I understand that you consider health insurance reform an issue near and dear to your heart - I'm sure many Americans share that view.
However, from what I've read of the various bills being tossed back and forth between the Senate and the House, I'm not entirely sure it's being gone about in the right manner. Furthermore; I can't, in good conscience, support a bill that requires a half-box of paper to print and seems to be thoroughly laden with catering to various special interests and contains "privileges" for various districts about the country - city, county, or state level.
And, reforming only coverage (I hesitate to call it "health insurance" - it doesn't follow the same model) isn't the best answer - it's the business model of healthcare itself that needs to be revised, with coverage revision secondary.
You're going to extend coverage to some thirty million currently uncovered Americans - not a bad idea. But, what provision is being made to allow them to have effective coverage in a system that is clearly overburdened as it is? While this may not result in de facto healthcare rationing due to regulation, it's very likely to happen as a matter of course, in response to increased workload and no concurrent increase in available resources.
Where is the money going to come from? We've printed quite enough - the economy is going to take an awful long time to recover (no matter what CBO tries to tell you.) From the taxpayers? That's the last thing we need - let's not place additional burden on the people who can least afford it. On businesses? That's going to eventually come from the taxpayers - where do you think that businesses get their money?
Further, what is being done about the other side of the problem, to wit: any or all of the following:
- People don't have coverage, and go to the ER for a sniffle - because there is no clinic available, and they know they can get the bill met by the taxpayer or written off by the hospital if they can't pay?
- People have coverage, and think that entitles them to head to the ER for minor issues (as someone recently relieved of the burden of giving care to a chronically ill elderly family member, I've seen plenty of people in the ER who really shouldn't have gone.)
- There are no "urgent care" or "ready care" clinics readily availble - which would reduce the load on the ER considerably. Go /there/ for a sniffle, and save the ER for major cases and trauma cases. Patients with minor ailments will be seen more quickly at a neighbourhood clinic, and triage at the ER will be simplified greatly.
And, to throw in another factor - what about billing by the hospitals and such? I had a four-day stay (trauma case) about four and a half years ago, where I was essentially "under observation" in the neurological ward for massive CNS trauma - I shall spare you the details for the moment. That four days in hospital - no surgery; merely observation, board & care, and a morphine drip - was billed at a cost of forty-eight thousand dollars and some change to the coverage plan we had then. While I know that hospital staff are not inexpensive, I have a difficult time believing they cost that much (particularly when the hospital accepted somewhat less than twenty thousand dollars in payment from the coverage plan, and then came after us for further payment - until I referred them back to the coverage plan.) Something seems amiss, there...
So, what do I finally think?
1) It is not merely coverage that needs to be overhauled. There is a significant disparity between what facilities (in particular) charge and what they get paid, so a better negotiation process really needs to happen there. The industry as a whole could probably stand to have its processes revised.
2) The structuring of the healthcare industry could stand a few changes - adding a "ready care/urgent care" clinic for a certain per capital population or for a certain geographical area would have a few net beneficial effects - reduction of healthcare costs (anything involving an Emergency Room gets expensive quickly!) reduction of ER workload (minor cases can go to the clinic, reserving the ER for majors or trauma,) the reduced cost makes it more likely that the bill would get paid (which would reduce costs all around, once it gets properly seen to,) workload would be reduced on private general practitioners (which would be drastically needed!) and the hospitals, private general practitioners, and private specialists could then focus on the people who really do require help (instead of the people who are generally healthy, and require little more than annual physicals.)
3) Improved negotiations between providers and coverers. Reduce the disparity between requested and paid amounts, and reduce the losses on hospitals (so they don't close up) and coverers (so premiums could then drop.)
4) It may be necessary to change the business model of the coverers. A 'corporation' as long been defined as an essentially sociopathic legal entity whose sole and only responsibility has been to the shareholders, and this has been upheld in court. While I don't enjoy that idea in general, for a healthcare facility, provider, or coverer to take such an attitude is definitely detrimental to the general health and well-being of the American public.
Madam Representative, I'm sure you'd like to see this bill pass. I know that President Obama wants to see this bill pass. Further, I know that I would like to see 'effective reform' pass - but I also know that this bill is not 'effective reform'. Truly effective reform will be balanced coverage across the Nation (with no preferential treatment for anyone anywhere,) will have a net positive effect on the people first and the industry second, and won't result in heavily overworked providers or "rationed care" - either in fact or by regulation. Yes, we as Americans do need to quit going in to the doctor or ER so much - but that needs to be done by individual Americans and not by regulation. "Rationing by regulation" will benefit no-one, and "rationing in fact" will likewise benefit no-one.
I have offered up a two-sided solution to the matter to Speaker Pelosi in the past - this may be readily reconciled without so much verbiage to wade through. Either put the entire American citizenship on the plan that you all enjoy, as elected officials; or put the entire American citizenship - including elected officials such as yourself - on MediCare and sort the problems out afterwards. This should also take care of the growing concern over having to assess taxes against "Cadillac healthcare plans."
I have decided to make a response necessary simply because I recieved /no/ response of any sort from Speaker Pelosi, and that shows a lack of concern for the wishes of the body politic - which is who you and your colleagues are supposed to be there to represent. I didn't even get a form letter with a stamped signature at the bottom, or a "boilerplate" email.
Not wanting to talk to your constituents is a mistake - not only does it show a lack of regard for the people who put you in that job, but you'll miss a great deal (many of us are intelligent people, and we see these problems firsthand. You'd be more likely to get a good solution - or a good start on a solution - from polling us than you would from the "experts" you tend to rely on - who breathe air just as rarefied as you yourselves, and are just as out of touch as you and your lot seem to be. Come out of your offices and talk to us and with us, not at us...)
Failing all of the above; should I find you have cast an "Aye" vote on this bill, I shall make it a personal priority to unseat you (and anyone else voting "Aye," for that matter) at this coming mid-term election. Madam Representative, it's time to clean the House. Will you pick up a broom and help us, or be swept away?
Jon D. Kelley
San Jose, CA; Sixteenth District
