Subject: RE: Health care or Homeland security?
From:
Socorro
Date: 28 Sep 02 - 08:50 PM
I won't address "homeland security" because I don't really have anything worth listening to re:that. My mind & heart make me pacifist, yet I have noticed very strong, & very physical self-defense-instincts in me, which may or may not be my "lower self" – I just don't know. However, I have a lot of experience in the Health-Care-System of the U.S. I spent 20 yrs as an RN, first in hospitals, then in Home Health as Case Manager, so I'm going to contribute a few thoughts: 1. "Fee-for-Service" (the system which preceded "Managed Care") was problematic, because there was nothing to set a ceiling on expenditures, for those who had health insurance. 2. "Managed Care" provided problems for providers (eg doctors, nurses in independent practice) – also hospitals & other institutions, but institutions don't have consciences, and cannot empathize with others' suffering, so they are in a different category. One major problem was: Provider believes certain treatments are appropriate. Insurer refuses to pay. Provider tells insurance company (to paraphrase) "How can you bastards refuse to pay for this obviously needed treatment?" Insurance company, "Well, if your conscience is so delicate, go ahead & provide the treatment, but we won't pay for it". 3. So-called "rationing". In the U.S. now, the only persons who have "socialized" medical care (that I can think of now) are all our congresspeople & their families, and the military. The rest of us participate in the "Free Market", which may work well when you're young & healthy – but try wrangling with an insurance company when you're in pain, old, or very ill. The deck is stacked against you, & it is truly kicking a person who is down.
That said, I know that, being practical, rationing is necessary, as no entity could provide every treatment for every person. Somehow our society will have to decide what care we will provide "socially". I would start with ex-Surgeon General Everett Koop's proposal that every citizen should have emergency, preventive, and catastrophic care covered. Beyond that, the state of Oregon made an attempt to face the issue head-on, when they devised a plan for allotting their Medicaid budget. They produced a system which used a panel of experts to rate treatments on a cost/benefit basis, from most beneficial/lowest cost, to the opposite. When they knew their annual budget, the plan was to draw a line at the place in the list, where the money ran out, and not provide anything below that line. (To vastly over-simplify). I saw this as a valuable exercise in facing reality, but the 1st President Bush over-rode the state's plan, so we lost a chance to start the societal debate. I may be optimistic to believe that conscious decision would be preferable to what we have now, but i would personally appreciate seeing what our society really does believe about the rights of a person to health care (the limits, who qualifies & why...). Now, it's more or less survival of the fittest, which is too like a jungle for my particular taste.
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sj
