ON GAY MARRIAGE
It would be so easy to blame gays for the erosion of family values. Everything would become so much clearer and simpler, and I could oppose their marriage agenda in good conscience. Unfortunately, while I seem to have reservations about homosexuality, I find that I do not have a problem with homosexuals; in my experience, they seem to have no less or more character than heterosexuals.
I cringe a little when I visualize what gays do sexually. I wonder if they cringe when they visualize the things I do? On one level, homosexuality seems so unnatural; on the other, it is clear that gays have been around at least as long as written history. Most gays when asked will say that they have been the way they are as long as they can remember. Why should I disbelieve them?
I’m not sure gay and lesbian couples should be in such a hurry to get married. Heterosexual couples are destroying the institution rapidly. Over half of heterosexual marriages end in divorce; many others barely survive infidelity and self absorption. There’s even a website now where married people who want to cheat can sign up.
The primary threats to family values are heterosexual divorce and the epidemic rise in fatherless homes. After that comes heterosexual promiscuity. Gay marriage poses little comparative risk.
Family values of are critical importance. Government cannot take the place of parents in child rearing and the instillation of values. Governments and villages cannot love children the way parents do. Families form the most basic, indispensible unit around which economic safety and responsibility can be built.
That being said, lets not put the erosion of family values off on gays. If we want to turn this process around, heterosexuals need to get married and stay married.
Some say we shouldn’t allow gays to marry because God is opposed to it. Maybe so. But neither do I think he comes down strongly in favor of divorce, fatherless children, or promiscuity in any form. I just can’t seem to find the moral high ground from which to deny these people.
My marriage is one of the biggest blessings of my life and I have a difficult time opposing giving gays and lesbians their shot. I’m not convinced they’ll muck it up any worse than heterosexuals have.
About Me
- Terry McMillan MD
- Raised in Fort Sumner, New Mexico, I am a fourth generation New Mexican. After high schoool, I received my undergraduate degree in Physics and Chemistry at Baylor University. I attended medical school and residency training at the University of Texas Medical Branch in Galveston, Texas. Retracing my steps to practice in Waco, Texas for three years, I returned to New Mexico in 1993. I have been in private pracice in Las Cruces since that time. While in medical school in Galveston, I met a nursing student who shortly became the love of my life, now my wife of 25 years, Jo Carol Hugghins formerly of Houston. Jodie and I have two children. Natalie will attend UNM beginning this fall and intends to study theater. Mitchell, our son, is 16 and studies sports and girls.
Sunday, September 13, 2009
Monday, August 31, 2009
WHO SHOULD PAY
WHO SHOULD PAY?
At the risk of my own pocketbook, I must tell you that too much health care is consumed in this country. There is legitimate concern about healthcare costs that outpace all the other costs of living; indeed it seems that the cost of providing care has an insatiable appetite that will eventually consume all our resources. It will in fact unless we make some changes.
Most health care consumers shop with other people’s money. Whether its Medicare, Medicaid, or employer funded insurance, with some exceptions of course, the majority of purchases are made with little concern on the part of the consumer as to the cost. In the case of employer provided health insurance coverage, employees lobby for plans that provide for the smallest copays and deductibles. It is natural and logical, at least on the surface, to seek a situation in which we are least responsible financially; after all, health care costs can be huge, right?
Why this disparity between how we view health insurance coverage and the way we view other forms of insurance? We purchase home, auto, and other forms of insurance in order to avoid financial calamity and bankruptcy. We do not expect those policies to pay for new paint, carpeting, or a remodel. Yet we do expect health insurance to pay for most any health service we want or that our doctor recommends.
Consider this: Some time back I was prescribed one of those pills we all see on television for prostate problems. After taking it for a month, I had no difficultly deciding it was not worth the $300 per month it would have cost toward my $5000 per year deductible. Would I have felt otherwise if someone else was picking up the tab?
We swallow a lot of pills, undergo a lot of tests and surgeries in this country. Many are critical, lifesaving treatments. Many are not. There are many treatments and tests we would forego, after educating ourselves about them, if we had to pay a significant amount of money for them. And yes, we can educate ourselves about health care just like we do when shopping for any other commodity.
When educated consumers shop with their own money, free market pressures drive prices down and efficiency up.
It is right that we take care of those who cannot take care of themselves; it is wrong to provide for those who can be expected to do so for themselves. With respect to Medicare, we can make changes that provide benefits commensurate with the ability to pay, rather than providing full benefits to all. Result: more people shopping with their own money. With respect to Medicaid, we can ask for small copays for each doctor visit and prescription. Same result.
With respect to private health insurance, we need to discontinue employer purchase of health care on behalf of employees. Rather, employers provide a cash benefit with which employees shop for their own insurance product, that meets their needs, and receive a tax deduction for their health insurance payments. Spend their own money, become discriminating consumers.
An important aspect of this approach to health care policy change is that it preserves our freedom to choose, and preserves availability of all kinds of health care services to choose from. Any policy which widens the separation between consumer and financial responsibility will inevitably result in explosion of costs. The payor will in the end have no choice except to control costs by involuntarily limiting treatment options. Consumers will begin to lose their options, and some of these options could become unavailable to anyone, regardless of ability to pay.
I personally would be unwilling to relinquish any freedom in exchange for a guarantee of lousy health care.
At the risk of my own pocketbook, I must tell you that too much health care is consumed in this country. There is legitimate concern about healthcare costs that outpace all the other costs of living; indeed it seems that the cost of providing care has an insatiable appetite that will eventually consume all our resources. It will in fact unless we make some changes.
Most health care consumers shop with other people’s money. Whether its Medicare, Medicaid, or employer funded insurance, with some exceptions of course, the majority of purchases are made with little concern on the part of the consumer as to the cost. In the case of employer provided health insurance coverage, employees lobby for plans that provide for the smallest copays and deductibles. It is natural and logical, at least on the surface, to seek a situation in which we are least responsible financially; after all, health care costs can be huge, right?
Why this disparity between how we view health insurance coverage and the way we view other forms of insurance? We purchase home, auto, and other forms of insurance in order to avoid financial calamity and bankruptcy. We do not expect those policies to pay for new paint, carpeting, or a remodel. Yet we do expect health insurance to pay for most any health service we want or that our doctor recommends.
Consider this: Some time back I was prescribed one of those pills we all see on television for prostate problems. After taking it for a month, I had no difficultly deciding it was not worth the $300 per month it would have cost toward my $5000 per year deductible. Would I have felt otherwise if someone else was picking up the tab?
We swallow a lot of pills, undergo a lot of tests and surgeries in this country. Many are critical, lifesaving treatments. Many are not. There are many treatments and tests we would forego, after educating ourselves about them, if we had to pay a significant amount of money for them. And yes, we can educate ourselves about health care just like we do when shopping for any other commodity.
When educated consumers shop with their own money, free market pressures drive prices down and efficiency up.
It is right that we take care of those who cannot take care of themselves; it is wrong to provide for those who can be expected to do so for themselves. With respect to Medicare, we can make changes that provide benefits commensurate with the ability to pay, rather than providing full benefits to all. Result: more people shopping with their own money. With respect to Medicaid, we can ask for small copays for each doctor visit and prescription. Same result.
With respect to private health insurance, we need to discontinue employer purchase of health care on behalf of employees. Rather, employers provide a cash benefit with which employees shop for their own insurance product, that meets their needs, and receive a tax deduction for their health insurance payments. Spend their own money, become discriminating consumers.
An important aspect of this approach to health care policy change is that it preserves our freedom to choose, and preserves availability of all kinds of health care services to choose from. Any policy which widens the separation between consumer and financial responsibility will inevitably result in explosion of costs. The payor will in the end have no choice except to control costs by involuntarily limiting treatment options. Consumers will begin to lose their options, and some of these options could become unavailable to anyone, regardless of ability to pay.
I personally would be unwilling to relinquish any freedom in exchange for a guarantee of lousy health care.
Tuesday, August 4, 2009
The Unintended Consequences of Obamacare
I guess nothing is more complex and maddening than our current system of health care delivery. Believe me, I live and work in it every day, and have done so as an Ear, Nose, and Throat surgeon for 20 years. I am commonly asked what could be done to make things run more smoothly, efficiently, and with less waste. We need major improvements; no one would disagree. My own opinions as to what might help will need to occupy some other editorial, however, as we are currently and immediately presented with at least a partial solution, by President Obama and our Congress. The actual details of this potential health care overhaul are not available, but some aspects of what is being considered are becoming clear, and there is little enough time for us to consider the issues, much less try to influence our legislators one way or another.
Everyone has heard that Medicare is going bankrupt. There are apparently no reserve funds (that have not been spent by Congress), and the financial burden of picking up the tab for a burgeoning number of beneficiaries falls to a working class that is not growing at the same rate. Congress has not found the will to reform Medicare, and what we have been seeing is a pattern of slowly allowing reimbursements to providers to stagnate, gradually transforming Medicare into a less desirable payor. Perhaps some of you on Medicare have been experiencing increasing difficulties being seen by Physicians, especially in primary care. In the absence of effective reform, these difficulties will only increase.
Part of the overhaul of health care currently being considered is tax payer funded health insurance for the currently uninsured. Part and parcel to this massive new capital outlay is a near 25% reduction in Medicare fees to Physicians, hospitals, and other providers. I would expect the reimbursements under any new federally funded health insurance program for the previously uninsured to be about the same as for Medicare. Ditto for Medicaid. Obviously, this would have further profound effects on access to care for Medicare patients, and would accelerate the decline of Medicare as a desirable second party payor.
In fact, these changes would lead, over the course of a few short years, to a two tiered system of health care delivery in the United States, with the lower tier occupied by patients dependent on federally subsidized programs. This lower tier would eventually evolve its own, separate network of providers and hospitals, and would be characterized by longer waits and a more limited menu of services rendered perhaps by less qualified providers. In addition, there would be the usual impersonal governmental bureaucracy to contend with. The upper tier health care system would, of course, be accessed by patients who are able to afford health insurance products that provide more market realistic reimbursements, and would be characterized by much quicker access to care and more cutting edge treatments and technologies. Unburdened by the requirement to “cost shift” the care of patients who now occupy the lower tier of health care, we might finally expect true market forces to begin to have their natural competitive effect on health care costs and efficiencies in this upper tier of health care, to the obvious advantage of this group of patients.
Up until now, patients of all payor sources, including those with no payor source at all, have basically been forced through the same health care delivery system, more or less. This process has allowed for almost everyone to access the same care, (if sometimes more haphazardly for the uninsured), and is in part responsible for the profound complexity and inefficiencies of our health care delivery system.
So, the legislation currently being considered will, if passed, likely create very suddenly a large group of “second-class” consumers of health care, and they would likely be relegated ultimately to a separate health care delivery system. The only thing that would then prevent the rapid rise of a market based upper tier of health care delivery would be another bit of legislation that is being considered. I’m referring to the possible creation of a tax payer subsidized health care product that would be placed in competition with private health insurance products. Obviously, because it would be heavily subsidized, this product would be very competitively priced, and would have the potential to drive competing products from the marketplace. The ominous outcome could be a situation in which the federal government has complete control of health care in this country, ironically using our own tax dollars to enslave us. In this circumstance, we would all be doomed to the same, lousy health care system, perhaps forever.
You pay with your money or you pay with your time. This has been an axiom of health care delivery, and it will not be violated by any of these new proposals. Does anyone else feel any skepticism about the federal government being able to provide cheaper, better, more efficient healthcare? In what other endeavor has it ever been able to accomplish such a thing?
We are all irritated, sometimes infuriated by the issues that plague health care in our country. Believe me, it could be worse. In my opinion, further government takeover of our system will not make it better. The real question goes to how we can make our health care delivery system more market and competition based, so that it can benefit from the same pressures that drive quality up and costs down for the other goods and services we purchase.
Terry McMillan MD
Everyone has heard that Medicare is going bankrupt. There are apparently no reserve funds (that have not been spent by Congress), and the financial burden of picking up the tab for a burgeoning number of beneficiaries falls to a working class that is not growing at the same rate. Congress has not found the will to reform Medicare, and what we have been seeing is a pattern of slowly allowing reimbursements to providers to stagnate, gradually transforming Medicare into a less desirable payor. Perhaps some of you on Medicare have been experiencing increasing difficulties being seen by Physicians, especially in primary care. In the absence of effective reform, these difficulties will only increase.
Part of the overhaul of health care currently being considered is tax payer funded health insurance for the currently uninsured. Part and parcel to this massive new capital outlay is a near 25% reduction in Medicare fees to Physicians, hospitals, and other providers. I would expect the reimbursements under any new federally funded health insurance program for the previously uninsured to be about the same as for Medicare. Ditto for Medicaid. Obviously, this would have further profound effects on access to care for Medicare patients, and would accelerate the decline of Medicare as a desirable second party payor.
In fact, these changes would lead, over the course of a few short years, to a two tiered system of health care delivery in the United States, with the lower tier occupied by patients dependent on federally subsidized programs. This lower tier would eventually evolve its own, separate network of providers and hospitals, and would be characterized by longer waits and a more limited menu of services rendered perhaps by less qualified providers. In addition, there would be the usual impersonal governmental bureaucracy to contend with. The upper tier health care system would, of course, be accessed by patients who are able to afford health insurance products that provide more market realistic reimbursements, and would be characterized by much quicker access to care and more cutting edge treatments and technologies. Unburdened by the requirement to “cost shift” the care of patients who now occupy the lower tier of health care, we might finally expect true market forces to begin to have their natural competitive effect on health care costs and efficiencies in this upper tier of health care, to the obvious advantage of this group of patients.
Up until now, patients of all payor sources, including those with no payor source at all, have basically been forced through the same health care delivery system, more or less. This process has allowed for almost everyone to access the same care, (if sometimes more haphazardly for the uninsured), and is in part responsible for the profound complexity and inefficiencies of our health care delivery system.
So, the legislation currently being considered will, if passed, likely create very suddenly a large group of “second-class” consumers of health care, and they would likely be relegated ultimately to a separate health care delivery system. The only thing that would then prevent the rapid rise of a market based upper tier of health care delivery would be another bit of legislation that is being considered. I’m referring to the possible creation of a tax payer subsidized health care product that would be placed in competition with private health insurance products. Obviously, because it would be heavily subsidized, this product would be very competitively priced, and would have the potential to drive competing products from the marketplace. The ominous outcome could be a situation in which the federal government has complete control of health care in this country, ironically using our own tax dollars to enslave us. In this circumstance, we would all be doomed to the same, lousy health care system, perhaps forever.
You pay with your money or you pay with your time. This has been an axiom of health care delivery, and it will not be violated by any of these new proposals. Does anyone else feel any skepticism about the federal government being able to provide cheaper, better, more efficient healthcare? In what other endeavor has it ever been able to accomplish such a thing?
We are all irritated, sometimes infuriated by the issues that plague health care in our country. Believe me, it could be worse. In my opinion, further government takeover of our system will not make it better. The real question goes to how we can make our health care delivery system more market and competition based, so that it can benefit from the same pressures that drive quality up and costs down for the other goods and services we purchase.
Terry McMillan MD
Monday, August 3, 2009
Thanks But No Thanks To Proposed Health Care System Changes
Our health care system needs an overhaul. In my experience, what most people rightly complain about are the high costs of insurance, the fear of losing it, and the complexities and inefficiencies that characterize our system.
I am always suspicious of someone who tries to motivate me by using guilt. Maybe you, like me, have been hearing that we need to be ashamed of ourselves for not providing health insurance coverage to everyone, like they do in many parts of Europe and Canada. I, for one, am not ashamed, and although I feel strongly that changes are needed, guilt is not one of my motivations.
I like the way Americans tackle issues like this, and I like what the current debate says about us.
We tend to believe that it is immoral to fail to provide for those among us who are most vulnerable. Hence we have such programs as Medicare, Medicaid, CHIPS, CMS, just to name a few. In Dona Ana County, about one fourth of the yearly county budget is contributed to our local hospitals to help with the costs of providing care to those who have no coverage. As someone who has been on call to our emergency rooms for 16 years, let me make sure you know that patients who have no insurance, but who are truly ill, get the care they need.
At the same time, most Americans tend to believe that it is equally immoral to systematically give to those who should be expected to take care of themselves. It cripples them. We also instinctively understand that guarantees by our government to provide for basic needs always come at the cost of liberty.
Put me down for providing for those who are truly unable to do it for themselves, while preserving maximum liberty for all. Needs cannot be converted into “rights” out of the thin air of wishful thinking.
I think what we Americans do about health care is admirable in its intentions, if not so much so in its execution. My own ideas about how to improve our health care system will have to occupy another editorial, but they certainly do not include turning any more control over to government. Such a move would have all the expected waste, dense bureaucracy, and inefficiencies we have come to expect from government programs. More ominously, we would be ceding one of our most precious freedoms: our right to direct our own health care.
I am always suspicious of someone who tries to motivate me by using guilt. Maybe you, like me, have been hearing that we need to be ashamed of ourselves for not providing health insurance coverage to everyone, like they do in many parts of Europe and Canada. I, for one, am not ashamed, and although I feel strongly that changes are needed, guilt is not one of my motivations.
I like the way Americans tackle issues like this, and I like what the current debate says about us.
We tend to believe that it is immoral to fail to provide for those among us who are most vulnerable. Hence we have such programs as Medicare, Medicaid, CHIPS, CMS, just to name a few. In Dona Ana County, about one fourth of the yearly county budget is contributed to our local hospitals to help with the costs of providing care to those who have no coverage. As someone who has been on call to our emergency rooms for 16 years, let me make sure you know that patients who have no insurance, but who are truly ill, get the care they need.
At the same time, most Americans tend to believe that it is equally immoral to systematically give to those who should be expected to take care of themselves. It cripples them. We also instinctively understand that guarantees by our government to provide for basic needs always come at the cost of liberty.
Put me down for providing for those who are truly unable to do it for themselves, while preserving maximum liberty for all. Needs cannot be converted into “rights” out of the thin air of wishful thinking.
I think what we Americans do about health care is admirable in its intentions, if not so much so in its execution. My own ideas about how to improve our health care system will have to occupy another editorial, but they certainly do not include turning any more control over to government. Such a move would have all the expected waste, dense bureaucracy, and inefficiencies we have come to expect from government programs. More ominously, we would be ceding one of our most precious freedoms: our right to direct our own health care.
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