Wednesday, June 17, 2009

Health Care Front and Center

It is nearing "put up or shut up" time for reforming health care. The right-wing lobbyists at the U.S. Chamber of Commerce will spend $100 million to defeat Obama's plans for health care and a clean energy economy. They call it their "most important project" in nearly 100 years. Apparently the only way to stop them is by a loud and vocal citizenry using the only tools they have - the telephone and e-mail - to demand real reform. If the Senators and Congressmen get massive calls from voters wanting Obama's public option to compete with the insurance companies they just might get the message. The only two things they listen to are 1) deep pocket lobbyists and 2) messages from the folks back home who have the ability to vote them out of office.

Medical bills are behind more than 60 percent of U.S. personal bankruptcies, U.S. researchers reported.

More than 75 percent of these bankrupt families had health insurance but still were overwhelmed by their medical debts, the team at Harvard Law School, Harvard Medical School and Ohio University reported in the American Journal of Medicine.

Below is a link to an excellent article entitled "Why Can't the United States Learn From Other Countries?" In it you will find reference to that excellent PBS documentary on how the single payer insurance succeeds in other countries and spend half per capita than we do.

Max Baucus stubbornly refused to listen to anything that would elminate the 'for profit' insurance industry out of the equation. Do you think there might be a correlation to the $45,250 donation from just one insurance provider, AETNA ? Baucus proudly proclaimed that we would end up with a plan that is "uniquely American". Sounds like he is too prejudiced to admit that other countries can do better than we can or to learn from them

I am sick of hearing that we have the best health care system in the world. Yes, we have the tools and hospitals, but we are among the lowest for results. The World Health Organization ranks us 37th.

You can read this excellent article by clicking on the link.

The Isolationism of Health Reform Why won't Congress consider how other countries do it?



http://www.slate.com/id/2220534/


(I have copied a few excerpts from the following article. It has been heavily edited and redacted by me, but if you have time and are interested in the current fight over health care reform it contains some valuable information. Warnng: it is a long article).

The Cost Conundrum

What a Texas town can teach us about health care.

by Atul Gawande

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?yra June 1, 2009

McAllen, Texas is one of the most expensive health-care markets in the country. Only Miami—which has much higher labor and living costs—spends more per person on health care. In 2006, Medicare spent fifteen thousand dollars per enrollee here, almost twice the national average. The income per capita is twelve thousand dollars. In other words, Medicare spends three thousand dollars more per person here than the average person earns.


Our country’s health care is by far the most expensive in the world. Spending on doctors, hospitals, drugs, and the like now consumes more than one of every six dollars we earn. The financial burden has damaged the global competitiveness of American businesses and bankrupted millions of families, even those with insurance. It’s also devouring our government. “The greatest threat to America’s fiscal health is not Social Security,” President Barack Obama said in a March speech at the White House. “It’s not the investments that we’ve made to rescue our economy during this crisis. By a wide margin, the biggest threat to our nation’s balance sheet is the skyrocketing cost of health care. It’s not even close.”


McAllen, Texas, the most expensive town in the most expensive country for health care in the world, seemed a good place to look for some answers.


“People are not healthy here.” McAllen, with its high poverty rate, has an incidence of heavy drinking sixty per cent higher than the national average. And the Tex-Mex diet has contributed to a thirty-eight-per-cent obesity rate.


I went on rounds with Lester Dyke, a cardiac surgeon. In the past twenty years, he has done some eight thousand heart operations. I walked around with him as he checked in on his patients recuperating at the three hospitals where he operates. It was easy to see what had landed them under his knife. They were nearly all obese or diabetic or both. Few were taking preventive measures.


Was the explanation, then, that McAllen was providing unusually good health care? I took a walk through Doctors Hospital at Renaissance, in Edinburg. The place had virtually all the technology that you’d find at Harvard and Stanford and the Mayo Clinic. Rich towns get the new school buildings, fire trucks, and roads, not to mention the better teachers and police officers and civil engineers. Poor towns don’t. But that rule doesn’t hold for health care.


There’s no evidence that the treatments and technologies available at McAllen are better than those found elsewhere in the country. Nor does the care given in McAllen stand out for its quality.


Several years ago, Texas passed a tough malpractice law that capped pain-and-suffering awards at two hundred and fifty thousand dollars. Didn’t lawsuits go down? “Practically to zero,” a cardiologist admitted. There is overutilization here, pure and simple.” Doctors, he (General Surgeon) said, were racking up charges with extra tests, services, and procedures.



The Mayo Clinic has fantastically high levels of technological capability and quality, but its Medicare spending is in the lowest fifteen per cent of the country—$6,688 per enrollee in 2006, which is eight thousand dollars less than the figure for McAllen. The four states with the highest levels of spending—Louisiana, Texas, California, and Florida—were near the bottom of the national rankings on the quality of patient care.

Health-care costs ultimately arise from the accumulation of individual decisions doctors make about which services and treatments to write an order for. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen.


He knew of doctors who owned strip malls, orange groves, apartment complexes—or imaging centers, surgery centers, or another part of the hospital they directed patients to. They had “entrepreneurial spirit,” he said. They were innovative and aggressive in finding ways to increase revenues from patient care.


Then there are the physicians who see their practice primarily as a revenue stream. They instruct their secretary to have patients who call with follow-up appointment when a phone call would do.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

If you read the article you will discover that there are several places that are the opposite of McAllen. The Mayo Clinic is one and Grand Junction, Colorado is another.


My impression of the point of this article is that by computerizing the system, eliminating unnecessary tests and requiring group medical practice, as done at the Mayo Clinic, the cost of medical care could be drastically reduced. Doctors would no longer be allowed to order unnecessary tests to increase their incomes. The way they are paid could manage this. In addition, more emphases must be placed on preventative medicine.


To sum it up, a single-payer system would eliminate the high cost of administration, copying the Mayo Clinic's way that doctors are paid, and practicing preventative medicine would drastically bring down the cost of health care. All will have to be put in place to achieve the goal of getting our health care system under control.


If it isn't done now no elder will see it happen in his lifetime. The confluence of a sinking economy, a president willing to push for it, and the public's demand for it will not happen again in many years. The time is NOW.

14 comments:

Betty said...

Thanks for the info. I hope everyone will contact his/her Congressmen and Senators urging them to pass a good, comprehensive bill. They need to do something for their constitutents for a change, and ignore the lobbyists. Just this once, they should do the right thing for the right reasons.

Darlene said...

*Betty - I have called and written to my two Senators. My Congresswoman is on record as supporting the Obama plan. My congressmen (John Kyle and John McCain)are both opposed Republicans. I won't vote for them anyhow, but I told them I was watching for their vote. I am sorry to say, they will care less.

Roshni Mitra Chintalapati said...

Thanks for this insight, Darlene.
Its true that a lot of doctors don't recommend the necessary preventive measures that could avoid these unnecessary astronomical costs. I'm happy to say that this is not the case in the clinic I use (Scripps Clinic, SD).
It also goes to show that the patient (or should I say consumer? Would that be more apt?!) should also be self-aware and take the necessary steps to improve their own health.
It is true that there are gaps in the Obama proposal but I think he has very sagely pinpointed key weaknesses in the US economy and his effort to take some steps towards reforms when others have failed is itself commendable!

Looking to the Stars said...

Good info, like your senators I don't think ours care either. It's good to know about Grand Junction, my in-laws are living there now.
I really wish Washington would do the right thing but I've lost hope that they will.

Rain said...

The problem I see with all the health care proposals is how to pay for them. Obama is suggesting giving hospitals and prescription drugs less money from Medicare. I am not sure who then makes up that difference but is it okay with those who want universal health care that if they currently receive benefits, they will get less?

Is it okay to decide what will be covered and make a list that limits people from having procedures that the government decides are not okay.

I am not against a change in our health care but right now I don't see the answers for how it will be done and once it's done, it might be too late to amend things.

A good start on drugs would be to allow American citizens to order drugs from out of the US. We could save a lot of money by that one simple change and yet it's not happening. If we could order our prescriptions from Canada, they'd end up about what they cost us now as a co-pay. That would save everybody money but the drug companies don't want it supposedly in the name of our safety. Isn't that our choice? Or rather shouldn't it be?

I also feel that if the insurance companies are taken out of it, how many ordinary people does that put out of work? It might be necessary to do that but we already have a lot of unemployment, how much might that add to it? If they continue making the money they have been, it will bankrupt our government to pay for it.

It might be that those of us who already have coverage, including Medicare, might have to pay more or face not having done what we want if we want to get this done right but we should know what we will be paying and who will pay it. Nothing is free.

I am not against it but I want the facts on what it will cost us laid out; so we make a choice based on what we as individuals will be paying for it. There might be a lot who want it but will find their benefits will be lessened if we get it...

joared said...

Good for you bringing forth this information. We need lots of dialogue about the issues, examination of what is and is not realistic and viable.

Really doesn't matter if we continue along with the status quo or adopt a health system change. There's likely going to be a lessening of services for some with any of the plans chosen, while others will finally have care they previously have been without. Our current system is rapidly deteriorating even if we do nothing, so the services we think we have now and will keep are going to and currently are declining.

I want to see a plan adopted that will have some features I think are important for everybody. I want to see a plan that is administered in such a way we improve upon the weaknesses of some of those foreign plans held up as models. I want to make an effort to create a workable system before the one we have completely breaks. I want to get rid of some of those private middle level non-medical health care dollar-eaters between the consumer/patient/client and the health care provider.

Tabor said...

I agree with Joared in that all change will involve compromise. Those who have good health care will have to give up some part so that everyone can have service. But I am willing to do that.

Paul said...

Good information Darlene...Our healthcare system does need revamping. I just don't know how it will be done though.

Darlene said...

*Roshni Mitra Chintalapati - I Believe that the patients need to stop demanding unnecessary tests and that doctors need to stop requiring them.

*Looking to the Stars - Our representatives will only do the right thing if the voters demand it.

*Rain - It will require another post to answer your concerns. You are right to want to know the details, but nothing could be much worse than what we have now.

The hospitals will get less money because everyone will be covered if Obama's reform program is enacted. Hospitals will no longer have to absorb the enormous cost of treating the uninsured in the ER. Big Pharma will get less because the government will buy drugs in bulk like Canada does.

Regarding the gv't making choices on procedures; this can be handled on a case-by-case basis. When doctors do not have to fear malpractice suits (which are very rare, by the way) and no longer get paid for referrals for MRI's , etc. the unnecessary tests will drop and save millions.

Rain, if we don't do it now it won't get done and this country cannot continue down this path. Laws are amended and, if we make a mistake, it is never too late to change it.

The only way to make real savings is to either force the insurance companies to compete (like Obama's plan) or eliminate them (like the single-payer system) There should be no profit in health care. Insurance companies would still be operating, but they would sell homeowner's and auto policies as they used to do, so some employees would not lose their jobs and ones who are let go could go to work for the gv't insurance program.

No, nothing is free, but in Canada the health insurance fee is based on a percentage of income. I have read of one family that pays $53 a month and another pays $93. Compare that to monthly fees as high as $1,250 here in the U.S. Low income families would be subsidized as they are now. We are already paying for the poor with higher medical costs. That cost will go down if this is done right.

I believe that the quality of health care will go up, not down, if reform is enacted. We are so near the bottom now as a nation, there is no place to go but up.

Finally, the change will initially,
no doubt, cost a trillion but over the years the savings will be enormous. Obama has promised to make it pay for itself in many ways. Personally, I would like to see the tax code go back to pre-Reagan when the rich paid their fair share. That, alone, would cover a lot of the cost.

I hope I have answered some of your concerns.

*Joared - You are absolutely right. We are already seeing some services that are no longer paid for.

*Tabor - I'm willing, also.

*Paul - It can be done right, but I fear the naysayers will mess it up in so many ways it will end up so complicated there will be no reform. I wish I could be optomistic.

Rain said...

Well what we don't have insured now is probably not the poor but the working poor and those here illegally. The poorest Americans can qualify for Medicaid. It also is young people who chose to not have it assuming that they wouldn't get sick.

What I have against the rush rush is what I have seen before. They push through things to not give people time to think. I read this morning that the health care proposal right now is 3000 pages with all its exemptions, clauses, and details. Nobody can study that fast enough to make informed decisions.

Right now the reason many doctors in Oregon will not take Medicare patients is because they aren't paid enough to cover their costs or so they say. The patients are forced to drive a long way to get insurance. What if hospitals just say no to it or doctors? Will they be forced? What if they close their doors? Not to say they will but in most businesses, they are allowed to work out what makes them profitable. Will this say that government decides, not the businesses? Would the government take them over if they said, no, we won't go along?

As I said, I am not against changing our system, even tend to like the single payer (which is a long way from even Medicare is right now) but I am against a rush to do it. I have this feeling it's like those shills who come to your house and try to sell you an encyclopedia set-- you have to do it now or the deal is off. In my experience, something is always wrong with that kind of pressure.

Our health care system right now is complex; so that when we signed up for medicare, something we had no choice about doing, we also had to have a supplemental insurance to stay with our doctor and get our prescriptions covered. As I said, if people could just use the internet and buy prescriptions from other countries, many of us would have less insurance claims.

The article I read today is that the likelihood of the Obama plan passing is going down hill and mostly that's because of the huge debt, the possibility that other countries won't loan us more money, the belief that this will cost us more than they initially thought, and the nervousness of Congress-- including Democrats.

While it is possible that the health plan will end up revenue neutral, that's definitely not a given. There may be people now who don't go to a doctor with every hangnail but who would if they had full coverage. There probably are ways around that but I am not sure whether they are all being considered.

In Oregon, we have a plan for the poor, the Oregon Health Care Plan, but it had to say no to many procedures that they decided were not beneficial. They drew a line in the sand and it's made many families very upset. They decided this not on an individual basis but working it from an economic and practical one. This will have to be worked through and a lot of other problems with it and if it's pushed through by September, it won't be.

To me when I hear the fear talk being pushed by Obama, do it now or it will not ever happen (and yes, we get those letters and phone calls also), It reminds me a lot of Bush and the war talk. Too often it works for politicians to do that but how often it works to the disservice of the people is also often the case.

It is good people are considering it long and hard, reading up on exactly what will happen if they get what they want, checking out the exceptions, the clauses, and using their heads. It is good for blogs like this that get people thinking. We should not just trust that 'they' will do it right. 'They' have screwed up a lot of things and that means Democrats as much as Republicans.

Darlene said...

Sorry, Rain, I do think Obama's rational to rush it through is much different than Bush's.

When Bush rushed us into war he knew that, if given time, his reasons would be proven false. Obama, on the other hand, has a logical and good reason for pushing this now. Health care reform has been discussed and talked about for fifty years. There isn't much new to learn.

The timing is right to get it enacted for the first time ever. The failing economy and the exorbitant cost of health care that is forcing businesses and individuals into bankruptcy, the voice of the people who are finally for reform, and the attention being paid to reform all coming together at the same time is the best shot for the politicians to get it done. If it doesn't happen now, it will not happen in our lifetimes.

Rain said...

Unless he is willing to raise taxes to pay for it and shows that it will not increase our debt, I won't favor it now. If it's the right thing to do, it's the right thing to pay for it. I heard a good analysis on it yesterday and they said the cost will be such that they must raise taxes or it will go onto the debt. I didn't favor the bail outs, don't like increasing our debt and feel if Americans want something, they better be prepared to personally pay for it. Free lunches never end up free.

Every rush to judgment I have ever seen has ended up a mistake. If it takes 3000 pages to write it and all the exceptions etc., it won't be the simple thing Americans want. I want to know what it is and not see it be something that ends up burdening my grandchildren with more debt from a generation who wants everything for nothing. Now if they're willing to submit the real cost, raise taxes to pay for it, I am more open to it. And I am saying that knowing that many people, like my family, are currently paying 50% of what they make for taxes now (counting them all and that isn't including hidden taxes). Still it isn't right to expect this can be done without cost (many countries with total health care have 60% or higher tax rates), and if somehow it really does it ends up without cost, then fine, but the willingness and arrangements for paying for it have to be there of it won't have my support. I would like to see something work out but not at the cost of more debt.

libhom said...

Maybe people should boycott businesses that belong to the US Chamber of Commerce.

Vagabonde said...

Darlene, I am not very optimistic for health care reform in this country. The insurance companies are too powerful to let it happen and people are more interested in what they political affiliations tell them than really understand what should be done. If they are Conservatives, they are against any Obama proposal, and if they are Liberals, they think he is not going far enough. Health care should be a right – when you pay taxes – not a profit for companies, but this is the American Way. If you will look at the Word Health Organization Ranking, site: http://www.photius.com/rankings/healthranks.html you will notice that France is number one for health with half the amount of expense and a longer life expectancy. My mother had uncontrollable high blood pressure and Parkinson’s disease. I wished to bring her to live with us in the US but I could not afford it and the care was not as good. So, instead I traveled to France 3 times a year for years to see her and she lived to be 92. My husband’s cousin (retired from the CDC) said she would have never lived as long here with the type of health care the citizens receive. But it is their choice, they could vote to get the same type of health care as in other countries (the US is ranked 37th, below Costa Rica). By the way both my younger daughter and son-in-law are finishing their medical residencies. I’ll ask them what they think next week when I go visit.