These lyrics were written in the late 80s by Neil Peart.  It was the beginning of the political discourse in which we live today.  The beginning of Rush Limbaugh.  The era of Lee Atwater.  Our national discourse has gotten progressively worse since that time.  We are becoming more European in our skepticism and mistrust of each other.  These lyrics really speak to our times.

Second Nature lyrics

A memo to a higher office
Open letter to the powers that be
To a god, a king, a head of state
A captain of industry
To the movers and the shakers…
Can’t everybody see?

It ought to be second nature
I mean, the places where we live
Let’s talk about this sensibly
We’re not insensitive
I know progress has no patience
But something’s got to give

I know you’re different
You know I’m the same
We’re both too busy
To be taking the blame
I’d like some changes
But you don’t have the time
We can’t go on thinking
It’s a victimless crime
No one is blameless
But we’re all without shame
We fight the fire while we’re feeding the flames

Folks have got to make choices
And choices got to have voices
Folks are basically decent
Conventional wisdom would say
But we read about the exceptions
In the papers every day

It ought to be second nature
At least, that’s what I feel
Now I lay me down in Dreamland
I know perfect’s not for real
I thought we might get closer
But I’m ready to make a deal

Today is different, and tomorrow the same
It’s hard to take the world the way that it came
Too many rapids keep us sweeping along
Too many captains keep on steering us wrong
It’s hard to take the heat
It’s hard to lay blame
To fight the fire while we’re feeding the flames

So, Congressmen are going home to speak to constituents and are being bombarded by mobs with pitchforks.

There seems to be a lot of noise, but not much substance.  I have yet to find a decent source that provides non-partisan details about the public health plan being proposed.  Instead, we are bombarded with propaganda from both sides.  The opposition is really from Health Plans that want to keep the status quo.  The support for change is because people want something different than what we have today.

Here is my issue with all of this.  There is no real debate taking place.  There is no real understanding of what the problems are.  Today, it is all noise and conjecture without a real discussion taking place.

What is the problem?  It is all about money.  The opposition are screwing the people clamoring against a Government sponsored plan.  The supporters of the Government sponsored plan are not really addressing the problems associated with high costs.   I think first we need to understand the costs we are being asked to pay.  Then, the population needs to become consumers of their healthcare.

Consumers of their health care.  What does that mean?

I would challenge anyone and ask, do you know how much your doctor charges you for a visit?  If you went into your Doctor’s office and asked, could they provide you a list of services provided and their costs?  The current system is fee for service.  Any service provided, there is an associated fee involved.

When you go to a mechanic, does he have the fees listed of his costs for basic services?  And, if it falls out of that service, doesn’t he provide you with an estimate to fix it?  Does a Doctor’s office, or a hospital do this?

Or that expensive MRI the doctor orders at the hospital?  What does it cost?  No one tells you, they just tell you that you have to pay whatever your insurance company does not cover.  There is no, you pay this!  Insurance company pays that.

Doctor prescribes a drug for you.  You go to the pharmacy and find out is $2.00 a pill.  Wait?  I can’t afford $2.00 a pill.

Where is the cost of healthcare delivery?  Can someone answer that question first?  How is the Government plan addressing it.  How is the opposition addressing it?  (Oh, they are not, they are saying everything is fine the way it is).

Here are a few suggestions:

Step 1 – Go back to cash for services.

A doctor should publish his services like any other service out there. For acute care, Physician groups should be utilizing Nurse Practitioners at a lower per visit cost – say $30 per visit.

Insurance should not even be utilized under fee for acute care.

Step 2 – Healthcare needs to become more efficient.

Physician practices should look across the street and see how their Dentist colleagues run their offices.  They do it efficiently.

(Yeah….yeah…yeah…they don’t have as many complications, etc.  They do it efficiently and make money doing it at a good value).

It can be done.  I have seen it done.  Everyone knows it can be done.  The consensus is Doctors don’t want to see the change.  Here is why:

1.  They don’t want to pay for it
2.  They don’t want to be accountable
3.  They like their pen and paper

(My Doctor uses pen and paper.  I am probably going to change because of it.)

Step 3 – Insurance should be for catastrophic injuries or disease.

Everyone should have health insurance, just like car insurance for that “accident”, or “catastrophic” disease like cancer.

The cost should be no more than 1,200 a year.  A patient or family only utilize it, if they have an accident or are diagnosed with a life threatening disease.

Step 4 – Get rid of the chotzke culture in medical device, pharmaceutical, and all the lunches.

Doctors advertise free lunch as a perk to work in their office, paid for by your favorite pharmaceutical company.  It has an influence on Physician decisions.  It is a freaking bribe and doctors are taking it.

There is a whole industry around supplying pharmaceutical companies with lunches including preparation and delivery.

Step 5 – Disease Management

Everyone says it is a good thing to do.  Physician groups could come up with programs to help their patients manage their diabetes and heart failure.  Make them affordable for patients to use them without insurance.

The value proposition between meds, hospitalization, and simply managing your health properly.  How about an affinity program for good health.  Join this program (pay a value less than what you would normally pay for bad health)  and if you meet your disease objectives, get prizes – a free TV, a free Trip, etc.

The problem with the United States today is that everything is right or left.  It’s either on the right, or it is on the left.  The current Representatives in Congress no longer represent the interests of the people, they are looking out for the special interests that fund their campaigns.

Here is where I have a problem with both parties.  Barack Obama said we have to make tough choices.  Yet, his recommendation is a Government sponsored program.  The Republicans are the “just say no” party.  They say we have the best health care in the world.  (That is another blog post).  Yet, healthcare costs continue to rise in this country.

If we are going to make tough choices, then let’s start by going backwards a little before we go forwards:

1.  Have health care service providers publish their prices
2.  Pay cash for services
3.  Become consumers of our healthcare  (The Doc down the street is charging $30 acute care visits).
4.  Insurance for catastrophic coverage

Let’s have a real debate on this topic.  This isn’t a right or left debate.  It is an economic debate.