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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 11 of 11. This is the beginning of the thread.
Posted by Abby on January 7, 2000, at 23:21:20
I know that this is somewhat off topic and rather dangerous, but I just wondered what people thought of the different candidates' approaches to healthcare.
I'm thinking: how would it affect you or people you know.In the interests of full disclosure:
I used to consider myself a Republican, but I can't
associate myself with those isolationist bible-bumpers
like Hatch who pushed that impeachment crap.I think Al Gore is a twit--had incredible educational
opportunities but not used them. Something about Tipper's
approach to mental health really bothers me. I'll take
Rosalyn Carter anyday. Gore speaks garbled jumbo and
waffles.So given the choice of Bush v. Gore I'd vote for Bush,
but I hope that's not the choice I have to make.
Bush is no intellectual, but he does have warmth and
won't cause too much trouble. He may have got Cs in
college, but he was a frat boy and probably didn't try
very hard. AL Gore is so deeply earnest about ambition
his own rectitude etc.Sorry for the rant. Anyway, Bradley and McCain really
interest me here, though McCain has been rather vague.
I think that FHEP sounds interesting. It would have
the advantage of portability when you switched
employers, and the mental health benefits might be
better than with most HMOs.New England is having real trouble with HMOs. Tufts
had huge losses in NH, Maine and Rhode Island and had
to pull out; it now operates only in MA.Blue Cross of Maine has been bought out by for-profit
Anthem.Harvard Pilgrim was getting bailed out and is now
in receivership. Before a merger, Harvard Community
Health was *the* original HMO, an idealistic one where
the emphasis was on managing care more than cost. The
idea was that people who didn't have to pay per visit
would go as soon as they got sick and would go for
preventative treatment, and they could triage by using
nurses effectively, but everyone was on salary and
everything was under one roof. Health Maintenance
Organizations started out as idealistic endeavors.
Hard to believe, isn't it?
Abby
Posted by Noa on January 8, 2000, at 0:41:35
In reply to Somewhat OT: Candidate Healthcare Proposals +HMOs, posted by Abby on January 7, 2000, at 23:21:20
I was a member of HCHP back then. It was good care under one roof, but with limitations. Not much choice, and minimal mental health benefits. When I was hospitalized, it was at a hospital with a poor reputation. To its credit, tho, HCHP sent a psychiatric nurse to see me, and the other HCHP patients, at the hospital, to supplement the care, and plan for what happens after discharge. But my therapy was private, paid for entirely out of my pocket, at a reduced rate, thanks to my therapist (I was rather financially challenged then).
Incidentally, back then, there existed an excellent community mental health program in Massachusetts. That is how I found my therapist. I lived around the corner from the town's CMH Center. I saw my therapist there for a couple of years, until he left and went into private practice. When I started, my fee for each session was $3. It rose with my income, and was about $20 by the time my therapist left. I continued to work with him, and charged me only about $25 initially. This, of course went up over the years, but very reasonably, and in conjunction with increases in my means. My point is, tho, that Community Mental Health was great, and it is sad to see it erode away. In some communities, there still is service, but usually only for the neediest, and usually there is a long waiting list. BTW, Community Mental Health was Rosalyn Carter's baby.
Posted by jamie on January 8, 2000, at 4:19:18
In reply to Somewhat OT: Candidate Healthcare Proposals +HMOs, posted by Abby on January 7, 2000, at 23:21:20
My father is an old-timer surgeon recently retired. He tells me how each government intervention into medicine over the decades has backfired and made things worse. Long complicated stories, but flawlessly convincing. Indeed every problem we have in medicine is an indirect result of government intervention. All too often in politics good intentions end with worsened results. That is especially true with Democrat policies, but Republicans have been guilty as well to a lesser degree. Had politicians stayed out of medicine all these decades, the free market alone would have kept prices down, quality up, and availability/access abundant. The more the government tries to influence improvement in these things, the worse they actually get. Good intenetions DOES NOT equal good results. Often just the opposite. In my book, good intentions are worthless without good results. The more tinkering the worse it gets.As for the candidates, I'm not sure any of them will make any difference. A president alone can't turn back the clock and untinker all the failed policies of decades past. One thing to consider though is that Bush has been running the 5th largest economy in the world (Texas) and has been overwhelmingly supported in votes by all ethnic groups and sexes in his home state, including those who normally would have supported a Democrat instead. He is clearly doing some major things right in a state that is far larger than most countries in the world...according to the people who really know--the people who live there.
It's too early for me to know who I'll vote for, but nobody has a track record as polished as Bush. Not even our current vice president, who in fact has accomplished nothing on his own in 7 years. The whole Clinton administration has done nothing in 7 years. The good economy has boomed DESPITE what they do, not because of what they do. Just look at a chart of the stock market. This current economic boom clearly started in 1982, even to someone who's not familiar with stock charts. Clinton is riding on its coattails. He has single handedly destroyed our military capability and moral, taken huge chunks of our paychecks, shown no improvement in schools, gottten dozens of countries to hate americans, led a a horrible example of a role model for "our children" and...never mind, this could get real long.
The moral of the story is that our HMO problems are direct results of good-intentioned government interventions gone awry. The brains of millions of people (the free market) are collectively infinitely wiser than the brains of a few hundred (the politicians). That being said, the candidate to vote for is the one with the best record and the one most likely to reduce government's influence. Honesty and integrity would be a refreshing change too.
Regards,
jamie
Posted by ChrisK on January 8, 2000, at 6:56:20
In reply to Somewhat OT: Candidate Healthcare Proposals +HMOs, posted by Abby on January 7, 2000, at 23:21:20
Clip
Something about Tipper's
approach to mental health really bothers me.Clip
The thing that bothers me about Tipper is the way she came out of the closet. She said that mental illness should not be a stigma and we need to change the way we look at it. She admitted to some mental health problems and then turned around to say "but I don't want to talk about it."
What a way to relieve the stigma!
Also, let's not forget that Al Gore "invented the internet" and without him we would not have a nice website like Dr. Bob' to discuss our problems.
Posted by CarolAnn on January 8, 2000, at 11:24:13
In reply to Somewhat OT: Candidate Healthcare Proposals +HMOs, posted by Abby on January 7, 2000, at 23:21:20
I'm not as clued in about politics as I'd like to be, but one thing about Clinton's work that has impressed me, is how effective he is at foreign policy. Of course, we all feel that our major problems are here at home, but with so many countries suddenly becoming nuclear powers, and so much of the earth in various countries being decimated(we won't have a country if we don't have an earth), it strikes me that dealing with other nations may soon be of supreme importance. This said, I am leaning toward the idea, that the best candidate is the one who would most likely be best at foreign policy. I would guess that this would be Al Gore, since he has spent the past eight years watching Clinton work and becoming familiar with all the nations and dignitaries who could possibly have an effect(negative or positive) on The U.S.
I'm sure that with sufficient info, I could be persuaded otherwise, but with my limited knowledge this sounds pretty reasonable.CarolAnn
Posted by Abby on January 8, 2000, at 12:34:50
In reply to Re: Somewhat OT: Candidate Healthcare Proposals +HMOs, posted by CarolAnn on January 8, 2000, at 11:24:13
Sorry, I didn't mean for my post to be a general
political discussion. I just thought issues of
access to care were interesting.Noa, yours was the sort of post I was expecting
more than foreign policy questions etc.Jamie---Yes, you can say that about government
intervention, and in a lot of ways it's true.
Employer-based healthcare was a product of post
WWII wage controls and then flourished as a non-
taxable benefit.Having said that, there have always been people
who were so sick mentally that they could not take
care of themselves, and the reform and asylum
movements of the 19th century, though flawed, did
some real good. That there are as many homeless
suffering from mentally illness today as there are
is a great shame on us as a nation.Abby
Posted by jamie on January 8, 2000, at 13:20:05
In reply to Thanks Noa, I guess my post was a mistake. Jamie, posted by Abby on January 8, 2000, at 12:34:50
> Having said that, there have always been people
> who were so sick mentally that they could not take
> care of themselves, and the reform and asylum
> movements of the 19th century, though flawed, did
> some real good. That there are as many homeless
> suffering from mentally illness today as there are
> is a great shame on us as a nation.
>
> AbbyHow very true. Funny how it was the Democrats just a decade ago screaming that the mentally ill should have the freedom to be let out of the institutions. And they succeeded in getting that done. Now they're screaming we have too many mentally ill homeless on the streets with nowhere to go. Well, duhhhhhh. You could see that coming a million miles away. Don't politicians think logic before they do things based on emotion? We have to sleep in the bed we make.
Concerning foreign policy, we are the laughing stock of the world. Clinton's foreign policy has been extremely damaging to the image of all of us. Never before in history have so many countries despised americans, and never before have we been the joke of the world as we are today. A powerful bully of a joke. A friend of mine was proud of Clinton's foreign policy accomplishments. I asked him to name just one. Selling military secrets? Ignoring our friends in Taiwan while China threatens them? Giving up the Panama Canal? Bombing aspirin factories? Killing innocent victims in Bosnia? Signing peace treaties that will never be enforced, because it looks good in the news? Succeeding in helping the enemy accomplish its goals by chasing the people out of their own country? Turning our mighty military into a half sized meals on wheels? I think back on all the famous events and sayings of past presidents and try to come up with a comparable one with the current president. The closest one I can think of that will stand out is, "I did not have sex with that woman..." Geezzz.
Sorry I got off on a tangent. Just my opinions anyway. Our medical system is indeed in disrepair. Yet on the bright side, it is still the most advanced medical system in the world. With all its shortcomings and bumblings of government, we are still the best there is. Doctors and patients from all over the world come to good ole USA when the going gets tough.
Regards,
jamie
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Posted by JohnB on January 8, 2000, at 14:35:19
In reply to Somewhat OT: Candidate Healthcare Proposals +HMOs, posted by Abby on January 7, 2000, at 23:21:20
> I know that this is somewhat off topic and rather dangerous . . .
Abby, I don't agree about "off topic" or "dangerous". I think pharmacology discussion is what makes this board unique (and valuable). But is would be a rather bland stew if that was all there was. Thanks for your post!
Posted by Noa on January 8, 2000, at 15:17:13
In reply to Re: Somewhat OT: Candidate Healthcare Proposals +HMOs, posted by JohnB on January 8, 2000, at 14:35:19
Have you heard of the organization, National Coalition of Mental Health Consumers and Professionals? I haven't visited their site lately, but they have a lot to say about health care systems. Their web site address is:
www.nomanagedcare.org
Posted by Noa on January 8, 2000, at 15:23:37
In reply to Re: Thanks Noa, I guess my post was a mistake. Jamie, posted by jamie on January 8, 2000, at 13:20:05
Funny how it was the Democrats just a decade ago screaming that the mentally ill should have the freedom to be let out of the institutions. And they succeeded in getting that done. Now they're screaming we have too many mentally ill homeless on the streets with nowhere to go. Well, duhhhhhh. You could see that coming a million miles away.
It wasn't deinstitutionalization that led to so many homeless mentally ill people. The plan was to have a solid community mental health system, clinics and residences, in place, to support people in their communities (as I said earlier, one proponent of this plan was Rosalyn Carter). This system was being built and heading in a good direction, until the Reagan era, during which time, and this has continued to this day, the funding for these programs has been cut drastically so that it is clearly not feasible to address the needs of these members of the community. Read No Where To Go by E. Fuller Torrey, a psychiatrist who is a staunch advocate for people with mental illness and who has specialized in schizophrenia.
Posted by Abby on January 8, 2000, at 16:08:48
In reply to Re: Thanks Noa, I guess my post was a mistake. Jamie, posted by Noa on January 8, 2000, at 15:23:37
I don't know that much about it, but my understanding was that deinstitutionalization was
the result of a combination of forces starting in the sixties.
1.) Aggressive action on the part of civil liberties lawyers (yes Jamie)
2.)an untested belief in the power of antipsychotic drugs.3.) My understanding was that even in the Kennedy
era the community mental health system was supposed eventually
to become self-funding and that many of the counselors preferred to
provide marriage therapy rather than seek out the schizophrenics.
4.) Medicare and Medicaid made healthcare a federal
program. State governments, which were responsible
for the inpatient mental hospitals wanted to shift
their costs to the Feds by getting their indigent
patients on Medicaid, and to do that, the patients
had to be living in the community. The resources
were never there.I really don't want to be partisan about this. I
read an article in National Review once by an
expert in the field which called the result "an
equal opportunity disaster" Democrats and
Republicans have both been to blame.Noa-- you have much more experience with Harvard
Community Health. I was on it in the late 70s
and early eighties when we lived on Beacon Hill
(just a small house on Pinckney St), but I was
only (4-7) at the time and generally healthy.Abby
This is the end of the thread.
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