Health care reform, part I

I've spent some time over the last couple of days looking at the House of Representatives proposal regarding health care reform. Of course, the bill is over 1,000 pages long, so I've only seen a very small part of it. Thus, this will probably be an ongoing (and sporadic) series of posts as I read more. I should say at the outset that I am wary of this plan, but I'm not about to dismiss it out of hand. I plan to frame this as a series of questions, and I will attempt to point out both the good and the bad in the plan. As always, [polite] commentary is appreciated.

One of the overarching questions that I think needs to be addressed: who is eligible for health insurance under this plan? Will, for example, illegal immigrants be able to receive health care under the so-called public option? (I think it's important to note here that I don't think this is necessarily a good or a bad thing; it's all in the context).

Another thing that needs to be addressed: part of the reason that health care reform is necessary in the first place is because of the ballooning costs to which Mr. Obama alluded in his remarks this evening. An enormous part of this cost is derived from the fact that physicians are virtually required to practice defensive medicine rather than being permitted to rely on their best judgment. If you take a blow on the head, unless the doc is 100% certain that there is NO risk whatsoever, you're likely to get a CT, over 99.9% of which will be negative. Why? Because of the threat of lawsuits for enormous amounts of money. Of course, not even doing everything right eliminates the risk. One woman threatened to sue any physician who 'let her father die.' The man was over 80 years old, everything in his body was falling apart, and he was kept alive and coded multiple times (very expensive and horrid quality of life) because the physicians were laboring under the threat of a lawsuit. Of course, they couldn't keep him alive indefinitely, and when at last he died, his daughter did in fact sue. The kicker? The insurance company settled for thousands of dollars rather than undertaking the "nuisance" of defending the physician's reputation and actions in court. We are a litigation-happy society, and that inflates malpractice insurance, requires physicians to order expensive and unnecessary tests and procedures, and drives health care costs through the roof.

A brief interlude here: Mr. Obama is certainly well-intentioned, but in terms of actual health care, he clearly knows not of what he speaks. He's right that we need better communication, but he seems to be laboring under the delusion that there's a single "correct" diagnosis or test for every patient, and that docs should always be able to arrive at the right conclusions. While I appreciate the confidence, that's not the way it works. There's a reason we have different kinds of specialists and different kinds of tests. He's also very deft at playing politics while appearing to take the high road. I know that's ubiquitous in Washington, but it's kind of disappointing in someone who's been portrayed as being above that. I will reiterate, however, that I DO believe that Mr. Obama is genuinely doing his best for the American people, and I agree with his assessment that he was given an absolute mess to begin with.

Another thing I want to comment on is the concept of exclusions for pre-existing conditions. In some ways, these are reasonable protections for insurance companies against fraud. That said, they can easily be abused, and the exclusion periods seem excessive. Certainly they do not appear tenable in their current form; however, is it financially feasible to eliminate the exclusion altogether? It seems like that's the kind of thing that unscrupulous people (and there's no shortage of those in America) could easily take advantage of. How can this be crafted to strike an appropriate balance?

Another interlude: props to Mr. Obama for this one. I completely agree that it should be the physician rather than the insurance company deciding what care is appropriate. Of course, the question of reimbursement becomes a sticky one, but still, the thought is right on the money.

Ok, that's it for now. I'm going to finish listening to this press conference and maybe do some more reading. Any thoughts or commentary would be most welcome!

Peace and God bless!