posted by meowser
Sandy from Junkfood Science just posted a long reply to my last post; since the thread had died by then, I thought I’d put it up top, because there are some issues she brings up that I wanted to tackle (and give other people a chance to also). This is the post in its entirety:
Arguments based on the past are irrelevant when we’re discussing healthcare REFORM. For everyone’s sake, the fat community desperately needs to understand the reality of what is being planned and put into place, the complete picture and consequences, and understand what words (like ‘quality’ of care) actually mean — not get caught up in what they’d like to see happen or what they think is right. Nor can anyone afford to believe media, anecdotes and social marketing. (RWJF interests, for example, have widely infiltrated online communities.)
The noncompliance examples given are spurious. What will label doctors noncompliant are pay-for-performance measures — those clinical guidelines and performance measures that make money for stakeholders (i.e. pharma). The medical literature has well documented that most all of these P4P measures are unsound and don’t actually improve patient outcomes or lower costs (and are all too often to the detriment of certain patients), yet the interests beind them have imbedded themselves in every level of the HHS and the CDC (see July 30th post). Under government managed care, the numbers of P4P measures have exploded and the consequences for doctors who fail to comply with them are steadily becoming more severe. Doctors who don’t do what the government says, already find their livelihood and licensure jeopardized (failure to comply is already on a schedule of increasing pay cuts, and negative ratings on their practices). Electronic medical records that are being required of every Medicaid/Medicare provider are being set up to monitor their compliance to P4P measures (tests ordered, prescriptions written, etc.) which will determine their pay, and automatically report their patients’s (our) medical information to the government to identify those for case management by government/insurance company. Medicare already pays doctors and hospitals 20-30% less than comparables, Medicaid pays 30-40% less, meaning fewer doctors and hospitals can afford to care for the poor. More importantly, out of necessity, care is restricted to what the government will cover.
Compounding the discrimination, they aim to pay doctors based on patient outcomes –- which means if you are fat or have a chronic disease and your health indices don’t meet guidelines, your doctor will receive less reimbursement –- doctors won’t be able to afford to take care of these patients and the patients will have increasing difficulty finding a doctor practice to accept them. Under their planned medical home model of government managed care, however, we won’t have the ability to just go to see any doctor to get the care we want. Instead, you’ll get the cheapest care because you’re costing the practice and hospital. Politicians are also looking at some troubling ways to ‘incentivize’ compliance among patients, calling it tough love. Look at what already happened to poor mothers on Medicaid in increasing places — noncompliance with healthy lifestyles contracts means no more government assistance or additional subsidized care needed for their special needs babies. There is nothing moral or compassionate about third-party health management.
You really don’t want your doctor having to answer to a third party payer (the government or government insurance plan), rather than provide the care he/she feels is best for you (especially if you are fat, aging, poor or have a disability). That also goes against every tenet of medical ethics. It’s why so many doctors and nurses have and will leave the profession rather than be forced to do that. Their conscience won’t let them be shills for pharmaceutical companies and political stakeholders or, worse, have to participate in things they know will hurt people.
Stakeholders are promoting bariatrics and weight loss interventions as saving the system money (while actually making THEM money) — they are not interested in the efficacy (soundness of the scientific evidence), long-range complications and deaths. Fat people are seen as undesirables in the prejudicial visions they have for a healthy perfect populace. But, the public largely believes obesity is a person’s fault and the obesity industry realized years ago that the public wouldn’t support paying for weight loss interventions for fat people – that’s why those same interests starting making it about their ‘health’ and turning to ‘obesity-related’ health indices, with a pill and lifestyle intervention for each. Another example of the need to understand what is going on: Did you know they are already eliminating funding for repeat hospitalizations for complications from the same diagnosis for all patients under government healthcare (Medicare/Medicaid)? This most affects elderly, about 20% of whom are rehospitalized after a medical incident due to complications. (And bariatric patients, of course.) Talking with ICU nurses last weekend, they were in tears because they saw that they were going to have to turn people away or give minimal care because the hospital was facing being unable to afford to provide it free and without compensation. And the hospital had already cut staffing, especially of the most experienced medical professionals, and they were being worked to death with mandatory overtime.
The most significant consequence of the clinical guidelines and pay for performance guidelines under managed care will be denying subsidized care to fat people who haven’t lost weight, to the disabled and to seniors; or providing suboptimum care. Such people are being said to be burdens on the system and not cost effective to expend much money on, under the comparative analysis method they are planning to use to prioritize healthcare spending. You need to understand how healthcare spending is planning to be allotted.
Most important: You are confusing health COVERAGE with heathCARE. As Big Liberty said, what will happen is that fat people and seniors who need care beyond the government’s free basic coverage, will have to find a way to pay for it themselves or suffer. Discrimination can be disguised as equitable.
The best hope for fat people and everyone getting older is a system that allows as many choices of plans and care providers as possible. Not one where the government eliminates their options.
First, Sandy, thanks for stopping by.
But I do think the past (especially the recent past) with regards to UHC is very relevant. You’re trying to tell us that we’re going to be the only country on the face of the earth where, if UHC is implemented, Big Brother is going to force us to live on plain broccoli and work out five hours a day and we’d better like it, when even current forms of U.S. government-sponsored health care, by all indications, are NOT like that. I have recent experience working at a VA Hospital; I did their medical records. Believe me, if they were only treating total goody-two-shoes whose abs you could bounce dimes off of, they wouldn’t treat anybody.
Also, all the problems you mentioned about third-party interference in care are going on right now. You’ve even written about it yourself! American doctors right now are experiencing more and more bean-counter interference from third parties (i.e. insurance companies). People kill themselves because they can’t get care approved by the bean counters.
This American for-profit health care wonderland where nobody interferes with individual doctor-patient decisions, and those decisions are always made in the patient’s best interests, doesn’t exist. (Just ask anyone who’s tried to get a birth control pill or Plan B scrip filled in the Bible Belt.) In fact, it’s likely it never really has; in the pre-HMO days, we (especially us hysterical wimmenz!) had to worry about sleazy doctors and hospitals goading us into accepting medically unnecessary surgeries and other treatments to line their pockets; now, in the name of preserving the ludicrously overprivileged lifestyle of insurance company executives, we are told that the care we’ve paid all our lives for might not be there at all when we need it, and that that’s just the way it is.
You (and also Big Liberty) seem to think all we need to do to get everyone completely covered without bean-counter interference is to allow everyone to purchase policies from out of state. Maybe I’m dense, in fact that’s probably a given, but maybe at least one of you could explain to me how that prevents the sort of rescission and cherry-picking or excluding coverage for preexisting conditions that we’re seeing now, and won’t lead to even more price-gouging and the sale of completely worthless junk policies from fly-by-night companies.
This rescission shit is serious. It’s not to be taken flippantly. Insurance companies actually have rescission quotas, a certain number of policies they have to find (or make up) a reason to kill each month in order to stay profitable. And if you’re on a group policy, they can slap surcharges on your company for your treatment so huge they have no choice but to either scrape together some reason to fire you, or sharply reduce coverage for everyone to make up for the surcharge. I worked for one company which, over a five-year-period, switched carriers four times, and finally wound up offering pretty much a total junk policy that would have cost so much out of pocket it wouldn’t have been worth signing up for. That’s what we poor old disabled fatties you claim to be beating the anti-UHC drum for are facing here, being totally fucked between now and Medicare.
Right now I have what I’d say is B-minus to C-plus coverage. I know it could be worse, and with trends in this country the way they are, and having experienced what I have, I can ill-afford to be smug about it. So what happens to me, someone who is increasingly difficult to employ because of size, age, and multiple disabilities, and isn’t eligible for state-run care or Medicaid, if my company lays me off, or drops or guts our coverage, and I can’t hook on anywhere that offers something better because this gutted care has become industry standard and everyone thinks I’m too high-maintenance? You think the free market will take care of me? How, when all carriers’ entire business, their whole reason for being, is set up to avoid people like me whenever possible?
OK, readers, I open the floor to you. (And once again, please stay on topic; I don’t want this thread to become open season on Sandy. As we used to say in “program,” principles before personalities.)