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Naam: Danielmup   Datum: 14 oktober 2017  04:39:27
Why are Americans so worked up about health care reform? Statements such as "don't touch my Medicare" or "everyone should have access to state of the art health care irrespective of cost" are in my opinion uninformed and visceral responses that indicate a poor understanding of our health care system's history, its current and future resources and the funding challenges that America faces going forward. While we all wonder how the health care system has reached what some refer to as a crisis stage. Let's try to take some of the emotion out of the debate by briefly examining how health care in this country emerged and how that has formed our thinking and culture about health care. With that as a foundation let's look at the pros and cons of the Obama administration health care reform proposals and let's look at the concepts put forth by the Republicans?

Access to state of the art health care services is something we can all agree would be a good thing for this country. Experiencing a serious illness is one of life's major challenges and to face it without the means to pay for it is positively frightening. But as we shall see, once we know the facts, we will find that achieving this goal will not be easy without our individual contribution.

These are the themes I will touch on to try to make some sense out of what is happening to American health care and the steps we can personally take to make things better.


<i><u>A recent history of American health care - what has driven the costs so high?</u></i>

<b>Key elements of the Obama health care plan</b>

<u><strong>The Republican view of health care - free market competition</strong></u>

<b>Universal access to state of the art health care - a worthy goal but not easy to achieve</b>

<b>what can we do?</b>


First, let's get a little historical perspective on American health care. This is not intended to be an exhausted look into that history but it will give us an appreciation of how the health care system and our expectations for it developed. What drove costs higher and higher?

To begin, let's turn to the American civil war. In that war, dated tactics and the carnage inflicted by modern weapons of the era combined to cause ghastly results. Not generally known is that most of the deaths on both sides of that war were not the result of actual combat but to what happened after a battlefield wound was inflicted. To begin with, evacuation of the wounded moved at a snail's pace and this caused severe delays in treating the wounded. Secondly, many wounds were subjected to wound care, related surgeries and/or amputations of the affected limbs and this often resulted in the onset of massive infection. So you might survive a battle wound only to die at the hands of medical care providers who although well-intentioned, their interventions were often quite lethal. High death tolls can also be ascribed to everyday sicknesses and diseases in a time when no antibiotics existed. In total something like 600,000 deaths occurred from all causes, over 2% of the U.S. population at the time!

Let's skip to the first half of the 20th century for some additional perspective and to bring us up to more modern times. After the civil war there were steady improvements in American medicine in both the understanding and treatment of certain diseases, new surgical techniques and in physician education and training. But for the most part the best that doctors could offer their patients was a "wait and see" approach. Medicine could handle bone fractures and increasingly attempt risky surgeries (now largely performed in sterile surgical environments) but medicines were not yet available to handle serious illnesses. The majority of deaths remained the result of untreatable conditions such as tuberculosis, pneumonia, scarlet fever and measles and/or related complications. Doctors were increasingly aware of heart and vascular conditions, and cancer but they had almost nothing with which to treat these conditions.

This very basic review of American medical history helps us to understand that until quite recently (around the 1950's) we had virtually no technologies with which to treat serious or even minor ailments. Here is a critical point we need to understand; "nothing to treat you with means that visits to the doctor if at all were relegated to emergencies so in such a scenario costs are curtailed. The simple fact is that there was little for doctors to offer and therefore virtually nothing to drive health care spending. A second factor holding down costs was that medical treatments that were provided were paid for out-of-pocket, meaning by way of an individuals personal resources. There was no such thing as health insurance and certainly not health insurance paid by an employer. Except for the very destitute who were lucky to find their way into a charity hospital, health care costs were the responsibility of the individual.

What does health care insurance have to do with health care costs? Its impact on health care costs has been, and remains to this day, absolutely enormous. When health insurance for individuals and families emerged as a means for corporations to escape wage freezes and to attract and retain employees after World War II, almost overnight a great pool of money became available to pay for health care. Money, as a result of the availability of billions of dollars from health insurance pools, encouraged an innovative America to increase medical research efforts. More Americans became insured not only through private, employer sponsored health insurance but through increased government funding that created Medicare and Medicaid (1965). In addition funding became available for expanded veterans health care benefits. Finding a cure for almost anything has consequently become very lucrative. This is also the primary reason for the vast array of treatments we have available today.

I do not wish to convey that medical innovations are a bad thing. Think of the tens of millions of lives that have been saved, extended, enhanced and made more productive as a result. But with a funding source grown to its current magnitude (hundreds of billions of dollars annually) upward pressure on health care costs are inevitable. Doctor's offer and most of us demand and get access to the latest available health care technology in the form of pharmaceuticals, medical devices, diagnostic tools and surgical procedures. So the result is that there is more health care to spend our money on and until very recently most of us were insured and the costs were largely covered by a third-party (government, employers). Add an insatiable and unrealistic public demand for access and treatment and we have the "perfect storm" for higher and higher health care costs. And by and large the storm is only intensifying.

At this point, let's turn to the key questions that will lead us into a review and hopefully a better understanding of the health care reform proposals in the news today. Is the current trajectory of U.S. health care spending sustainable? Can America maintain its world competitiveness when 16%, heading for 20% of our gross national product is being spent on health care? What are the other industrialized countries spending on health care and is it even close to these numbers? When we add politics and an election year to the debate, information to help us answer these questions become critical. We need to spend some effort in understanding health care and sorting out how we think about it. Properly armed we can more intelligently determine whether certain health care proposals might solve or worsen some of these problems. What can be done about the challenges? How can we as individuals contribute to the solutions?

The Obama health care plan is complex for sure - I have never seen a health care plan that isn't. But through a variety of programs his plan attempts to deal with a) increasing the number of American that are covered by adequate insurance (almost 50 million are not), and b) managing costs in such a manner that quality and our access to health care is not adversely affected. Republicans seek to achieve these same basic and broad goals, but their approach is proposed as being more market driven than government driven. Let's look at what the Obama plan does to accomplish the two objectives above. Remember, by the way, that his plan was passed by congress, and begins to seriously kick-in starting in 2014. So this is the direction we are currently taking as we attempt to reform health care.


Through insurance exchanges and an expansion of Medicaid,the Obama plan dramatically expands the number of Americans that will be covered by health insurance.


To cover the cost of this expansion the plan requires everyone to have health insurance with a penalty to be paid if we don't comply. It will purportedly send money to the states to cover those individuals added to state-based Medicaid programs.


To cover the added costs there were a number of new taxes introduced, one being a 2.5% tax on new medical technologies and another increases taxes on interest and dividend income for wealthier Americans.


The Obama plan also uses concepts such as evidence-based medicine, accountable care organizations, comparative effectiveness research and reduced reimbursement to health care providers (doctors and hospitals) to control costs.


The insurance mandate covered by points 1 and 2 above is a worthy goal and most industrialized countries outside of the U.S. provide "free" (paid for by rather high individual and corporate taxes) health care to most if not all of their citizens. It is important to note, however, that there are a number of restrictions for which many Americans would be culturally unprepared. Here is the primary controversial aspect of the Obama plan, the insurance mandate. The U.S. Supreme Court recently de
Naam: AScemsfeance   Datum: 02 oktober 2017  18:20:54
By dealing together, you both can address problems of self-esteem and mutual trust. However, it is important to obtain the doctor's opinion first before you take these oral medications because they might have negative side effects around the body.
Naam: Jacoline   Datum: 07 juli 2015  22:32:13
Komen de foto s van t tentfeest nog op de site? 😀
Naam: Piet de Jong   Datum: 26 juni 2015  16:49:43
Kan je morgen kaarten aan de deur halen?
Naam: Melrose   Datum: 29 juni 2014  15:40:47
Wat hebben we gisteren genoten bij jullie in de feesttent!
Uitstekende ontvangst toen wij na een lange reis in Berkenwoude aankwamen, leuke mensen van de organisatie, publiek dat helemaal uit zijn dak ging, kortom: het was allemaal super geregeld! Het zou fijn zijn als wij elkaar snel weer op een leuke feestavond tegenkomen!

Muzikale groet,


Melrose
Naam: Hans (Melrose)   Datum: 25 juni 2014  08:37:02
Zaterdag komen wij, de band Melrose, naar Berkenwoude om samen met jullie er een superleuke feestavond van te maken! Wij hebben er heeeeeeeel veel zin in en aan jullie website te zien zijn jullie ook echte feestgangers, dus dat zit wel goed!
www.melrose.nl

Tot zaterdag.
Naam: PJG Berkenwoude   Datum: 02 september 2013  16:38:52
Hoi Arian van Dam,

Sorry voor de late reactie.
Er is inderdaad zo'n jas gevonden. Wil je aub via het contact formulier een bericht sturen met je gegevens? Dan kunnen we contact met je opnemen.
Naam: Arian van Dam   Datum: 12 juli 2013  22:06:18
Ik hoorde dat er een jas is gevonden op het tentfeest.
Het is een bruine jas met soort schapenwolle voering,waar kan ik kijken of hij van mij is
Naam: Ruben   Datum: 30 juni 2013  18:55:31
was geweldig tentfeest! waar blijven de foto`s? :p
Naam: Louise   Datum: 25 mei 2013  19:24:09
Boek de band Paper plane es die zijn pas leuk
Naam: Elsbeth   Datum: 02 juli 2012  21:00:24
Was weer lache afgelopen zaterdag! ...en nu de foto's!
Naam: Robert Benjamins   Datum: 12 februari 2012  20:49:51
Jullie hebben er een mooie site van gemaakt! Gr Robert
Naam: Jeroen   Datum: 10 juni 2011  22:04:55
Wordt wel lastig om de cijfertjes te onthouden met zoveel bier :)

Naam: Manon   Datum: 08 juni 2011  15:09:26
@ Cien, In het vervolg neem ik gewoon een cijferslot :P Haha En die huissleutel past vast niet op mn fiets...
Naam: Francien   Datum: 08 juni 2011  08:45:23
@ manon, geen fietssleutel, maar wel een huissleutel van iemand, is dat ook goed? ;-)
Naam: Manon   Datum: 07 juni 2011  09:10:09
Hoi, ik ben mijn fietssleutel verloren... Hebben jullie die nog gevonden? Haha ;) Leuke foto's! Groetjes Manon
Naam: hoi   Datum: 05 juni 2011  15:28:01
waar blijven de foto,s van het tentfeest in berkenwoude?? want wij zijn hier erg benieuwd!
Naam: joost   Datum: 05 juni 2011  05:05:39
waar zijn de foto's van het feest!!
Naam: Francien   Datum: 31 mei 2011  13:34:23
@ joost, deze jas is inderdaad gevonden.
Via het contactformulier op deze site kun je een mail door naar de pjg. Dan zal via de mail het adres worden opgegeven waar deze jas op te halen is.
Mvg, Francien Lammerts
Naam: Joost   Datum: 31 mei 2011  09:32:59
ik kon mijn jas niet meer vinden zaterdag!
zijn er nog jassen gevonden?
het is een dunne bruin/paarse zomerjas!
was verder wel een geslaagd feestje
Naam: Francien   Datum: 24 mei 2011  18:45:33
@ natascha; Er is geen fooienpot op het feest aanwezig. Je betaalt voor het kaartje en verder koop je bonnetjes voor het drinken.
Groeten Francien
Naam: Natascha   Datum: 24 mei 2011  17:48:03
Hoi, weet iemand of er een fooienpot is en dat je daar geld in doet en voor het kaartje betaald en dan gratis drankjes of dat je voor elk drankje nog moet betalen? Op het tentfeest. Groetjes.
Naam: Martin   Datum: 23 mei 2011  21:59:27
@ Francientje, kaartjes afscheuren doe ik graag hoor, en is nog wel te doen hoor, maar de gezelligste uurtjes aan het eind ben ik in de tent te vinden denk ik ;-) ! nu nog even duimen voor droog weer!
Naam: Francien   Datum: 23 mei 2011  19:11:35
@ Martin; en dan ga je gewoon als vrijwilliger bij de deur staan! Je kunt het ook niet laten he, haha! Nee hoor, wij vinden het heel fijn dat jij dit wil doen!

@ Sebastiaan; Bedankt voor de complimenten! Laten we het hier maar eens bij laten, we zijn wel een plattelands jongeren vereniging h, dan is facebook toch veel te modern ;-)

Groetjes Francien
Naam: Martin   Datum: 20 mei 2011  21:26:22
Zo eindelijk een keer naar het tentfeest als niet-dj ;)
Greetz Martin
ex dj wonderland
Naam: Sebastiaan DvL   Datum: 16 mei 2011  20:16:46
Gefeliciteerd PJG met jullie nieuwe site!!!
Op naar de Facebook pagina...

Groet, Sebastiaan
Naam: bestuurslid cas   Datum: 28 april 2011  16:23:58
28 MEI JAARLIJKSE TENTFEEST AAN DE ZUIDBROEKSE OPWEG IN BERKENWOUDE
Naam: Anouk   Datum: 28 maart 2011  16:53:02
Ik vind de PJG echt een top organisatie!
Ook heb ik veel respect voor de voorzitster, hoewel de rest van het bestuur er ook mag zijn.
Ik kijk nu alweer uit naar het volgende tentfeest.
Ga zo door!
Naam: Francien lammerts   Datum: 23 maart 2011  20:58:48
Welkom op de vernieuwde website van PJG Berkenwoude!
Heb je een leuk idee voor een uitje of activiteit of heb je iets te vertellen over een uitje plaats dit dan in het gastenboek.
Verder kun je je ook aanmelden als lid via de tab registreren.

Tot ziens!

Francien Lammerts
Voorzitter P.J.G. Berkenwoude