Nationalize Healthcare

3/10/03 9:42 AM

A case for Nationalization of Primary Healthcare based on National Security
An Outline by David Donnell
(Social Liberal, Fiscal Moderate, Constitutional Conservative)


I would like to present a bold idea to our “leadership” that would address many pressing problems in American Society.

Nationalize primary healthcare on the bases of National Security.

I) Why National Security?

A) One of the greatest potential threats to the general population of the United States is a clandestine attack by radioactive, biological, or chemical (NBC) suicide terrorist on civilian population(s).
1) Such attacks can have a significant time delay between event and symptoms.
2) Attack events might only be detected by emergency and primary care facilities.

B) Of the 3 forms of clandestine attack, the Biological type has the greatest future to cause the greatest long-term havoc.
1) Whereas radioactive and chemical attack requires access and usage of restricted (tracked) materials and are of known properties, biological do not.
2) The advent of genetic engineering: DNA sequencing of the human, animal, plant, bacterial, and viral genomes.
a) Completely novel genetic sequences have been created[1] (a chimera) that (worse case) the entire world population would have no natural resistance and (potentially) 100% infection rate.
3) Emergency and primary care workers would bare the brunt of a surreptitious attack that potentially could potentially collapse the entire medical system of an afflicted region.
a) It is not hard to imagine that a regional collapse could further spread and become a pandemic requiring extreme measures.
b) Of the known suitable infectious agents, almost all initially present as a bad cold or flu.
c) The flu can of itself become pandemic (despite vaccinations).

C) There are only 2 methods to directly deal with a biological attack on an unprotected population.
1) IMMEADIATE Medical response by vaccinations, antibiotics, antiviral, and antigens with isolation and support therapies.
a) On the spot diagnoses of infectious agent, natural or otherwise and appropriate treatment.
(i) Diagnoses of virus genomes require expensive laboratory work not normally performed except under extreme conditions.
b) Competition exists in some vaccines while others are single source subject to price manipulation or elimination if the facility closes due to economics
c) The problem dovetails into the antibiotic overuse by the agricultural industry.
2) Quarantine by civil and/or military authorities.

D) Nationalizing primary care would further unify the existing programs of the CDC and Homeland Defense and enhance the effectiveness.
1) Nationalizing primary care would save taxpayer money by including biological defense spending into healthcare.
2) This would unify part of the DOD and DOHS healthcare budget with the civilian agency (Medicaid etc.), appropriations.
3) This would address the homeland security state funding issues for first responders: Ambulance, fire, police, Emergency rooms, clinics and primary care physicians.

II) Why Nationalize primary healthcare?

A) Healthcare is on the verge of a total meltdown. Healthcare is the number one employment issue for business AND Government.
1) The private health insurance, HMO, and managed care industry is failing to protect a vast and growing segment of population.
a)People in the margins of society under the currant insurance industry driven healthcare system, would delay seeking help in an epidemic, with extreme negative consequences
2) The population without health insurance defaults to public sector (taxpayer) Medicare, Medicaid, Veterans Administration, as care is required.

B) Healthcare is the number one economic drag on low and middle-income finances.
1) For many segments of society, the life span is already diminishing!

C) Healthcare is the single most expensive part of retirement.
1) The needs for the social medical system is exploding as the uninsured Baby boomers age

D) The malpractice insurance and health insurance system is out of control and showing meltdown.
1) Patients blame a greedy Insurance Industry, greedy and Incompetent Doctors, greedy Tort Lawyers and a profiteering pharmaceuticals industry.
2) Doctors blame greedy Tort Lawyers, unrealistic Patient expectations, profiteering pharmaceuticals industry, and greedy Insurance industry making up for stock losses.
3) The Insurance Industry blames excessive jury awards to frivolous suits authored by greedy Tort Lawyers, Incompetent Doctors, profiteering pharmaceuticals industry, unrealistic Patient expectations, and stock losses.
4) Tort Lawyers blame incompetent Doctors, profiteering Pharmaceutical Industries and a greedy Insurance Industry making up for stock losses; “frivolous” patient lawsuits are a matter of perspective and who is suing.
5) The Pharmaceuticals Industry blames greedy Tort Lawyers, Incompetent Doctors, unrealistic patient outcomes, miserly Insurance and Government reimbursements, FDA regulations, research and development costs, and stock losses.
6) Any way you look at it; taxpayers pay and only the lawyers profit.

III) The alternative to Nationalization would be taxpayers bailing out the medical Insurance Industry.

A) That would be tantamount to socializing medical cost without actually socializing medical care – the worst of all worlds!
1) Allowing the social medical system to collapse would conceivably lead to people dying on the streets. That would not be conducive to insuring “domestic tranquility”.

B) Vaccinations are a particular area of special concern:
1) Pharmaceutical Industry has at times failed to provide or maintain adequate stocks of Tetanus, Flu, Pneumonia, DPT, Measles, etc.
a) Lack of profit margins from standard vaccinations where competition does exist.
b) Fear potential lawsuit liability for new vaccines and problematic vaccines with high negative patient outcomes.
c) Failure by industry to research new vaccines for existing disease and emerging 3rd world diseases.
d) A great deal of vaccine research is performed by publicly funded University research and yet claimed as overhead by pharmaceuticals industry.
e) Pharmaceutical Industry has at times failed to provide or maintain adequate stocks (or control) of antibiotics, antiviral, and antifungal medications.
f) By removing vaccination, antibiotic, and antiviral from the “free market” research efforts could be streamlined and treatments of emerging diseases more quickly addressed.

IV) The government is responsible for the present healthcare situation because:

A) It has failed to address the fundamental problems of healthcare throughout the 70’s, 80’s, and 90’s.
1) The Insurance Industry is allowed by legislative faint to move claims losses between Home, Auto, Property, Casualty, Malpractice, and Medical Divisions.
2) The Insurance Industry Is allowed to recoup stock losses from ratepayers.
3) Congress made a bad problem worse by ignoring consequences of the 1989 Tax “Reform Act”.
a) Temporary agencies are not required to offer medical or retirement.
b) The Insurance Industry has failed to allow Temporary employees, part time, and self employed to form groups.
c) Congress has not forced the Insurance Industry to allow temporary, part time, and self employed to form groups to negotiate Health Insurance, Pensions, and Retirements. (Unlike the State and Federal Legislature & Judicial Health plans)

B) Federal, State, Local governments jumped on the non-benefited “Temp” bandwagon to avoid hiring freezes and lessen exposure to pension obligations and additional healthcare.
1) It is particularly ironic as this ultimately shoves the retirement and healthcare costs back into the social services – just as business is doing. Even more poignant is the fact elected officials are themselves “temporary workers” in every sense.

C) Government has allowed the pharmaceutical industry to act as individual monopolies for necessary “sole source” drugs, granting dubious new patents on existing drugs that industry has repackaged
1) Pharmaceuticals that have reached the end of their patents should retire to the public domain.
2) Pharmaceuticals discovered by government paid university research belong to the American public and should be licensed for manufacture accordingly. The pharmaceutical industry should not be allowed to claim taxpayer funded research and studies in its pricing structure.
3) Public advertisements for pharmaceuticals should be curtailed (if not outright banned). Prescription Drugs should not require public marketing as only Doctors can prescribe them. Certainly, the cost of such marketing should not be passed to the public in the form of higher prices.
4) Congress has failed to address profiteering of the insurance, pharmaceutical, and healthcare industry choosing business interests over the publics even as they enjoy lavish congressional health plans.
5) Vaccines, public vaccinations, and vaccine research must be recognized as an integral part of National defense. Adverse reactions and negative outcomes should be removed from courts (unless criminally negligent & particularly egregious) and covered by Medicaid.

D) Rationing healthcare already exists under pay or suffer and die.
1) This leaves large segments of society particularly vulnerable to creating a major epicenter for a biological assault.

E) Drug Addiction Is a Medical Problem: Detoxification and Treatment should be available upon demand.
1) When hard[2] drug addicts are finally willing to seek inpatient treatment, there is a limited window of opportunity before the addiction takes control again.
a) Treatment must be as available as the drugs society is trying to rid itself of.
b) Waiting lists do not serve the interests of communities or save government coffers
c) The only question to an addict seeking help should be: “may we send a car to give you a ride?”
d) Mental healthcare must also be employed with drug addicts, as many have underlying thought disorders, mental illness, and trauma that must be alleviated to prevent relapse and recidivism.
(i)Length of inpatient treatment often requires more then standard 28 day insurance benefit.

F) Failure to promptly treat hard drug addiction thru readily available treatment, either voluntary or forced, passes (and magnifies) the cost into the Criminal Justice system and social services (children, spouses of incarcerated).
1) Active (hard drug) addicts continue to cost society in the form of personal and property crimes to pay for their addiction, and when caught: cost of a trial and incarceration. ($28k/yr - min Security to $52k/yr - Max Security in Oklahoma).
2) Closing mental hospitals, restricting access to mental health care, unwillingness to pay the psychiatric medical practitioners and facilities has created a crisis swelling the streets, jails and prisons.
3) This not only fails to serve the public’s interest, it fails to save the public’s tax dollars as the cost is merely shifted (and increased) in the form of judicial proceedings, personal and property crimes, and incarcerations.

V) The only other Industrialized country besides the United States without a comprehensive social medical plan is South Africa.

A) The Insurance Industry/HMO/PPO has been allowed to manipulate and control the medical system to their benefit at the expense of the general population.
1) The present privatized Healthcare system is based of the concept of profiting off individuals misfortune.
a) Generally, the sicker people are the less money they have to pay for it.
2) The present privatized Healthcare system puts the onus of insurance claims between laboratory, x-ray, diagnostics, on the patient who many times is too sick to be able to function or care.
3) There is something intrinsically wrong with a healthcare system where the first question asked of a patient is “How do you intend to pay” rather then “what’s wrong”. Many Specialty Doctors offices now require the patient to pay the entire office visit fee “up front” and force the afflicted patient to negotiate with the insurance company for reimbursement.

B) There will be economic losers in the future from this problem
1) If things continue unchanged: the healthcare system will eventually implode leaving Medical Insurance Industry/HMO bankrupt and seeking taxpayer bailouts.
2) The Medical Insurance Industry/HMO can be seen as a modern equivalent of the proverbial “Buggy Whip” manufacturers.
3) Hillary Clinton was vilified for addressing healthcare reform without inviting the Insurance Industry. As a major root cause, She was right to exclude the relatively small amount of people employed in the Medical Insurance industry compared to the effected population the Medical Industry is feeding on.

C) This is not ignoring capitalism or competition - There will always be Private care, the extremely wealthy can always “spare no expense”.
1) There will always be a market for elective surgeries, private “high end” care, cosmetic surgery, extreme measures, and experimental care.

D) Pharmaceuticals manufacturers will still compete with their counterparts – both American and abroad for the latest and greatest medications. The US industry needs to follow their foreign counterparts like the Swiss, French, Scandinavian, British, et al. The foreign drug manufacturers manage to exist and create a profit even under socialized medicine: must be doing something right.

VI) In Conclusion: Something has to be done, the multitude of problems will not go away by themselves, even as individual people eventually do. Only the federal government has the power to step in where the States and Industries have failed, unify the healthcare system, and provide at least minimal care to everyone – if not for altruism then enlightened self-interest. Diseases do not honor governmental borders, socio-economic status, political affiliations, religion, or ideology. This is the governments constitutional business and responsibility falling under the provisions of “preserving domestic tranquility” and “promoting the General welfare” “with freedom and Justice for All”.

[1] 60minII – Russian Genetic Microbiologist claimed to have successfully inserted smallpox DNA into a flu virus.
[2] I make the distinction between “Hard” addictive substances: Opiates, Cocaine, Crack, MethAmphetamine, Valium where withdrawal symptoms entails dramatic and overwhelming physical “illness” (occasionally fatal) that reinforces the addicts desire to feel “well” no matter the cost (or crime). The so-called “Soft” addictive substances: Caffeine, Nicotine, Marijuana, etc. that do not manifest an overpowering physical inducement component to the Addiction (more mental then physical). The Reagan administration moved Marijuana from its own status to Schedule 1 (the same as Heroin – no known medical or industrial use).