Liz (The Liz Army) posted the link below and made me reflect a lot about the challenges facing the world's health care system and the lack of strategic thinking from politicians. The disconnect between what politicians do and the defense and implementation of rules that benefit the people they represent is quite shocking. While the headline paints a much worse picture of what the politician meant, I do believe that this issue needs to be debated. Rep. David Dreier said "I don't think someone who is diagnosed with a brain tumor should have health care provided".
http://thinkprogress.org/health/2012/07/10/513735/republican-rep-i-dont-think-someone-who-is-diagnosed-with-a-brain-tumor-should-have-health-care-provided/
In a well-functioning democracy the Government is supposed to be composed of people elected by the people and should work for the people. The American Constitution is one of the most incredible timeless documents ever assembled and it created the foundation for the most incredible society ever devised: a free society that self-regulates itself based on free markets and the rule of law, a machine that constantly adapts to the needs of its time and that every once in a while requires a set of new regulations to control certain aspirations of its society. A few examples:
- The Pure Food and Drug Act - created in 1906 to address food and drug safety, giving birth to the FDA
- The Federal Reserve Act - created to address financial instability in 1907, giving birth to the Federal Reserve Bannk
- The Affordable Care Act - created in 2012 to address the increase in health care costs in the US
I am using the US in my example because I am more familiar with it and because this Congressman's statement affects me personally. I will soon talk about Brazil, a relatively new social experiment that seems to be thriving for the first time in its history by emulating what the US once did well.
In this specific case this politician argues that insurance companies should be able to discriminate against people with brain tumors while as a safety net people with pre-existing conditions enroll in a high-risk insurance pool paid by the Government. This is just another classic example of socializing losses and privatizing gains. The complete lack of strategic thinking from a U.S. Congressman is concerning and somewhat puzzling, putting the issue of "capture" at the forefront of this debate. Is this elected Government Official thinking about his country or about his campaign contributors?
His tagline might appeal to the tax-cutting Republican voter who does not like to see that there is a cost to live in a civilized society, but as my uncle used to say the only difference between Republicans and Democrats is on how they pay for Government costs. The first one pushes the burden to future generations by issuing debt while the second one places the burden on current citizens through taxes.
Health care is not something where you can regulate in a "half-pregnant" way, I believe regulation should be explicitly driven by what we want to socialize and what we want to privatize, and who is keeping the profits and losses in each case. There is no argument that an unhealthy society places a huge burden on the heatlhy, but there is also no question that most people understand the need to spread the risks and costs of health care, hence the development of a large health insurance industry.
The biggest risk I see in this proposal is the lack of transparency on who is going to pay for the expensive treatments provided by the Government and what will be the benefits of having an insurance plan if catastrophic events are covered by the Government.
If the Government does not get a pool of money from healthy individuals I do not see this as a viable proposal, unless the costs are simply going to be paid by higher tax costs, which reduces visibility to how much money is entering the healhcare piggy bank and how much goes out, although the out-going flow is easy to track.
My suggestion would be to absolutely not accept discrimination in the insurance industry. This is the exact same issue that led to the collapse of the Blue Cross Blue Shield system. When insurance companies were allowed to discrimate, new health insurance firms popped-up and captured all the profitable, healthy patients that subsidized the costly, older, sick patients. This lead to the collapse of the BCBS system and to the big increase in health insurance costs due to a pervasive competition for the healthy individuals and an unacceptable discrimination against the sick ones, defeatting the purpose of the Health Insurance industry.
On the opposite side we have Brazil. I pay high taxes and public health care is deducted straight from my payroll, but in exchange I get my expensive chemo medication through the public health case system. I also have private insurance and a law was just passed saying that insurance companies need to provide coverage for this drug, and therefore I should have it covered privately.
Until this law was passed I would have needed to go to court to receive the chemo drug that I have always paid for through my health insurance, but since I am covered by the public system I did not have to go through this hassle. Health insurance is always there when you are healthy, but once you are sick you need to fight hard to claim your benefits, in some instances even having to go to court, like a friend of mine that won her case against a widely known problematic health insurance company in Brazil to have her glioma treatment covered.
However talk to any doctor in Brazil and they will argue that I should not get this expensive treatment through the public system as it places a massive burden on the system costs. Given the fact that I do have private insurance I do agree that I pay too much to have the Government fund my treatment, but in any case I pay for both systems, a somewhat inneficient model but one that provides a good safety net.
To summarize this long rumbling, I have the following suggestions:
- Not allow for health care discriminatory practices - if discrimination is not acceptable based on race, gender or sexual preferences, why should they be accepted for health care purposes?
- Create a publicly based high risk insurance pool but also create an income stream to pay for it that is highly transparent and congruent with the investment needs;
- Never end the debate for a better, more efficient health care system. There will never be a right or wrong answer to this, we need to keep trying until we are all satisfied with what we get relative to how much we contribute, as individuals and as a society;
- Always be aware that for every cost we need an income stream, in the short-term and in the long-term. This is particularly critical for countries with increasingly older people such as the European countries.
In this whole debate I have not mentioned NGOs. I have been blessed to count with the indirect support of several Brain Tumor NGOs that helped me clarify treatment options, research avenues and survival stories. Without the efforts of tireless volunteers from the UK based Astrofund, the American Brain Tumor Association and the German Brain Tumor Association I am sure several people afflicted with brain tumor would have had a much worse prognostic. However we should always strive for more and as I get closer to all these issues I see many opportunities for the future, such as:
- Organized collaboration between patients, research, medical, business and regulatory communities. We all have the same interest and should work together to accomplish our goals, a better and long life for brain tumor patients;
- Increased collaboration and competition between NGO's and drug companies - by threatening to lower drug costs by funding cancer-drugs research, NGO's might help re-direct drug companies investments from erectile-disfuntion drug marketing to cancer drug research;
- Global collaboration between NGO's to increase research collaboration, reduce adminstrative costs (websites maintenance, content development etc.), reduce fund-raising costs (the money is going towards the same purpose) and give more hope to all of us living with glioma.
To come back to this post's title the Affordable Health Care Act is good news because it finally changes something that most people were not happy about, let's just hope it doen't take people from one bad place to another bad place, and the only way to make that happen is by actively understanding what it means to you.
This is it for today, I missed my bike ride but I had to get this off my chest (and brain).
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