Universal Coverage and Misnomers

Here's the sort of fucked-up logic in a recent post about Hillary Care on John Washburn's blog that keeps us from getting anywhere with health reform.

Here are my random thoughts:

• What the fuck is "Hillary Care"?  This is the problem with vague terms that entice the less informed to make generalizations that don't have anything to do with key beliefs.  The same is true with the Republican party's strategic use of the term "Socialized Medicine"  If you don't like Hillary Clinton's views on healthcare, then take the time to say specifically what you don't like.  I personally don't like her current approach, but it has nothing to do with providing coverage for all.  It's got to do with the fact that she's tight with the insurance lobby.  It's definitely not the plan she proposed in the past.
• Mandates don't work.  
• Fee-for-service medicine will continue to lead to escalating costs.
• Universal coverage doesn't mean that the solution must automatically be government-run.  And if you accept this and you still have a problem with the concept of healthcare for all (universal coverage), then I wonder why.  Wouldn't society be better if we were all more likely to be healthy?

Coverage and access are two different things.  Medicaid provides coverage, but not access (who's going to be able to provide access when reimbursements don't come anywhere near covering the cost of care?).

I want universal coverage.  I also want universal access.  Universal coverage and access leads to fewer people getting more expensive care in higher acuity settings.  And there's no more money in the pie (or at least, no one is willing to sacrifice for it), so it means that some people will end up making less.

From a business perspective, it makes sense to cut where no additional value is added, and redistribute to where greater value is generated.

This means cutting the ridiculous profits made by the insurance industry (not necessarily killing the industry...I think there are ways to keep the industry happy in a single-payer model).  It also means not letting people do things that don't add value.  Total body imaging is one example...the more sinister examples are the epidural steroid injections, the spine surgeries, the radiologic churning that goes on behind the scenes.  

Yes, the "RAPE" specialties (radiology, anesthesiology, pathology, and emergency medicine) will need to be reigned in...you can't play in the system without having to feel the effects the rest of us have to feel.

It also means taking a stronger stance on end-of-life care.  News flash:  You won't live forever.  Get used to it, and don't squander dollars for that extra six months of miserable quality-of-life.