Thursday, January 22, 2009

A Sign Of Worried Folks

The Steelers are going to the Super Bowl and Obama was inaugurated this week.

So what is the theme of the "most e-mailed" stories from the Post-Gazette?

Ouch. I guess we do care about something besides football.


Bram Reichbaum said...

Of the several, "Highmark Merger Called Off" strikes me not as bad news, or even the result of bad economic news as prologue. The scrutiny this merger would have generated would have been intense, and the lack of competition it would have brought about (among non-profits currently enjoying $3B+ in profits) would have been troublesome.

Crystal Eastman said...

Yeah, that's actually great news.

Jermaine said...

The sooner they figure out a way to remove PROFIT from the healthcare industry the better! Taking care of our people shouldn't be done in order to turn a buck. Hopefully Obama and the new administration can finally make a push to get this worked out once and for all.

Bram Reichbaum said...

Whoa, Jermaine! I feel your frustration, but I think when it comes to health care the profit motive needs to be curbed, not exactly extinguished.

Crystal Eastman said...

I agree with you Jermaine.

EdHeath said...

We do realize that Highmark and UPMC are both not-for-profit companies... OK, after the laughter dies down, I will point out that some people who are smart but do not feel a calling to any particular business become doctors,. because being smart can be an asset in medicine. Now, I will suggest that much of the rise in the cost of medicine in general has to do with the perverse incentives caused by the creation of private health insurance in the fifties (or so), and medicine still has a perverse relationship with health insurance. That said, there is something to the notion that the quality of certain types of medicine will go down in certain instances if we nationalize healthcare (even as the quality of care will go up in other instances). Specifically, doctors for the rich will go into other fields if they are paid as much. Since the rich give the most money to politicians, there will continue to be resistance to the idea of nationalized healthcare, or indeed too much in the way of curbs on the increase in profits. That said, the ideas of increasing technology in healthcare, such as using wireless PDA’s to access and update medical records in real time, and medical records being available for doctors to access through the internet, promise to reduce the incidence f medical mistakes and improve the quality of care for all.

Jermaine said...

I've been fortunate enough to travel around to a few different countries in Europe and have found some of their systems to be far in advance of ours.

I find it extremely ironic that we're currently under a system in which you "shop" for health coverage. I'm surprised they don't sell pace-makers at wal-mart, and sadly enough it probably won't be long before we're reading the ads in the Sunday newspaper searching for the best deal on a given medical procedure as if it's a deal on strawberries.

Maybe I'm way off base here, but I'm simply of the opinion that a true measure of a society is how well it treats its citizens....NOT simply the rich.

To Bram, healthcare companies (Corporations) should only be in the business to break even. I don't mind high slaries, but what's the point in always pushing for the extra buck when it means turning people down for care they really really need?

To EdHealth, I appreciate your opinion (we're all civil here), but I think it's a cop out to say that if doctors didn't earn as much as they do we'd have less qualified doctors! How much money does it take to be happy? What's the difference between 300k a year while working somewhat normal hours and 500k while working 70+ hour weeks? How many cars does one person really need?

Who does rich person deserve better healthcare? Are we not all people? Are we not all Americans? Think about that question for a minute.

Look forward to reading your response.

EdHeath said...

Actually, I wasn't really giving my opinion so much as what I think the opinions of free market advocates might be (I am more of a free market with increased oversight advocate myself, in general, and a single payer system advocate for healthcare). As I said, I do blame the rise in health care costs more on the interaction between medicine and health insurance. But I am also curious what people who oppose nationalizing health care (let’s call them some random name, like “Republicans”) mean when they say we have the best health care in the world. Since aggregated health care indices for the US are pretty low, the “Republicans” must mean that the people who have a combination of a lot of discretionary income and the best health insurance in the country must also get the best health care in the world. I think they are worried that if we act as if rich people don’t deserve to get better care than everyone else, then rich people might not get better care than everyone else (shudder).

There is an interesting parallel with the justice system. In theory, everyone is equal before the law. In reality, the rich can afford to hire the smartest (and most expensive) lawyers around, people who will research and find obscure precedents and then charm and beguile a jury. The rest of us get Joel Hyatt’s minions (unless we happen to have a juicy product liability case, in which case we get Edger Snyder’s minions). But if the rich didn’t get better treatment in the justice system (even though they have to pay for it), they would either buy Congress or buy their own army (whichever was more cost effective) and change the system to benefit themselves.

So my point is that as we start to mess with the healthcare system, we need to be mindful that there are powerful interests on the other side. If Obama says we have to go slow, or start by introducing more technology into healthcare (to raise everyone’s quality of care), that would be because he is aware he can’t change things too fast, or fact pushback from the Republican/wealthy elite establishment that had things their own way for the last eight years.

Jermaine said...


Very well written and clearly explained answer. I actually chuckled when you decided to throw out "some random name" to classify those who may be opposed to any changes in our current sick-care system.

You're right in saying that change (if it is to indeed come) will happen slowly. However, can it be done in less than 4 years? Less than 8 years? What are the chances that we as a united people will continue to push for the greater good by electing officials who will fight our cause?

I think the key here is not classifying healthcare as "better or worse" "less or more expensive". The best possible care should be available to all, and it should be paid for by all of us.

More people alive and healthy equals more workers paying more tax dollars into the system. It'd be easy to get off on a tangent about the amazing level of obese people in America (compared to other countries), but how much of that is due to income? It's sad. It's sad that people sneak to Canada for healthcare. We pride ourselves on so many things here and are quick to say "we're number 1" let's be number one in health care as well.

How long will it take?

EdHeath said...

Jermaine, I dunno how long it will take to tackle healthcare. By the way, I didn’t answer your previous question about why doctors feel they need to be well paid. That’s a pretty complicated subject in and of itself. I often wonder how PhD’s feel when their some what less intelligent roommates from undergraduate (Harvard, Stanford, Duke, Chicago, Penn, what have you) go into business and pull in 50 million dollars in salary and stock options in one year, while the smarter PhD is still paying college loans and limping along on a low six figure academic salary (well, limping comfortably but perhaps not grandly). I heard (second hand) that Herbert Simon once spoke at the Shadyside church and said that you can’t really say that a CEO expends more effort in their job than a janitor does, just a different sort of effort.

That said, we measure our success by how well we are paid in our field. As you say, doctors often work quite long hours. Some expect to be compensated for their intelligent application of their medical knowledge, and future potential doctors may decide to go into business or some other field if they think they will not be as highly paid in medicine. That’s just a fact of life, something the nation will have to deal with as mre universal healthcare is implemented.

As for how long it will take, it looks like the Obama administration does not want to waste time tackling everything. I expect to see measures this spring on introducing more technology into medicine, and a bill that sets up the system where the uninsured are offered insurance some time in the summer. Just my personal guess. Remember, the Obama plan is not true universal health care and is certainly not a single payer system. We might see a single payer system in our lifetimes, but only if we follow the advice of our doctors (eat healthy and exercise). Otherwise we’ll be some worried folks, just like the post said (why do I hear the Kingston Trio?).

Bram Reichbaum said...

Jermaine - I can't really argue with that, except to say that we do need continued heroic efforts and innovation in the field of health care, AND we need to generate these efforts (to paraphrase Don Rumsfeld) using the culture that we have, not a culture we do not have or a culture we may wish to have at a future time.

To the extent that Europeans have a more sensible health care system, I don't think it's because they figured anything out; I think it's because they have a more balanced culture all-around. And when it comes to changing the culture, I guess I (like Ed Heath I suppose) am an incrementalist, and incrementalists may be naturally allergic to dogma.