Healthcare
Position Paper:
Health Care and the Uninsured/Underinsured
IMPORTANT UPDATE: Since the following position paper was written, it has been announced the 2010/2011 California Budget is late, in the red, and the legislature will be cutting Healthy Child Care and In Home Supportive Services. THIS IS A FALSE ECONOMY, and I want to state for the record I am opposed to both…
Every dollar spent to keep the children of California healthy will pay back dividends of between three to ten dollars, depending on the progression of the flu season and advancement of unchecked childhood diseases. To cut these well child programs simply defers a greater expense into the next fiscal year, possibly at the cost of the lives and well being of our most precious assets… our children…
Although In Home Supportive Services is known to be perhaps the most graft filled, corruption plagued program in state government, such shortcomings are not at the service level, which is precisely where the cuts are scheduled to occur. IHSS allows most of our elderly and disabled citizens to live in their own homes with some measure of independence and dignity. This is made possible by compassionate caregivers who are paid minimum wages, and are supervised by county social workers forced to handle 300% or greater caseloads than they could possibly manage effectively. Yet it is the caregivers and the social workers who will be cut, not the corrupt bureaucracy which drains 4 out of every 5 dollars budgeted for this most compassionate of state services. These cuts will only force many of our most vulnerable family, friends, and neighbors into already overcrowded and inadequate nursing homes with a resulting dramatic decline in life expectancy. Yes, the warehousing of our elderly and disabled may be cheaper… but at what cost to our humanity…*
Once again our Democrat led Legislature has failed in its responsibility and ignored its duty to ensure the health, safety and best interests of the People of the Great State of California…
“Ultimately, every society is judged by how it treats its young, its old, and its infirm… we are failing all three…” Ralph Denney, March, 2004
When is Enough, Enough… November 2nd is when we tell our elected offices we’ve had enough…
* I should disclose before I lost my Mother last year, she was a long time client of IHSS in Riverside County. In defending her rights and ensuring her care under the program, I came to learn far more about the workings of the program than I ever would have imagined. It was almost a constant battle against the unseen and uncaring bureaucracy which through errors and plain meanness was always ‘disqualifying’ her continued care which she paid for by years of taxes and service. Although this doesn’t make me an expert, I suspect I know quite a bit more than the Legislators now playing God with peoples lives, and certainly more than the typical voter who has thankfully never had to battle this monstrosity. My highest praise goes out to her former caregivers and most other caregivers and the social workers and vendors who work long hours doing their best to ensure no one falls through the cracks, and that an unworkable system is tweaked at least enough to somewhat serve their charges. My heartfelt thanks to all of you. And my utmost contempt to the bureaucracy which does nothing constructive and whose sole purpose seems to revolve around creating a deluge of nonsense regulations to justify their paychecks.
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There is a solution to the health care crisis, and like most solutions… this one involves common sense and not government interference…
Once you get past the hyperbole and political maneuvering, we find our great nation actually does have the best and most efficient health care system in the world. The real ‘crisis’ then is not of healthcare itself, but the cost and availability of insurance.
I have been told there is not a constitutional right to healthcare, and certainly that’s true, but it’s also irrelevant. The American people have made it clear they do want and expect an affordable healthcare option. And certainly it is in the best interests of society to ensure the health and wellbeing of its citizens. Not only has history shown us how disruptive untreated decease can become to an entire community, city, or even a nation, prevention and early treatment is simply far less expensive than emergency rooms, extraordinary life saving measures and long hospitals stays.
Certainly, this is an extremely complex issue, and there is no one solution…
Existing Government Run Plans: What about MediCare/MediCal and the VA?
We already have a multitude of state run and federal run healthcare systems. They are the various MediCare/MediCal programs and the Veterans Administration Healthcare system, and they are without question the most poorly run and ineffectual systems in this country. For anyone who believes the government is the best manager of our healthcare, a simple question… if MediCare or MediCal is so good, why does every union organization – including government employee unions – fight so hard to avoid inclusion in these programs?
Any discussion of healthcare reform MUST include reform of these basic government programs. Our veterans deserve the finest care available, and our elderly have already paid for the care they should now be receiving. We must aggressively attack the wanton corruption and abuse of the MediCare and MediCal systems. Such corruption siphons BILLIONS of dollars desperately needed to care for our elderly and disabled Californians.
We also must reduce the conflagration of rampant regulations and bureaucracy which ties the hands of our healthcare professionals and too often deny or delay treatment until it’s simply too late. We must also improve availability by offering reasonable compensation to those healthcare professionals. MediCare and MediCal payments are often so low, they fail to cover the minimum cost of services and medication, forcing many of our most vulnerable to ‘MediQuacks’ because they cannot find a competent doctor or nurse- practitioner who is willing to accept non-emergency MediCal patients.
We must also reinstate such things as dental care and treatment for hearing loss. Especially the absence of dental care can and often does lead to emergency (and costly) medical care because of untreated tooth decay resulting in infection, or failure to catch early other diseases of the mouth traditionally caught by a dentist.
Private Insurance: its cost and availability
Our healthcare system is the envy of the world. Why then must we ‘reform’ that system? The simple truth is we don’t. The term Healthcare Reform’ itself is misleading and inaccurate. What we do desperately need to reform is not the healthcare system itself, but its cost and the availability of affordable heath insurance.
The finest healthcare system in the world is useless if no one can afford it. The cost of healthcare has increased by twice to three times the rate of inflation for more than a generation. We have now reached the point where even a relatively minor hospital stay will cost an uninsured middleclass family their entire life’s savings, and quite possibly drive them into bankruptcy. This is completely unacceptable by any measure of society. Yet, we cannot have true reform until we address the two main reasons for the escalating costs of healthcare and health insurance… Lawsuit Abuse and the Anti-Trust Exemptions of the Insurance Industry.
TORT REFORM: No one is saying that someone who is genuinely harmed by an error, incompetence of, negligence or misdeed of a healthcare professional or institution and isn’t entitled to reasonable compensation for his or her loss. But lawsuit abuse is a cancer which spreads and effects every element of society, causing unimaginable harm not only in healthcare, but also in employment, education, taxation, even home ownership, (please see my position papers on Education, the Budget, and Jobs and Workman’s Compensation). Because of lawsuit abuse, doctors feel compelled to run numerous unnecessary and expensive ‘CYA’ tests which must be paid by someone. It is little wonder that the most historically important element of healthcare – the family doctor – has all but disappeared when malpractice premiums can run the gamete from $50,000. to as much as a half million dollars a year for some specialties. And the problem isn’t restricted to doctors… In the last several years, we have seen an exodus of qualified nurses leave the healthcare industry, causing a severe shortage of qualified and experienced RN’s and LVN’s, greatly diminishing the quality of healthcare when there simply are not enough nurses to properly care for the sick and injured, forcing the remaining to work long hours with inadequate rest or time to de-stress. The bottom line is that the absence of true Tort Reform is costing society billions in added costs, placing quality healthcare and affordable health insurance out of reach for too many.
ANTI-TRUST EXEMPTION: What do Insurance Companies and Professional Baseball have in common… they are both exempt from National and California Anti-trust and Anti-competition laws…
I am an unabashed capitalist, and I make no apologies for it. But the strength of capitalism lies in COMPETITION. Unfortunately, by statute there is no true competition in the insurance industry. Unlike any other industry (except for professional sports), insurance companies are allowed to jointly set prices and mandate what they will pay to medical providers. Because of this, in a period of the greatest economic upheaval we’ve seen since the 1930’s, insurance companies are experiencing record profits at the expense of providers and their insured. Yes, there is supposed to be oversight by the California Insurance Commissioner’s Office. But historically this has been a toothless tiger at best, and barely concealed collusion at worst. The Insurance Industry Anti-Trust Exemption must be eliminated at both the state and federal levels. Any politician who talks about reform without declaring his or her support for this is attempting to mislead the voter.
In Conclusion: The high cost of healthcare and health insurance must be addressed. Although most Americans are in fact covered by health insurance through an employee benefit package, for the first time in history we now find an increasing number of employers dropping their healthcare benefit, or drastically cutting the benefit back. If we don’t find real solutions to the escalating costs of healthcare and health insurance, we just might return to the days of the first half of the 20th century where employer sponsored healthcare was the rare exception instead of the norm.
The Uninsured and Under Insured: Defining the problem and solutions
The Sacramento and Washington Big Government proponents of solving the ‘Health Care Crisis’ are fond of decrying the 40 million uninsured/underinsured people who do not have healthcare. What they don’t say, is that this represents less than 14% of our country’s population! What of the remaining 276,000,000 people?
Studies and polls have continuously shown the vast majority of Americans are quite happy with the health plan they have, and that they are well served by their existing coverage. So why is the Democratic Leadership in Sacramento and Washington so fixated on tearing apart and scrapping a system which not only works, but also provides the best healthcare in the World? That does not however mean we should ignore the most vulnerable of our society. And again, the solution is simple and requires only common sense… Extend MediCare/MediCal to include more of the poor and lower middle class! Or an even better solution would be to grant families a voucher based on reasonable income levels and family age to offset the cost of private insurance. This would allow each family to buy the type of insurance they need and not force them into a ‘one size fits all’ plan.
The problem with all one size plans is that my health needs are not the same as those of a young family with children. While I need some form of prescription coverage, my daughter’s family needs well child and childhood immunization. While I need regular exams for prostrate, colon, and other concerns of men and women of more… experience… my son needs a flu shot once a year that can be given by an EMT and to see a Doctor once in a blue moon. This may be a bit simplistic, but the point is quite valid; one size does not fit all…
The other advantage of a voucher is that they can be combined, say given to an employer or a co-operative, to purchase even better coverage on a group basis.
But even if we simply expand MediCare/MediCal, this solution is still far better, less intrusive, and much less costly or disruptive than the plans now coming out of Sacramento or Washington. However, I do want to make one thing perfectly clear; I will not support either option until we fix the problems identified in the first two sections, Tort Reform and Insurance Exemptions.
Healthcare Availability and Affordability: A more immediate solution
Perhaps there is no more politicized and divisive issue facing our State and our Nation than healthcare… or more misunderstood…
The laws of California, and indeed most if not the entire nation, are such that in reality no one is truly without healthcare. Any homeless person in need of treatment can walk into an emergency room and receive that treatment without cost. When a dear friend of mine went through a rough spot and was unemployed (and uninsured), she developed acute cellulites of the leg, a condition which if untreated could have caused her to not only loose the leg, but if it spread she could have lost her life. She, like so many others, assumed she could not receive healthcare without insurance. I not only got her admitted into Sharp/Hillcrest Hospital, but also helped her receive treatment and outpatient care as an indigent equal to what I would have received as a member of Kaiser Healthcare. But is this a quality and cost effective system we want to continue? Of course not. Is that reason enough to scrap the entire healthcare system that so ably covers 276,000,000 people? Absolutely not…
I remember very well when I attended California Public Schools in the late 50’s and early 60’s when once or twice a year the Los Angeles County Health Department came to our school and gave each of us our required immunization shots. About every third year – or sooner if your teacher noticed a problem - the school nurse would check our vision and hearing. Now most of our schools don’t even have nurses!
Clearly well child examinations and immunizations must be the cornerstone of any healthcare reform. By in some cases going back to the old ways, we can save millions each year while providing better care for our children and preventing many childhood diseases, some of which are making a very regrettable comeback. Polio, measles, flu… these and many other diseases are preventable. In a group setting such as a school, we could by spending a dollar or two prevent the need to spend millions in healthcare to treat the sick children. And is there anything sadder than a sick child?
By the same token, we can invest a relatively small sum in expanding community healthcare clinics to provide for the uninsured and under insured quality treatment at the onset of illness or injury instead of clogging our hospitals and emergency rooms with the indigent The closing of clinics because of ‘budget constraints’ doesn’t make sense to this fiscal conservative.
What does make sense to this fiscal conservative is to allow and make better use of alternative methods of treatment. Not every injury or illness requires a doctor. We could substantially decrease costs and improve overall treatment if we allow better and more effective uses of midwives, doctor’s assistants, nurse-practitioners, specially trained Emergency Medical Technicians, (EMT’s), and other non-traditional healthcare professionals including the easing of certain regulations and restraints placed on their ability to treat.
Healthcare: A National Need Must Have a National Solution
Healthcare Reform is a national issue that must have a national solution. No state… not even California… is large enough or wealthy enough alone to do the things which must be done. For us to embark on this crusade would only place our State’s employers and taxpayers behind an even bigger burden and greater disadvantage than we already are. More jobs would leave the State at a time when our unemployment rate is not only historically high, but is the third highest in the nation. Like it or not, economic recovery must be encouraged, created and protected. The simple and bitter truth is that without more jobs… good paying jobs… the best and most enlightened healthcare system in the world is useless if there’s no one left to pay for it.
We must hold our national representatives accountable to develop a National Healthcare Reform Package which is reasonable, responsive and responsible, as well as affordable & attainable. While I will work with local and State officials of both parties to protect and put in place what measures we can do now and at the state level, I will work with and demand from California’s members of Congress and Federal healthcare officials that they do what must be done on the national level… to provide the People of California a balanced and well thought out National Healthcare Reform Package.
Signed;
Ralph Denney
Revised 12 Sept 2010
For more information, please contact Ralph directly by email at: Ralph@VoteRalph.org .
