14 November 2007

Dear American Medical Association: please stop pissing me off.

The AMA has stood in opposition to most major efforts to expand health insurance coverage for the uninsured for much of the past century. It makes perfect sense. As an organization of physicians advocating for physicians, they have physician interests (high pay, less regulation, more independence) rather than public health interests in mind. When those interests are in conflict, physician interests take priority. Totally obvious- it's like asking the NRA to lobby against assault rifles (their primary goal, defending the 2nd amendment, trumps any argument why it is freaking ridiculous for individuals to have these weapons). And remember, nobody is spending AMA-like money every year advocating for the diverse and fluid group that makes up the 47 million uninsured. 999 times out of 1000 doctor interests win out. Those interests often align with keeping the current system in place; the system that has allowed doctors to be paid more in America than any other county, by far.

This same logic applies to health insurance as a whole. The current private, market-centered system has actually been remarkably successful at it's primary goal- profit taking (check out WellPoint, the nation's largest private health insurer) but astoundingly inept at achieving broad public health goals. Every year there are more uninsured, higher premiums and less overall coverage. Why would you expect these two goals to be inexplicably linked?

I know, I know, I sound like a dirty pinko commie. But wait, I love capitalism. I can buy a mother f-ing DVD player for $25. 25 dollars!!! That is freaking ridiculous. Which begs the question, why does the market work gangbusters for DVD players and not for providing health insurance? What I believe- health is not a commodity (or good, or service for that matter), it can not be accurately priced, it is not like making a choice between a Honda Civic or a Toyota Camry.

What got me started- a few weeks ago now I noticed an AMA advertisement in the New York Times, voicefortheuninsured.org. I got really excited. I thought they had changed their ways. But then I read their actual policy. Their position- no more employer based health insurance (the way the MAJORITY of American get coverage), no individual mandate, tax credits for individuals to purchase coverage. The logic: sick people are not insulated ENOUGH from their costly illnesses. If only they were more responsible for paying their $200,000 in chemotherapy they would understand it is a much more cost effective option to save that cash, buy a sports car and then drive it off a cliff.


The Becca said...

The last twenty years, pretty much everyone has been fucking the doctors in the ass from every direction. The insurance companies haven't paid my dad in six weeks. Try taking care of herds of sick people when you've got NO money coming in the door. I don't know how more governmental red tape is going to make this any easier.
I'm just saying.

Chrissy said...

i agree, becca (my dad has gone through the same thing)...but at the same time, in general...i feel like there has got to be a better way for everyone involved. i've had insurance, and i've not had insurance, and life with it is (obviously) much better.

then again, i talk to people who are from countries with universal health care, where they end up paying their doctors money out-of-pocket as a bribe for better treatment. that sucks.

i like the article about this doctor in williamsburg: http://gothamist.com/2007/10/01/jay_parkinson_m.php

at least he's trying, you know?

Flagil_Reinhumps said...

The whole system is broken. My point is that doctors (or insurance companies) can not be blamed for working in their own self interest.
Doctors are not medical priests, insurance companies are not relief organizations. But my other point is that you can not expect that when these two parties work in their own interest you will somehow get a great system that provides health care for all. It is just completely counterintuitive.

But what other option do we have? For decades people have been screaming about how shitty our current system is and nothing has been done about it specifically because of this pervasive fear that government intervention will fuck everything up. I believe that problems like this necessitates Government. It's why we even have a government in the first place.

There are really simple things that a Government can do:
1. A universal electronic medical record.
2. Standardized paperwork.
3. Mandatory payment protocols.
4. Negotiated drug formularies.
None of these things will happen without government intervention.

And as for scary things that happen in other countries. What about this one: you get sick in America, you can't work, you loose your insurance, you're unbelievably fucked. Now that really frightens me.