Congressman Mike Roger's Opening Statement on Health Care Reform in Washington, DC

[OCNaturalDoc]

I'm curious (not sarcastic)...What source does congress use to get these numbers? It seems every time you turn around, people site a different set of numbers. It gets confusing. So who's right?

In a way, it doesn't matter how many are without insurance -- It matters that people's needs are taken care of in a timely fashion. How can we accomplish this without breaking the country, not only financially, but spiritually and fundamentally?

There's no doubt that something must be done to fix the current system. If you could write a plan (and you can, cuz they're looking for one!), what would it include and how would we pay for it?

[OCNaturalDoc]

no worries, greg.

[Greg Wilson]

OOps, sorry Doc, I had skipped over your post! (I have no idea how I did that! It was late?)

[Greg Wilson]

Alendar, do you work for Obama? No Doc, read some of those positions.

There must be waivers for risky behavior.
There must be limits on benefits.

Any who enforces all those items? Read it Doc.

[OCNaturalDoc]

toby, you claim to have experience and a great deal of passion for the medical profession. one would think that you, of all people, would be the first to make a valuable contribution to a health care discussion.

alendar has a lot to say on the subject, and i'm interested in knowing more about his thoughts.

[OCNaturalDoc]

alendar---
how would you enforce all those rules?
what criteria would you use to "set limits"?
and what do you mean when you say "preventative health care should be mandatory"?

[OCNaturalDoc]

if only, mike. but the truth is that medical school costs big money and most graduates have heavy student loans to pay off, so money is very important. the rest of it (insurance, etc.) is part of the machine they are caught up in if they choose to be a part of that system.

more and more doctors are choosing not to accept insurance -- it keeps their operating overhead down and your medical expenses are less per visit.

it would be wonderful to live in an altruistic culture. sometimes it takes losing everything for people to become more about the greater good. i hope it doesn't get that far.

[Alendar]

It's true, it doesn't really matter how many are uninsured, because no one has said what an acceptable number would be. If 1 uninsured person is not tolerable, then the number is meaningless. Only government could give insurance to everyone. No private company could afford to insure everyone regardless of the risk. All insurance has always been restricted at some point. At issue is the burden placed upon the average insuree by the number of high-cost individuals. If no limit on insurability is in place, then you have a completely new type of insurance.

My plan would be:
- Caps of some sort. Something that reduces costs to doctors. Reasonable limits.
- Offices would be required to post their tort limits in plain language and view, so if it was an issue, you could choose not to see that doctor.
- Tax the uninsured young and working. If you are planning on ever getting sick, then you should pay in.
- Allow young people to opt out by signing a form saying they refuse all future care.
- Disallow pre-existing conditions being used as denial of coverage.
- Legalize assisted suicide. If people don't want to live, why force them to?
- Cap the amount of care any one person can receive via insurance.
- Allow people to consign their estimated future care costs to loved ones who are tapped out.
- Consigning your benefits would be taken out as a percentage of current care, not at the end. This would reduce the consignment of perfectly healthy above-average people to extremely sick.
- All health care would be calculated against the actuarial charts of the nation.
- Attach forfeiture requirements to lifestyle activities. You sign a form forfeiting your claim to any future care for anything diagnosed as resulting from smoking before you can smoke.
- Require licenses for lifestyle choices. Licenses are easy to attain, but doc your health coverage every time you eat at MickeyD's.
- Require medical assessments for continued coverage. Failure to receive an assessment at a registered facility results in loss of coverage.
- Conviction of crimes involving risky behaviors results in reduction of coverage.
- Illegal drug use results in loss of coverage.
- "no-fault" illnesses receive additional coverage.
- experimental treatments receive less coverage.
- FDA removes restrictions on experimental medications for incurable diseases. People can choose to try anything they want within a normal hospital environment.
- If your care benefit runs out, you are consigned to hospice - no ifs, ands, or buts. If hospice exceeds average duration, the plug is pulled.
- Doctors given the right to terminate life-support for incurables within strict guidelines.
- Adjust the care benefit cap dynamically according to funds available. Why pay out more than you have?
- Create sites where doctors, patients, and insurance companies negotiate care costs.
- Insurance companies can only adjust your care costs through open bid system.
- Doctors can adjust the care benefits of a patient according to their perception of life-style habits, poor choices, or bad luck.
- Doctors, hospitals, insurance companies are analyzed for competency, and outcome per cost. Poor rated doctors get increased tax rates according to their cost burden that they added to system. For instance, their failure to cure a young person with an estimated 40 years of pay-in to the system left and a disease outcome of ease to cure would gain some tax percentage relative to that loss of input. Reduced tax burden could be given for excellent care.
- A person's "value" would be defined by his life expected input. A baby would have a standard 100 years input. People who earn more and pay in more would have their LEI increased, thereby increasing their value. Those who never earned would remain at a fixed LEI. The LEI defined based on standard life expectancy of Americans would never be reduced regardless of income. LEI can be reduced due to criminal activities. If someone kills someone, their LEI should be reduced by the victim's remaining LEI, in addition to any criminal sanctions. This would more fairly control medical costs in prisons. We should not grant care to someone who has taken life.
If someone has committed egregious harm to others (rape, etc), then the cost of theoretical lost LEI due to failure to adjust or likelihood of suicide should be deducted from the rapist's LEI.
All crime can be assumed to have a social affect, and assumed to increase disease related to stress, anxiety, etc. This would be deducted from that person’s available benefit.

We cannot take care of people's needs beyond society's ability to provide money. We cannot ask drug companies, insurers, tax-payers and hospitals to care for people without compensation. It can't be done. It will fail. Only if a level of fairness is in play, without consideration to a person's current situation, will a plan work. And lifestyle has to be taken into account only in so much as it can be known ahead of time the risk a person is incurring.

There must be waivers for risky behavior.
There must be restrictions on liability.
There must be limits on benefits.
Everyone must pay in. SS income should be taxed, just like any income is taxed.
The tax should be flat, being wealthy should not incur a greater percentage. Isn’t the greater amount enough?
There must be limits on the care of those who have killed.
There should be greater benefits to those who willingly take on risk; soldiers, firefighters, police officers. Saving a life should grant you greater benefit.
Preventive care should be mandatory.
Assessment should be mandatory.
Pre-existing conditions should never prevent insurability, though lifestyle incurred illness will result in lower benefits towards related illnesses.
Insurance companies can never go below these numbers. But they can offer greater benefits for greater pay. Wealthy people should be allowed to gain greater care within the system, or they will find ways around the system, and these will be untaxed, adding work to the judicial system to police unavoidable behavior.
Doctors must be rewarded/fined according to outcome based on statistical outcomes. There should be no penalty for working on a low-cure patient, other than if the QoL is reduced below an average for someone of that age, gender, lifestyle, disease profile. Another words, if an 90-yr old has stage 4 lung cancer, and the life expectancy is 3 months with QoL of life support, and the doctor succeeds in improving QoL to home wheel chair for 6 months, then he should be rewarded, have more leeway in protocol decisions, etc. If he increases a persons tax input, then he should be doubly rewarded. This is unfair for the retired, perhaps, but retirement must have some risk. The best way to determine a fair retirement age is to link it to benefits, instead of making it some sort of reward we look forward to. Work should be made more desirable, and leisure less desirable.
QoL must have some metrics, to properly assess outcome. Otherwise a doctor will only do what is measured. He will extend life, without looking at motion or even consciousness. He must also be assessed on the loss of tax income, so he won’t be desirous of lots of life support outcomes, or death outcomes.

We must track lifestyle, or else we cannot properly assess costs.
We must insure everyone, or people will balk at it.
We must tax everyone, or else how will it be fair to only onboard the sick and elderly? Does that make sense? We can’t pay for a health care system with the income of disabled, non-working people. It’s like buying car insurance after you get into an accident.

We must give people the ability to reward themselves by working, or else no one will work. They must be allowed to improve their care by taking care of themselves.

Above all, we have to stop caring for people when they run out of options. Everyone dies. That’s not going to change, nor should it. Death should not be the enemy. Health care should be about QoL, not just extending life forever.

A person’s age, however, should not affect his total amount of care. People could be grandfathered in, so that the young would have a clean slate. Schools could teach this in health class; your choices will affect your ability to receive care.

What about people who want to live dangerously? Perhaps they could sell their care credits? That would encourage people to tell on themselves. Get $300 if you sign a waiver that you may smoke 2 packs a day and give up any care associated with that. Get $1000 if you plan on engaging in behavior that is likely to result in incurable disease.

Essentially, force people to make decisions and take responsibility, instead of trying to care for the irresponsible infinitely.

[OCNaturalDoc]

as it relates to caps, etc?
you mean 'no fault'?
'splain, please.

[Whiny Old Bastard]

Tort reform