Sunday, April 27, 2008

healthcare plan 2

OK, I know it won't work to make health insurance just like car insurance. You can drive safer and have lower rates, or have wrecks and tickets and get kicked off your insurance, and even if you're "innocent" in a wreck or problem, your rates still seem to go up. That doesn't seem feasible for health insurance. Too many things are "innocent", especially with kids, who are at the mercy of their parents, and to be too restrictive in the care that some parents seek for their children would be to invite disaster. So we probably shouldn't punish people for health problems but...and in this I'm the one I'm talking about...the health problems we bring upon ourselves by doing things we shouldn't do and know better, those might need to be grounds for raising our premiums. These are the tickets, speeding, reckless driving, DUI, etc. Some are forgivable if only in their commonality, but some are downright bad not only for the person doing them but also for those around him.
I obviously wax philosophical at times, quit laughing, and I need to be grounded by wisdom vs. overthinking. A friend did this for me yesterday. We were discussing (I was spouting off, he was apparently listening) whether the chemicals in plastic were a concern since we're all drinking from plastic of some sort all the time, it seems. He said "until people aren't obese and they are exercising at least a little and they take care of their type 2 diabetes and high blood pressure and high cholesterol, I think it's stupid to worry if the chemicals in plastic are harming us. We're harming us!" I took liberty with the quote, his was more pithy than mine and I don't recall the exact words but the message was loud and clear. We strain at a gnat and swallow a camel as Jesus said. The chemical issue is the gnat, the obesity "epidemic" is the camel. Sorry, but some need the explanation of the metaphor. 
So...perhaps the equivalent of "points" in the car insurance industry - where our records reflect our wrongdoings like speeding tickets and the like and our premiums are up and down commensurate with the number of points - should be our weight, waist size, BMI, you pick the measurement, and make it broad (no pun intended) to account for those of us who are "big boned" but not really obese (yeah, right). Truly there are persons whose weights or BMI's look to be out of whack but they are in shape, etc., and need not be punished. Perhaps to justify one's size, one must come up with laboratory results that reflect the state of one's health - so if your BMI is over 30, but your cholesterol and triglycerides and hemoglobin A1c are in acceptable range, you're exempt from the premium increase. Life insurance companies sure don't mind raising premiums if you're high risk. So, if your weight or BMI is OK, you're good to go on the "no points" premium, but you're rated higher for obesity, etc., if you are, in fact, obese and can't provide good evidence that your obesity hasn't apparently endangered your health yet. I guess you'd have less money to spend on food if your premiums were high, then you'd lose weight, right? Wrong. Because good, healthy food, unless you grow it yourself, is at least allegedly more expensive and doesn't keep as long as the frozen tv dinner with 40g of trans fat per serving. 
This little aside is to let people know that I realize you can't just penalize people for having bad health by charging them more for health insurance. Too many illnesses are not directly the cause of anything we know anything about. Babies born with birth defects through no fault of the mother or father. Premature babies who just happened to be born a few weeks early and had to spend expensive time in the intensive care unit. Someone gets run over or into by a drunk driver. 
Realize that anytime we begin to discuss such things the issue of euthanasia or "letting someone die" or attaching quality of life potentials as parameters for who lives and who dies begin to surface, since an entity, likely the government but just as easily Blue Cross and Blue Shield, will be determining who pays what for health care and how much should any one person get, etc. Tough questions. Not for us to decide. For God to decide, but God, though He hasn't been consulted on these issues in our science for quite some time, often has different ideas than our human wisdom. We've taken Him out of the equation, and what's funny, even sometimes I, as a Christian who should know better, forget that He is sovereign over all. I have a parenting technique I tell parents about called the "good luck" theory, I think I stole it from Foster Cline and Jim Fay of Parenting with Love and Logic, but oh well. I think God knows about the "good luck" theory. He's saying "good luck", go ahead and try to decide who lives and who dies and who has what cancer or disease and try to cure it and screen for it and delve down into the human DNA code and see what you think you can do with it - I created the whole thing! Try to make things perfect here on earth by eliminating disease and suffering and starvation and toxins and try to have your cake and eat it too by flying and driving everywhere and using food for fuel and...good luck. The next line after "good luck" is "I'm sorry" when things turn out the way the parent knew they would. God has infinite patience, and I think He's saying "I'm sorry" to lots of things right now. There was a good Dilbert recently where the boss presented an idea that we could turn fresh water into oil - and thankfully Dilbert saw through the solution to the problem and asked "wouldn't that turn the world into an uninhabitable wasteland in the long run?" Someone needs to follow several lines of medical and other scientific "logic" out to the long run. 
My point there was that we really have no ultimate control over things, we just think we do. We play around with genes and chromosomes and talk about stem cells and cures for diseases, but in reality, we're kids playing in the sandbox while the One who made the whole beach is just watching and waiting and letting us think we can do it our way, and what's worse, that our way is better. At least that's what many think. That the way God's had it going for several millenia is a bad deal and that we, as humans, are here to save the day! We've got a better plan.

Back to health insurance, sorry. We need to quit requiring every test for every thing there is before we act on anything. I'm all for making sure a diagnosis is correct, but did you know that there was disease before the MRI was invented? And people somehow managed? Doctors made diagnoses by taking histories and doing physical examinations and thinking and studying, whereas now even if we do the H and P and actually think and study, we have to have our decisions backed up by test after test, so after a while, it's easier just to do the test and forget the first part. That's where much of medicine is, and the public is partly responsible. It's like depending on a calculator vs. learning simple math. Sure, the calculator's nice, but if the basics behind it aren't known, a vital piece is lost. Or even more pertinent and current, keeping phone numbers in our brains vs. our phones - once we start using the phone to store numbers under peoples' names, etc., we lose the memory of that number and rely on the machine vs. the mind. In medicine, the public currently is bowing to the prowess of the equivalent of a synthesized computerized piece of music over the art of a gifted performer. We want the test, not the doctor's opinion. But what's funny is, the patient wants the doctor, too. They want to know what I would do if it was my kid. Or my dad or mom. They can search out the diagnosis on webmd and they still want the doctor to confirm it or refute it.
So, as far as I'm concerned, we still need doctors. We still need hospitals and medicines and tests. Don't get me wrong. I like storing numbers in my phone. I just don't want to lose the ability to remember them myself. The art of medicine is to decide when to go with the obvious diagnosis instead of covering one's ass with a zillion dollars' worth of tests. And this is where both doctors and patients will benefit in a good healthcare system. The doctor who is able to practice good medicine, I mean good medicine, with a minimum of testing and treating, would be rewarded, and the patient who goes to the doctor for a real problem vs. a problem they think they might have and demands a bunch of tests is penalized with the doctor who orders a CT scan for every headache and a CBC for every fever. Just because one can order and do a test doesn't mean the test is needed. We've lost the doctor/patient relationship over the past 2 decades due to insurance rules and tests. 
So...we need to remember Who created us and that He has a plan. We are apparently being forced into at least discussing a "new" health care plan, and depending on the winner of the November election, the discussion will differ, but the outcome likely will not be that different. We are talking about doctors and patients here, and neither handles change well, especially change that feels like it's forced upon us. It's amazing that no insurance or government entity forced the concept of the "urgent care center" upon us, but I would venture that these "docs in the box" are the fastest growing healthcare providers around. Obviously, the drug companies and the doctors who write for their products are paying no attention to the fact that people are having to spend more and more at the pharmacy for their medicine. And as newer tests become available, patients demand and doctors order (or is it the other way around) ultrasounds so expectant parents can have daily cell counts on their new embryo! Or MRI's on joints that are sprained, and then instead of a "sprain", which sounds mundane and survivable, they have a "torn ligament" or a "stress fracture", which sounds (and is) more expensive. And guess what? The insurance company will pay for more physical therapy for "stress fractures" than shin splints. So, we're shooting ourselves in the foot, and we probably should stop. It's going to be hard, it's hard for us to give us something then tell us we can't have it anymore. There will be so many loopholes in any new healthcare plan that it may need to be administered by the IRS! 
OK, that's enough. Just rambling. Maybe I can take off on one of these thoughts and go for another hour or two, but I'm done for now.

1 comment:

Summer Lashley said...

Found your blog the other day...I enjoy reading your "radical" thoughts. Keep em comin'!