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HEALTH CARE: More questions need to be asked

Letter by Michael H. Wilson, Olympia on April 9, 2012 at 1:38 pm with 58 Comments »
April 9, 2012 1:38 pm

Re: “Uninsured freeloaders’ option: Stay out of the ER” (editorial, 3-27).

Let me clearly state as a Libertarian I oppose the mandates.

If your concern is with alternatives to emergency rooms for minor care, then we need to look at the role of retail health clinics and ask why we have so few in Washington state compared to other states. Does the Corporate Practice of Medicine law or other regulations play a role in this issue?

If you wish to find alternatives that reduce the high costs of medicine, we should be asking questions about how medicine is practiced.

Midwives deliver about 10 percent of infants in Washington state and less across the nation, whereas in Europe midwives deliver about 75 percent of infants with as good, if not better, results than doctors and at lower costs. In Washington, 50 percent of births are paid for by Medicaid. What would the savings be if midwives delivered 75 percent of the infants?

We know that almost 30 percent of Medicare’s $300 billion budget is spent in the last year of a patient’s life. How much could be saved if all patients filled out Advance Directives and all states honored them?

Why does the nation spend $100 billion annually on medical research, when we know that as much as 85 percent of it is of questionable quality?

There are a lot more questions that need to be asked. Ignoring them won’t make them go away.

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  1. Why does the nation spend $100 billion annually on medical research, when we know that as much as 85 percent of it is of questionable quality?

    How do “we know that as much as 85 percent of it is of questionable quality?”

    Who are “we”, how are you measuring “questionable quality” and, more to the point, how did you fund the study to study the studies?

  2. We know that almost 30 percent of Medicare’s $300 billion budget is spent in the last year of a patient’s life. How much could be saved if all patients filled out Advance Directives and all states honored them?

    “Soylent Green is people!”

  3. Outlaw healthcare insurance. Let the competition begin.

  4. Midwives deliver about 10 percent of infants in Washington state and less across the nation, whereas in Europe midwives deliver about 75 percent of infants with as good, if not better, results than doctors and at lower costs. In Washington, 50 percent of births are paid for by Medicaid. What would the savings be if midwives delivered 75 percent of the infants?

    So, as a Libertarian, are you proposing we mandate that 75% of Americans make use of mid-wives?

  5. billybushey says:

    The “personal freedom and liberty” argument against the healthcare mandates is ridiculous. What most people don’t seem to understand is that in order for any improvement in health insurance to work, everyone has to have it. It’s called a risk pool.

    Ideally, we dump healthcare as a for profit industry all together and save 40% in overhead from the get-go. No more advertizing of drugs, stock holder obligations and inflated CEO salaries. Single payer insurance can and does work. The Tea Buggers will lie and scream about all the Canadians allegedly coming here for care, the ambulance back ups in England and so-called “rationing”. Those arguments are based on Fox News and Koch Brother talking points and bear an astonishing resemblance to the night soil of a well fed male ox.

    Will Libertarians pledge to bite the bullet and die like good soldiers if they get a condition that isn’t covered, exceeds lifetime policy limits or can’t be covered at all because it is pre-existing? I think not.

  6. alindasue says:

    billbushey said, “about all the Canadians allegedly coming here for care, the ambulance back ups in England and so-called “rationing”.”

    There are a number of people who come here from Canada and other countries for care, but I think it’s pretty safe to say that number is easily countered by the number of people from the US who go to Canada and Mexico for affordable medications, medical, and dental treatments.

    My parents, who winter in Yuma, Arizona, get all their dental work and eye care done in a town just across the border during their time down there because the care is as just good (often performed by American doctors) at less than half the price.

    While we do have some innovative doctors and clinics in this country, we do not hold a monopoly on innovation. We do, however, seem to be one of the last stubborn hold-outs who do not consider universal basic access to health care to be a fundamental right.

  7. aislander says:

    alindasue writes: “We…seem to be one of the last stubborn hold-outs who do not consider universal basic access to health care to be a fundamental right.”

    Please explain how anyone can have a “fundamental right” that obligates others to serve him in any way. Think of the implications of such a “right…”

  8. night soil = right wing talking points.

  9. billybushey says:

    aislander: How about the right to protection by law enforcement? Others obligated to serve you and it is paid for by taxes. How about putting out a house fire? Emergency medical transportation or response? Others obligated to serve, we all pay.

    The cost of lack of healthcare is far higher. No preventive care means we don’t see the victim until the condition is out of control and we all pay for it through higher premiums to cover unpaid ER service. Do you believe someone should sicken and die because they can’t afford to see a doctor? Contrary to the Tea Buggers and Faux News pundits, it is not lazy people who don’t have insurance. The majority are working folks that have per-existing conditions themselves or with their children, don’t make enough money to afford private insurance (the most prohibitively expensive kind) and don’t have an employer sponsored plan (which in most cases would reject them if they had preexisting conditions anyway).

    These situations are addresses in Obamacare and it requires a large risk pool to make it work. That’s why we have to have the mandate. And the mandate does work. Check out the Swiss system which has had a mandate in place for 19 years.

  10. alindasue says:

    aislander,

    Even under a universal health care system, no one is “obligated” to provide medical care for others. It’s not like the government selects children and says “You will be a doctor; you will be a nurse…” etc..

    If you are speaking in terms of being obligated to pay into the health care system (that nasty “T” word?), how would that be any different than the medicare taxes we already pay? Heck, all of us – even conscientious objectors (which I am) – are OBLIGATED by the very Constitution to “serve” others by paying taxes to support our military.

    The “implications” of a right to basic access to health care coverage are that people would have access to medical care and perhaps our infant mortality rate will rise to a level lower than nearly third world level (even higher than Cuba!)

  11. cclngthr says:

    billybushey,

    A lot of the high costs also are associated with the lack of pre existing condition care that often results in ER visits that insurance companies seem to refuae to treat.

    I have CP, and through employer sponsored plans, they refuse to cover me at the same cost and coverage as everyone else. I don’t get care with anything associated with the CP, which is anything from dental care to general medical care. Even if the company decides to cover me, the premium would cost $2,100 a month with a $2500 deductable.

    People seem to prefer that people who need care for pre existing conditions need not exist.

  12. anotherID2remember says:

    Just a couple of comments to get off my chest.

    1. Why does the government regulate my water bill but not my health care premiums? I don’t want government to provide my health care, I just want them to regulate it like the badly needed commodity that it is.

    2. Lawsuits drive up health care costs by forcing practitioners to practice the most expensive medicine possible. Disagree? Think about this…would you park in a crowded parking lot if you were required by law to turn every door ding you get into your own insurance company? or would you park as far away as possible?

  13. concernedtacoma7 says:

    You can stop drawing water from the utility and face no penalty.

    Yes, tort reform is needed. Point?

  14. MarksonofDarwin says:

    Of course, insurance is heavily regulated already.
    Each state has an elected insurance commissioner whose job is to solely regulate insurance and to help the consumer.

    Our current insurance commissioner is Mike Kriedler.

    hth

  15. aislander says:

    So…alindasue…you’re saying that I don’t have to be a slave, but that portion of my life that I spend working has to pay for your stuff. Right?

    What’s the enormous difference? I don’t see it.

  16. The letter mentions Corporate Practice of Medicine laws. Washington, like most states, has no such law, but does give legal guidance that no corporation can hire a non-professional under one license that would allow them to practice medicine (or any other of the “learned professions” without the requisite license.) Washington actually has a generous law that allows Nurse Practioners great leeway in giving care.

    Many of the states which have a huge number of retail health clinics (RHC) have exactly the same legal situation as Washington State. See: http://www.nhpco.org/files/public/palliativecare/corporate-practice-of-medicine-50-state-summary.pdf

    I think the letter writer meant laws specific to retail health clinics (RHC). RHCs were touted as the next best thing. Unfortunately, at first, they took cash only no insurance or other payments. Many still demand full payment and then will give a rebate when insurance payments come in.

    At present, no RHC takes Medicaid. Many do not take Medicare or VA benefits. Supply and demand is the biggest restriction, and almost as many RHCs have closed because of lack of business and stiff competition as have opened.

    http://www.startribune.com/business/26850829.html

  17. sandblower says:

    I have yet to meet a completely rational libertarian.

  18. cclngthr says:

    tuddo,

    Having RCH’s under your description is not the answer either. If they demand cash payment, not many people would have the kind of cash to pay for that who needs that type of medical care. Those who can afford such payments already have insurance so they would normally go to their primary doctor for care under their insurance plan.

    Tort cases do exist. I often see commercials claiming if you have a child with cp you can get money from your doctor and hospital who “damaged” your child. It would not surprise me if the same thing can be said with the high rate of autism. I don’t think these cases can completely go away, since there are problems that do exist that are rectified by these cases.

  19. Frankenchrist says:

    Arby’s and Proactive are boycotting the Rush Limbaugh show. The exodus grows. He is getting desperate now.

  20. “Please explain how anyone can have a “fundamental right” that obligates others to serve him in any way.”

    Please explain how single payer is “serving” anyone?

  21. “Yes, tort reform is needed.”

    Tort reform is nothing but corp welfare, unless it mandates the insurance companys pass the ‘savings’ on to consumers, which as we all know they will never do.
    Tort reform doesn’t work and never will.

  22. I say it will be 5 to 4, the left will piss and moan…priceless! Now we have to get the state out of liquor, oh yeah we did…priceless! All arguments have been made so I see no reason to continue this conversation…back to bed…

  23. Tom Baker, a University of Pennsylvania Law School professor said in a 2009 interview: “We have approximately the same number of claims today as in the late 1980s. Think about that. The cost of health care has doubled since then. The number of medical encounters between doctors and patients has gone up — and research shows a more or less constant rate of errors per hospitalizations. That means we have a declining rate of lawsuits relative to numbers of injuries.”

    http://www.feldmanshepherd.com/blog/2012/03/has-medical-malpractice-tort-reform-enacted-any-positive-change-in-the-united-states/

  24. I say it will be 5 to 4, the left will piss and moan…priceless!

    The likely vote by the same 5 will confirm two things:
    1) There should be more discussion about impeachment of Justices who regularly demonstrate more care about ideology than concepts of law
    2) We won’t be saddled with this crappy law that was thought up by the Heritage Foundation and put into place, originally, by a Republican governor and we can work on real reform – to put single-payer in place.

    Now we have to get the state out of liquor, oh yeah we did…priceless!

    Until home distilling is legalized the job isn’t finished.

  25. Vox_clamantis_in_deserto says:

    The likely vote by the same 5 will confirm two things:
    1) There should be more discussion about impeachment of Justices who regularly demonstrate more care about ideology than concepts of law…

    Besides Breyer, Ginsburg, Sotomayor, and Kagan, who would be your 5th?

    The feigned outrage because this is one of the few appellate courts in the US that is not wholly owned by liberal justices is truly priceless.

    Tell me, bB, do you feel the same about the 9th Circuit Court?

    Doubt it.

  26. The 5 who wrote:

    “Our consideration is limited to the present circumstances, for the problem of equal protection in election processes generally presents many complexities.” (Unlike most weighty decisions, Bush v. Gore had no single author and was delineated “per curiam,” or by the Court, a designation the Justices usually reserve for minor cases.)

    What made the decision in Bush v. Gore so startling was that it was the work of Justices who were considered, to greater or lesser extents, judicial conservatives. On many occasions, these Justices had said that they believed in the preëminence of states’ rights, in a narrow conception of the equal-protection clause of the Fourteenth Amendment, and, above all, in judicial restraint. Bush v. Gore violated those principles. The Supreme Court stepped into the case even though the Florida Supreme Court had been interpreting Florida law; the majority found a violation of the rights of George W. Bush, a white man, to equal protection when these same Justices were becoming ever more stingy in finding violations of the rights of African-Americans; and the Court stopped the recount even before it was completed, and before the Florida courts had a chance to iron out any problems—a classic example of judicial activism, not judicial restraint, by the majority.

    Read more http://www.newyorker.com/talk/comment/2010/12/06/101206taco_talk_toobin#ixzz1reW47ASf

    Read more http://www.newyorker.com/talk/comment/2010/12/06/101206taco_talk_toobin#ixzz1reVmHFJx

  27. The echoes of Bush v. Gore are clearest when it comes to judicial activism. Judicial conservatism was once principally defined as a philosophy of deference to the democratically elected branches of government. But the signature of the Roberts Court has been its willingness, even its eagerness, to overturn the work of legislatures. Brandishing a novel interpretation of the Second Amendment, the Court has either struck down or raised questions about virtually every state and local gun-control law in the nation. In Citizens United v. Federal Election Commission, decided earlier this year, the Court gutted the McCain-Feingold campaign-finance law in service of a legal theory that contradicts about a century of law at the Court. (Citizens United removed limits on corporate expenditures in political campaigns; the decision is, at its core, a boon for Republicans, just as Bush v. Gore was a decade ago.) When the Obama health-care plan reaches the high court for review, as it surely will, one can expect a similar lack of humility from the purported conservatives.

    Read more http://www.newyorker.com/talk/comment/2010/12/06/101206taco_talk_toobin#ixzz1reWSWZ6i

  28. scooter6139 says:

    beerboy – Notice how the right no longer trumpets the idea of an activist court being bad. Now that the “conservative” majority is out redefining law and legal precedent at whim, the conservative right thinks judicial activism is all good. And here I thought only those “liberal” justices were evil for legislating from the bench!
    (Now just watch and some idiot will try and counter, saying the conservative justices are not activist but defending the constitution!)

  29. averageJoseph says:

    “How about the right to protection by law enforcement?”

    Stop makinstuff up. No such right exists. Police have no obligation to protect individuals.

  30. averageJoseph says:

    newyorktimesblog LMAO.

  31. LornaDoone says:

    “Allow us to avoid lawsuits for our negligence and we’ll lower prices”

    Why do the conservatives actually buy into this sort of garbage?

  32. lmao – OK, fine, maybe you have insurance to cover an ass replacement but you still haven’t provided any evidence to support the claim that tort reform will make a significant difference in medical costs.

    Lawsuits have remained at a constant level while medical costs have doubled – explain that.

  33. concernedtacoma7 says:

    It is the size/verdicts that scare doctors into providing meds/procedures above and beyond what is required.

    The insurance premiums for any doctor dealing with infants is beyond insane. Those costs get passed to the user (govt, insurance co, or consumer).

  34. “The insurance premiums for any doctor dealing with infants is beyond insane.”

    And your solution is to make sure the insurance industry is completely unregulated and unfettered in anyway so they can charge….less?
    I have to ask….how stupid are you?

  35. averageJoseph says:

    BigTimeLOL C7.

    You’re confounding both of them with simple common sense.

  36. CT7- ‘providing more than required’ also increases the cost of health care.

  37. averageJoseph says:

    yea, knuckle head. Did you miss the TORT comment?

  38. You’re confounding both of them with simple common sense.

    Simplemindedness is, indeed, confounding when trying to discuss correlation and causation.

    I have requested repeatedly that evidence be shown and, in response, I receive repetitions of common simpleness.

    And Jimm plays cheerleader, imagining that his side is winning…..

    There are several states that have enacted tort reform – if it is the magic bullet you claim then it should be easy to demonstrate that medical costs have fallen as a result.

    If the citations that lawsuits have remained constant, yet the rates for malpractice insurance have risen, it would seem that the culprit would be the Insurance companies….

    That is deductive logic – not simpleness.

  39. “Tort reform would require what exactly? Oh, regulations!”

    Add ‘tort reform’ to the long list of things you don’t understand.
    Amazing the depth of your lack of understanding. I have to wonder if there is any topic that you do understand.

  40. No, it’s the definition of desperation.
    I notice a couple of posters here seem to be able to post anyting they want, with out it ever being removed.
    Why is that?

  41. C7 your statement regarding to stop drawing water from the utility. try it.. You will still get a bill for basic and also the Health Dept will mark your home as inhabitable, same with electric, gas company.
    AJ I guess the police dept and sheriff dept, needs to repaint their autos. To “Protect and Serve” Maybe I can stop paying that portion on my property taxes, since it is not my right, ya think?

  42. aislander says:

    Euphemisms are an impediment to communication. Better to name things as they really are…

  43. concernedtacoma7 says:

    BB- are those not simple and clear terms? If you look at the posts prior to any one of those comments, you would see I did not initiate.

    And I do not think I can take credit for “knucklehead”.

    Klu acts like a child and needs to be spoken to in his language. Like Lardnos, he lingers here for the sole purpose of agitating.

  44. concernedtacoma7 says:

    And in case you needed more proof that the left is just a bunch of soft takers

    http://www.telegraph.co.uk/news/newstopics/howaboutthat/9197597/Strong-men-more-likely-to-vote-Conservative.html

  45. Why did you go there? Do you really want the studies demonstrating that conservatives tend to be more prejudiced and less intelligent?

  46. concernedtacoma7 says:

    Because it was something we all knew but has now been proven. Strike a nerve there? Real men are conservatives. Weak, type-B men are liberals, progressives. Facts are in!

    Quote your surveys on intelligence, race, etc. It will not make you more of a man. It will not make up for the childish, petty, and stupid antics from the left on this board (ref lardnos, klu, FC).

  47. “Euphemisms are an impediment to communication.”

    You mean like
    “fumb”??

  48. “And in case you needed more proof that the left is just a bunch of soft takers”

    A UK tabloid??
    Man you really are a piece of work!

  49. ct7 – you really should reread that study. It shows that conservatives tend to use aggression as a method for solving problems and – in order to demonstrate their manliness – feel a need to build bulky, useless, muscles for show.

    And, your glee about this suggests that you are rather blithely unaware that by claiming bodybuilders as the archetypal conservative you have claimed a “sport” that is dominated by homosexuals….

    You really make me laugh.

  50. anotherID2remember says:

    response to random comments:

    1. Healthcare premiums are not regulated. Enough said.

    2. Ever wonder why you had $2000 dollars worth of diagnostic tests when you went to see the doctor for a cough? oh that’s right, litigation does not drive up health care costs, health care drives up the cost of health care. Think about it clearly now. How would you do your job today if even a potential error could ruin your career at any time over the next 18 years. How expensive would it be to have your taxes done if you could sue your CPA for any error that he made in the last 18 years? Imagine…..any error would result in loss of his/her license and malpractice premiums that go so high he/she is out of business.

    Still think C Y A medicine does not drive up the cost of health care?

  51. And my fanboy continues with his homages….

  52. averageJoseph says:

    Truth hurts huh bB? I see you had the post pointing out your rampant hypocrisy removed. ;)

    I also note your homphobic projection ramping up lately.

  53. Wasn’t me – as my response indicates, I took it as a compliment.

    When someone claims that “real men” are conservatives with such obviously homoerotic imagery it really is difficult not to point it out.

  54. concernedtacoma7 says:

    A little humor (yes, I realize that article should not be taken very seriously) and BB shows his homosexual tendancies or bigotry, A or B.

    Bulk is useless? Sorry bud, but your world of ‘everybody gets a trophy’ ended in pre-K. In the real world having mass pays a dividend, in a bar fight, sports (real men play those to win, even today!), getting a woman, etc. Looks play into how much you get paid or achieve in the workplace.

  55. averageJoseph says:

    You just can’t help yourself tho. Perhaps that you believe it’s obviously homoerotic imagery says more about you.
    My wife watches Dancing with the Stars… maybe those fellas are the one’s you are thinking of?

  56. ct7 – Weight lifting is part of an overall, balanced training system but bulk is useless when it is amassed strictly for show (like the body-builders the article you linked said that you conservatives admire so much).

    All I do is, like the little boy in the Emperor’s New Clothes, is point out the obvious – if you want to deny that your gown is invisible by claiming that my vision must somehow be skewed – oh well, it don’t change reality.

    There are none so blind as those who will not see

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