The Best Plan for America - Part 3

When we've reformed campaign financing, letting us end corn subsidies, we can get to the task of reforming tort laws and malpractice resolution processes.

3) Stop frivolous lawsuits against hospitals and doctors.
Why can suing doctors and hospitals be bad? It leads to doctors running unnecessary tests and performing unnecessary procedures and prescribing unnecessary drugs so that they can't be accused of not trying everything. These unnecessary tests and treatments can cause problems for a patient (side-effects, infections), and increase health costs. When costs go up, people with less money are rationed out of health care. Also, over use of these services creates delays, making people who need them wait, perhaps too long. Where lawsuits are common (Pennsylvania), malpractice insurance rates go up, which also increases the cost of proving care, and drives doctors away, which reduces the availability of good care. Hospitals need to hold larger amounts of money in reserve in case they get sued, which is money that could otherwise be used to improve care for patients.

But what if something bad happens because of a doctor's decision? Well, that's not exactly what malpractice is. We live in a very complex system, and have complex bodies with complex problems. There are hardly any treatments that work 100%, and sometimes bad things happen even when all the correct decisions were made given the available information. Doctors and hospitals should absolutely be protected from lawsuits if they can demonstrate that they followed known best practices. Rogue doctors who make decisions based on their feelings or personal experience instead of the collected empirical data of their fields can go hang.

Even when a doctor does do something wrong, the money involved should be more reasonable. Payouts are sometimes so ridiculously large (which hurts the entire system, remember, and not just the one doctor) that malpractice insurance companies often choose to settle for smaller amounts instead of going to court. This happens even when the doctor is innocent. So, we end up with a bunch of doctors being denied the opportunities to prove their innocence because an insurance company doesn't want to risk a big payout. These settlements are strikes against innocent doctors, and affect their abilities to get jobs, and can even result in licensure problems. If payouts were limited to reasonable amounts, the system would be more conducive to actually determining whether a doctor did something wrong, instead of settling with opportunists who sue at the drop of a hat.

By making it more difficult and less profitable to sue, we improve the entire system. Treatment becomes more accessible to those who need it, costs go down, overall outcomes improve, we can more often actually learn which doctors did something wrong and which were frivolously accused, and we encourage evidence-based medicine instead of defensive medicine. The only people who would really suffer are lawyers.

The Best Plan for America - Part 2

So, the first step was campaign finance reform, taking away some of the incentive for politicians to pander to big companies instead of the health of our nation. Once that's out of the way, we can target another big systemic issue.

2) Stop subsidizing corn.
A big reason that America has such bad health outcomes compared to all those other industrialized countries that pay less for health care is that Americans are fat. Fat, lazy Americans eating lots of meat and drinking soda get those really expensive chronic illnesses like diabetes and hypertension. This raises costs for everyone, since we're in this system together. A major reason that so many people eat meat and sweets is that those foods are so cheap. An apple costs more than a candy bar. Juice costs more than soda (juice is also high in calories, but fructose is easier on your pancreas than dextrose). Also, impulsive and ignorant people would rather get fast food or some other form of processed junk than take half an hour to cook. Cooking healthy food can actually be very inexpensive, but it takes a little time, and most Americans would rather do something else.

So, how would ending corn subsidies lead to healthier eating? American corn is produced in far greater quantities than needed because the feds pay the big farm conglomerates to do it. There is so much unnecessary corn that the price is very low to buy it. Since it's so cheap, it gets fed to chickens, pigs, and cows to get them big and fat at a low cost. It also gets turned into corn syrup to keep our sodas and candy cheap (the price of sugar is artificially increased in America by federal tariffs on sugar imports, keeping down competition with corn). So, heavily because of this one crop subsidy, meat and sweets are very cheap and plentiful in the US.

There are other consequences. Since so many fields get devoted to corn (which does not require crop rotation like some other crops), less of other crops are grown that are not subsidized. More corn for animals and sweets (and fuel) results in fewer carrots and spinach and peas for humans. A smaller supply of those healthy foods for people means that they cost more.

So, ending the corn subsidy would make meat and sweets more expensive, and probably other healthy foods cheaper and more prevalent. There would be an economic incentive for people to eat food that is better for them, and restaurants would serve smaller portions of meat to keep costs low. Diabetes and heart disease rates, etc..., would fall, and life spans would increase again.

Animals might get switched to a different food, which would then be taken from humans, but I don't know what that would be. There would be other effects of the change, as well.

If the price of corn went up to the same level as that of other countries that do not subsidize (Mexico), those countries would stop importing the poor-tasting, standardized, potentially dangerous American corn that is wiping out their indigenous corn strains and making them slaves to the entirely unethical Monsanto. More expensive American corn would lead to more preservation of genetically diverse corn, which would protect our global supply from disease or insect. It would also let "heirloom" corn strains compete, which taste better and are safer to eat.

The Best Plan for America - Part 1

When I walk down the street, people often ask me, "Hey, old man, why aren't you wearing any pants?" Only slightly less often than that, they ask me what the best health care plan would be for America. The best plan is complicated, but not as complicated as many people think. Unfortunately, the best plan requires many changes to other aspects of our government and culture. Over time, I will gradually explain what would be the best health care plan for our country, and what it would take to get it.

1) Campaign Finance Reform
The necessary first step would be campaign finance reform. What does campaign finance reform have to do with health care? Very simply, the current system lets big companies control our nation's policies via legalized bribes to congressmen. The average citizen is practically unable to voice his or her needs to representatives. Our voices are drowned out by the sound of money getting transferred from corporations to politicians' campaign chests.

As we can see right now, it is nearly impossible to get enough politicians to serve the interests of the country instead of the interests of their financiers. If politicians could no longer be bought by corporations, we could have a government that serves the people. Instead of looking out for the interests of only Aetna's and Pfizer's shareholders, congress would look out for the other 300,000,000 of us.

Grab Bag 1

Here's just a bunch of topics I've pulled aside and not gotten around to posting.

Teen pregnancy and STD rates got worse under G.W.Bush's watch, especially in the South. No surprises, there. When you take money away from programs that work and give it to programs that don't work, the outcomes suffer. When you have a culture that uses evidence-based practices, you see returns on your investments.

Putting stents in arteries may be unnecessarily done 240,000 times per year. Dr. Teirstein is an obvious example of the big problem with many doctors. He is biased towards something he has experience with and makes a fortune from, which leads him to discount real research. He doesn't care what really works best for people. He doesn't want to be told what to do. He wants to do what he likes and effectively defraud insurers. Fee for service is a terrible way to pay doctors. We need fee for outcomes. They need to be accountable.

Stupid Americans will not vote for politicians who would actually make the best decisions for our country. Rationing is not bad. Every health system has rationing. In fact, every system that involves money or resources has rationing. It's a fact of life. Get over it. Right now, insurance companies ration the Hell out of people's health care, and the uninsured get nothing at all. The British system is brilliant. The British try to make sure they get the most pop for the pound. With finite resources, they try to do the most good that they can for everyone. Only complete idiots would take the American route and deprive children and workers from basic care while spending the bulk of resources on people who are going to die soon. Also in this article is the idea that we should find out what treatments work best in which situations, then NOT require doctors to use that information. I sure as Hell want my doctors to do what's been shown most effective instead of whatever else they feel like.

Corporal Punishment for Kids

We've had conclusive proof for the last half-century that striking kids is counterproductive. Corporal punishment makes kids more violent, angry, and likely to break rules when you're not around instead of incorporating rules into their personal values. It's one of the more stupid things an adult can do. Corporal punishment is especially counterproductive as a response to children's behaviors related to mental illnesses or developmental disabilities, as those behaviors are generally a result of anxiety, disregulation, and an inability to understand situations. Punishment increases the anxiety and disregulation, and makes further behavior problems more likely. Punishment of any kind is a terrible way to reduce unwanted behavior, especially for kids with disabilities. Teachers and school administrators should know this.

The American Civil Liberties Union just reported on a study of corporal punishment in schools. The report is unfortunately diluted with emotional anecdotes by people who clearly do not understand clinical diagnoses (not that they should, just keep the junk out of a report). It does have some interesting data in it, though.

Who is doing all this counterproductive nonsense?
It's our good friends in the South. The states that do the most are (in decreasing order): Texas, Mississippi, Alabama, Arkansas, Georgia, Tennessee, Oklahoma, Louisiana, Florida, and Missouri. We recall that these are also the states with the lowest education, most crime, lowest life expectancy, highest teen pregnancy, highest infant mortality, lowest incomes, etc... New England, the west coast, and the north central states have outright banned corporal punishment in schools.

What does this have to do with health care?
For starters, kids with disabilities are more frequently targeted for corporal punishment, which exacerbates their problems rather than treating them. I think this is also yet another symptom of the Southern culture. This is a culture that does not value human dignity, civil rights, or evidence-based interventions. This is a culture that relies more on invalid beliefs and tradition in making policy decisions. This is evident in their overall health care practices, as well as the educational system and so forth. Everyone needs to make decisions based on empiricism. Physically punishing (nearly any punishing, really) kids today is going to create greater ongoing mental health care needs, and the problems are more likely to get passed down generationally. Stop the cycle now.

More Truth about Proposed Plans

Since there are so many lies being propagated by those who oppose improving our health insurance system, the White House has had to create this site to help citizens understand what is really going on. Unfortunately, I expect that the people least likely to automatically recognize that death panels and so forth are lies are also the people least likely to go to the website.

Truth-o-meter

St. Petersburg Times' Truth-o-Meter is a good resource. There is so much misinformation getting propagated, especially by Republicans and other free market ideologists who want insurance companies to stay rich at the expense of America's health and productivity, and Obama shows up on the site very often. Both sides are represented, and it is interesting to see so many comments and sources evaluated side by side. Some statements are true, and some are qualified. The site does a good job going into detailed explanations of its ratings for each statement.