political prediction

[beallmd]

this corrupt bigot routinely provides free healthcare including in the middle of the night while watching expenses run wild and profits continually shrink. If you have all the solutions for the corrupt healthcare system, run for office and everyone will immediately elect you when they see how brilliant your solutions are.

[windsrf]

OK, we are finally onto something I do know and care about - no, not "illegal" immigration, but health care. After 20+ years in hospital admin I've seen most of it in action and believe there's one excellent chance to fix, but it does involve clear thinking and not succumbing to blatant lies of the Pharm/Doc/Hospital/Insurance industry propaganda machines.

Sheila Kuehl's SB850 Single Payer initiative will indeed make health care coverage universal and affordable, at least for Californians. Basically it's extending MediCare to all - sort of like what all Federal politicians already have.

http://info.sen.ca.gov/pub/07-08/bill/sen/sb_0801-0850/sb_850_cfa_20070904_200926_sen_floor.html

Before you panic about "gov't run healthcare", take a deep breath and realize that MediCare isn't "run" by the gov't, simply paid for. That simple fact eliminates about 25% of the upfront cost of healthcare due to insurance industry inefficiencies and profit margins. That's where the "affordable" kicks in. As a doc, even BeallMD should understand the value of not having to negotiate and manage 20 different insurance company contracts and paper trails to run his private office. As patients, we should appreciate the value of simply handing a card to the provider of our choice and no further paperwork.

Please note that almost all hospitals and docs take MediCare patients and most hospitals even prefer them now due to profitability as the insurers continue to delay reimbursements and play low-ball bidding games. One example, is that my wife pays $75/month for full Kaiser MediCare coverage, and that rate is down by 25% from last year, while my same non-MediCare Kaiser rate is $407/mo and went up again this year. However, similar potential savings/efficiencies also exist in the non-Kaiser hospital world - where I functioned for my career. And it is true that even private, non-profit hospitals such as Kaiser's, Sutter's, and CHW's need to be in the black financially if we expect them to earthquake-proof their facilities and continue to offer latest state of the art machines/care.

So, you can try to distract by crying "socialized medicine" and/or federally run "bureaucracies", and/or "rationing", but none of that is either true or even on point. And if you work for those insurers, just plan to take a job in the federal system - think good healthcare and retirement plans for you and your family!

Oh, and just to add further relief, by covering even the "illegal immigrants" that Buellmd is so worried about, they will be much more likely to access preventive care and stay out of the ED's as their first resort - further diminishing cost/impact. I've seen the current inefficient process in action as well - but do not believe, other than perhaps in a few border areas, that "illegal immigrants" are anywhere close to the majority of the problem Buellmd describes.

Thanks for listening, David

[beallmd]

I mostly agree with david. Expenses dealing with insurance companies are killing all of us. This is why I said the healthcare environment is totally different from 15 years ago. Govt Healthcare isn't as threatening as it was then. BUT then why did Hilliary say she would NOT offer healthcare coverage to illegals-because she understands the magnitude of the problem. True that shifting the poor out of the ER's would save money and provide better care. Mostly agree, but BUELLMD? That really hurts!

[windsrf]

Sorry about the typo - but my first attempt came out "BullMD" so could have been worse!

Glad you agree with most of my points.

As far as Hillary goes, she is waaay to gun-shy to buck the insurers this go around - which dramatically undermines hers and Obama's proposals in terms of both coverage and cost savings.

David

[nealpar]

Sheila Kuehl is awesome! She was one of my favorite professors at Loyola Law School in 1989-1991. Brilliant and hardworking.

As for the healthcare insurance industry mess, I've experienced first hand (as a patient) major bullshit. It's as if the right hand doesn't know what the left hand is doing on the inside at those companies, or as if they are purposely trying to screw people left and right. No wonder there are so many lawsuits against them.

Immigrants? Don't break out the violins just yet for them "hardworking" immigrants. Fact is that the immigrants are much more savvy and cunning than you'd imagine!!! There is a total undergound system which they use to learn to cheat the system. Whether it's fake SS#, fraudulent marriages, flying under the radar without paying taxes, without paying worker's comp for their businesses, without getting bonded or insured, etc...going to the E.R. and pretending to be broke..... meanwhile they are buying the house next door to you! WAKE UP!!!

[windsrf]

There's always been a bogey-man created for our consumption whenever times are tough. This go-around it just happens to be the "illegal immigrant".

Waking up isn't the problem/solution - it's actually discerning who runs things and why we are in the fix we are in. It's both naive and simplistic to worry much about the scarecrows/red herrings they put out to distract us. Sort of like panicking over "socialized medicine" IMHO.

[nealpar]

[windsrf]

OK, at least we've "reduced" the problem to just one of many. At times it would appear some folks think all our problems would be solved by an impervious border (see Repub candidate rhetoric). Didn't work for China or East Germany, isn't working for Israel, and won't work for us.

Meanwhile, interesting that you emphasize that:
"EUROPE AND CHINA IS (sic) KICKING YOUR ASS!",
as using our "illegal immigrants" is often justified as necessary to compete with China's inexpensive workforce (think WalMart cleaning contractors) and Europe's immigration policies are WAY more open than ours - not that we want to emulate either. However, somehow it doesn't affect Euro economic viability? Or am I missing something in your reasoning?

Finally, I too like that bumper sticker. I just choose to look beyond the rhetoric and more analytically at the situation perhaps.

[nealpar]

[mac]

Hmm, now this has gotten a bit more interesting. Immigration and health care. Definitely problems that need to be solved. Immigration may be the only issue I agreed with Shrub on. We aren’t going to export 12 million people, and it needs some type of bi-partisan action. Congratulations to Tom Tancredo, (characterized by Rolling Stone as “the undisputed king of Republican bigotry”) who made moderation on immigration the third rail of American politics–he gets the modern “Know-Nothing” award. The right-wing Republicans conveniently forget that the existing immigration situation is the product of Ronald Reagan’s presidency, and his close ties to California agriculture. The Republican industrialized agriculture folks wanted borders that were open enough to depress wages. Do any of you remember Cesar Chavez? Reagan was the counterrevolution to farm labor unionization. A solution that left borders open enough to depress wages and fight unionization combined with policies that didn’t pursue enforcement of business, both Reagan policies, have created the situation we have now.

Now the argument of Beallmd that illegal immigrants overwhelm the emergency rooms. Most reputable studies of illegal immigrants conclude that they generate more in tax revenues than they demand–mainly because they are afraid that they will be deported if they go to the doctor, or otherwise ask for tax-supported services. They do depress wages for the poorly educated–that’s their purpose, see Ronny Reagan Poor people overwhelm emergency rooms; it is their only health care recourse. I cannot say that Beall doesn’t see a lot of Hispanics, but I kind of doubt he checks their immigration status carefully in intake. I volunteer in an urban school, and I see lots of kids from multi-generation poverty, and lots if children of Hispanic immigrants. In my experience, the cost and rigors of immigration, legal or illegal, selects pretty industrious people.

I am covered by Kaiser, and I have been badly injured in another state. Almost all of the health care people I have dealt with were wonderful–motivated by care-giving and not so much by money. Very different than people I have met in industry. Their insurance people were a nightmare–they sent literally hundreds of letters to the non-Kaiser hospital where my wife and I were treated, trying to deny coverage. Most of those letters were factually wrong. Eventually, with some strong encouragement from my lawyer, and my calls to the CEO of the organization, the bills got paid. But most of the insurance screening was simply wasted effort by very poorly paid people that knew almost nothing about medicine.

Medical costs are going up more rapidly than other costs for a number of reasons–high tech equipment, rising wages (particular nurses where there is a shortage of supply), increasing obesity in the population (aah, there’s where windsurfing is a public service), an aging population that needs more health care. But the emergency room costs and bureaucracy are a part of it. Hospitals are legally and ethically obliged to care for those who walk into their emergency rooms. We pay those costs, which are much higher than other approaches might be. I don’t see any way in our current political culture that we could move towards a single payer system like Canada’s, whether it is better or not. But I would suggest that one of the questions that we should ask ourselves when we think about presidential candidates, is which one might be the best equipped. Hillary failed under Bill Clinton’s presidency because she simply didn’t have the political skills and she was (and is) a polarizing figure. She also didn’t listen very well to the medical industry. Since then, she’s taken a lot of their money and developed much better political skills, as an incrementalist, while a Senator. It is yours to decide whether she might have a more realistic idea for reform, or she’s sold out to the industry. I am hopeful that the next President works for a health-care reform that provides better preventive care for the poor, less restrictions on changing providers for those already sick, and only modest cost increases by reducing emergency room and bureaucratic costs. Don't hold your breath.