonder just where some of those uninsured are going to get funding to buy those drugs so that drug companies can realize those profits? Oh I forgot, there will not be any profits because taxes will to be so high in order to pay for the uninsured.

Caution - The Surgeon General has determined that constant blogging is an addiction that can cause a sedentary life style.

SPQR's picture
Submitted by SPQR on Thu, 07/16/2009 - 12:20pm.

The wheels began to fall off U.S. health care with the advent of employer subsidized insurance. It made great economic sense at the time to provide medical insurance as a perk. We can see that it evolved into a system of almost no financial accountability for the healthcare providers. So here we are with a healthcare system that clearly does not understand fiduciary responsability with a goverment that understands it even less telling us it can make everything OK. I think it's probably going to get pretty ugly before it gets better. Oh, I do hope I'm wrong!

Submitted by AtHomeGym on Thu, 07/16/2009 - 4:22pm.

But wait! If I understand correctly, one of the provisions of the Dem-introduced legislation will be to MANDATE employer provison of health insurance and tax them if they don't! And if the employee refuses it, then they'll get taxed something like 8% of their salary! Is that what you want?

Submitted by boo boo on Wed, 07/15/2009 - 3:01pm.

You said it better than anyone.

Submitted by AtHomeGym on Wed, 07/15/2009 - 4:49pm.

As a Feferal Annuitant who participates in the Federal Employee Health Benefits Program, I can tell you that the Govt does NOT pay 75% of the premimum--it's right at 66%--and I pay 100% of the premimum for Dental and Vision coverage. Hey, it's part of my benefits package. I held up my end of our contract and I fully expect the Govt to hold up theirs. And I had no part in designing the Retirement System under which I served and retired. And the Retirement System changed in 1984 and the current system is not so lenient and rewarding.

Submitted by boo boo on Wed, 07/15/2009 - 3:01pm.

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