Americans were frightened out of a single payer, medical health care system similar to one in operation in many countries using a number of tactics, including by using the term “death panel”. Sarah Palin, who claimed “proposed legislation would create a “death panel” of bureaucrats who would decide whether Americans—such as her elderly parents or child with Down syndrome—were worthy of medical care.”
So a federal or national health care system, or single payer system passed into history and we ended up with whats become known as Obamacare.
As an executive, who is divorced, and has no dependents, I have the best medical plan available through my employer, it comes with an EXPRESS SCRIPTS prescription plan. Recently they started sending out communications on the changes for the 2013 plan. It included a word I’d never before heard “formulary“.
In essence, what it is is major aspect of what Sarah Palin referred to as a death panel. Express Scripts tries in its communication to pass it off as an employer choice. They write “Medications not on [insert employer name here] formulary will remain available, but you will pay full price for them.” (highlighting theirs).
This is EXACTLY what happens with the UK NHS Prescriptions. You pay a flat charge of £7.65 approximately, $12. Thats pretty much all drugs, except mostly untested, unapproved ones. Many of the long term sick and unemployed get exemptions from the charge. We though have a copay, no one is exempted from the copay, and it varies from drug to drug.
Express Scripts list though is pretty short in total, the good news is it does include viagra and cialis. So, with none of the real benefits, we’ve got death panels by the back door.
This article in Saturdays Wall Street journal was mostly about healthcare industry stocks, but what blew me away was the chart that was included. I’ve long felt the US Healthcare system aka “industry” was not only too expensive, you can’t have a balanced discussion about it, people immediately get very defensive.
Once you’ve been treated a few times it becomes obvious that insurance is used as a blanket to cover
a vast array of unnecessary services, loads of extra tests, samples, examples, scans and xrays. Often because upfront you’ve paid your co-pay, pre-pay etc. so what do you care? The medical facility is paid for what they do, not their results.
Excessive administrative costs – for example, during my recent broken collarbone rather than visiting a single hospital and doctor/specialist, I had to visit 2-separate facilities, each duplicating the entire billing, insurance debacle, requiring many pages of documentation and background information. Every medical facility comes with it’s own army of billing and administrative staff to negotiate the insurance rules, claims and reclaims.
Inefficiently delivered services – Americans with insurance take great pride in the system as it delivers choice and prompt service and treatment. The reality it doesn’t, it does it through the illusion of choice based on whats available through insurance, and through a long list of appointments which are “first” available, but compared to a single payer system where you can move quickly and efficiently between providers, it isn’t efficient. For those without insurance there is little or no option but to sit in the emergancy room and hope for the best.
Prices are too high – because they have to cover an inefficient system and high administration costs.
Fraud – of course there is fraud, in any efficient system there are always those that seek to exploit the system; also in a system which excludes many, they look for a way to get what they can.
Missed prevention opportunities – and of course any system which generates huge amounts of money to deal with problems isn’t really focussed on prevention. While their are pockets of good practice in prevention, mostly there is a lack of priority in prevention.
Add up the numbers, you could pay for a single payer system with everything except the prevention missed opportunity.
On the drive home yesterday I heard an interesting piece that tied my crop and drought posts into a neat closed loop, on the Marketplace show from American Public Media. You can read the summary here but the full radio interview is available here and is much more interesting.
In summary the rancher, Ken Lenox is a fifth generation cattle rancher in Rolla, Missouri says:
The rain from Isaac isn’t nearly enough
started feeding the cattle hay in August
Normally doesn’t start doing this until January
They’ve driven a 400-mile round trip to buy hay from western Missouri
Which endorses the significance of the drought; the fact that there is a real shortage of hay already, and that the livestock industry is in for a long dry Autumn and trouble ahead.
The Republicans have been making a big deal out of the changes to the welfare rules, bitching about the removal of the requirement to work for welfare. I’ve been reading about “crop insurance” – it’s a huge transfer of income from the Government money to private businesses, many of which are effectively multi-millionaires if you take into account their estates/assets.
We are in the worst drought in living memory here in Texas. Farmers along with >50% of US States are designated drought disaster zones. More than 84% of farmers have drought insurance, it covers corn, rice, barley etc. It’s paid for through federal tax dollars. I’m wondering what the Republicans will explain this… over $7-billion goes from the US Government to private companies to offer insurance, the Government then make payments to farmers to help cover their premiums. Welfare with no work…
Farm states are politically important; the numbers of voters are to a degree, relatively low compared to the urban areas. The Republicans are bitching about the Urban poor, mostly but not always non-white. The Farmers are mostly old white guys, and the Republicans are appealing to old white guys. There are just 2% of the attendees at this years Republican National Convention that are non-white.
Right around now Congress is about to sign a new crop-insurance bill. Let’s hear it for old white guys, winning even under a black President.