Nurses and Michael Moore's Sicko
I received a brochure via US post mail from the California Nurses Association complete with paid postage "Business Reply Mail" requesting that I "educate [SiCKO] moviegoers about Guarenteed Healthcare in America" by sponsoring a SiCKO screening. (see: www.guaranteedhealthcare.org/sicko) Even though I'm sure the movie is entertaining and full of facts that are well presented, I'm not sure this presentation should represent a medical organization. I question the political sales tactics of the above web site, and this one as well: http://americanhealthcarereform.org/.
There are two common themes at the above sites. One: Our healthcare system is full of problems. Shocking problems, too horrible to think about problems. And the biggest blame goes to the Health Insurance Companies. Two: socialized medicine ("guaranteed healthcare" - to use the more palliative, new age term) is all-American, it's patriotic, it's right, and it's about breaking the bonds of tyranny for freedom. These strike me as the same kind of sensationalistic / feel-good emotion-based arguments like those we see all the time that hack EBM in support of sCAM.
Evidence-Based Medicine will fade with more socialized medicine. The bureaucratic committees and legislative sessions of socialized medicine will base decisions more on a consensus of what can be believed as right and wrong, and rely less on what is provable, probable or fallacy. "Experimental" and "medically necessary" are touted as the evil tools of Health Insurance. Currently, and more so each day, these definitions are meticulously based on principles of EBM by Insurance Companies. But, be sure these "denials" will go-away with our new-found freedom in socialized medicine.
To digress for those who believe Insurance Companies have a sick and twisted sense of EBM. I must say, yes, some companies sometimes do. But, it's much more complicated than that. First, "Investigational" and "medically necessary" are subjective terms, even in the strictest sense of EBM. Our courts and legislative sessions argue them all the time. There is no sure line when something crosses over to being accepted and proven; it's a place of opinion. Second, Insurance Companies process hundreds of thousands of claims per day. The systems must be automated, thus based on analog logic of a computerized system, where all aspects and descriptions of medical care are forced into sets of numbers put into fields on a Medicare-based claim form. I attest to having years of first-hand knowledge of the difficulty of making this kind of complex system accurately and fairly identify, adjudicate, and pay for the medical care provided. (Not the least of problems is the shear potential for human error, and intentional fraud and abuse by any party with a touch in the system.) Even when all works flawlessly, there will always be the occasional square peg in a round hole, where a claim is accurately but wrongly denied. Finally, third, Insurance Companies are beginning to give up the "investigational / medically necessary" fight. They too often lose in courts and in lobbying, despite having the best EBM science backing them up. So instead, they're beginning to write and broadly apply more "exclusions" to benefits. These allow them to contractually carte-banche deny claims and services no matter how necessary they are, or how senseless the exclusion is applied. Remember, this is happening ironically because we are taking EBM out of the payment-process of health care, and the alternative is proving to be unscientific, often nonsensical and more money-driven.
Which brings us back to having less use for EBM in socialized medicine. We have Medicare and Medicaid, and the VA system as current representatives of socialized medicine. What will qualifying everyone for one of these mean? If I'm a nurses union, I probably gain more power to direct wages, hours, etc., and have more political clout in other health-related issues. Congratulations, California Nurses Association. Can we trust a nurse's union to back the science to determine coverage for health care? Based on the record of the ANA in backing science, I'd say it will be no more a priority than for any other political lobby.
If Insurance Companies are beginning to rely less on EBM to adjudicate claims anyway, what's wrong with taking them out of the picture? Because doing so will do nothing to re-emphasize EBM. The burden of being the evil denier of care will now be the US Government. We can no longer gripe at our employer who gave us the benefits in the first place, or call the insurance to give them a piece of our mind, demand independent medical review of the claim, or threaten to sue. Can we expect a legislator, who is no longer in the pocket of the Health Insurance Company, to lend us an individual ear? Or, will s/he now be in the pockets of other remaining commercial entities in the globally capitalistic health care industry? Can we expect the Government bureaucracy to run the tighter ship than commercial companies? Will the primary goal be to altruistically provide medical care that is fair to the patient and provider? Will it operate with financial responsibly and appropriately address errors, fraud, and abuse?
Personally, I like the accountability inherent in a private health care system, admitting to the horribleness we see in it currently. Even though I know the AMA has made statements in support of socialized medicine, I'm on board with their current recommendation for public health policy that advocates a consumer driven, market based system. http://www.ama-assn.org/ama/pub/category/7834.html)
dras
There are two common themes at the above sites. One: Our healthcare system is full of problems. Shocking problems, too horrible to think about problems. And the biggest blame goes to the Health Insurance Companies. Two: socialized medicine ("guaranteed healthcare" - to use the more palliative, new age term) is all-American, it's patriotic, it's right, and it's about breaking the bonds of tyranny for freedom. These strike me as the same kind of sensationalistic / feel-good emotion-based arguments like those we see all the time that hack EBM in support of sCAM.
Evidence-Based Medicine will fade with more socialized medicine. The bureaucratic committees and legislative sessions of socialized medicine will base decisions more on a consensus of what can be believed as right and wrong, and rely less on what is provable, probable or fallacy. "Experimental" and "medically necessary" are touted as the evil tools of Health Insurance. Currently, and more so each day, these definitions are meticulously based on principles of EBM by Insurance Companies. But, be sure these "denials" will go-away with our new-found freedom in socialized medicine.
To digress for those who believe Insurance Companies have a sick and twisted sense of EBM. I must say, yes, some companies sometimes do. But, it's much more complicated than that. First, "Investigational" and "medically necessary" are subjective terms, even in the strictest sense of EBM. Our courts and legislative sessions argue them all the time. There is no sure line when something crosses over to being accepted and proven; it's a place of opinion. Second, Insurance Companies process hundreds of thousands of claims per day. The systems must be automated, thus based on analog logic of a computerized system, where all aspects and descriptions of medical care are forced into sets of numbers put into fields on a Medicare-based claim form. I attest to having years of first-hand knowledge of the difficulty of making this kind of complex system accurately and fairly identify, adjudicate, and pay for the medical care provided. (Not the least of problems is the shear potential for human error, and intentional fraud and abuse by any party with a touch in the system.) Even when all works flawlessly, there will always be the occasional square peg in a round hole, where a claim is accurately but wrongly denied. Finally, third, Insurance Companies are beginning to give up the "investigational / medically necessary" fight. They too often lose in courts and in lobbying, despite having the best EBM science backing them up. So instead, they're beginning to write and broadly apply more "exclusions" to benefits. These allow them to contractually carte-banche deny claims and services no matter how necessary they are, or how senseless the exclusion is applied. Remember, this is happening ironically because we are taking EBM out of the payment-process of health care, and the alternative is proving to be unscientific, often nonsensical and more money-driven.
Which brings us back to having less use for EBM in socialized medicine. We have Medicare and Medicaid, and the VA system as current representatives of socialized medicine. What will qualifying everyone for one of these mean? If I'm a nurses union, I probably gain more power to direct wages, hours, etc., and have more political clout in other health-related issues. Congratulations, California Nurses Association. Can we trust a nurse's union to back the science to determine coverage for health care? Based on the record of the ANA in backing science, I'd say it will be no more a priority than for any other political lobby.
If Insurance Companies are beginning to rely less on EBM to adjudicate claims anyway, what's wrong with taking them out of the picture? Because doing so will do nothing to re-emphasize EBM. The burden of being the evil denier of care will now be the US Government. We can no longer gripe at our employer who gave us the benefits in the first place, or call the insurance to give them a piece of our mind, demand independent medical review of the claim, or threaten to sue. Can we expect a legislator, who is no longer in the pocket of the Health Insurance Company, to lend us an individual ear? Or, will s/he now be in the pockets of other remaining commercial entities in the globally capitalistic health care industry? Can we expect the Government bureaucracy to run the tighter ship than commercial companies? Will the primary goal be to altruistically provide medical care that is fair to the patient and provider? Will it operate with financial responsibly and appropriately address errors, fraud, and abuse?
Personally, I like the accountability inherent in a private health care system, admitting to the horribleness we see in it currently. Even though I know the AMA has made statements in support of socialized medicine, I'm on board with their current recommendation for public health policy that advocates a consumer driven, market based system. http://www.ama-assn.org/ama/pub/category/7834.html)
dras
posted by nawledge at
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