"Universal Health Care" - Pelosi

Figuring that someone needed to say something reasonably coherent (and, for me, not terribly wordy...) about the whole "universal healthcare" debacle, I've just sent this message to Speaker of the House Nancy Pelosi.

Will it help? Probably not. But, taking the effort and having it fail is certainly better than not taking any effort at all. I'll probably write something similar to President Obama, and I'll put that up here as well.

----- SNIP -----

Speaker Pelosi -
I've been hearing much in the news of late about the "universal healthcare bill" being tossed around in committee, and I'd like to take a moment to weigh in with the comments of a constituent:

1) I find it worrisome that not only is the wretched thing some 1100 pages long, but everyone seems to be in a hurry to pass this thing. Has anyone actually read it all the way through? If not, why are we trying to accelerate a vote on it? How can anyone, in good conscience, vote on something they haven't even read, much less understand?

2) Why are so many pages needed to describe what needs to be done? I'm writing technical books that are considerably shorter than that, and I've got engineering texts that go into much greater detail on subjects in fewer pages - and give a better understanding of the topic at hand (I must admit, I've not even read the thing yet - legislative language tends to be a cure for insomnia for me. However, this sort of thing is what you and your colleagues are paid to do - so you should be able to read it, and you should be provided with the opportunity to do so.)

3) I've also been given to understand that there is to be no tort reform in this bill. Pity that - tort reform would be one of the single greatest things that could be done to bring medical costs down overall! Raise the bar for a malpractise suit to proceed (have a panel akin to a Grand Jury that hears the initial merits of the case, and decides whether or not true malpractise actually occurred, for instance;) and the cost of malpractise insurance should drop sharply. Considering what a malpractise policy typically goes for, this would be HUGE.

4) Streamlining the FDA approval process for new drugs (or - and possibly more importantly - the manufacture of ALREADY ESTABLISHED generic versions of drugs on the market) would work wonders for bringing the costs of prescriptions down. I'm on several due to a massive physical trauma I sustained in NOV2005, and they're expensive even with insurance (seeing the "Your Insurance Saved You:" line on the receipt worries me greatly... Most of this stuff is second-tier or third-tier on the schedule for our insurance plan.) Pharmaceutical companies seem to be willing to work with patients if asked. Medicare recipients can get supplemental coverage (through AARP) for a reasonable cost to bring their prescription costs down to effectively nothing out-of-pocket at the pharmacy. If the FDA simplifies their approval process for generics (simply making the manufacturer hold to quality materials and proper manufacturing processes, instead of having to do pretty much the entire process over again,) then MOST OF US would be able to get our prescriptions covered fully or nearly fully by insurance.

5) Make it easier for service providers to deal with insurance companies, and vice versa. Perhaps have the fixed "Medicare negotiated rate" paid out by any insurance company - this should effectively eliminate overbilling as a negotiation tool with individual insurance companies, and should help to get more providers "in network" for various insured persons using an employer's plan.

6) I've also read in the news how some of your colleagues are considering fining people for NOT carrying insurance under the new plan. I'm not so certain this is a good idea - allow me to modify it slightly:
- There are people who don't carry health insurance in general, paying out of pocket (OOP) for their physical every year or so instead. Why? Because they're reasonably healthy, and paying OOP for the annual (or so) checkup is cheaper than carrying a regular healthcare plan.
- Many of these people have a catastrophic medical coverage plan ("cat coverage",) which covers them in the event of a massive trauma or illness.
- There are also people who, I am sure, WILL NOT BE ABLE TO AFFORD any insurance plan. I'm sure you've heard the phrase "working poor?" There are more of them than you probably think. If they can't afford coverage, how will they afford to pay the fine for not having it?

Offer a "cat coverage" plan for the healthy, since that's really all they need.

For the "uninsured" who end up going to the ER at a County hospital for even a mild case of the sniffles, perhaps having "neighbourhood clinics" for that sort of thing will bring the ultimate costs down, reduce the billable expense, and perhaps enable low-income people to be able to actually pay AT LEAST SOME of their billable expenses, or carry coverage that can cost less due to the availability of a clinic? The clinic may be located near an ER - anyone who gets triaged as "non-critical" would then be sent to the clinic, rather than treated in the ER. This would also free up ER resources - having been a trauma case a few times myself, and being a caretaker for an end-stage emphysema patient (my mother-in-law,) this would be a good thing for me. I see people in the ER that I would like to honestly check for malingering, myself.

I place myself at your disposal for further discussion. However, I feel that further discussion IS necessary - with whomever, but preferably with constituents who actually have to DEAL with this sort of thing - before action be taken. Rushing this sort of thing through committee, through voting, and for the President's signature can not possibly be a good idea.

However, if you and your colleages are in such an all-fired hurry to pass this, please allow me to offer a couple of options:

1) ALL CITIZENS go on Medicare. Yep - including you and your colleages. That should handle any perceived disparities in the system (and probably get Medicare sorted rather quickly to boot.)

2) ALL CITIZENS go on whatever plan you have. It must be good - I'm sure Senator Ted Kennedy never even saw a bill for his medical treatment before he expired (I had to fight to get a bill dismissed as "Paid By Insurance" after my trauma four years ago. Not fun to do. Took only two months.)

Either one should put everyone on an equal footing and make access to healthcare more "universal" than it is now. I'm sure most of American would prefer the second option - especially those of us who are tired of fighting with insurance companies.

I certainly shan't argue that something does need to be done. However, it should NOT be done in a hurry, it should NOT be made overly complex, and it SHOULD be carefully thought-out and discussed out in the open - and made relatively equal for EVERYONE. A line from Orwell comes to mind whenever I see a news blurb on this: "All animals are created equal, but some animals are more equal than others."