Monday, April 16, 2012

Principle Based Decision Making - Health Care #2 - Some Reflections

Using and reiterating the principles from Part One of this topic to develop solutions, here are some of the things that either need to be or can be done. We will only be dealing with possible state and local solutions, since the Federal Government has no jurisdiction over health care, except for the responsibility to care for people who receive injury, physical or mental, while in and because of service to their country.
States, local governments and civic or service organizations can, if their constituents agree, provide certain types of health care to those constituents and/or others as a group by levying fees or taxes to provide that care. There should never be a mandate to participate in any state or locally sponsored healthcare program, but people who opt out may possibly be barred from the benefits of the programs provided.
If, because of a charitable mind and not because of governmental requirements, groups such as those above choose to provide additional benefits to the poor, injured or those who need long-term care, they should be given every possible consideration to make their job easier. Groups such as Primary Children's Hospital, the Shriners, the Children's Miracle Network and the various health charities for specific diseases such as cancer, diabetes, MD, MS, etc. can be of great service to those who need help and cannot afford it. These are funded by voluntary donations.
Using the individual states as an example, but not excluding other local entities, below is an example of how a group could provide a level of care to those who cannot afford to purchase it themselves. It is not provided as a solution but only as a possibility or a starting point for discussion of ways to assist those who need it. I must post the disclaimer that I personally would not vote for any government sponsored health care - even at the state level but would prefer that a prosperous and generous society (which must be restored) take care of their less fortunate members through charity and personal assistance.
  • The state could choose to educate, at taxpayer expense, healthcare professionals that cannot pay for their training themselves (scholarships). They can also purchase, rent or build health care facilities (clinics, hospitals, etc. - preferably purchasing old healthcare facilities that are being abandoned) that are staffed by those who have thus been trained as well as asking specialists to provide some volunteer service. These state-trained professionals would be required to spend a certain number of years serving in these facilities as a requirement of their free training. If they choose to leave the program before their commitment is filled, they must reimburse the state for their training so others can be trained to replace them. They would be paid at a rate similar to other state employees while working under this program.
  • Those who use these facilities must sign waivers excluding them from the possibility of lawsuits except in cases of gross negligence or intentional harm. They would need to clearly understand that the level of care and comfort in these charity facilities would be lower than in commercial facilities.
  • States can also choose to provide nursing homes for long-term care of residents who have no other options with the same type of stipulations as those above. A number or states already have programs such as these in place or subsidize clinics to provide basic services.
These are all choices and should be made by the people who are affected by the taxes required to pay for those choices - not by any federal mandate.
Below is an article I wrote a number of years ago. As you can see, I have changed in a few particulars over those years, but the concepts and philosophy remain the same.
Defining the Problems 

A perception that people are not responsible for their own well-being. In some cases such as injuries, congenital defects etc. that may be true. Most illness and disease is created by personal choices as to diet, exercise, life-style choices, etc.
Ridiculously expensive technology used to artificially keep unhealthy people alive in a diminished capacity for years often including mental conditions that make them unaware or uncaring about that very lengthening of life.
 A Legal system that makes reasonable quality care with good intent insufficient. HC Professionals are required to do massive testing and multiple procedures that are usually unnecessary and often create their own problems for the patient so that under threat of lawsuit they can say "I did everything conceivable to create a good outcome".
 A philosophy that says, not only do we have to artificially sustain life long after it is enjoyable, but we must take extreme measures to take away any discomfort of aging and poor health habits.
The key things that need to be done here (and were not even considered in the current legislation) are tort reform and a national debate and decision on what is reasonable to expect of health care professionals and what is the responsibility of the individual. When the cost of health care is reduced massively by expecting people to live in a more healthy manner and not rewarding stupidity in their nutrition, exercise and habits, by making lawsuits only available to those who have been wronged by actual incompetence or carelessness, by capping punitive damages or removing them altogether except in cases of intent to harm or defraud, and (most controversially) deciding as a society what we, as a society are willing to pay for, we can actually create a system that is reasonable, successful and reliable without destroying the economy.
If on the other hand, we decide that the state (or nation, if you like) is going to be responsible for every illness or accident, every congenital condition and every person who intentionally does damage to their health through poor choices and that we, because of budgetary restraints can no longer pay quality health care professionals a reasonable amount for all the extra expense, time, schooling and lost sleep they sacrifice - we will lose the best and brightest from the profession and there won't be enough money to continue which will create a collapse of the system to where even basic health services will be hard to find and ineffective. These are the choices. If we choose the second option, the system will eventually fail, bankrupting the country in the process.
Secondly, we the people need to change our perception. We think that, if something isn't the way we want it, we should go to the government and they will dispense the solution. That is the essence of "state-ism". Can you imagine George Washington saying to the government, "My teeth are falling out - you (meaning we the people) should take care of me and make sure I get some nice dentures". This is the guy to wouldn't even collect his pay as commander of the armies or as President because he could get by without it and he considered it his duty to do all he could to protect and maintain the freedoms and liberty of his fellow citizens. I know it is why people think conservatives are heartless and cruel, but we need to consider what is the "proper role of government" and what is the province of the individual. When the group of individuals decide that they are willing to take on a responsibility (such as health care for the needy or providing food to the hungry) it is a choice, not a requirement, and as such provides help but does not destroy freedom. If, on the other hand, we are forced to try to "be all things to all people", we will fail and with that failure, our liberty, our prosperity and our very souls will fall into servitude.

There is a basic level of service that we as a society can afford and some of that we can ask of the professionals if and only if they are well compensated for their usual paid work. In law it is called pro-bono and most attorneys expect to give a portion of their time to it. In health care it can work the same way, but it must be limited in order to not destroy the very people providing it and their livelihood.

The debate, though uncomfortable, needs to be held and decisions made about what the public trough can provide and what we individually are responsible for.
Finally, we need to recognize that the current legislation is not a health care proposal. It is, instead, a health insurance requirement that mandates that I buy government approved health insurance and use government approved health care providers. It gives me no freedom to invest in my own type of insurance (savings), go to alternative health care providers (naturopaths, chiropractors, etc.) or to choose to live as healthy as I can and deal with problems when they arise to the best of my own ability.
We could learn alot from many of the native american cultures. Many indigenous cultures live in harmony with mother earth. They use natural herbs and medicines to improve their health, mental state and lives in general. They are peaceful with that. Could our culture accept that approach? Probably not. Should we think about it? I think we should.

No comments:

Post a Comment