Sunday, March 28, 2010

Republicans, Facts, Truth and the Future of America.

There is a lot going on in America these days. Republicans have been trying to convince us that health care reform was going to destroy America---leading to care rationing and huge deficits. It's funny isn't it, that they fail to mention that, with 45 million uninsured Americans, we already had a totally unacceptable form of rationing going on in the greatest country on earth for decades----health care only for those who could afford it. Many more of us could not afford it, by the way, if our employers did not offer it. Most of our country's uninsured are working but their employers do not offer it.
What is even more laughable is when Republicans worry about the huge deficits run up by Democrats for programs that benefit all Americans, including the neediest American. They fail to mention that almost all the debt owed by America, and all the huge deficits America has faced, except, technically for the current year, has all been from Republican administrations. They like to run up the debt---but admittedly, not to help out all Americans or needy Americans. They do it for tax cuts for the rich and for wars invading countries after they fabricate threats supposedly against the free world by those countries. All the while, taking their eye off the war on terrorism, and befuddling the balance of power allowing a newly resurgent Iran to threaten the free world.
Now, the Republicans are talking about taking back America for the people. They don't like that President Obama is trying to get as much done by bypassing them as he can. He does this of course because unlike the way the Democrats gave George W. Bush the benefit of the doubt and supported his initial agenda, they have stood in President Obama's way since Day One! Some day, Republicans will remember their roots; as the party of Lincoln, and will once again remember that when they are elected they are supposed to govern for all of the people, not just the few they choose. Until then we need to remind them that the people are watching---and keep them out of office until they learn their place---as civil servants to care for the will of the people, not demagogues imposing their will and policies to the detriment of so many.
Next: My dinner with Satan---The Devil chimes in!


Bruce said...

I can't share your positivity on President Obama's version of health care reform. He fixed the least broken and the most expensive problem (expanding coverage).
While the are problems with who is covered, we structural problems were left to rot. I do not see it as a beginning, but as a feel good measure which will raise costs and leave an out of control system untouched.

LHwrites said...

I have to say I cannot agree with much of that assessment. As I have made it clear here, and what I agree with you, this is not really reform, no structural changes---all true. HOWEVER, I cannot see how you can say it was the least broken part when 45 million (at some points as much as 47 million) Americans did not have health coverage. Expensive, yes. Most expensive? Debatable. You need to factor in the costs of the uninsured to the system and to society for the overuse of emergency care, the lack of early interventions, the lost productivity, etc. I look at that in much more detail elsewhere. In fact, I think you brought up a very good point that will require its own post soon! I also look at what health care for all could cost---if real reforms are instituted. Nevertheless, how I view this is as the single most important step because in the greatest country on earth we should not have so many citizens without coverage. The great tragedy is that with all the effort and cost it is estimated that millions (as much as 10 million) may still go without coverage under this system. This is certainly not a feel good measure for any of the 45 million. I knew a member of that group who put off needed and expensive coronary care for a little too long--and he died. We were working together on a project related to the health company I developed and co-founded in New York for the uninsured back in 2000. As for leaving an out of control system untouched---I do not believe this is the end of reform but the beginning---which is why I bother with this blog and--- (hopefully)---the book. Stay Tuned.

Bruce said...

I promise to read your book.

The reason I say that expanding coverage is the least broken, is because uninsured folks are already 'covered'...admittedly poorly, but they can walk into any ER in the country and receive top flight medical care.

Now if you tell me that ER care is too expensive to be used as primary care, i'd agree. But President O has done nothing to provide an alternative to it, like Primary Care initiatives which would not necessitate enrolling them in plans, but merely provide [cheaper that ER] primary care alternatives in poor neighborhoods.

And without any attempt at tort reform, he's left the playing field ripe for cost escalation.

LHwrites said...

ER care is too expensive, but it also causes crowding and delays for care that is more appropriate for the ER. Also, all ER's are not alike, and you get hospitalized in that hospital which is not always great when it is sometimes the public hospitals more available to those uninsured which don't always provide the level of care they need or should get. However, the President's plan does address this while still, for now, falling short of structural changes or developing preventative care measures. Enrolling them in coverage is the only responsible thing to do, which is why every other nation with a similar standard of living has already worked this out and done it cheaper than we already do it. Yes, I don't want to harm our innovation of free market positives so I don;t ant to socialize our programs by any means, but that does not mean government innovation is wrong when the system clearly does not work for so many millions. However, there is no way to adapt the ER's to provide primary care. That is not what ER's are, or are set up for and turn them into a clinic, which would want to be compensated for their work like any other medical provider anyway. For some reason everyone is looking for solutions that make little sense, are contrary to what they already believe (Mitt Romney and Massachusetts) or in this case, would alter the structure of the way medicine is delivered in a way these structures were never designed to do and could not support that level of activity. Finding a way to expand coverage to everyone fits within our system much better. After factoring in the various costs, and the fact that hospitals should get more reasonable reimbursement for caring for covered patients instead of government subsidies which often fall short in the neediest areas, which would mean the hospitals could start adding more to the economy again, we will see that the costs are outweighed by our joining all of the other civilized nations of the world in 20th Century medical ethics, in time, of course, to start working on the improvements to the system of the 21st century.