nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
See here for more discussion.

Monday, October 25, 2010

Dragged Kicking And Screaming Into Posting On HCR

Against my desires, I'm writing about health care reform again.

I've kept away from this for a while.  The media seems to have (finally) picked up on some of the intended and unintended consequences of the health care reform (HCR) law.  The last time I wrote a Poison Pill post, it was approximately #36 or so.

You hear it every day now.  Plans being cut back or cancelled, holes where certain populations were overlooked in implementing pre-existing illness provisions, rising costs in anticipation of the need to cover all, government regulated benefit packages that will eliminate alternative plans that some people prefer, elimination of retiree drug benefits, the likelihood that young adults who qualify for health exchange subsidies will be dumped into Medicaid, the un-debated costs to the states that must implement the provisions of the subsidies...  The list goes on and one.

Despite all the reassurances over the last 20 months, I'm hard pressed to come up with a single promise that's been some cases there was blatantly an un-truth, but more often a partial truth (like families with pre-existing illness that can now be covered, but they can't afford it) that ignored consequences.  I discussed most of this back before passage of the law.

As a citizen I'm convinced that we get what we deserve.  It was folly to watch Congressional staffers, lawyers, and academic reform activists draft a hugely complex law.  The whole process was characterized by the absence of input from people who treat people, run clinics, manage hospitals, and have spent a lifetime delivering care to the population.  In other words, the people who know how the system runs, and where it goes off the rails.

As expected, prognostication that the public would like the law once passed have not come true.  We see politicians who supported the law and voted for it neglecting to mention it in their campaigns,  or saying it now needs to be "fixed."  In one case, (Manchin, West Va), a candidate who campaigned for the law during its passage now has the gall to say he wouldn't have voted for it "if he had read it."  Unbelievable.

Allegations that opponents of the law didn't offer alternatives are laughable, but I suppose some will buy into that theme.  There were six comprehensive alternatives offered to Congressional committees during the period of the law's development.  They were unrecognized because nobody mentioned that under our system of party dominance, all committee chairpersons come from the ruling party.  Those Chairs have ultimate control of the committee agenda, so no alternatives saw the light of day.

In summary, when Congress and the President had an opportunity to preserve what's best in our health care system (I've refuted claims to lack of quality in previous posts, here and here), and create the kind of umbrella we wanted over our health care, while creating incentives to reduce that is quintessentially American and in line with our culture of opportunity and growth...they chose instead a top-down, managed care mechanism that created up to 150 new government activities, increased cost, and overlooked patient needs and desires.  A solution that placed ideology over individual patients.

All along there was enough money in the system that could be recouped to accomplish the entire overhaul.  No significant provisions were included to leverage those resources (fraud, tort reform, cross-state insurance plan name just a few).

If all that's too long a summary, try this:  the problem with the new law is incompetence. 

Doc D

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