Purposeful Ramblings Through My Mind

This short essay describes the negative and unlooked-for (but easy to predict) effects of attempting to marry measurement of results with paying people for achieving them. Someone needs to forward it to the U.S. Department of Education, and to a variety of state departments of education. It's a clear, concise explanation of why merit pay is an absolutely abysmal idea, guaranteed to result in poorer outcomes for the students most in need of better ones. It's in the context of the British health care system.

I finally understand why support is falling for the health care reform as proposed. It's because you guys managed to elect the most cowardly bunch of idiots in the history of politics to do it for you. And it's not your fault - because the party that should have been doing it, not only didn't do it, but probably messed it up so badly that no one else will ever get the chance to do it right.

They should have gone for single-payer from the outset and then SETTLED for a robust public option. Now? Totally, completely fucked.

In the testimonial from the Mayo Clinic she went to in Arizona, her
condition is not a life-threatening cancerous brain tumour; it's a
vision-threatening benign cyst on her pituitary gland. She was not
going to be dead to wait six months, if in fact she'd even had to wait
six months - she didn't wait to find out.

Furthermore, she's not suing the government to get her money back;
she's suing the government to dismantle the health care system we
have, and she's funded by a registered charity called the Canadian
Constitution Foundation. Registered charity - that means our tax
dollars are paying for it via tax deductible contributions.

Holmes is misrepresenting herself, and our system, to Americans.
She's a fraud. I wonder if her circuit of talk shows and that
commercial have paid off the new mortgage yet?

I don't think I do, so I'll give you the links and the brief version of the rebuttal.
My mother knows this woman through a business connection. Her story is true. It is not the whole story.

It is true that many Canadians wait for care. Some of those waits are fine, as mine were. Some are not. That's unfortunate, and the government is working at reducing it.

However, the fact is, this happens extremely rarely. I'd like to see the stats on how often patients with brain cancer die without ever getting the opportunity for aggressive treatment in the U.S. I can guarantee it would be more often than here, and here's why.

In the U.S., if you lose your health insurance after having cancer, you're uninsurable. That means if your cancer comes back, you're dead. What this woman isn't saying is that her follow-up care, and her care if her cancer comes back, will still happen for free. She was diagnosed here. She had no medical debt before this happened, no co-pays. She runs her own small business and has not had any supplemental insurance for a long time because of that (or if she did, she bought it separately) but the cost was likely about fifty dollars a month for her dental, drug plan, and whatever other supplemental health services she chose to get on it. Her babies were born in a Canadian hospital and she never paid a cent to a doctor or other practitioner for that to happen.

It's likely that a person in her position in the U.S. wouldn't have had much health insurance, because nobody in her family had the kind of job that would have provided it, and the insurance available for those who aren't getting it through their work is, I understand, nowhere near as good. She wasn't rich - just comfortably middle-class. So there's a decent chance that, had she lived in the U.S. with other details much the same, she wouldn't have been able to get the loans she took out to go to Arizona and get that treatment. And she wouldn't be able to sue anyone to get that money back later, as she's doing now. (She's suing the government to get her money back, and she's probably going to win.) And of course, she'd be waiting for the next bout of cancer, knowing that it would not only kill her, it would finish bankrupting her family.

Very few treatments are denied outright. A few new or experimental treatments for certain types of cancer are not yet covered by OHIP, usually because the drugs are extremely expensive and not yet proven. Her treatment was not denied - it was delayed. It's a gross exaggeration to imply that it happens often.

The last problem with the ad is that Obama isn't proposing Canadian style health care. He's proposing a model that will make a public option available alongside the private option that will remain available. So people who believe their insurance company is doing just fine for them have the option to stay. If you're happy with your health care? Don't change anything. If you're not? You may just survive if you get brain cancer, and you may not have to bankrupt yourself to do it.

A petition for American health care that you take with you regardless of your employment status, subsidized as needed, and high-quality. I haven't taken the time to investigate it fully, but for those of you who would like to, there's your link. Have fun.

Not if Bush has anything to say about it.

Thanks wyldraven for the link.

I get really tired of the standard capitalist jargon that a business can be held accountable for its product by its customers, and therefore an informed health care consumer can hold their medical providers accountable by demanding good service, whereas a socialized system has no way of demanding good service except at the ballot box.

That's bull. There's just no other way to say it.

Obviously, the only motivation anyone ever has for doing a good job is greed, right? And therefore, voting with your wallet always works, because if you deny them your business, you're taking away the only thing that matters to them.

In my experience, most people don't go into health care - any aspect of it - for the money. The fact that the money is good is one motivating factor among many, but equally important are the desire to help people, the desire to do good in the world, the desire to solve puzzles and improve people's lives in the process. I'm sure there are doctors whose main motivation is the cash. I'm not denying that. But the vast majority are in medicine because they want to help people. The problems with doctors come up when the doctor has a different opinion about what's best for the patient than the patient has for themselves. But the issue is not one of demanding good service for the consumer of that service - it's in making everyone see eye to eye on what good service entails.

Then we get to the other side of the equation, and that is: in a private insurance-driven health care system, the people trying to decide what's best for the patients are different from the people who end up paying for the treatments. The people doing the paying are at several removes from the actual provision of services. The insurance companies often have people over a barrel. If you're in need of the services, that means you have some kind of condition that is being treated, and that in turn means many other insurance companies would either turn you down outright, or put you in a waiting period before you were covered. So they know very well that most people aren't in a position to take their business elsewhere. It's cheaper for them to risk the loss of a customer by refusing to pay services, than it would be to serve those customers well.

In a socialized system, you CAN go to other doctors if you're not happy with the one you're with. I've done that several times. The restriction is on doctor availability, not on who will pay for it. I wasn't happy with my first OB - I went to a midwife. I needed to see an OB later, and saw three different ones before I found one that would provide the service in the way I wanted it provided. And I didn't have to fight with my insurance company about certain doctors not being covered in their plans, either. I could have gone to any doctor in Southern Ontario who had room for me in their caseload.

The ONLY time when you need to hold the entire system responsible is when there isn't enough of a service to go around. At which point, instead of one person or a few people fighting with a company in the courts, you get public debate and public accountability, because everyone has a stake in seeing that things improve. It's a lot harder to write something off as someone else's business.

The capitalist model doesn't work for health care.

This rant brought to you from someone else's journal, where I politely refrained from directly engaging the person who posited the capitalist model, because the owner of the journal has asked me not to engage her or her me. Fortunately, this is what my journal is for.