family practice issues and general life events

Healthcare debate

I have so far done two blogs on the ACA, which barely touches the surface of the bill, but yet they are pro and con.  The most important is that it does open the debate to reforming the healthcare in this country.  I don’t think that the bill was written by anyone who has ever even looked at purchasing insurance.  I don’t think the writers ever actual spoke to physicians who actually see patients in primary care, and I don’t believe that they talked to smaller business owners as to how to best help their needs.

Unfortunately this bill appears to cater to large businesses, healthcare organizations and insurance companies.  Look at the support that the nation’s largest employer, Wal-mart, drooled at the thought of its implementation.  From my experience they seem to have the most stringent rules in insuring their employees, I have heard the 39.5 hours a week, keep them from having many full time employees.  This is in stark contract to my insurance policy which requires me to offer coverage at 30 hours a week.  Anyway, Wal-mart solves its insurance issues by paying a low enough rate for most of its employees that them and their families qualify for Medicaid.  That being said, to require them to pay higher would require them to raise their prices, or at least it would eventually.  I avoid Wal-mart like the plague so a rise in prices would not affect me as much, but living in a town where the major grocery store is Walmart I hesitate to advocate for the downfall of the organization in general.

The development of an employer based healthcare system is the result of a compromise in 1936 so that the creation of the social security system did not include a healthcare plan.  And yet, maybe the decision where the consumers were not the individual itself but first the company and then the insurance company helped lead to the increase in cost.  For years, patients were allowed to remain blissfully ignorant of the costs of their care both requesting unnecessary tests, and happy to have this tests without regard for the costs.

The problem is that advocating for some form of universal care is bound to get me driven out of town or an effigy might be burned on my yard by my local colleagues.  Yet, I started my career in medicine after the “golden” age of payment was over.  I will never see the payment that come without documentation.  I started residency after the first Pharm D rulings were made, so I was never sent to Hawaii in return for my prescriptions.

Yet I have concerns that removing all responsibility for ones care will not result in better care, but allows certain patients to advocate all responsibility for their own care.  Who cares if I have another donut, the government is paying the bills.  Why should I stop smoking?  Someone else is covering my bills.  At least that is one concern.  The other major concern is that with government control, there will be legislatures deciding your treatment and care.

On the other hand, a health care policy that is at least partially universal may help the unemployment problem for the older population.  Ask many employers why they would rather hire a 20 year old than a 55 year old?  While salary might be an issue, the greater expense difference is often the benefits, i.e. insurance.  Insurance benefits are often triple for the 55 year old than they are for the 20 year old.  And while age discrimination is illegal, good luck proving it.  You can come up with a reason for hiring anyone other than age.

I don’t like the idea that the government is requiring me to buy anything, but on the other hand, if you don’t buy insurance it does affect me, because guess who is paying the bill for you when you go into the hospital without coverage.  So your choice to not pay for coverage does affect me.

So what is the solution?  I don’t know.  I don’t think that this will be the final plan.  In fact, I am not sure that this plan won’t collapse the entire system.  However, it is certain that we cannot keep going on the same course that we are currently traveling.

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