My previous post examined the how empathy (i.e., the ability to put oneself in the shoes of another), which is often lacking from the healthcare reform debate, ought to be an essential ingredient in the decisions our country makes. My discussion about the need for greater empathy triggered a contentious debate on another blog. Following is the debate. This is very timely discussion, so please feel free to join in!
One person asked me: "Can you please identify for me a country that is long on 'empathy?'" and I replied:
All nations having publicly-funded health care with universal coverage as the goal show more empathy than ours since the United States is the only wealthy, industrialized nation that does not provide universal health care (see this link)
He also asked: "Can you please identify for me a model of public sector healthcare efficiency?" and I replied:
Read Maggie Mahar's post on THCB a few years back titled 'Why Medicare is More Efficient Than Private Insurers' at this link.
He wrote: "Health care is not a right!" to which I replied:
So, what makes YOU deserve it!
He wrote: "...if you are a MD, then you would not be supporting the Abomanation being devised in D.C." and I replied:
In March '08, more than half of U.S. doctors now favor switching to a national health care plan and fewer than a third oppose the idea US doctors support universal health care according to a Reuters survey at this link. Also see the Physicians for a National Health Program web site at this link.
Here are two links on other blogs to discussions on healthcare reform and empathy:
[Another person then joined the debate.]
He wrote:
Steve you got to be joking.
All nations having publicly-funded health care with universal coverage as the goal show more empathy than ours since the United States is the only wealthy, industrialized nation that does not provide universal health care
So the 22 year old that died in England because they refused him a transplant was shown empathy? The ICU baby brought down from Canada was shown empathy? 80% of Americans have the best healthcare in the world. Those enrolled in our empathetic public plans like Medicaid are those suffering. You want to reduce the quality of care and drastically increase the cost for 80% of Americans so our Medicaid population can get a slight increase in quality, and you call that empathy. You can keep your empathy we'll all be much better off without it.
In response to my statement—"Read Maggie Mahar's post on THCB a few years back titled 'Why Medicare is More Efficient Than Private Insurers' at"—he wrote:
Quoting a far left factually challenged propagandist proves what? Maggie has no background in healthcare and very little understanding of it. Her opinion on the efficiency of public plans carries about as much weight as well yours. Examples of her deep understanding of the facts;
In response to my statement—"In contrast to private insurers Medicare doesn't have to spend millions on marketing, advertising, and Washington lobbyists." —he wrote:
Actually it does spend hundreds of millions, where do you think the Medicare commercials come from. The annual CMS material on how to enroll in Medicare and options available doesn't print itself. Search for Medicare blimp advertising, part of a 13 million campaign Bush admin was attacked for.
In response to my statement—"But if you look at cases where healthcare providers like National Medical Enterprises cheat insurers, you'll find that they are just as likely to bilk private insurers." —he wrote:
No one questions Medicare has a fraud rate 5 times that of private insurance. The GAO, CMS, and everyone every year publish reports about how many billions Medicare loses to fraud. Medicare loses more to fraud then private insurance companies make in profit yet is a fraction of their size.
Maggie's entire post is lies and BS easily refuted by 20 seconds on any search engine. To quote it is a joke.
In response to my statement—"In March '08, more than half of U.S. doctors now favor switching to a national health care plan and fewer than a third oppose the idea US doctors support universal health care according to a Reuters survey" —he wrote:
When asked a generic question like would you like things to be better most doctors said yes, WOW what cutting edge research. When given any facts about the proposed changes being discussed the support drops off almost completely. Please Dr., if you really are one, tell me why a generic survey void of any facts or controls should be given any thought? Ask doctors if they want to be reimbursed Medicaid and Medicare rates in a universal system and what happens to support? Exactly.
My replies follow:
I wish I was joking.
In response to his statement—"80% of Americans have the best healthcare in the world" —I wrote:
Not according to the reports I've read, e.g., see this link.
In response to his statement— "Ask doctors if they want to be reimbursed Medicaid and Medicare rates in a universal system and what happens to support?" —I wrote:
Of course people don't want to pay higher taxes, see their incomes lowered, change the way they do things, or to have to work harder to maintain their standard of living. But I disagree with your implication that healthcare professionals care only about money and that their empathy is shallow and brittle. I suppose you believe that the 16,000 physicians, medical students and health professionals who support single-payer national health insurance through the non-profit Physicians for a National Health Program are lying.
In response to his statement— "So the 22 year old that died in England because they refused him a transplant was shown empathy? The ICU baby brought down from Canada was shown empathy?...Those enrolled in our empathetic public plans like Medicaid are those suffering."—I wrote:
While I don't have enough facts to comment on the individual cases you site, there are many horror stories about the way Americans have been treated under our current system, including denying care recommended by providers and dropping coverage when people get sick and need it in order to increase profits. I refer you to a recent interview of insurance exec turned whistleblower Wendell Potter, who spoke out against the underhanded tactics of the health insurance industry at this link.
Empathy doesn't mean reckless spending. The empathy I'm discussing means assuring everyone has access to the kind of high value care I want for myself and my family. As I wrote in a series of blog posts starting at this link, we should be focusing on radical changes that dramatically increase care value to the consumer to overcome the "pathologically mutated" form of capitalism" that has broken our healthcare system and has pressured doctors into delivering more care rather than losing money by rendering care cost-effectively.
There are actually two areas in which we agree: (1) I doubt that much empathy went into setting Medicaid reimbursement rates and (2) Much more should be done to control Medicare (and Medicaid) fraud.
In response to his statement—"Please Dr., if you really are one …"—I wrote:
I've twice been questioned about my credentials. I'm a licensed clinical psychologist specializing in treatment, research, and health IT. I'd venture a guess that you are a health insurance lobbyist!
I ask again: If access to good healthcare is NOT a right (which I assume you contend), then what makes YOU more deserving than millions of others!
Anyway, my main point is this: If our culture (and others) were more focused on promoting greater empathy (and compassion), we'd have a much better world. The healthcare problem is a reflection of an economic culture that has "lost its way" through excessive/imbalanced focus on "What's in it for me?" and "How can I have more by manipulating and taking advantage of others." This is the root cause of our current economic and healthcare crises. I believe President Obama recognizes this fact and sincerely wants to change things; I applaud and support his courage and efforts!
He also wrote:
Your report is off from the start and is built on the same faulty rationale as most liberal attacks on our healthcare systems. Notice the S on the end of system, we don't have one homogenous system. We have 50 state, couple federal and thousands of employer systems. The vast majority of those systems are better then anything else in the world. That is the problem with studies, they are done by academics who don't have any functional understanding of our healthcare system. Any study that lumps all US systems into one is worthless. Why would you scrap a highly efficient large group self funded plan because Medicaid sucks? Then further why would you propose replacing that once efficient and best system in the world with something that more resembles the failed Medicaid plan?
I never said healthcare professionals care only about money, never implied anything close to that. Our systems are suffering and are in their current unsustainable position because of inadequate reimbursement form Medicare and Medicaid. My Implication is providers need to be paid considerably more form these plans. Please debate what I say not the talking points you wish I had that you have answers for.
Wendell Potter was not an insurance executive, he was a PR hack who will say what ever he is paid to save. I have previously destroyed any creditability he had, look up any time I have commented on him on this blog to see how clueless he is. All those years as an "insurance executive" and he doesn't even grasp basic industry terminology. If someone would pay him to sing the praise on insurance companies tomorrow he would change his tune again.
If you think we have a capitalist healthcare system you need to go back to square one and start HS all over. Capitalist systems don't have 50% of expenditures coming from government nor operate under the yoke of regulation our systems do. Our insurance systems have not been capitalist since Medicare passed 40+ years ago.
Not a lobbyist just a small business owner who helps employers offer affordable insurance by reducing what they pay to evil insurance companies. My living is made pissing off the big carriers.
I would expect someone who has a PhD and specializes in research to know how to do basic research. Everything you have referenced so far makes you appear more like a vacuum of propaganda. You cite poorly designed studies with flawed premises and build opinions on the shrilling of political operatives. I haven't seen you once reference any solid facts or data.
In response to my statement—"If access to good healthcare is NOT a right (which I assume you contend), then what makes YOU more deserving than millions of others!"—he wrote:
Who said I deserved anything? I don't think I am entitled to any access. I do believe I am entitled to the fruits of my labor though. If I wish to exchange that labor for access or healthcare services that is my right. That is why I have an issue with politicians telling me I must first work 2-3 months a year so those that choose not to work can have access and care and then they further dictate to me I must purchase their inefficient version of care. They have zero constitutional right to force me to participate in a health insurance exchange or to pay for others so they can.
Question to you, why are 12 million non US citizens allowed to confiscate my labor to pay for their care?
In response to my statement—"If our culture (and others) were more focused on promoting greater empathy (and compassion), we'd have a much better world."—he wrote:
If you ignore reality and pretend there are no unintended consequences. Your empathy and gentler world argument is the same one Liberals gave when forcing blacks into public housing. Now that they have destroyed 4+ generations of African Americans do you still consider those actions empathetic? By feeding the starving in Africa you are actually dooming millions more and generations to starvation. As long as people that have no means to feed themselves continue having babies they can't feed they will starve. So while you might feel good about yourself and think your empathetic your actually monsters enabling the suffering of millions more for your own selfish reasons. Sometimes it is better to let one person die so 10 more don't have to. If you can't properly feed them all forever then half ass efforts are only helping you.
I replied:
Hmmm…Sounds like you're downplaying empathy because there may be unintended consequences. It's like saying, Why put yourself in someone else's shoes and try to understand things from their point of view since there have been times when half-assed attempts to help those in need have backfired? I would take a completely different approach by asking: How can we use the understanding empathy brings to do things that are effective in helping those in need to help themselves in a sustainable way?
Let me add that empathy toward healthcare providers is also important. Put yourself in the shoes of a doctor who strives to deliver cost-effective care when our crazy insurance system actually punishes him financially for doing so! That's why I disagree with your blanket statement that all Medicare and Medicaid providers ought to be paid more. Instead, I contend that providers who deliver HIGH VALUE care should be paid considerably more than those who don't, be it from Medicare, Medicaid, and private insurance companies. I would also argue that that the disparity between primary care and certain specialists is lop-sided and ought to be corrected.
Please support your claim that the vast majority of state, federal, and employer systems are better than anything else in the world.
I cannot comment on your critique of Wendell Potter since, being an insurance guy, you have a vested interest in disparaging him. Nevertheless, his interview was powerful and convincing. He seems to be a person who let empathy "get in the way" of doing his job as an insurance company spokesman.
I don't understand the rationale of your statement that our insurance systems have not been capitalist since Medicare passed 40+ years ago.
I've cited studies from reputable people and organizations; and there are many more. You've criticized them all, but have not presented any of your own validated research.
I don't understand your statement "That is why I have an issue with politicians telling me I must first work 2-3 months a year so those that choose not to work can have access and care and then they further dictate to me I must purchase their inefficient version of care. They have zero constitutional right to force me to participate in a health insurance exchange or to pay for others so they can." What "inefficient version of care" are you forced to purchase? Where's the evidence that it must be inefficient? Why is it that only about giving people who "choose not to work" access to care? What about the working poor, etc.?
"Question to you, why are 12 million non US citizens allowed to confiscate my labor to pay for their care?"
If our country's priorities were different, if our broken healthcare system was fixed, if we knew how to and were rewarded for delivering high value care, them I believe we'd have the money to give them good care without jeopardizing the care to American citizens. That would have help improve the image of America in the eyes of the rest of the world by demonstrating empathy. But because the overall healthcare is so screwed up, we can't even take care of our own citizens. So, our options are to say the hell with them, or to cure American healthcare in a way that enables us to do more to improve the health and wellbeing of other people's.
In response to my statement—"Nevertheless, his interview was powerful and convincing."—he wrote:
Because he said what you wanted to hear and reinforced what you thought. It does not bother you that factually he was totally off base and even though he was supposedly an insurance executive he misused basic industry jargon? What your admitting is you don't care rather the facts are accurate as long as you agree with the point, not very scientific. Being paid by a left leaning pro reform organization means you should also not comment on Mr. Potter. I get paid to take money away from insurance companies so you can't trust what I say good about them, Mr. Potter gets paid to critique insurance companies so you can believe what he says? I don't follow the logic on that.
In response to my statement— "I don't understand the rationale of your statement that our insurance systems have not been capitalist since Medicare passed 40+ years ago."—he wrote:
Capitalism is an economic and social system in which trade, industry and the means of production (also known as capital) are privately controlled (either singly or jointly) and operated for a profit
When the government owns 50% of the market and controls through regulation the remainder it does not meet the meaning of capitalism. I don't understand the rational for thinking for one second our current systems are capitalist, by what possible measure?
In response to my statement— "I've cited studies from reputable people and organizations;" —he wrote:
Reputable in the eyes of those who support them and share common goals. I didn't find anything reputable in any of the studies you referenced. In regards to validated research the majority of my opinions and statements reference my personal knowledge. When you work daily in the field being discussed you don't need to reference the work of others that work in the field. This is the fallacy of studies, they are to far removed from those actually doing the work and have the knowledge. The people you cite are studying what I do, I don't need a study to cite myself.
Some points, like the fact we don't have A system, we have thousands, do you really need me to name the 1000s of systems to prove to you we don't have just one?
In response to my statement— "What "inefficient version of care" are you forced to purchase?" —he wrote:
House bill 3400 or what ever was passed sets up an insurance exchange and over times outlaws any insurance being sold outside of said exchange. Any ERISA plans would need to meet approval outside the exchange. What would be required is not addressed of course.
Currently I am forced to pay for, and then strong armed into using Medicare. Medicare being one of it not the most inefficient systems in the world. This is evidenced by the fact it loses ten cents on every dollar.
In response to my statement— "I believe we'd have the money to give them good care without jeopardizing the care to American citizens." —he wrote:
Why am I forced to give them any care? Why don't they start collecting empathy from their own people and government instead of breaking into the US and stealing it?
Empathy only works in the naïve world where people respect it. What you are failing to admit is American could show all the empathy in the word and the world would suck us dead. The billions congress rushed through for Katrina was full of empathy, and billions where stolen. You can't show open ended empathy without protection and you have proposed zero protection.
Your initial metaphor is wrong, putting yourself in someone else's shoes to see their point of view is not the same as offering to buy anyone that wants it free insurance. I understand people's difficulties and struggles that doesn't mean I need to open my wallet and give them all my money.
If you really wanted to help those in need you would stop with the handouts and instead give them opportunity. The old teaching someone to fish versus giving them a fish. Tax credits, welfare checks and food stamps create dependent voting blocks. Guaranteed jobs sorting trash or acting as crossing guards helps people. This is why liberalism is BS and doesn't work, you pretend it's empathy for others that you offer welfare programs even though they hardly ever work. In fact you are creating slaves forced to vote for you. If you really cared about these people you would give them jobs not handouts.
In response to my statement— "your blanket statement that all Medicare and Medicaid providers ought to be paid more." —he wrote:
Again not at all what I said.
"My Implication is providers need to be paid considerably more form these plans."
I don't see the word all anywhere.
Who do you expect to measure HIGH VALUE, the same people that think me have 1 system instead of 1000s? The government is created and run the most inefficient healthcare systems in the world? I think High Value is best gauged by the consumer and should be rewarded with the consumers money.
In response to my statement—"I would also argue that that the disparity between primary care and certain specialists is lop-sided and ought to be corrected." —he wrote:
Know the best way in the world to accomplish this, let the doctor justify his fee to the patient. That is why cosmetic and elective procedures decline in price while all other healthcare inscreases.
In response to my statement—"Please support your claim that the vast majority of state, federal, and employer systems are better than anything else in the world." —he wrote:
Again not what I said, federal and state Medicaid are the worst. Employer plans are the most efficient and deliver the highest quality care.
I replied:
In response to my observation that Mr. Potter's interview was powerful and convincing, you said my perception is such because "… he said what you wanted to hear and reinforced what you thought."
It's true that Mr. Potter's scathing critique is aligned with many other things I've learned about the health insurance industry and that his comments reinforced those perceptions. Nevertheless, I have an open mind and am definitely interested in debate.
In response to his statement—"It does not bother you that factually he was totally off base and even though he was supposedly an insurance executive he misused basic industry jargon?" —I replied:
What industry jargon did he misuse and how does that prove he lied to Congress and now lies to the public? In search for truth, please quote all statements he made in the interview (and elsewhere of which you are aware) that are false, and explain how they are invalid.
In response to his statement— "I get paid to take money away from insurance companies so you can't trust what I say good about them, Mr. Potter gets paid to critique insurance companies so you can believe what he says? I don't follow the logic on that." —I replied:
First of all, I don't know exactly what you do, but it sounds like you work for smaller insurance companies (as a broker?) and get paid when an employer switches to one of your clients. For transparency sake, my personal info is freely available on my blog and wiki for public review. Where can I/we find out more about you? Anyway, are you implying that Mr. Potter became a whistle blower IN ORDER to become a paid critic, rather than his claim that his motivation was influenced by insurance company abuses for which he could no longer in good conscious ignore or accept? Did some liberal leftist organization with deep pockets convince him to start lying against the health insurance industry so he could earn even more money as a whistl-blower? I can only assume why you reject the notion that an insurance company PR person such as Mr. Potter can become empathetic and seek to take the "high road," but I would like hear you explanation.
In response to his statement— "When the government owns 50% of the market and controls through regulation the remainder it does not meet the meaning of capitalism. I don't understand the rational for thinking for one second our current systems are capitalist, by what possible measure?" —I replied:
I can understand how a single payer system would not be capitalistic, but why do you say that strong gov regulation is a factor in killing capitalism? Are you are insinuating that the right kind of capitalism is the pathologically mutated form of free market capitalism we've been living with for many years, with its weak gov regulations, which has been destroying our country while making a few people very wealthy?
In response to his statement— " I didn't find anything reputable in any of the studies you referenced. In regards to validated research the majority of my opinions and statements reference my personal knowledge. When you work daily in the field being discussed you don't need to reference the work of others that work in the field. This is the fallacy of studies, they are to far removed from those actually doing the work and have the knowledge. The people you cite are studying what I do, I don't need a study to cite myself."—I replied:
Sounds like you're insinuating: Don't bother with academic research, just take the word of non-empathic people in the industry who have a vested financial interest in the status quo and avoiding harsh criticism. Not a convincing argument, imo!
In response to his statement— "Some points, like the fact we don't have A system, we have thousands, do you really need me to name the 1000s of systems to prove to you we don't have just one?"—I replied:
Semantics. We have ONE healthcare system comprised of many sub-systems. These sub-systems share various business models, operational processes, and metrics. So … What's your point?
In response to his statement— "Medicare being one of it not the most inefficient systems in the world. This is evidenced by the fact it loses ten cents on every dollar."—I replied:
Are you implying that we should eliminate Medicare because it has inefficiencies, or are you saying we should work to make it more efficient? Personally, I think ALL of government should be made much more efficient, as well as making our entire healthcare system (including all sub-systems) much more efficient by cutting out waste, fraud, abuse, and inefficient operational processes. This requires a RADICAL OVERHAUL of our entire healthcare system (with all its sub-systems). Do you want private insurance to become more efficient and affordable as well?
In response to my belief that by fixing our healthcare system (with all its sub-systems) we'd have the money to give the 12 million non US citizens good care without jeopardizing the care to American citizens, he replied, "Why am I forced to give them any care? Why don't they start collecting empathy from their own people and government instead of breaking into the US and stealing it? Empathy only works in the naïve world where people respect it. What you are failing to admit is American could show all the empathy in the word and the world would suck us dead. The billions congress rushed through for Katrina was full of empathy, and billions where stolen. You can't show open ended empathy without protection and you have proposed zero protection."—I responded with:
It sounds you're saying that understanding what it's like to be in someone else's shoes can a bad thing because (a) it isn't our responsibility to take care of other peoples, (b) people can't be trusted, and (c) people for whom we have empathy will take from us without end; therefore, we need to be protected. Well, empathy DOESN'T mean you HAVE TO do anything just because you understanding other people's woes and points of view (which is something to which you agree). But if you want to act on your empathy to help others—which I contend we should for many reasons, even though we are not obliged to—then I agree that it should be done wisely, including safeguards (rules, regulations, and oversight). The same can be said for empathy toward the bailed out financial institutions and auto manufacturers, as well as toward health insurance companies, the elderly, poor, and disabled, and even foreign governments.
In response to his statement— "If you really wanted to help those in need you would stop with the handouts and instead give them opportunity…Guaranteed jobs sorting trash or acting as crossing guards helps people…If you really cared about these people you would give them jobs not handouts."—I replied:
If the jobs included access to excellent healthcare and a better quality of life, then I agree with you!
In response to his statement— "Who do you expect to measure HIGH VALUE, the same people that think me have 1 system instead of 1000s? The government is created and run the most inefficient healthcare systems in the world? I think High Value is best gauged by the consumer and should be rewarded with the consumers money."—I replied:
One thing I your statement appears to confirm is that your 1 vs. 1000 systems comment is a clever semantic ploy meant to discredit me by insinuating I didn't know the difference. Nevertheless, you do bring up a valid question concerning who should measure the value of care. I contend that one appropriate metric of value would be clinical outcomes (e.g., changes in signs, symptoms, and quality of life; readmission rates; and safety) divided by cost (of meds, procedures, hospital charges, etc.) with due consideration of the severity and complexity of each patient's condition. In other words, value is a measure of cost-effectiveness. This is not an easy thing to do and there are many daunting challenges. To think that a consumer can judge care value validly and reliably is very naïve to say the least (see this link, this link, and this link).
In response to my statement that I would also argue that that the disparity between primary care and certain specialists is lop-sided and ought to be corrected, he wrote "Know the best way in the world to accomplish this, let the doctor justify his fee to the patient."—I responded with:
If you mean that we should have pricing and performance transparency, then I agree, although doing it right is a real challenge (see see A Path to Profound Healthcare Transformation). But, similar to what I said above, expecting patients to effectively evaluate the relative validity of justifications by different doctors is naïve. In a four-part post I wrote about the dilemma modern consumers face in this era of "personal responsibility," I presented stories from a consumers point of view in which a person (1) has to make difficult treatment decisions when there are no clear-cut answers and (2) decide on a health insurance policy from among dozens of confusing alternatives. This series of posts begins at this link.
In response to my statement— "Employer plans are the most efficient and deliver the highest quality care."—I wrote:
Please validate this statement and explain what you mean by most efficient and highest quality. Also, discuss if this high efficiency and quality translate into high value to the consumer.
The debate continues at this link.
Related links:
