published Saturday, February 5th, 2011

TennCare

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about Clay Bennett...

The son of a career army officer, Bennett led a nomadic life, attending ten different schools before graduating in 1980 from the University of North Alabama with degrees in Art and History. After brief stints as a staff artist at the Pittsburgh Post-Gazette and the Fayetteville (NC) Times, he went on to serve as the editorial cartoonist for the St. Petersburg Times (1981-1994) and The Christian Science Monitor (1997-2007), before joining the staff of the ...

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AndrewLohr said...

"The heart of the problem is the problem of the heart"--Henry Krabbendan, Th.D.

If I get sick, it's because I stay up late and eat too many sweets. Does Tenncare deal with eating too much? It does not. Does it deal with eating unwisely? It does not. Does it deal with hours of sleep? It does not. Even when we make ourselves sick, Tenncare (Medicare, Medicaid, O'care) simply pays us to be sick, instead of tackling the stupid choices we make.

February 5, 2011 at 6:27 a.m.
mountainlaurel said...

Everytime I reflect on the healthcare crisis in this country I come up with the same shameful conclusion – we are morally bankrupt as a Nation. To insist on a system that makes profits off of sick people is a disgrace. . . Indeed, there is something wrong us? . . . Is there a doctor in the house?

February 5, 2011 at 7:14 a.m.
EaTn said...

Tenncare can be summed up as another mismanaged government cash cow that was milked dry by greedy patients and health care providers.

February 5, 2011 at 7:35 a.m.
dude_abides said...

Andrew, do you feel the same way about auto emissions, FDA weakening legislation, etc.? Should we impound the cars of speeders? All this would be attacking root causes. I'm sure the insurance providers will be reading our grocery store lists soon enough. "Sorry, Mr. Lohr, we have to cancel your policy. You are one Smore over the sweet line, Jesus." C'mon, everybody!....sittin downtown in a railway station...

February 5, 2011 at 7:49 a.m.
mountainlaurel said...

EaTn said: "Tenncare can be summed up as another mismanaged government cash cow that was milked dry by greedy patients and health care providers."

Good grief . . . Tell us more, EaTn. . . In your opinion, which group is exploiting the State of Tennessee more – lower income children or lower income pregnant women?

“He warned that hospitals are near the end of what they can legally do to help TennCare, the state's version of Medicaid, and cannot afford to permanently fund forever the program that helps 1.2 million Tennesseans. Most recipients are lower-income children and pregnant women.”

February 5, 2011 at 8:05 a.m.
woody said...

Since Andrew started today's quote-a-thon I believe I'll take it one step further. Jesus said, "Physician, heal thyself."

I guess that could be taken several different ways but I would like to believe it means healing (quite like charity) begins with us (at home).

Ned Ray had the right idea, weaning us away from Medicaid, with TennCare. Then along came Don Sundquist, who trashed one of the best 'independent' medical programs to ever see the light of day.

Granted there were, and always will be, those who did their dead-level best to take advantage of a good situation. They, too, have been around since biblical days.

If Tennessee's leaders today would just go back and take a look at how Ned Ray envisioned TennCare back then, I honestly believe we could still salvage one of the best ideas to ever come out of the south. It must have been a really good idea or else or why would so many have tried to take advantage of it??

Remember, it all begins right here at home, Woody

February 5, 2011 at 8:06 a.m.
EaTn said...

Shortly after Tenncare came on board, our state borders started seeing the influx of "immigrants" from other states with the sole purpose of setting-up residence to enroll in Tenncare. I personally knew a family of three adults who sold out in another state and moved here for that specific purpose. Not one was employed. Yes, Tenncare helped a lot of needy people as well, but the wide spread abuse has led to a lot of needy people now being kicked off.

February 5, 2011 at 8:48 a.m.
dougmusn said...

@AndrewLohr: Today, you are absolutely right: we dig our graves with our knives and forks (and our other behaviors). That's the easy part. Now, Andrew, what would you have us doctors do about it? Obesity rates directly follow rates of poverty: cheap food makes you fatter. Should we give people money? Good food? Should we cull them from our practices like the doctor in West Virginia who told smokers he could no longer care for them or the urologist who told Democrats to look elsewhere?

I don't think I have ever seen a patient who said "Gee, I would like to go see the doctor today to have some fun." People come to see a doctor because they have a pain, a concern or an absolute need (think crushing chest pain or a mangling injury). They seek relief of suffering. TennCare may not have a quick fix for obesity or a sedentary lifestyle but no care does that. Motivating people for change is particularly difficult--just think how long you have been sharing your conservative views while we uberliberals just won't budge!

February 5, 2011 at 9:11 a.m.
whatsthefuss said...

It seems the Medicare Waiver granted Tennessee by the federal government in 1993 that allowed the creation of TennCare was the start of a financial impossibility that has been treated as a corner shell game by the powers to be. When one keeps robbing Peter to pay Paul, and Peter dies it isn't very difficult to see the problem. Per member spending for Medicare and Medicade patients in Tennessee under the TennCare label is and has been the lowest in the nation. The balanced Budget Act in 1997 only made the program move further underground. The national % of hospital and doctor revenue from government in 2000 was 66%. It should become obvious that this number has only increased in the last 10 years. The financial viability of healthcare is planted directly on the taxpayer already. Somewhere, somehow this country must come to the conclusion that every citizen should be provided BASIC HEALTH CARE funded by everyone. When the taxpayer is making the major contribution already to support the Medicare, Medicade members and the rest are paying higher costs for the same service the time has come to make National Health Care the top priority in the country. With our education system failing students past and present it would only seem logical that the Medicade rolls will continue to increase without money to fund the new members. This is the number one problem with ObamaCare. There is no money to fund the program. Remember, TennCare was created as a reactive thought, not a proactive action. This process has continued to today where the well is dry and no one has any answers only because there are none under the current plan. I thought Gov. Bredesen did a very good job but the truth is when all three shells were lifted off the table there was never anything under anyone of them. SUPRISE!!!

February 5, 2011 at 9:33 a.m.
mountainlaurel said...

Woody said: “If Tennessee's leaders today would just go back and take a look at how Ned Ray envisioned TennCare back then, I honestly believe we could still salvage one of the best ideas to ever come out of the south."

I believe you may be onto something good, Woody. After reading your post, I found some interesting articles about the “original” TennCare plan developed by Ned Ray. I’m still reading, but so far I’m impressed. Also, I note there are others who agree with your comment about Sundquist trashing the “original” TennCare concept. Anyway, this 2006 interview provides a lot of details:

BONNYMAN: It is important to understand that within the state, TennCare was always an ugly duckling. This was primarily because it imposed managed care cost discipline in a state with little managed care penetration. Resistance of organized medicine to managed care in general got focused on TennCare as a kind of lightning rod. There were medical association lawsuits and public relations campaigns to discredit the program from the beginning.

It was a godsend to the uninsured, but political influentials saw it as always controversial. Although the program has collapsed, it is key to make a distinction between policy failure and political failure. By any fundamental measures of success, as a policy initiative it exceeded expectations. It saved money. It represented the most dramatic reduction of the uninsured of any single state program I am aware of. And it actually was beginning to affect health outcomes, as documented in Health Affairs and elsewhere.1

HURLEY: But what about the alleged savings? What is the basis for them, given that so many more people were being covered and state spending increased?

BONNYMAN: We had to show savings as part of the cost-neutrality requirement of the Section 1115 waiver application, and I think we met accepted standards in doing so. Recognize that it was savings against projected growth in traditional Medicaid spending. Because we started in 1994, we did indeed get the benefits of a dip in medical inflation, which helped us demonstrate savings. The amount of savings has been disputed, but estimates range from a couple hundred million to over a billion dollars. TennCare was able to achieve expansions and some savings without any serious dislocation of providers. “

http://content.healthaffairs.org/content/25/3/w217.full ["TennCare- A Failure of Politics Not Policy" - Robert Hurley]

February 5, 2011 at 9:39 a.m.
fairmon said...

Mountainlaurel,

Do you think health care providers and insurance companies should provide their services for no profit? I wish that were possible but how we would we keep the best Dr.'s and specialist in the world if they had to work for no gain? Who would ever spend the years and money required to be a Dr. if there was not to be a good return? Who would build hospitals and medical facilities if there was to be no profit? What pharmaceutical company would invest in R&D to develop new medicines if there was to be no profit?

Kevorkian may have had the right idea but the legal system stopped him. I would like to have the option of voluntary termination of life if I reach the point of being totally incapable of caring for myself or if death is certain after a long period of inactivity and pain. The courts support pro-choice and allow aborting life on one end but not the other, what is the logic?

I have no objection to helping and supporting the elderly and kids that have no help or those working and trying to do the right thing but can't afford health care. However, those that could and won't and crank out kids like a gum ball machine, live in section 8 housing, get food stamps, utility subsidies and other assistance irritate the heck out of me. And, those able men that "hang out" and won't work, get involved in illegal activities and abuse women as far as I am concerned can buy the farm if they get sick or hurt. This behavior is not race specific as some would conclude.

I know you think this comment is so "insensitive and cruel" but I still feel that way and no bleeding heart will be changing my mind. I recently observed a person paying for groceries with food stamps then load them in a new Cadillac Escalade and drive away. You may find it acceptable for me to help pay for that, I don't!

We can keep on for a while but some verifiable facts are: The government is spending $400 billion on welfare, $200 billion for government pensions and $700 billion on defense. This exceeds all the annual tax revenue without paying the $200 billion interest on the growing debt. Double the tax revenue and we still come up short. How bad do things have to get before we realize what is happening?

February 5, 2011 at 11:49 a.m.
steve_smith_tn said...

As a kid, I didn't have insurance. Most people didn't. I went to an M.D. in Soddy-Daisy whose office was attached to his house. I remember he seemed real old. My folks paid cash. I'll bet that is illegal now - zoning ordinances, licensure requirements and such. I also remember getting haircuts at a "salon" in a woman's garage. People used to work from home more I guess.

I sense some growing belief that people are entitled to health. That seems to me to be the silliest of the utopian pie in the sky notions that I have ever heard. We can't even agree what health is. Last year butter fat was unhealthy. This year trans-fat is unhealthy. 100 years ago only the wealthy could be healthy and fat. Anyone ever heard of pellagra?

The loss of medicine as a profession directly correlates with the rise of Medicare and insurance companies. When you separate the provider of a service from its payor, prices go up. Labor (being a doctor) becomes a commodity that others can profit from. Other examples include the education industry, the military industry, and the housing market. This privity-free profit machine allows the connected to stand on a ladder at the top and scoop away the tax dollars of us peons at the bottom. The bubble has to break eventually.

Of course the upper class is not the only culprit. While the evolution of the system has prevented the middle class from being able to pay the inflated prices of necessary healthcare services, the feral humans at the bottom have no scruples about taking their kids to "free" emergency rooms because of a low grade fever and a runny nose. I remember news footage last year of lines out the door at hospitals in Memphis. The argument that we should expand healthcare for free because "we are paying for it already" just presumes there is nothing wrong with giving people something for nothing.

Profit and loss is a motivator. I profit from working out four days a week. I am at a loss if I can no longer hike up Mt. Leconte. There is nothing disgraceful about that. Of course every malady isn't directly tied to the choices of a patient. That is life. We are not all created equal. Some of us have worse genes than others. Absent some nightmarish resort to eugenics, I don't think health inequality will ever be rectified, no matter what President Obama might argue. But, the corporate-insurance-government healthcare monopoly can come to fruition.

The republicans favor adjuster/accountant/doctors and the democrats favor a mythical Uncle Sam with a stethoscope. I like the old, Soddy-Daisy doctor. He was a nice guy. Let's bring back solo practitioners and let insurance corporations sell auto policies and the government make cars.

February 5, 2011 at 12:12 p.m.
dave said...

There is an appointed time for a man to die. Tn. care is just another demo-money grab failure. soon we will have one on the federal level.

February 5, 2011 at 1:39 p.m.
mountainlaurel said...

Harp3339 said: “I know you think this comment is so "insensitive and cruel" but I still feel that way and no bleeding heart will be changing my mind.”

Of course, this is just a suggestion, but I believe you should consider adding the word “dumb” to your description, Harp3339. Since all of the other industrialized nations have affordable universal health care systems in place and we don’t, it makes it really difficult for U.S. businesses and manufacturers to successfully compete with other industrialized nations.

February 5, 2011 at 5:48 p.m.
steve_smith_tn said...

Mountain Laurel is right. Other industrialized nations subsidize corporations by providing health care for their cubicle and assembly line dwellers. I've never thought about socialized medicine as corporate welfare before but I guess it is.

February 5, 2011 at 6:16 p.m.
blackwater48 said...

I think Andrew speaks for all Republicans everywhere when he declares, "If I get sick, it's because I stay up late and eat too many sweets." No it's not. That may be a contributory factor but you're just making a gross generalization to shift the focus of the discussion and change the subject.

By saying that, however, my right wing friend, you illustrate perfectly the key response to any Liberal attempt to address social ills or elevate domestic tranquility.

Regardless of topic, the Conservative default position is to always blame the victim.

February 5, 2011 at 6:29 p.m.
mountainlaurel said...

Steve_Smith_Tn said: “I sense some growing belief that people are entitled to health. That seems to me to be the silliest of the utopian pie in the sky notions that I have ever heard.”

Steve, I don’t know how to tell you this, but every major industrialized nation in the world – including capitalistic democracies - have a universal healthcare system for its citizentry.

And while no one is saying that people are entitled to "health," they are all saying that people have a right to healthcare and that it should be done without anyone making a profit:

“Swiss politicians from the right and left enthusiastically support universal health care."

"Everybody has a right to health care. . . It is a profound need for people to be sure that if they are struck by destiny ... they can have a good health system."

[Pascal Couchepin - Former President of Switzerland]

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/synopsis.html

February 5, 2011 at 6:59 p.m.
steve_smith_tn said...

Mountain laurel

I almost agree with you. Every major industrialized nation in the world, except one, has a universal healthcare system for its citizenry. There is a really large industrialized nation that is yet to commit to profitless healthcare.

Many of these European nations also provide a free education, including college. Everyone is enlightened there. The average IQ is a standard deviation above ours. They all live to be at least 85. Everyone drinks red wine and eats fine cheese. Most can trace their lineage to royalty, but nonetheless are hospitable and humble to a fault. They even have no need for firearms.

Alas, they have terribly expensive food and consumer goods. Land is almost an impossible dream for most. Most cannot afford to travel except by public transit. They have soccer hooligans. And let's not forget riots and growing far right militants. They have governments who have recently singled out gypsies and young muslims for special scrutiny. Knife fights are epidemic.

But hey, they got free healthcare and nobody is worried about profit. Sounds like paradise. LOL.

Have a good night Mountain laurel. Because of this discussion, I'll probably dream of eastern european pickpockets and dirty Scottish pubs tonight.

P.S. Do you think it is unethical to profit from the sale of food? What is the distinction between ethical profit and unethical profit?

February 5, 2011 at 8:10 p.m.
trburrows said...

tenncare will be history when we get universal care. it will be nation wide not state controlled. this is why tenncare was and is stupid. why waste the money. it wont last pass O. you are right, as long as we have liberals we will have people taking advantage of medicine and drugs. they want everything for free.

February 5, 2011 at 8:13 p.m.
lkeithlu said...

Excuse me, trburrows, but I am a liberal and worked hard all my life and depend on no one. I live a healthy lifestyle, control my weight, stay fit, and don't expect anything "for free". Try not to stereotype, okay?

Some of the biggest gold-diggers I know are conservatives. Stereotypes do nothing to solve problems.

February 5, 2011 at 9:33 p.m.
trburrows said...

you sir are one in a lot of millions and a diamond in the rough. good for you, you are a future repub recruit. i am not stereotyping, i am talking about the majority.

February 5, 2011 at 11:34 p.m.
blackwater48 said...

Steve Smith raises an interesting question: "Do you think it is unethical to profit from the sale of food? What is the distinction between ethical profit and unethical profit?"

Oh goody. An ethics question concerning insurance company bureaucrats standing between you and your doctor.

Let me ask you this, Steve. If you were diagnosed with cancer and your insurance company refused to authorize treatment, would your first response be to ponder the ethical implications?' What if your insurance denied a claim that would save the life of your child - citing a 'preexisting condition - would you first wax philosophical?

As to your other point, I don't think it's unethical to profit from the sale of food, but supermarkets and restaurants cannot overtly screw you the way health insurers could.

At a restaurant, for example, if you order and pay for a meal the manager can't then refuse to serve you. If you check out at a grocery store and pay the cashier, the store doesn't have the right to then put everything you just bought back on the shelves.

The Affordable Care Act will cut into the profits of giant Health Insurance Corporations and they are fighting back hard. The want to go back to the "good old days" when their bureaucrats literally wielded the power of God over who lived and who died.

You might miss the good old days but I do not.

February 5, 2011 at 11:48 p.m.
trburrows said...

bw i cant believe this but every thing you said i back 100 %. i dont see eye to eye with you, and you and i butt heads, but every word you say is right on. damn.

February 5, 2011 at 11:59 p.m.
mountainlaurel said...

For the guys: Harp3339, Steve_Smith_Tn and Trburrows

  1. How would you assess the U.S. health care system?

The U.S. has a system [that] does have a poor cost-benefit ratio. I mean, 40 million people lack insurance; another 30 [million] or so are underinsured. The people who are insured do have to worry whether they are able to pay the bills. People become bankrupt because they cannot pay the medical bills, and there are vast differences in the quality of care depending on how much you are prepared and able to pay. I think the system is not working well. . .

  1. What could we learn from looking at the German health care system?

One can learn that competition is good. You need competition in the health care system and transparency, but you do not need for-profit competition. So limit profit and maximize competition and have everyone covered, and limit bureaucracy wherever possible. ...

  1. Another problem with the American health care system is that American insurance companies can a, turn you down and . . . deny claims.

Well, denying people and denying claims is both unfair and a waste of money and time for everyone. It is major bureaucracy, very frustrating, and ultimately someone has to pick up the bill. So this is only, let's say, repairing failures in financing the system. . . .

Very important is that there's a pool of money from which sickness funds do get money if they have poorer or sicker patients because if that is working then you do not have deny anyone, you do not have to deny claims, and it is of interest to you to take everyone. Risk adjustment and the risk pool for the sickness funds, I think that is the most important single piece of the German health care system which might be of interest to you.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/themes/lessons.html [NPR Interview with Karl Lauterbach, German Parliament]

February 6, 2011 at 12:04 a.m.
AndrewLohr said...

Tenncare, Medicare, insurance, and a lot of health care deal with effects while ignoring causes; treat 'symptoms,' so to speak, while ignoring underlying 'diseases' (bad choices) that, however hard to treat, are not wholly resistant.

Smoking is more or less addictive, but some people do quit smoking. Should X-care pay to treat the effects of smoking, but do nothing about the smoking itself? Should Tenncare kick smokers off? (Or maybe treating six months of lung cancer costs less than treating 30 years of old age? Any CPAs out there? Even a soft heart needs a hard head. And I've heard half a pack a day MIGHT be harmless.)

Some fat people manage to lose weight and keep it off. Should X-care pay to treat the effects of gluttony, but do nothing about the gluttony itself?

Some people improve their sexual habits; Wendy and I got married. Should X-care pay to treat the effects of fornication, but ignore the cause? Should people who practice abstinence or monogamy be taxed to subsidize riskier lifestyles?

I've read that Safeway (western grocery chain) kept its health costs flat A.D. 2005-2009 by incentives to wiser behaviors. Well?

("Krabbendam," not "Krabbendan." Sorry.)

February 6, 2011 at 12:04 a.m.
trburrows said...

ml bottom line is, i dont think a healthy person should pay health care for a non healthy person if both people choose that way of life. smart people should not have to pay the way for stupid people's way of life. there is no answer and no way to stop this behavior, its just my belief. if there was an answer to the american health care system it would be in effect, but there is not.

February 6, 2011 at 12:19 a.m.
steve_smith_tn said...

Blackwater

I like your enthusiasm. Unfortunately for your position, I don't favor insurance companies. They are the problem. We don't fix the problem they have created by requiring everyone to give them more money. To think that a managed healthcare system - single payer, double payer, poly payer - won't result in someone between you and your doctor is a little shortsighted. The only way to keep someone from getting between you and your doctor is by paying your doctor out of your pocket. We used to have that kind of system until medicare and the rise of the insurers. We could have it again if we wanted it.

Costs need to come down. You can't get costs down by giving the government or insurance companies more money. It only comes down if people stop paying the ridiculous prices. Some people are willing to die for a principle. Others will sell out everything and everybody for 5 minutes more. There are some things more important than life.

February 6, 2011 at 1:15 a.m.
blackwater48 said...

Steve Smith

Competition is the great equalizer. Require everyone to have insurance, provide a public medicare style option, and let the market place run its course.

The private insurance companies will have to reorganize and rededicate themselves to putting customers first. Competition works wonders with auto insurance.

Heck, it works well in all industries. Corporations, by nature, hate competition.

Some things may be more important than life but the health care crisis isn't one of them. It's a man made problem and there's a made man solution.

February 6, 2011 at 2:19 a.m.
fairmon said...

mountianlaurel,

You should be in congress. You select part of one statement that requested no response and commented on it and siezed the opportunity to reveal your understanding of business economics and why American companies can't compete.

I was hoping to be educated when by you revealing your opinion or how you would handle issues in the other comments and questions. Instead, like a good politician, you select one sentence that was not a question at all and stuck to your talking point without addressing any other question or comment. Welcome to D.C.

February 6, 2011 at 10:50 a.m.
whatsthefuss said...

BW Wrote

Competition is the great equalizer. Require everyone to have insurance, provide a public medicare style option, and let the market place run its course.

The private insurance companies will have to reorganize and rededicate themselves to putting customers first. Competition works wonders with auto insurance.

Heck, it works well in all industries. Corporations, by nature, hate competition.

Some things may be more important than life but the health care crisis isn't one of them. It's a man made problem and there's a made man solution.

Competition does work wonders but not with insurance companies. Their losses are your premium payments. People who are not insured driving our roads are covered by the people who pay their premiums. Healthcare works in a complete opposite manner. The poorest people who cannot afford auto insurance, many of whom drive our roads illegally, are given the best health care called MEDICADE, free of charge with no co-pay or deductible provided by the working Americans, including the 30 million freeloaders as you call them. Government workers along with public school employees do not produce a profit. They are all on the cost end with no return except their rhetoric that their doing a great job. So perhaps Lazy, Drunk and Stupid is the new America.

February 6, 2011 at 11:25 a.m.
mountainlaurel said...

Harp3339 said: “You should be in congress. etc. etc. etc. you select one sentence that was not a question at all and stuck to your talking point without addressing any other question or comment. Welcome to D.C.”

What a dastardly thing to someone, Harp3339. Granted, we seldom agree, and at times we’ve traded mild insults, but this latest insult is just plain old mean-spirited.

As for the “questions” that you say that I don’t answer, I feel that I have already answered them either on the current thread or a prior thread on the same subject, but you’ve just opted to ignore my thoughts on the matter. For example, in your post you ask me if I believe that health care providers and insurance companies should provide their services at no profit. Since I have already expressed earlier on this thread that I felt it was wrong to make profits off of sick people, your question seems disingenuous to me - why are you asking when I've already stated my thoughts?

Your argument that a “profit” system is needed because its the only way the U.S. can continue to provide the “best” also seems disingenuous to me. I say this because many posters – including myself - have already pointed out in prior threads that this is a faulty argument. If the U.S. system were the “best,” the final results would show it, which, as you know they do not. Our infant mortality rates are higher and life expectancy rates are lower compared to many other countries – so how can you continue to insist that a “profit” system is the “best” system?

I also think your questions about people who receive welfare, food stamps etc. are disingenuous, Harp3339. You speak of your compassion, but your response to the food stamp-Cadillac scenario suggests something else. By this I mean your immediate response was to assume that the woman was a lazy freeloader. But in reality, the woman you saw in the market could have been just as easily a middle class woman who had lost her job and was struggling to get by on unemployment benefits. My point is that there are numerous possibilities to the scenario, and I believe a compassionate person wouldn’t rush so speedily toward “lazy freeloader” stereotype.

February 6, 2011 at 4:11 p.m.
fairmon said...

mountainlaurel, I hope we both live long enough to see the results if the health care industry is forced to be a zero profit entity. I assume we will force some individuals to attend medical school, serve an internship, invest in equipment facilities and staff, develop a practice and not profit if sick people come to them to utilize their years of study and learning? We can also force insurers to invest have reserves to pay claims and process payments without a 4% profit margin? Hospitals will have to be required to be non-profit, I wonder where they will get the money to build a hospital with no one willing to invest in them? Being all non-profit and not accountable to stock holders means they will have to be restrained from lavish spending for facilities and other rewarding behavior. Who would we want to do that at what cost? Do you think other factors may come into play that attribute to the difference in survival rates or is it simply attributable to our not having universal health care?

None of your scenarios are accurate. The Escalade lady has for years cohabited with a well employed gentlemen and they opted to not be legally married for obvious reasons. She is eligible for many forms of assistance and the alternative minimum tax refund. I just need to find a similar friend, she is a very attractive woman. I have to admire their genius of using the system to their advantage. How many names and addresses would you like of similar situations?

Believe me, I know something has to be done to provide for those incapable of providing for themselves and I have no objection to contributing to that. However, I am certain neither political party or a huge government can manage anything well.

February 6, 2011 at 9:05 p.m.
mountainlaurel said...

Harp3339,

I don’t know if you’ve seen the PBS series “Sick Around the World”, but, if not, I suggest that you do so. The program gives a pretty good overview of the various kinds of healthcare systems in other countries, and they are not having the kind of troubles that you’re predicting. While it’s true that some physicians are not making as much as some are in America, they are still doing quite well. And as I recall, there are plenty of physicians, plenty of hospitals and plenty of people doing some very innovative things – personally, I was impressed.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/themes/doctors.html

Per your survival rate question, since we have millions of Americans who do not have access to healthcare, I suspect that this may be one of the most important factors. Another obvious factor is probably due to diets. Americans consume an incredible amount of junky fast foods, which as we all know is not especially healthy on a regular basis. I think some of this reflects the amount of fast food advertisements that Americans see on their television screens day after day – almost American child has heard of McDonalds and Burger King by the age of two.

The scenario that you describe involving your “Escalade lady” friend does sound less than honest, and I suspect that the “Escalade” lady has not been totally honest in her assistance applications. Occasionally, you read about these kinds of fraudulent scenarios in the news, and usually it involves someone who has either a friend or relative who is working for a social service agency. The fact that the “gentleman” is well employed is a bit unsettling - what a jerk he must be. Hopefully, there are not any children involved in this scenario.

February 7, 2011 at 12:17 a.m.
fairmon said...

mountainlaurel,

Thanks for responding. I agree lack of preventive care can be a contributor to survival rate deltas although I think life style and a serious drug problem in this country has a greater impact. Another "war" we are ignoring and losing.

Since the introduction of the current bill I have read and studied other systems. I have seen a PBS special about health care in different countries but I didn't pick up that most were "no profit" plans other than where entirely government owned and operated. I have even talked to friends and acquaintances in countries with government controlled universal health care plans and get a different slant than the media gives us. I repeat, I don't reject the concept of everyone having access to good health care. But, have you read the actual bill that was passed?

I wasn't predicting anything, my questions are about the incentive for people to be a Dr. if there is no profit or reward for the 7-12 years of preparation? Would you go to a Dr. willing to do all someone has to do to become a Dr. when they have to work for "no profit". I would be suspect of their intelligence. Without people to invest in a company that builds, owns and operates hospitals where will expansion and new hospitals come from?. Did you see adequate highly specialized care and transplant ability in those countries? Did you see how many teaching hospitals they had? Did you notice where a lot of their Doctors were trained? Not all but a lot.

Zero profit has some very bad ramifications and can be even more detrimental to the general health of the country than what we have although what we have is not acceptable.

The Escalade lady doesn't have to be dishonest in applying for assistance. I have assisted some needy and deserving get assistance but not her or others like her. She has one child from a prior marriage and probably gets child support, I don't know about that. I do know another person in a similar situation that is receiving a $6,700 income tax refund due to the goodness of the alternative minimum tax although she paid zero. in addition to the noted assistance and working just enough to earn just under the qualifying limits her male friend owns a nice house and she is rarely at her section 8, rent paid, apartment. Unscrupulous on her part. She plans to trade cars with the refund, not an Escalade I am sure. Her 22 year old daughter is following in her foot steps. The problem is they grow up seeing and being dependent and think that is the way to be, so one equals 2, 3 or more. Of course they have TN CARE.

There has to be a better way, I am not smart enough to know what it is but I am not alone and I am sure our elected elite don't even recognize or acknowledge the problem.

February 7, 2011 at 2:52 a.m.
mountainlaurel said...

Harp3339,

Perhaps, you only heard what you wanted to hear. [Grin]

Indeed, the government through citizen taxes provides the British system, but it’s not the case with some of the other countries like Germany, Japan, and Switzerland.

According to the PBS special, Germany, Japan, and Switzerland use a social insurance model. In Germany, citizens are free to to buy their insurance from one of more than 200 private, nonprofit "sickness funds. In Japan, all citizens are required to have health insurance, either through their work or purchased from a nonprofit, community-based plan. In Switzerland, all citizens are required to have coverage; those not covered were automatically assigned to a company. [non-profit]

In each country, the government provides assistance to those who can't afford the premiums.

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/countries/

In regard to preventive healthcare situation in America, I suspect our Nation’s current economic crisis will - along the "Party of No" - only continue to make things worse:

“The nation's economic crisis has catapulted the number of Americans who lack enough food to the highest level since the government has been keeping track, according to a new federal report, which shows that nearly 50 million people -- including almost one child in four -- struggled last year to get enough to eat.

The magnitude of the increase in food shortages -- and, in some cases, outright hunger -- identified in the report startled even the nation's leading anti-poverty advocates, who have grown accustomed to longer lines lately at food banks and soup kitchens. The findings also intensify pressure on the White House to fulfill a pledge to stamp out childhood hunger made by President Obama, who called the report "unsettling."

The data show that dependable access to adequate food has especially deteriorated among families with children. In 2008, nearly 17 million children, or 22.5 percent, lived in households in which food at times was scarce -- 4 million children more than the year before. And the number of youngsters who sometimes were outright hungry rose from nearly 700,000 to almost 1.1 million.

Among Americans of all ages, more than 16 percent -- or 49 million people -- sometimes ran short of nutritious food, compared with about 12 percent the year before. The deterioration in access to food during 2008 among both children and adults far eclipses that of any other single year in the report's history.”

http://www.washingtonpost.com/wp-dyn/content/article/2009/11/16/AR2009111601598.html

February 7, 2011 at 1:41 p.m.
fairmon said...

Mountainlaurel,

Good post. I don't think we disagree on the need but on the method we will be using to achieve the desired result. I can't imagine how a no profit system would work and didn't see that being the case in those countries you use as as examples of success. Regulating and taxing can restrain the gouging some few do.

I am aware of the hunger situation and contribute to the food bank and others. I think local governments and churches should do a lot more to see that children and the elderly have food and other necessities such as clothing, shelter, heat and cooling. The two examples I used in what are in my opinion abusers makes less available for the truly needy. More jobs and low unemployment would improve the situation tremendously. I like Obama's position of closing loop holes and lowering the corporate tax rates so the tax system doesn't favor one business over another and improves our trade balance. Congress talks tough but favors the financial and service sector over the industrial sector where most middle class Americans work. We don't gain much from banking, insurance and services exports.

The party of NO is no better than the other party. Both are compromised by lobbyist and special interest groups. EX: We should be making it easier and encourage students to be an M.D. instead of limiting the number as the AMA promotes. We should do the same for nurses and other medical fields to assure a good supply of skills which via competition reduces cost and improves quality. Most states limit the number of hospitals and hospital beds per capita, a regulation hospitals support.

I know the bill is almost an impossible read and takes a lot of time. It is full of accommodations, exemptions and other special items obviously to gain support. I wish it had been modeled after Germany with a lot less of our congressional twist. Japan is not a good example of managing any economic issue, including health care. I am sure you are aware how many Canadians come to the U.S. for special or urgent health care needs.

February 7, 2011 at 5:31 p.m.
tgarr2001 said...

TennCare serves over 1.2 million Tennesseans. About 750,000 are children, about 100,000 are disabled adults, about 70,000 are low-income elderly folks, and about 300,000 are single poor parents. In general, the quality of care is as good ad it is in the private sector and it does it for less that you and I pay in the private sector. Readers need to understand the facts before they expose their prejudices. Go to http://www.tn.gov/tenncare/ for the facts.

February 10, 2011 at 7:55 a.m.
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