Thursday, September 10, 2009

Journey Stories Exhibit at Historic Foundation

It would seem to me that the Smithsonian Institute would be quite meticulous in choosing sites for it's traveling exhibits, so the fact that we have this extraordinary SI gem spending a little over a month in Natchez, is extraordinary in itself. Mimi Miller has been working elbow to elbow with the SI staff in setting up the information panels that make up the exhibit, as well as with a few locals who volunteered to pitch in during the installation process. The exhibit will be showcased at the Historic Natchez Foundation building from Sept. 5th - Oct. 20th. Journey Stories documents the travels of the pioneer families who braved traveling across our great country under an array of arduous conditions. It answers the questions "Why did our ancestors come to America? Why did our families choose Natchez as home? The Journey Stories exhibition explores four centuries of American history through images, audio clips, music, maps, and artifacts. Visitors will listen to stories of travelers and trace their routes on an interactive map; read harrowing accounts of escaped slaves on the road to freedom; and use an 1859 guidebook to prepare for a westward trip on an overland trail. The exhibit is worthy of academic field trips, and material for school projects, so if you're a teacher, it would be a wonderful educational tool for students to learn about how the U.S. was born and what it took to bring us to where we are today.

Sunday, September 06, 2009

Why are Health Care Costs So High - and Growing

The real problem is that our health care delivery system is based on a model that makes no economic sense. The system is broken and needs to be redesigned. The current debate seems to assume this is a fight between the free market and socialism. Although there are people who would like us to go one way or the other, our current system is neither.

Our current health system is not that old. It started during World War II when wages were frozen. Employers, looking for new ways to attract workers, came up with the idea of providing health insurance. Thus began employer based health insurance, which is how most Americans get their insurance.

In most economic transactions in America, there is a consumer and a provider of the product/service. If the consumer doesn't like the product quality or price, they go to another provider. Providers keep their quality and prices competitive to keep their customers.

In health care, patients are the consumers, but they don't pay for the service and rarely even know the price. They don't have sufficient knowledge to evaluate the quality of the service - and even if they did, they have limited choices in providers.

Doctors are the providers of the service, but they don't get to set the price, and the price is not determined by any measure of quality, but rather of quantity.

In our crazy health care system, neither the consumers (patients) or providers (doctors) have anything to do with setting the price.

Instead, the insurance companies serve as the providers, and the employers serve as the consumers. They are the ones operating in the free market, and neither has any interest in what's happening to patients or doctors.

Employers and insurance companies are both motivated by the bottom line - their profits and stock prices. So employers try to spend as little as possible on insurance. Insurance companies make their product as cheap as needed to get the business of the employer.

Employers upset with health care costs shop around until they find a lower cost insurer and/or increase the share paid by their employees. If they're too small to be able to negotiate a good deal with insurers, they may just quit offering insurance. But whatever they pay is totally deductible from their taxes.

Insurance companies keep their prices as low as needed to keep their customers, the employers. Then in order to make a profit, they just reduce their costs. They do this in many different ways. They lower their payments to doctors, they reduce procedures they reimburse, they increase the paperwork needed to get reimbursement to discourage use, etc.

Doctors find their payment for procedures reduced, and their overhead increased through hiring more staff to process the paperwork. Therefore, they must perform more procedures just to keep even, which reduces time spent with patients. Doctors also (consciously or not) perform procedures that pay more.

There are other complicating factors. Drug companies and for profit hospitals that are also operating under the profit motive. Nonprofit hospitals are more like doctors. Then there all those individuals with individual or small group policies that just buy whatever they can afford, regardless of their health needs. All the uninsured, growing daily, also affect the market. Medicare and Medicaid are another different problem.

It is easy to see that our accidental health care delivery system is totally dysfunctional. If we want to ever bring health costs under control, we have to change the system to recognize real incentives that work - and it must be done now!

If we don't change it now while we have the opportunity, our country will shortly be bankrupted by totally unnecessary health care costs. We could have a fair, cost effective system, but that would require the Republicans to enter into a discussion and debate of real issues. Unfortunately, most Republicans in Congress are more interested in defeating Obama than they are in the economic well being of their country or the health of its citizens. Very sad.

In my next post, I'll discuss elements of reform that could be agreed upon.

Tuesday, September 01, 2009

Health Care Reform or Bankruptcy - Take Your Pick

Have you heard all the scary things that will happen if health care reform passes? Most of them are untrue or misleading, but that doesn't matter. Unfortunately, big issues like this are never won with facts, reason, or logic. Emotional appeals always win the day - and there is no stronger emotion than fear to motivate people.

Those in favor of reform are busy spouting off facts - and they're getting their butts kicked by the opponents who just bring up every bogeyman they can think of - eg death panels, rationing, increased taxes - without worrying a bit about the truth. The truth is irrelevant in this fight. Of course, the scare mongers have the advantage of having gazillions of dollars to spend on their horror show. After all, those who truly stand to benefit from doing nothing are all wealthy - and they're willing to spend plenty to be sure they stay wealthy. Whereas those people without insurance or who have huge medical bills don't have any money to spend at all. Not a very fair fight, is it?


First of all, health care reform is not just about the uninsured - it's for everybody - even you.

Individual health insurance or insurance for small groups is not worth the paper it's written on. If you have that kind of insurance, you may as well consider yourself uninsured right now - and it's only going to get worse. A far better investment is to take the same money and buy lottery tickets - your odds of pay off are much better.

The only dependable health insurance nowadays is with large employers. However, the costs for that health insurance more than doubled in the last ten years and will double again in far less than the next ten. What does that mean to you as an employee?

You will be asked to pay a larger and larger share in premiums, deductibles, and copays. It will be twice as much as it is now in less than ten years.

More and more employers will stop providing health insurance at all to their employees - and you'll be unexpectedly uninsured.

If you lose your job, you're suddenly uninsured. Forget about COBRA - no unemployed person can afford it.

Your taxes will go way up to pay for Medicare and Medicaid, which will be half of all health care spending in just three years, and other government programs.

If you like your health insurance now, it's likely because you haven't been seriously ill. Think you won't need it? Think about this.

Your chance of having cancer in your lifetime is 1/2 for males and 1/3 for females.

Cancer patients can face severe challenges in paying for life-saving care – running up large debts, filing for personal bankruptcy, and even delaying or forgoing potentially life-saving treatment – even when they have private health insurance, according to a new report by the Kaiser Family Foundation and the American Cancer Society.

You or someone in your immediately family is going to be seriously ill sooner than you think. And when it happens, unless you're very wealthy, your family can be financially destroyed. 62 percent of all bankruptcies filed in 2007 were linked to medical expenses. Of those who filed for bankruptcy, nearly 80 percent had health insurance.

OUR HEALTH CARE SYSTEM IS A FINANCIAL DISASTER RIGHT NOW. If we don't do something drastic about it immediately, we can forget about the financial survival of our country. Opponents carry on about the horrors of having a European health care system. How about the health care system of a third world banana republic? Because that's where we're headed right now.

And I haven't even touched quality of care yet.

Be scared - be very scared - not of made up bogeymen but of the truth.