The American Healthcare System: Renovator's Delight.

[Johnno]

I came across probably the most heartfelt piece of writing I've seen in a long time today, it would make a good Bruce Springsteen song. You can read near the end of this long post.

But first...........

There'a joke in the Australian real estate industry, that if a house is an absolute shambles in an almost ready to be demolished condition, the cliched positive spin applied to the advertisements for the wreck is a "Renovator's Delight." It's become a phrase that is ridiculed and somehow again been reclaimed tongue-in-cheek by witty real estate agents country wide.

It's spread into the Australian vernacular. A "Renovator's Delight" is a basket case; something that will will require a lot of capital and effort to restore to its former glory. Recently one of the duopoly supermarket chains downunder which is in the financial doldrums had the "Renovator's Delight" badge pinned to it.

I was tidying up my bookmarks on the PC and I came across a strange link to a one page blog at the Journal Times in Racine County, Wisconsin where I had left a comment in January. From memory, this one page document somehow found its way onto Google News and 45 comments were left from around the planet. There was a real global exchange and a lot of incredulity from the other side of the pond as most of us from other countries, pretty well take health care for granted.

The article was about the "Renovators Delight" that is the American health care system has become; the original piece originated from the Washington Post.

Here's the article.

http://www.journaltimes.com/nucleus/index.php?itemid=10362

WHO WILL HELP?

01/22/2007: Universal Health Coverage Attracts New Support
Category: General
Posted by: Editors
By Christopher Lee
(c) 2007, The Washington Post

WASHINGTON — Harry and Louise have had a change of heart.

Thirteen years after television ads from the insurance industry featuring the fictional middle-class couple helped kill the Clinton health-care plan and make universal coverage politically radioactive, comprehensive proposals for expanding coverage to millions of uninsured Americans are flowering again inside the Beltway and around the country.

And this time, advocates hope, the political climate is right for the best ideas to grow, in large part because many business groups that opposed earlier efforts now agree that rising health-care costs and increasingly tougher access to insurance are unsustainable trends.

Whether Washington will do more than talk about the problem, however, remains to be seen. Money is tight, and some experts say major shifts in federal policy are unlikely until after the 2008 presidential election, in which health care is expected to be a major focus.

Many are not willing to wait. Karen Ignagni, president of America’s Health Insurance Plans — the same industry association that once funded the “Harry and Louise� ads — was among representatives of 16 business, medical and consumer groups that last week called for Congress to spend $45 billion over five years to extend health coverage to most of the nation’s uninsured children. After that, the groups said, lawmakers should direct billions more toward covering uninsured adults, mostly through a mixture of tax breaks and expanded federal programs.

“On this issue, the polls show that Democrats, Republicans and independents want progress,� Ignagni said. “The most expensive course is to do nothing.�

John Castellani, president of the Business Roundtable, an association of chief executives of 160 U.S. companies, issued a similar call at a separate news conference last week with leaders of AARP, the politically powerful seniors organization, and the Service Employees International Union (SEIU). “Our soaring health-care costs put American goods and services at a significant competitive disadvantage, and they slow economic growth,� Castellani said. “Policymakers must act.�

In recent weeks, proposals for dramatically expanding coverage have been floated by Ignagni’s industry group, the Children’s Defense Fund and Sen. Ron Wyden, D-Ore. Sen. Edward Kennedy, D-Mass., and Rep. John Dingell, D-Mich., who lead important congressional committees, plan to pursue legislation to allow Americans under 65 to enroll in Medicare or in the health coverage enjoyed by Congress. And a bipartisan group of two senators and three House members introduced legislation last week to help states fund innovative ways to cover more people.

“Health care has been poked and prodded for years,� said Wyden, who wants to replace employer coverage with a centrally financed system of private insurance for all Americans. “I believe it is time for diagnosis and treatment.�

Much of the activity in Washington is being spurred by a wave of experiments at the state level, particularly Massachusetts’s decision last year to require all residents to obtain health insurance, through state-subsidized policies if necessary. This month, California Gov. Arnold Schwarzenegger (R) proposed a similar plan for all 36 million Californians, funding its $12 billion cost partly through fees on employers, hospitals and doctors.

In Pennsylvania, Democratic Gov. Edward Rendell last week proposed creating a program of state-subsidized private insurance to help many of the 767,000 uninsured people in his state. The plan would impose taxes on tobacco and on businesses that do not offer coverage, and it would phase in a requirement that people earning more than 300 percent of the poverty level (about $60,000 for a family of four) obtain insurance.

“It is no longer a question of whether we can afford to act,� Rendell said, noting that treating Pennsylvania’s uninsured costs $1.4 billion annually. “The cost of inaction is far greater in terms of individual health consequences and from the increasing burden on taxpayers.�

Vermont enacted legislation last year that seeks to expand coverage so that at least 96 percent of residents will have insurance by 2010. Illinois began a major expansion of coverage for children in 2005. That same year, Maine began implementing a plan whose goal is to cover all of the state’s 130,000 uninsured residents by 2009.

Other states considering expanding coverage include Connecticut, Indiana, Iowa, Louisiana, Minnesota, Missouri, New Hampshire, New Jersey, New Mexico, North Carolina and Wisconsin, according to the National Conference of State Legislatures.

All the state activity is adding pressure on politicians in Washington to act on a problem that grows worse year by year. Recent census figures show that a record 46.6 million Americans, including 8.3 million children, had no health insurance in 2005, up from 39.7 million in 1994. Employer coverage is more expensive and less available.

“As usual, Washington is behind the rest of the country,� said Andy Stern, president of the SEIU. “We’re ready to have a very bipartisan solution. What you are seeing now that you didn’t see in 1994 is that everyone is on the same side saying, ‘We want universal coverage.’ The only question is, ‘How?� ’

Ah, yes, “how� — and how to pay for it.

Expanding coverage is a costly proposition, and Democrats, in control of Congress for the first time since 1994, have pledged not to pass major new spending proposals unless other programs are cut to avoid increasing the federal deficit.

While there is bipartisan support for reauthorizing the decade-old state-federal Children’s Health Insurance Program, which covers more than 4 million children at a cost of $5 billion a year, experts say at least $12.7 billion more is needed over the next five years just to keep covering the same number of kids.

Moreover, President Bush has given no sign of departing from his advocacy of special tax-favored savings accounts and changes in the tax code as the best ways to make health insurance more affordable. In his State of the Union speech this week, Bush plans to propose more such changes and to announce a new initiative to help states get more residents into private insurance.

“We must address these rising costs so that more Americans can afford basic health insurance,� the president said Saturday in his weekly radio address. “And we need to do it without creating a new federal entitlement program or raising taxes.�

Despite the new enthusiasm, in the short run, most attempts to expand coverage will probably continue to happen at the state level, some lawmakers said. Federal efforts will be largely incremental and devoted to helping the states find their way.

But ultimately, Washington will have to do more, said Charles N. Kahn III, president of the Federation of American Hospitals.

“At the end of the day, I think the federal government and the federal taxpayers have a responsibility,� said Kahn, whose organization was among those calling for $45 billion to cover children. “Clearly, there are states that are looking into this. They can come up with some resources. But we feel that in order to get the ball rolling from where we are now, this is the role that the federal government needs to play.�

Why did I leave a comment in such a pretty bland dry article?

Well it was more to do with the responses from people who also managed to catch that article on Google news on the day. The first really riled me.

Juan wrote:
I can't afford health care. Please make my neighbor pay for it.
01/22/2007 11:31:15

You could write an entire essay on those two sentences. It covers so many issues, the growing divide between the haves and have nots, the ridiculous amount it costs to have basic surgery in the USA, the litigation, the ideal of the individual in USA society....one could opine for a few pages.

Then there's this.

Trust but Verify wrote:
Cancel ALL third party coverage including the government system and give everyone wage increases and tax cuts to buy their own plan. When people have to pay out of pocket for coverage you will see competition because people will shop around for health insurance/care just like they do for everything else.

I do not want the government in charge of my health care!
01/22/2007 11:53:42

Hmmmm. Give people more money by increasing wages and dropping taxes....... that even BIGGER big screen TV is lookin' kinda good.

Then this,

Otto wrote:
Our cost at the hospital would drop 30% if you kept the illegals out. When they go in and can't pay, that cost gets put on our bill.
01/22/2007 14:46:13

Yep, those darn "illegals"...... there's an essay or two in that one as well regarding this rather maleficent term that has crept into the American vocabulary.

However, it wasn't all hard nosed Fox watchin', redneckin', taxpayin' banter though. Some of the 45 comments included:

Denny Beck, Toledo, Ohio wrote:
I tried to get freelance writing work from a global business news resource in the UK. I was told my fee was much higher than proposals coming from the UK. Of course, they did not have to include health insurance in their overhead costs. Manufacturing workers in China get a free ride with their health care, too. If other countries won't change to help level the playing field, it's time we change.
01/22/2007 16:19:36

Which was a welcome bit of objective observation rather than opinion.

Another added an article on medical BANKRUPTCIES which I found astounding when I first heard of it a few months previously from an American friend.

I liked this comment

Cate wrote:
One more thing. A French doctor said to me: "Why don't you have health coverage for everyone in your country? Don't Americans feel loyalty to each other?"
01/22/2007 16:40:19

And this (the last comment) was another that appealed to my bleeding heart liberal tendencies.

Li Tai Fang wrote:
There is a difference between capitalism and profiteering.
I'm all for corporate profit and capitalism. No one who has argued for universal health care is arguing for socialism, so please no more straw man tactics.
I have no problem if a software company or a real estate broker is making a load of money and a lot of people get rich from them. I have no problem if a football player is making $10 million a year if the system is able to come up with that kind of money.
However, there are certain fields where responsibility comes before profit, and people's health and life should be one of them. In fact, the government already engages in many not-for-profit operations precisely for that purpose: police force, fire fighters, military, scientific research, etc. Why not individual health care for her citizens?
01/24/2007 18:34:12

And there were other comments. Singapore has a good health sytem apparently covered by a 6% percentage of wages. Now, for my bit of piety and moralizing. Embarrassing and to an extent laced with opinion looking back today.....it even has a typo or two. Nevertheless I'll stand by it.

Aussie Readerwrote:
To this Australian "illness bamkruptcy" is a term that seems comedic if it were not so tragic. 1.25% of my wage goes towards Australian nationial health care which seems to be working rather well.

Travel Insurance to USA is more expensive than anywhere in the world.

Some of the hard-nosed comments regarding caring for others rings of some sort of "moral bankruptcy" to me.
01/22/2007 16:25:13

Nevertheless, it got one God fearing Christian thinking.

Good Points From Europe wrote:
Reading the blogs from the folks in Europe who have Universal Healthcare make me think it is Americans who have it all wrong.

These foreign bloggers are telling us that their universal healthcare systems are fine. Some of them even seem troubled that we Americans don't have loyalty to one another.

That was evedent in the comment byAussie Reader, who posted: "Some of the hard-nosed comments regarding caring for others rings of some sort of "moral bankruptcy" to me.

Does anyone want to tell Aussie that we are a Christian nation -- One Nation Under God and we don't have to do a damn thing as "Our Brother's Keeper?"
01/22/2007 17:58:08

But it was this comment from a guy in Michigan who was really in the economic battlezone on this one. I felt for him, half a planet away. The spelling and punctuation need a polish but it's one of the best pieces of frontline reporting from the economic trenches I can recall. He's included some of the problems the most powerful country in the world is in. Broken & expensive healthcare, unemployment and the black hole of military spending.

Unemployed Worker from Michigan wrote:
I lost my job because my boss and owner of a small manufacturing business had cancer. His business did not make enough profit to pay his medical bills for cemo treatments he needed. He had to apply for state or medicade assistance. He was a strict republican and did not believe in a nation health program. His shots to fight cancer where like $4000 dollars every two weeks. He did not have health insurance at his business. My boss died 2 weeks ago. In some cases the alternative too no health insurance is a hole in the ground. I myself have had to have a hynea surgery about the same time of the plant closing. I was told it would be a $5000 doctors fee for the operation. With asistance that i applied for the surgery would be aprox. $1000. I said go ahead and we had the surgery. The first bill i recieved was for 10,000 dollars hospital fee, 109 dollar tissue exam fee, 765 dollar anesthesiologist fee plus some pre-op visit costs. They then applied the discount of 80% for assistance to the hospital fee and 50% discount to the anesthesiologist fee and i owe aprox. $2,462 for the expected $1000 dollar operation. The rest must go for a tax carity write off that is passed onto the government. Meanwhile i have 3 weeks unemployment left and looking frantic for a new job. I had to have the operation as no one would hire anyone with a hynea or lifting problem. We are healed now and have many skills including cnc vmc milling and turning experience. We live in the Upper Penninsula of Michigan where there are not many jobs listed for machinist. Most the jobs listed are for the National Guard and Army that amount to about 30% of the jobs listed at Michigan Works, for people up to age 40, military cut off age. We are age 54. I have not seen it this bad since the last recession. We need a unemployment extension badly here. Listing Army jobs on a civilian job service postings is not showing the true extent of the joblessness in upper michigan. Just looks good on paper. People have many needs that are not being met now days and health care is one of the largest ones.
01/22/2007 17:12:59

I'm not sure who you are "Unemployed in Michigan" but I hope there has been some glimmer of hope in that Renovator's Delight that you've found yourself living in.

MIchael Moore's next movie is on this subject......should be a doozy.

 

[Yupo]

There is a big change coming to the way CMS (Center for Medicare and Medicaid) pays hospitals, beginning in July of 2017. I expect implementation of it to be equivalent to the devastating effect DRGs (diagnostic related groups) payment system had on hospitals in mid-1980s. Just saw this story last week. I think the implosion is beginning.

Brigham and Women's offers voluntary buyouts to 1,600 workers
Written by Tamara Rosin (Twitter | Google+) | April 27, 2017 | Print | Email
Boston-based Brigham and Women's Hospital said Thursday it is offering voluntary buyouts to 1,600 employees as a means to cut costs, The Boston Globe reported.

Officials said the hospital, which is one of the city's largest employers, is profitable. However, it's facing pressure amid shrinking payments from government and commercial insurers and growing labor costs. Labor represents about 66 percent of the hospital's costs, according to the report.

Brigham is also dealing with debt from two major infrastructure projects, including a $510 million building that opened in 2016 and a $335 million software system that rolled out in 2015, according to the report.

"You can't just keep spending more and more and more and not making any more," Brigham spokeswoman Erin McDonough told The Boston Globe. "We know we need to work differently to sustain our mission for the future. We're really looking at how you reduce costs."

Although the buyouts are voluntary, hospital officials said layoffs could come later this year depending on how many employees accept the buyout offer, reports The Boston Globe.

Brigham and Women's, which is owned by Boston-based Partners HealthCare, has about 18,000 employees, according to the report. To be eligible for the buyout offer, employees must be 60 or older. The deal includes one year of base pay.

About 5,300 employees — including physicians, faculty and research staff — will be excluded from the offer, according to the report. Approximately 475 unionized workers are eligible for the buyout, but Brigham officials said it must get approval from the unions before offering members the deal.