A thoughtfully written article about Veterans Administration (VA) health care came to my attention today, with the suggestion that government management of health care, given reality, did not seem like a great idea.
The article pointed out several past problems that are no longer problems in the VA system. And the actual problem that has been needing to be addressed for years seems to have minimized that of scheduling and long waits. In fact, the main scheduling problems appear to be "community care" based. That means the hybrid government funded/insurance managed private sector which VA has been able to offer for a number of years. It mostly started out on a case by case basis regarding women's health issues the VA was not prepared to handle. The question in the article was whether or not VA care had improved its deficiencies since the previous audit. And it seems to have done so with the exception of farmed out appointments to the private sector (community based care) which were routinely requiring a seven day wait to be seen, while the VA itself was meeting its goal of a wait no longer than three days for an appointment.
I start with VA because I like to think the structure of both original Medicare, and VA are probably good places to start when envisioning what a functional, all inclusive, equal opportunity for all, no tax increase, single payer, national health care system that is government managed could be - like Senator Bernie Sanders has researched and promoted for years, with increasingly more people signing on as the necessity of it becomes clear. Keep in mind that government already funds a huge chunk of the insurance managed industry, like all "Part C", and some amount of Medicaid, so it is not a far reach to consider well structured national insurance without the insurance industry as the for-profit middleman. Medical personnel endorse it, including M.D. who went into medicine to be healers, who efforts have repeatedly been thwarted by the managing insurance companies at cost to health of patients. I have listened to many of them speak in interviews, who retired early, stay current with research, and do their own research, who wish they could have treated their patients as they deserved to be treated, as the healers they were motivated to become who the patients needed them to be.
From experience, observation, and personal accounts I have to say the manifesting of government managed and funded health care within a functional framework, imo, would be better, warts and all, than the current hybrid system which basically prevents and undermines the partnership between a patient and a physician so they can agree to be a team that manages the patients health and wellness choices. After all health is all about wellness, not only restoring people to wellness but maintaining wellness and learning to optimize metabolic health - first primarily through nutrition and natural tried and true integrative functional holistic means for the patient in coordination with those physicians who are also credentialed to treat the whole person and take the time to properly do so. And that requires extensive metabolic testing at first, to know exactly what metabolic cellular level problems and deficiencies a person might have. The way the current system works, without some type of symptoms of a serious illness, not even half the metabolic testing of holistic baseline discovery which is possible, is done.
That is the way we gain, regain, and maintain health as a nation of healthy individuals when basic holistic medical care is available to all so that problems are more likely to be prevented from developing. And of course is is much more cost effective, in a variety of ways, into the future, partly because of an increased quality of life for all.
Consider that health care in our nation is managed by a for-profit industry, funded by government, being pushed by the insurance industry with its increasingly obnoxious harassment of people through uninvited phone calls, mail, texts, and mail, and ads on all media - print, broadcast, and internet. The pushing for Medicare folks to change to Part C, or change the insurance company they have selected to do the managing, is relentless whether or not people have actually agreed to use Part C. It used to be through October, November, and part of December. Next it went from October to March. And this year it did not ever stop.
Instead of patient needs and Doctors discussing with patients what they determine is needed, the for profit insurance industry oversteps its authority and ability to do so, for the purpose of manipulating its own profits, first. There is no comparison to the patient doctor relationship of trust. Dumping the insurance industry into the mix is unacceptable to doctors and patients, and it should not be acceptable to government that the insurance industry profits from the amount of government funding it takes, when it should be going to patient care, with medical folks being salaried. Otherwise the 15 minute limit, is little different from the push, push, push, of sales people who get a commission for selling Medicare Advantage. The more patients an M.D. see the more income they earn. It undermines the quality of health care when physicians become accustomed to being managed by the insurance industry. The fact is that many retire early. And early retired physicians create valuable websites where they share vital information that they all say they wish they had been able to do prior to retirement. In fact it haunts some physicians to consider what they could have done to improve the health of their patients.
The insurance industry creates actuarial models on which they base their predictive extrapolation models and methods that are used to manage the industries own profit-making. In this case that has been extended to and superimposed on managing the government funded health care that industry is hired and funded by government to administer. That creates a middle man bureaucracy of health care management that is costly and interferes with both patients rights and physicians rights, not to mentions is stingy with government funding for patients when it has to cut corners AFTER taking its share. The insurance industry is not qualified to manage health care choices. For the most part their profit driven model superimposes consequences of negative health predictors from their actuarial models, on everyone based on select data about age; and crime rates, frequency of disasters, current types of health problems, in specific demographics of people, and who knows what else - based on the area in which people reside. Insurance predictions and rates differ from zip code to zip code for those reasons. It truly is bizarre to do what is labeled as "health care" as a statistical analysis that results in a one size fits model for patient care, when health never has been and never will a result of that. Bet the same folks think astrology is ridiculous. What the insurance companies do is damaging, astrology is not whether one considers it a silly parlor game, or a type of interpretive physics.
However one problem with insurance industries actuarial data used for managing health care could be its lack of consideration for the level of toxicity from pollution of water, air, soil within a zip code which they may know but the folks living there do not. Of course anyone's first response to that would be "that's criminal!" Toxicity also overwhelms our food chains and us. It is worse in some areas than others, which also has to do with placement in storage during shipment and at end points, plus the insecticide in the form of gas that is used during shipping that easily penetrates flimsy plastic and paper, thus having the potential to create and exacerbate medical conditions, in clusters.
Clustered health problems in specific areas are indicators of toxicity and/or poverty. Instead of addressing the toxicity the insurance industry increases insurance rates in those areas where people are poorest. Poverty and environmental toxicity, together, seem built into actuarial databases as witness to slow collusive blameless depopulating which that industry does not want to address in its health care model, except to increase rates.
Holistic, integrative, functional M.D.s who are true healers have no place in the health insurance industry middle man model. It could actually be a health care industry if they did have, instead of a for profit driven "illness industry" because of the hybrid partnership between government and the insurance industry which mismanages government funding, and patient care, not to mention obstructs how appointments work, and the treatments recommended by physicians.
VA has had to eventually deal with the problems of specific cluster medical conditions because of environmental pollutant exposure, not only in people who were in combat zones, but also those stationed at domestic bases. And we see what that has created for veterans deserving of medical care when at least 20 years must pass before government admits the evidence actually does point to clusters of medical conditions, then provides funds to VA to ameliorate some of the problems - for those who are still living. And veterans not part of a "cluster"? Forget it, even with substantiating medical records. If people pursue an issue after the first time they take a claim to V.A., they will have to jump through a series of hoops V.A. must create to be able to delay - for the purpose of appeasing government financing - for decades, in some cases.
My uncle, a WWII Purple Heart recipient veteran, who was fortunate to live through his ordeal, eventually went to V.A. (at his son's suggestion, no doubt) after 40 some years, which resulted in his service related disability rating. I do not know what it was, however an educated guess suggests probably 100% given his wartime experiences.
What has become clear to me is that adequate government oversight does not necessarily apply to hybrid partnerships between government and industry as it should, especially when it comes to use of funding provided by government. In the case of health care, currently, the partnership between government and the insurance industry regarding Medicare, and "Obama care", appears to be based on the dictates of the for-profit insurance industry which government hires to manage the hybrid systems it funds. That is what Obama care turned Medicare into with the Part C additions - because of insurance industry managing. That managing includes ceaseless and costly hiring of phone folks, and costly media advertising to push, push, push, people to enroll in the part C hybrid of Medicare Advantage. That relentless push has turned into an all out war that zeros in on relentless individual unwanted contact harassing that is targeting people who prefer to stay with original Medicare instead of totally allowing insurance companies to manage their care; preferring instead to manage it themselves along with their M.D. who the insurance company does totally dictate to.
And of course the Dual Care system for folks who receive medicare and medicaid, without the permission or knowledge of Medicaid qualified individuals of retirement age who were changed over to a into a managed care Medicaid plan both without their knowledge and consent, which creates an Original Medicare, Medicaid insurance managed hybrid some people do not want, preferring both original medicare which is available and original medicaid, which does not seem to be available . . . until or unless retired folks, themselves, consider making a change to Part C, which the state Medicaid folks want to push. No doubt with the federal funding it is more cost effective for states, and does more for more patients. Presumably that would relieve them of a lot of accounting - and perhaps relieves them of the cost so they are able to hire fewer employees to do the work.
The fact is that the insurance industry profits more when there are more healthy people signed up for Medicare Advantage, because they apply their actuarial models at their most doom and gloom worst for each individual which results in the amount they are allocated for each individual. If/when an individual does not use up all that has been allocated to the insurance company to use on their behalf (estimated through the actuarial data the accumulate about an individual) then it can be used on other patients. That apparently means big profits for the insurance company at the end of the year when they have funds remaining because of the number of healthy people who did not need the funds allocated. That model would only have individual excess funds available at the end of the year.
Does the insurance industry actually transfer their unused funds at that time, the start of a new year, to people whose allocated amount was used up? Or do they continue to deny them the treatments without allocating the remaining funds to those treatments at the start of the new year for those patients? Without government oversight on how the insurance industry is supposedly taking from Peter to pay Paul, who knows where the remaining funds for healthy folks who did not use all of them, go when the same individuals who were told "no" to treatment or procedures the year before are still being told "no" the next year! Individuals are not told how much is allocated on their behalf based on actuarial models.
Only recently did I happen upon an article (while not looking for anything about that topic) which gave a name to that hybrid effort and outright stated it was unethical to foist the insurance managed Medicaid of Dual care Medicare folks onto people without their knowledge or consent. It seems an effort to force Original Medicare people to succumb to the unnatural pressure to voluntarily choose the Medicare Advantage hybrid they purposely choose to avoid. Dual care people, according to one of the people who actually answered my questions did admit, when pressed, that if an original medicare patient chose to see a physician or covered Medicare medical provider outside of the Medicaid insurance managed system, that people of retirement age who had unknowingly been put on the program instead of regular medicaid, would still be able to have their care choices covered, same as it was with regular medicaid, instead of having to select a provider from the Medicaid insurance managed list. So essentially Medicaid supposedly continues to supplement Medicare payment not dictate to it from the state level.
Whether or not what I was told is factual I have no way of knowing. I arrived at the point decades ago of asking for copies of regulations for the purpose of seeing in writing just exactly what we should be able to depend on as factual. Thing is when we don't know the facts, we don't know when we are being bamboozled by the folks employed by the system who like to behave as if the money is coming out of their own pockets. Plus they enjoy being obnoxious about revealing what the regulations entitle one to be able to expect. If we do not know what government entitles us to, we can not ask for it when insurance companies do not inform us of the covered entitlements. Why government insists on investing in the insurance industry with funds that should be used for patients, is nonsensical.
Have hybrid relationships between government and industry ever ended up not screwing government - which means we, the people, too? It is our collective taxes doing the funding. Either way it is lose/lose, imho. And it creates situations where either government owns industry, or industry owns government, the same way the economy was hybridized in German and Italy after WWI which improved the economy and corrupted the governments, thus enabling the fascist descent into WWII in Europe. The U.S.A. also admired that model, which may have had something to do with our nation not joining the war until after being attacked by an Axis power. It is not even a century later and we collectively seem to need to relearn that lesson the world learned the hard way - once again in the hard way!
We, the people, are empowered to collectively steer the ship of state, yet we can do nothing about industry - except with our collective purchasing power. Rarely does it seem that we are able to persuade or force government to actually apply the law to industry - or, locally, apply the law to any businesses that fund the election campaigns of those who will be the victors. And how about government giving corporate conglomerates the rights of an individual - a very wealthy "individual" with a huge amount of narcissistic, nepotistic, Machiavellian influence, through the financial power of the sum total of their investors, who may not be nearly as cut throat.
It will not end well for we, the people, if we do not put the skids on the monetary power of monopolies and wealth to buy government cooperation - starting at the party level. And we still wonder why our choice of presidential candidates has too often seemed to be no acceptable choice? We have a plethora of good decent law-abiding people who relate well to all people in respectable and respectful ways, and are not embroiled in legal problems that in times gone by would have been identified as treason, or at least would have disqualified them as presidential or any other office holding candidates. Those characteristics of good character should be a preliminary requisite for all who want to be presidential candidates
Government being duped into wasting tax payers money on the insurance industry as a health care manager, instead of those taxes being returned as needed to us all by government funded health care that goes entirely to health care without the insurance industry profiting from it, is not what anyone is advocating for when they advocate for "Medicare for All" or "single payer". What people are envisioning is what a functional all inclusive equal opportunity for all, no tax increase, national health care system could be, based on a Mayo clinic structure, with its efficiency, efficacy and and quality of care that is adequately funded to the advantage of all. However, the manifesting of that within a functional framework, currently is basically undermined because of - in a word - corruption that creates a for-profit illness industry instead of a salaried, government funded and managed Mayo Clinic like holistic national health care system for all. How can people not comprehend that a healthy nation of individuals is at the foundation of the continuing quality of evolution rather than devaluation and genetic devolution of our nation and its people?
