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seekerz
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There you go again making assumptions about who does or does not practice their faith. A person’s voting choice is just that: theirs. With all due respects to you, it’s not about you.
US Catholics back bishops on religious freedom, but still favor Obama, poll shows [CWN]
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PJD1987
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Dawnia
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For as much as I disliked Bush and some of his policies, and had such hopes for Obama, I would take Bush back in a heartbeat.
I don’t think he totally wants to destroy religion, but he certainly wants to make religion secondary to the state. Religion is an obsticle that stands in the way of his plans. If he can get religion out of the way, he can use the force of the law to make everyone do what he wants them to do. He has been pushing to limit the right to free exercise of religion since he got into office. Lucky for us, the Supreme Court still stands behind the Constitution for the most part. (They occasionally get things wrong)
While I would prefer a more solid candidate, Romney is much better gamble, than another 4 years of Obama.
I don’t think he totally wants to destroy religion, but he certainly wants to make religion secondary to the state. Religion is an obsticle that stands in the way of his plans. If he can get religion out of the way, he can use the force of the law to make everyone do what he wants them to do. He has been pushing to limit the right to free exercise of religion since he got into office. Lucky for us, the Supreme Court still stands behind the Constitution for the most part. (They occasionally get things wrong)
While I would prefer a more solid candidate, Romney is much better gamble, than another 4 years of Obama.
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Dale_M
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Pew Forum polls typically make a distinction between Catholics who attend Mass weekly, and those who attend less often.
This poll is no exception. Here are the relevant results
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pewforum.org/Politics-and-Elections/Catholics-Share-Bishops-Concerns-about-Religious-Liberty.aspx
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Ridgerunner
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If, as seems to be the case, Obamacare is likely to throw the country into an “official” recession, simply saying “we’ll get by somehow” is not a sufficient defense of the program.
I agree with you that there is no particular reason to affirm or deny that focusing on “preventing to the max” by government policies will have any effect on health or healthcare costs. Nevertheless, it may be observed that the poorest people are the least likely to concern themselves with “prevention”. Shifting dollars from “cure” to “prevention” serves them poorly, because they are also the ones most likely to suffer from chronic conditions requiring ongoing and repeated care. It is already causing “patient dumping” of those who need care the most in favor of those who don’t.
Why do I think the poorest will be poorly served by Obamacare? Well, in addition to the “dumping” encouragement inherent in the redirecting of “chronic care” money to “well care”, medical providers already limit the number of Medicaid patients they will take. In some places, this is not a terribly big problem for poor people, but in some places it is. Adding an estimated (conservative estimate in my view) 17 million people to the Medicaid roles will necessarily crowd the poor even more from those limited slots.
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Elizabeth502
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I absolutely agree with this part, and this is a huge Catholic social justice issue. This is observable; it’s not a hypothetical.
As to your other point, Ridgrunner:
To be fair (my sister works in medicine, most often with poor populations} education about medicine is most often the lack which makes them “least likely” to be concerned. Supposedly (she tells me) dollars are being targeted right now for these education programs. Nevertheless, I am most concerned with the multiplying of the Medicaid availability combined with the continued inadequate screening of qualification for that aid. There have been times in my life, not long ago, when I have been way poorer than those receiving Medicaid, and I have not “qualified.” This is one of the many reasons why the APA is being too hastily enacted.
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seekerz
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That is not my experience or observation. Around here most practices are more than happy to accept any sort of insurance including Medicare/Medicaid, perhaps because of the significant numbers of uninsured or perhaps because doctors are generally disinclined to put remuneration concerns before the needs of the most vulnerable. I suppose there are places where financial survival of a practice has to come first, but to my knowledge in most places there is always at least one local facility that accepts Medicaid.
Health care access is not a matter of doing good if we can or doing good and hoping we will get by - it’s a matter of finding a way to do that which duty binds us to. Evidence from other nations shows us that providing universal access to health care is neither impossible nor unfeasible - it just requires the appropriate level of commitment to an admittedly difficult task.
P.S. Redirecting funds to preventive care should NOT mean that chronic care suffers because there are different levels of preventive care and only PRIMARY preventive care applies to people who are not yet sick. Diagnosed diabetics for example could greatly benefit form preventive care which would delay or prevent very expensive complications like kidney failure. There are ample reasons why doctors might be divided on the preventive care approach - traditionally curative services required higher skills/training and receive higher reimbursement - but this is about what’s best for the entire population, not about preserving medical tradition.
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Ridgerunner
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Acceptance of Medicaid, as I said, varies from place to place. But most providers have “quotas” of the number they will accept.
“Universal access” can mean a lot of different things. By Obama’s own admission, Obamacare won’t achieve that. I’m guessing it will fall shorter than even he has estimated.
In many places where there is “universal access”, access may be “universal” but it is not the same at all levels. That’s not too unlike what we had before where 70-80% of the people had insurance, some were in transition, some were Medicaid qualified but never signed up and some used the ER. It remains to be seen whether Obamacare ensures that any more people have coverage than had it before. Some 10% of employers say they’re going to drop it (I suspect it will be more than that) Some states won’t accept the Medicaid expansion. We’ll see.
People who are diabetic are already “chronic care” patients. You can’t call that “preventive care” any more than you can call chemotherapy “preventive care” because it hopefully prevents metastases and death.
What we definitely do know about Obamacare is that it is going to cost some people a lot. “Cadillac plan” recipients will pay a 40% tax on the cost of it (except unions, of course). Families of four making more than $88,000 will definitely pay more for coverage. Employers with more than 50 employees, 31 of which are, because of income, qualified for Medicaid or “exchanges” will pay a LOT in terms of additional tax. And then there will be the salaries and benefits of no fewer than 1600 new IRS employees and innumerable bureacrats in the 159 (and growing) offices set up to administer Obamacare.
And, since it is going to cost this country a lot, we really do need to ask whether anybody has really gained anything with Obamacare, who is going to still have no coverage and, last but not least, what additional and morally unacceptable mandates this administration is going to force on Catholic institutions and employers.
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St_Francis
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I was talking with a doctor, one who is himself very concerned about the poor, about a recently-built clinic with which we are both familiar.
The problem, he explained, was that because most of the patients were Medicare/Medicaid patients, in order to pay for the clinic facility itself, the medical person (doctor or PA) would have to see a *lot *of patients. One of the people there, who left, routinely worked 10-12-hour days.
Yes, it’s always good to work on “finding a way,” but you can’t squeeze blood from a turnip. If the funds are not there, they are simply *not there. *The area in which the clinic is located is a poor remote area which has already cut a lot of services from lack of money. Most people do what they can to help their neighbors, but a lot of them also have a lack of resources.
Yes, it’s true that many other developed nations manage (altho they have not yet been hit by their coming Baby Boom crisis), but how much medical and pharmaceutical research gets done in those places? Do they have additional funding due to reduced defense costs? Are they able to negotiate meds rates which are much lower than ours because they do not have to pay for the FDA testing (which can run into the millions)? Do their doctors start off with hundreds of thousands of dollars of debt?
The main problem with Obamacare is that they did not look into *why *our costs are so high, and they did not look into why the costs of other nations are not as high. They had one thought in mind, and that was to hide the fact that the government is unable to continue to pay for Medicare as the Boomers retire, and *that *they have accomplished. At least for now…
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Ridgerunner
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I doubt that any one thing explains U.S. healthcare costs. Among those I have seen discussed are:
- In the U.S., providers tend to do it all rather than ration it at the point of service. That’s why, for example, the U.S. has so many more MRIs per capita than do other developed countries. If I injure my shoulder, my doctor is quite likely to prescribe an MRI. If he does, it will probably be done within an hour or two. If, say, I have a rotator cuff tear, he will set me up with a surgeon and it will be repaired within a couple of weeks, easily. In some other countries, the MRI will take months to get done and by then my cuff tear might be inoperable anyway or, if there’s no tear, I might have healed. In either event, there will be no surgery. In the U.S., if there is a 5% chance of survival through an expensive treatment, the medical system will do it. In many other countries, that 5% chance is not deemed sufficient to justify the expense and it doesn’t happen.
- In the U.S., we treat all comers in all ERs and in many clinics, regardless of ability to pay or legal status. ERs are very expensive. In France, by contrast, illegals have to pay cash up front for services, get no reimbursement from the government. One must establish one’s status at the point of service. In the U.S., we have greatly more illegals than do other developed countries. We pay for their care one way or another, whereas not all other countries do.
- We allow large numbers of immigrants, legal and illegal, to come from primitive countries where past medical care, nutrition, etc are not good. Some are used to “self-medicating” and have already harmed themselves by doing it. Some have developed drug-resistant strains of disease that require very expensive treatment.
- A lot of foreign medical costs are “hidden”. In France, for example, medical school tuition is paid totally by the government. That isn’t calculated in “the cost of medical care”. Thus, those doctors do not have huge loans to pay back through their earnings. Malpractice insurance there is paid for by the government, another huge cost that is passed on to the consumer here. There are other costs that are not part of the “statistics”.
- In some countries there are special judge-only courts for malpractice claims and lawyers get only hourly fees. This greatly cuts down on the cost of malpractice insurance and the need for expensive “defensive medicine”.
- Many developed countries have considerably more and higher taxes than we do. Yes, their lack of defense costs aids in that. For example, France, a nation of some 65 million, would be hard put to knock over Syria, a nation with 1/3 the population, and probably couldn’t do it at all. France and England each have one operational aircraft carrier. The U.S. has eleven major, state-of-the-art operational carriers and a number of specialty carriers. Each carrier requires a number of escort vessels. It may be that the U.S. does not need eleven major carriers, but there is some importance to keeping a presence in the world’s sea lanes.
- Many foreign countries buy in huge bulk from (largely American) pharmaceutical companies. They tend to buy the “secondary” versions, sometimes from manufacturers that are licensed to produce them or who have simply knocked them off. Pick a fairly expensive American drug and look it up from foreign suppliers. The product is not exactly the same a good part of the time and might be manufactured in India. That doesn’t happen in the U.S.
- The U.S. has attempted to maintain a “one tier” medical system, whereas some other countries don’t. In France, for example, there is a largely unregulated 1/3 that’s “private”, used largely by those with good insurance or a lot of money. And there is the “government” part, about 2/3, that is staffed by doctors who are employees of the government and make about 40% what American doctors make. Not too surprisingly, the care in the “private” system is considered superior to that in the “government” system.
“medical tourism” is another out for the well to do in some other foreign countries.
Finally, something ought to be said about the cost of insurance pre-Obamacare. Insurance companies invest their premiums in fixed-income securities. For years now, returns on those have been terrible, and even then, some turned out worthless due to the bad mortgage securities. They have to make it up somewhere, and premiums is the only other way.
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St_Francis
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Thank you for that excellent and concise explanation
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Ridgerunner
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I appreciate your kind words.Thank you for that excellent and concise explanation
I might add that some strains are showing up in some systems. In some developed countries in which the government pays for medical education, they expand and contract the number of admittees based on the perceived need of the population. Consequently, their costs go up and down but none of it is “counted” in the cost of care.
But there are costs to everything. So, for example, in France, the rapidly aging population has caused the government to expand medical school admissions, necessarily drawing on less qualified students taken from a shrinking group of young people. In Germany, the government finally gave up on providing totally free medical education and started charging a still-modest tuition. As a consequence (and because of mobility within the EU) German students started crowding into Austrian medical schools where it was still free, crowding out prospective Austrian students. Austria got very huffy about that and threatened to, and perhaps did, bar Germans from free Austrian medical education.
But nothing can cure the demographic winter most European countries and Japan are facing. An ever-older population served by an ever-shrinking pool of young workers, taxpayers and medical providers. The welfare states they have created simply cannot continue indefinitely in the face of population collapse.
It’s a vicious circle. Income (“I”) = Consumption (“C”) + Transfers (“T”). Transfers include forced transfers to the government, voluntary transfers to spouse, children, charity. To the extent government absorbs more and more of “T”, there is less and less left for voluntary transfers, including for expensive child-rearing. Consequently, one of the prices some developed countries (most, actually) are going to pay for excessive forcible transfer payments is demographic collapse. One of the consequences of demographic collapse is increased scarcity of those resources that require human work.
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JimG
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It seems to me that this is one dangerous and forseeable problem that governmens ought to be paying attention to, but aren’t. When the collapse hits, they will act as though it is something out of the blue, and blame it on lack of regulation.(!)
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St_Francis
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I had to laugh!
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seekerz
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What convinces you that getting more people on the rolls is going to crowd out those presently there? To my knowledge, the government actually gives financial incentives to physicians who practice in under-served regions (read high Medicaid regions), they also are giving financial incentives for those practices with certain percentages of Medicaid patients who transition to electronic records systems. Why is it that I never hear any complaints about those significant incentives but always about low reimbursement? A practice depends not just on the absolute amount paid for individual services, but on having a sizable number of regular clientele - something Medicaid virtually guarantees providers.
“We’ll see” is right. Obamacare admittedly does not provide universal coverage but does promise to take us nearer to that goal. I’d rather wait like you suggest, but minus the proclamations of gloom and doom…
Like I said, there are different levels of prevention: primary, secondary, tertiary. Not making this up - you can research it. Preventive care does not exclude the care of chronic illnesses: indeed, for the common chronic conditions facing society (e.g. diabetes) preventive care to avoid costly complications, is an integral part of their correct management. When chronic conditions are properly managed (both the curative and preventive aspects) there is less need for hospitalization and highly specialized care. Basic principles that save lives and money (at least in the immediate sense; the theory is that the associated costs of longer lives cancel out the short-term savings).
For any venture there will be costs, benefits and projected savings. I see you simply looking at the costs, like those are all that matter. The real truth is that there is some uncertainty about the full effects of some of those changes because Obamacare has not been fully implemented - a fact that is often overlooked. Perhaps an examination of the successes and failures of Romneycare would be instructive; from what I can tell, the rate of rise in health care costs has decreased in MA. One thing I’m totally sure of is that doing nothing to address the crisis in health care is not an appropriate response.
If a person still has no coverage after Obamacare, then what they have gained is that if and when they incur health care costs that they cannot afford to pay, there will be less people like them whom hospitals have to absorb the costs for. Who knows, maybe it will become easier to qualify for charity care when there are less uninsured people…?
I’m not sure I get your stance: universal healthcare is unfeasible/bad/too expensive, but Obamacare is bad in part because it isn’t really universal? Does that about sum it up?
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seekerz
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Very good analysis, though I might take issue with the magnitude to which any one contributing factor affects costs and I would venture to add to that list (near the top, actually) the lack of transparency in the health care market.
For the life of me I have not been able to figure out how health care is supposed to perform like any other market when costs are so hidden from the person who foots the bill (both as insurance premiums and as out of pocket costs) - the consumer. How is a person supposed to make decisions based on costs, when pre-service billing information is very often incomplete/inaccurate/after the fact, and when costly ancillary services are still commonly based on provider recommendations or dictated by insurance companies?
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jwinch2
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jwinch2
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