Tuesday, March 23, 2010

On Health Care

One of the reasons that I rarely post to the political part of my blog is that I find politics rather, well, unpleasant because in the end, its all about who you stand with. It becomes more about ideologies than reality.

In some sense, and some would find it surprising for me to say this, I am apolitical. I don't believe in any one party. I am a very strong Catholic and yes, my religious beliefs do effect what I support and do not support. I don't apologize for that in the least.

So some might ask then, why I do not support Obamacare. After all, if I am a Christian, why would I not want people to be taken care of. The answer is I do. I don't like double tonged politicians and one of the common political tools that is used is the false dichotomy. The concept is that someone makes a statement, I don't believe in A. The respond is, you must believe in B. The fallacy is that A and B are the only options.

Here is a practical example. I say, I don't believe in Obamacare and someone responds: then you don't believe in health care. The truth is that I believe that people with pre-existing conditions should get health insurance and I believe that everyone who is in need of medical care should get it with some exceptions.

But, I don't' believe in Obamacare and I think that its a colossal mistake for our nation. One which has the potential to collapse our economic system and even send our nation into a state of civil unrest.

Why? Am I a a lunatic right wing fanatic? No. The truth is that I am a realist. I have worked a lot with finance in my life and I also have many opportunities to speak with medical professionals (not as a patient). First, let me say that to demonize those who dedicate their life caring for people and to claim that they only want to make money is grossly unfair. Do I think all doctors and nurses are saints? Far from it. But I do believe that they have to wade through a garbage dump of insurance regulation every day and then balance what they know about sound medicine with the fear of being sued and families that often will agree to anything as long as they think there is a glimmer of hope of keeping a patient alive.

I don't' want to go into a lot of detail but frankly, I see nothing in the Obamacare bill that will cut costs except for health care rationing which I do believe has to happen. Why? Finance is simple. Think of it like a pipe. Whatever amount of water goes in the pipe (let's call this revenue - insurance premiums) is what comes out (medical care). Now insurance is also a large pool. The purpose of insurance is simple. It's easier to pay for small accidents (let's say I break my eye glasses) but large costs (let's say I need a major operation or have a long term disability or illness). The more people you put int he pool the more you can distribute those costs and dramatically reduce personal bankruptcy. If certain groups of people who we know are going to be costly (such as those with pre-existing conditions) are excluded from the pool then insurance will be cheaper which is the motivation for this. I am not saying its a good thing but no one complains about the lower insurance rates do they?

So the trick should be to need less water (money) coming out the other end of the pipe (reduce costs). Adding large bureaucracies does not help costs but only adds to the burden of paperwork for doctors and nurse therefore giving them less time to spend with patients.

OK, I could go into more detail here but I am a realist. Just because I want something to be true does not make it so. I don't want people to die of cancer but they do. I don't want people to get sick and go to the hospital but they do. To some extent people can be healthier but many healthy people get sick and when we get old, even the healthiest people are less healthy. One ways to cut those costs is not pay for the older people and that is what is happening right now. How do I know? Because I don't listen to ideologues but friends who are afraid that they will lose their doctors because they will not accept Medicare. Many doctors may not practice medicine much longer because of the bill passing. Rationing will happen not because people want it to but its just like the pipe analogy. Less doctors in the system, less medical care out. Or more poeple in the system, less medical care for each person. I don't understand why this simple math is so hard for people to understand.

I guess I am trying to simplify something very complex but I do get upset when people defend Obamacare as the only option. I think its short sighted. I would rather see realists who want to deal with the current realities of health care and insurance as unpleasant as those might be and to find solutions that truely reduce costs and insure that those who need medical care can get it.

So that is what I have to say on the subject and I will debate anyone who wants to post here as my timer permits.