New Haven Independent

Posted by: concrenedwestvilleres | September 8, 2009 12:04 PM

Long-term care and end of life decisions are important. However, having Medicare and Medicaid pay for these services is an invitation to fraud which is already rampant in the system. How many times will dishonest doctors bill for consultations that don't occur. Also, part of a doctor's services should include advising as to treatments and options. My doctors don't charge for telling me I need to lose weight or I am losing my hearing or I have this or that problem. It is part of the appointment.
This country needs healthcare reform that reduces costs as well as provides for the needs of an aging population. For example, tort reform that protects a doctor from being sued for a legitimate mistake and makes those that are truly negligent and incompetent suffer consequences. Today people sue for every mistake and whether they win or not it runs up the costs of malpractice insurance and results in defensive medicine. Reduce legal costs and defensive medicine and costs are cut. A second area is the overwhelming debt that medical students incur in becoming a doctor. Maybe the government can include loan forgiveness for practicing in disadvantaged urban or rural areas or even pro-bono work for the poor. The next area is supply of doctors. There is a shortage especially in primary care. Adding millions to the patient rolls will only increase costs as supply is not there to meet demand. Possibly offering free tuition to help increase supply in exchange for working in disadvantaged areas on a salary could be a helpful partnership. Also targeting financial aid towards those areas of medicine where supply is down (OB-GYN, Primary Care, Geriatrics, etc.). An additonal way to increase supply is to have doctors practice primary care while also having training in a specialty (i.e. a internal medicine doctor who also has a specialty in cardiology could help). Another step to reduce costs is to change the delivery method. Stop insurance for every doctor visit. Require employers to put a percentage of payroll into HSAs which would help cover the costs of routine medical visits (i.e. the flu, not feeling well, etc.). Have insurance for hospitalization, devastating diseases (ALS, MS, Parkinsons, Heart disease, Cancer)treatments. Also require insurance at an early age (25) for everyone. The money saved in early years could pay claims in later years.
There are many ways to reform the system and the reform must include end of life as well as cost reductions. Unfortunately our political system is so bad that it is hard to do properly.

Posted by: Concerned Citizen | September 8, 2009 11:58 PM

Thanks to Josiah Brown for his very sensible piece on the total cost of aging. If many of us are lucky, we will get there. However, from the way the US health care system works now, and especially here in CT, getting past where we can function independently might not be something to look forward to.

One of the benefits of having grand and great-grandparents around for a long time is the remarkable way they teach without preaching. If we are alert, we can benefit from many lessons. As a society, we tend not to value or even notice many of these rich lessons; they are often priceless. We who have had the good fortune to have in our lives (into adulthood) wonderful grand- and great-grandparents are often better parents ourselves. Mistakes are often the building blocks of wisdom. That wisdom is most often passed on to grandchildren because children are more resistant until it is too late. That is what is happening to us as a society. We are missing the entire forest because we are too busy trying to count the trees.

The "concrenedwestvilleres" writer has made some good suggestions; the point is - most of those are already a part of the package med students get if they practice in certain areas, and go into certain specialities. This is a BIG part of the health reform debacle. People are objecting to things they know very little about. The fact that something is challenging and complicated is NOT a good reason not to fix it. If we do not fix it now, it will only get worst. Where would we be today without Medicare, Medicaid & HUSKY?

In the mid 60's there was outrage about Medicare. When President Johnson signed the Medicare Bill in 1965 many of those who protested the most are the ones who are today enjoying the benefits of Medicare and don't know how they could ever live today without it. Ask those Republicans who are objecting to a socalled govt-run health plan - how many of them would give up the plan they have? Who pays for their plan? Why did John McCain go to govt-run Walter Reed Hosp to take care of his skin cancer rather than to his private doctor in Arizona? So many of those opposing a public option use one whenever they need the best in health care treatment!

The far "Right" has been using the rhetoric of assertion most liberally; they do not care if there isn't even an ounce of truth in what they say. In fact, they are confident that their lies -- if asserted loudly and boldly enough-- will be accepted and responded to "positively" They do not have to worry about fact-checking. They count on most of us behaving like lemmings. We see it in those town meetings. We are supposed to be a civilized society. Let us be rational and thoughtful. We NEED health care reform. We need a humane and civilized way to keep our citizens healthy. I would like to see more emphasis placed on personal responsibility in terms of lifestyle & behaviors. Tobacco growers need to retool and find a more healthy way to earn a living. The insurance companies need to start being in the insurance business than in the denial and ripp-off business. Whatever happened to ethics in business? Ask AIG, Pfizer, Merck.

For the rest of us -- let us think carefully; let us think longer term; let us think about our total society, not just ourselves. If there are blighted trees throughout the forest it will eventually die. We need healthy informed citizens. We are number one in many things, but we are far behind in health care outcomes among civilized countries. According to the World Health Organization:

"The U.S. health system spends a higher portion of its gross domestic product than any other country but ranks 37 out of 191 countries according to its performance, the report finds. The United Kingdom, which spends just six percent of GDP on health services, ranks 18 th. Several small countries - San Marino, Andorra, Malta and Singapore are rated close behind second- placed Italy." We CAN do better than this.