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?

By Timothy Noah

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.

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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.

Another Health Care Rant

Here I go again - another rant on health care. If President Obama fulfills his modest health care plan we may yet be able to insure everyone.

However, those of us who have studied the issue know that the most efficient and least costly plan would be a single payer system. We also know it could be done immediately if the politicians were all on board. Of course, most Republicans blanch at installing such a sensible system just as they shuddered at Social Security. Pragmatism is not their strong suit. Ideology trumps everything. Here are a few facts that bolster my contention that a single payer plan would be the best way to go.

• The nation spent $2.4 trillion on health care in 2008, and yet 46 million Americans have no health coverage at all.

• Attaining universal health care will almost inevitably cost most Americans - businesses and taxpayers - more. But the cost of doing nothing is more extreme.

• The insurance industry try, most successfully, to avoid insuring the sick, or those at risk of being sick. (think pre-existing conditions). Profit is, of course, the motive.

• Private insurers spend more than 15 percent of the money they collect in premiums on administrative costs. Medicare spends about 2 percent. Marketing is part of the administrative expenses and there would be no need for advertising in a universal Medicare plan.

• Hundreds of thousands of people are employed in administrative positions in every doctor's office, nursing home and hospital due to the myriad of insurance forms. That would be eliminated under a universal system.
  

• State and Federal agencies add to the cost of medical care by having to monitor the insurance companies for fraud and abuse. If the profit motive were gone the cost would be much less.

Perhaps President Obama's plan is the best and only path to Universal coverage. Under his plan the insurance companies will still exist if they can compete with a Medicare type government plan. (The insurance companies are already beginning a campaign complaining that they don't want to compete with a Medicare type plan. They could no longer cherry pick the healthy to insure. That sounds like a good reason to have a government plan to me.) If they can't compete, then a Single Payer Plan would emerge by default.

I know that right now someone is thinking, "where will all those displaced workers find jobs in this economy?" Some of them would switch to work for the government. Nonetheless, this clouds the issue. The economy must have health care reform or the whole house of cards will fall. The United States, industries, small business operators and individuals are drowning under the current system. Obama knows that health care reform has to be the third leg of his recovery program. "If we don't tackle health care," he said at the White House health care summit last week, "we're going to break the bank"

To read the plan copy this in your browser: http://www.barackobama.com/index.phppdf/issues/HealthCareFullPlan.pdf

Support the single payer health care bill, HR 676, The United States National Health Insurance Act, ("Expanded & Improved Medicare for ALL"). Please write or call your Congressperson today.

Five Myths

Readers who have followed my rants on the health care system and the drive for Universal coverage know that I will never give up. I have already voiced my strong views on this subject and really cannot add much more on my own.

There is another statement that you often see on my posts. FACTS ARE STUBBORN THINGS. I like dealing with facts on all subjects and am rarely swayed by myths. I am, by nature, very pragmatic. The following article uses facts to dispel the myths floating around.

Even though the following facts undercut some of the assumptions I made on the previous post, they are worth reading. According to the editorial the administrative cost of health care is not as important as I had assumed.

This article helps to confirm my belief that we must simplify our dysfunctional medial system or it will continue to spiral out of control until no one will be able to afford coverage.

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Five Myths About Our Ailing Health Care System

by: Shannon Brownlee and Ezekiel Emanuel, The Washington Post

Are Americans ready to pay to overhaul the health-care system? It may be more doable than you think, provided we dispel a few myths about how health care works and how much reform Americans are willing to stomach.

1. America has the best health care in the world.

Let's bury this one once and for all. The United States is No. 1 in only one sense: the amount we shell out for health care. We have the most expensive system in the world per capita, but we lag behind many developed countries on virtually every health statistic you can name. Life expectancy at birth? We rank near the bottom of countries in the Organization for Economic Cooperation and Development, just ahead of Cuba and way behind Japan, France, Italy, Sweden and Canada, countries whose governments (gasp!) pay for the lion's share of health care. Infant mortality in the United States is 6.8 per 1,000 births, more than twice as high as in Japan, Norway and Sweden and worse than in Poland and Hungary. We're doing a better job than most on reducing smoking rates, but our obesity epidemic is out of control, our death rate from prostate cancer is only slightly lower than the United Kingdom's, and in at least one study, American heart attack patients did no better than Swedish patients, even though the Americans got twice as many high-tech treatments.

Moreover, the quality of health care is different in different parts of the country. The Centers for Medicare and Medicaid Services have issued a list of 26 measures of quality, such as making sure that heart-attack patients being discharged from the hospital get a prescription for a beta blocker or aspirin to help reduce the risk of a second attack. It turns out that quality is all over the map, and it isn't necessarily better in the places we might expect, such as academic medical centers. Worse still, according to the Congressional Budget Office (CBO), there appears to be no connection between how much Medicare and other payers spend on patients in different parts of the country and the quality of the care the patients receive. You are no more likely to get that beta blocker or aspirin in Los Angeles than in Portland, even though Medicare spends twice as much per beneficiary in Los Angeles.

2. Somebody else is paying for your health insurance.

Nope. Even when your employer offers coverage, he isn't reaching into his own pocket to cover you and your fellow employees; he's reaching into your pocket, paying you lower wages than he would if he didn't have to pay for your health insurance.

Rising health-care costs are partly to blame for stagnant wages. Over the past five years, health insurance premiums have risen 5.5 times faster on average than inflation, 2.3 times faster than business income and four times faster than workers' earnings. Four times. That's why wages have been nearly flat since the 1980s, even as U.S. productivity has been going up. In effect, about half the money you should be earning for being more productive is being sucked up by ever more expensive health-insurance premiums.

If you pay taxes, you're also paying for the health care provided through state and federal programs such as Medicare, Medicaid, the Veterans Administration and the military. All told, the average family of four is coughing up $29,000 a year for health care through taxes, lower wages and out-of-pocket medical expenses.

3. We could save a lot if we could cut the cost of administrative expenses.

The idea that we could wring billions of dollars in savings this way is seductive, but it wouldn't really accomplish that much. For one thing, some administrative costs are not only necessary but beneficial. Following heart-attack or cancer patients to see which interventions work best is an administrative cost, but it's also invaluable if you want to improve care. Tracking the rate of heart attacks from drugs such as Avandia is key to ensuring safe pharmaceuticals. (There goes my argument in my previous rant.)

Let's just say that we could wave a magic wand and cut private insurers' overhead by half, to what the Canadian government spends on administering its health-care system - 15 percent. How much would we save? Not as much as you may think. Private insurers pay a little more than a third of what we spend on health care, which means that we'd cut a little more than 5 percent from our total budget, or about $124 billion. That's not peanuts, but it's not even enough to cover everybody who's currently uninsured.

More to the point, we only get to save it once. That's because administrative waste isn't what's driving health-care costs up faster than inflation. Most of the relentless rise can be attributed to the expansion of hospitals and other health-care sectors and the rapid adoption of expensive new technologies - new drugs, devices, tests and procedures. Unfortunately, only a fraction of all that new stuff offers dramatically better outcomes. If we're worried about costs, we have to ask whether a $55,000 drug that prolongs the lives of lung cancer patients for an average of a few weeks is really worth it. Unless we find a cure for our addiction to the new but not necessarily improved, our national medical bill will continue to skyrocket, regardless of how efficient insurance companies become.

4. Health-care reform is going to cost a bundle.

Only if you think that covering the uninsured is our only priority. Yes, making health care available to all citizens is the right thing to do. But it isn't the only thing to do. We also have to fix the spectacularly wasteful and expensive way doctors and hospitals deliver care.

Our physicians are working within a truly dysfunctional, often chaotic system that prevents them from caring for us properly. Between 50,000 and 100,000 patients die each year from preventable medical errors. According to the Centers for Disease Control, 1.7 million Americans acquire an infection while in the hospital and nearly 100,000 of them die from it. Laboratory imaging tests are routinely repeated because the originals can't be found. Patients with such chronic illnesses as heart failure and diabetes land in the hospital because their physicians fail to monitor their condition. When patients have multiple doctors, there's often nobody keeping track of the different medications, tests and treatments each one prescribes.

Our doctors and hospitals are failing to provide us with care we need while delivering a staggering amount that we don't need. Current estimates suggest that as much as 20 to 30 percent of what we spend, or about $500 billion, goes toward useless, potentially harmful care.

There are two bright spots. One: We can improve the quality of care and cut costs without rationing. There are models out there for how to do it right - the Mayo Clinic, the Geisinger Clinic in Pennsylvania, the Cleveland Clinic and California's Kaiser Permanente are just a few of the organized group practices that are doing a better job for less. Their doctors are better than average at using the best medical evidence available. They're more likely to be using electronic medical records, which can help keep track of patients who have multiple physicians and need complex care. And they're less likely to provide unnecessary care.

Two: Even moderate reform of the delivery system would improve care and save money. The Lewin Group's analysis shows that a bill proposed by Sen. Ron Wyden, an Oregon Democrat, calling for a more comprehensive overhaul of the health-care system than either McCain's plan or Obama's could actually insure everyone and save $1.4 trillion over 10 years. More reform is cheaper.

5. Americans aren't ready for a major overhaul of the health-care system.

We may be readier than you think. A recent study published in the New England Journal of Medicine found that only 7 percent of Americans rate our health-care system excellent. Nearly 40 percent consider it poor. A whopping 70 percent believe it needs major changes, if not a complete overhaul.

Now is not the time to think small, to cover a few million Americans and leave the bigger job of controlling costs and improving quality for another day. We can't afford not to reform the delivery system as soon as possible. At 17 percent of gross domestic product, health care is the biggest single sector of the economy, and it's consuming a larger and larger proportion every year. According to CBO projections, health care will account for 25 percent of GDP by 2025 and 49 percent by 2082. That's simply unsustainable. Any plan that reforms health care has to do more than simply cover the uninsured. The nation's health and wealth depend on it.

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Shannon Brownlee, a visiting scholar at the National Institutes of Health Clinical Center, is the author of "Overtreated." Ezekiel Emanuel, an oncologist and author of "Healthcare, Guaranteed," is chairman of the center's Department of Bioethics.

Health Care Reform - First Post

By now I am sure most of you have received a packet from your HMO or insurance provider outlining the changes to take effect in 2009. If you have looked them over you probably saw that benefits were cut as much as 50% and co-pays and/or premiums were increased. Many of you will have to spend hours comparing the benefits from other providers before making a decision on which company to go with next year. It gets confusing, doesn’t it? Did you ever wonder why this annual chore is necessary? How simple it would be if there was just one provider and you all paid the same premium regardless of the severity of your medical situation. Even those with good insurance must not be too happy with this broken system now.

Before anyone starts screaming “Socialized Medicine” consider this: The president of the United States, his cabinet, the Congress and Senate all enjoy the single payer medical plan. The military (active duty and retired) also have a single payer plan. The single payer is you, the taxpayer.

When I have a tough decision to make I write two lists. On one list I itemize all of the reasons for taking action and the other list contains all the reasons against doing so.

I then write what will be the consequence if I decide to do the thing and what will be the consequence be if I don’t. Using that logic I will try to itemize all the reasons that are for a single payer health care system (pro) and all the reasons against (con). I will not be able to think of everything and I am asking those of you who read this to add your own thoughts on the subject.

WHAT'S WRONG WITH OUR SYSTEM: (This is the Pro side.)

• The insurance companies now dominate the medical system and, being a business, are only interested in the bottom line. Their motivation is profit and not the welfare of the patient..

• Insurance companies can deny coverage for pre-existing conditions and can deny expensive treatments or medication. They try to take only the healthiest of us.

• A referral is needed to see a specialist in an HMO (more red tape and paper work).

• The insurance industry can raise premiums and co-pays every year. The annual costs keep rising to obscene levels.
  

• The cost of paper work necessary for doctors to comply with dozens of different forms from different insurance companies forces the physician to have a large office and a large staff. You and I end up paying for that.
  

• Because the insurance industries compete with each other, they spend millions on marketing. Health care is a 'for profit' industry and salesmen sell it to you.

• We are just clients and to keep us informed the industry spends additional millions on pamphlets, books and reports that are mailed to us. I received a package that weighs as much as a small dog from my HMO. I am constantly getting something in the mail from my company and each time I think how many trees had to give up their life to furnish the paper for all of this. The postage isn’t free either.

• The Pharmaceutical companies are one of the most profitable industries in existence. The billions they spend on advertising would pay for the medical treatment for thousands of children. You can’t open a magazine or turn on a TV without being bombarded with ads for medicines that require a doctor’s prescription. What's wrong with this picture?
  

• The pharmaceutical industry claim they need to charge $75 for a pill that costs pennies to make because they need the money for research. If that is why perscriptions cost so much. I think they should be required to spend their profits on research instead of advertising. Isn’t the Federal Government subsidizing them for research and development?
  

• Both the insurance and pharmaceutical industries spend millions each year on lobbyists. This is disgraceful when people are dying for lack of medical care.

• Hospitals are going broke absorbing the cost of the uninsured who show up in the emergency rooms.

• Businesses like the auto industry have been bankrupted providing health coverage for their employees.
  

• The United States Government spends more per capita on health care than any other industrialized nation. In spite of that we have the poorest results. 41 countries have a lower infant mortality rate than the U. S.
  

• 43 Million people under 65 are without any coverage. 8.9% children are without any coverage. Many more have inadquate coverage.
  

• Hundreds of families are just one catastrophic illness away from bankruptcy.

• The total U. S. spending on Health Care in 2007 was $2.3 trillion or $7,600 per person. (From the National Coalition on Health Care site) Please don't tell me we can't do better.
  

WHY THE U. S. SHOULDN'T CHANGE: (The Con side.)

• The initial cost of changing over will be extremely expensive.
  

• Having to fight the resistance from the Insurance and Pharmaceutical Industries.

• Resistance from people who like their coverage and like the status quo.

• Difficulty in changing from one system to another.

CONSEQUENCES PRO:

• After the plan is implemented every single man, woman and child will enjoy good medical attention regardless of income.

• Once the plan is fully changed over the cost of medical care will be far less expensive for the individual and the government.

• It will be much more efficient with very little paper work for the provider, patient and doctor.

CONSEQUENCES CON:

If we don't simplify our medical system the price will keep increasing until no one will be able to afford coverage. It will not get better and everyone will suffer.

For those people who believe all the myths that you can’t choose your own doctor, you have to wait months for surgery, et. al. in government run programs let me reassure you that none of it is true. The facts do not back those anecdotal stories up.

PBS FRONTLINE aired a program by an investigative journalist who visited other countries that have a Single Payer system. He visited Japan, Switzerland, England and France. (Again, I am relying on memory for the countries. I was unable to find this program in the archives.) Even the doctors in France liked the system because it is so simple for them. They get paid a salary and don’t have the hassles and paper work that our doctors have to endure. He could not find a single person that didn’t like their medical plan. There were different forms of implementing the system and some of them had problems (Most were rising costs. Well, that’s not new to us, is it?) In some cases the patient didn’t even need an appointment; they simply walked in to the doctor’s office.

When one of the countries decided to change to a government run system (I think it was Switzerland) they sent a committee to each country that had the single payer system to study the their plans. They took the best from each system and adapted it to their own needs. Why can’t the richest country in the world do that? Why must hard working people become impoverished by one illness through no fault of their own? Why must children and adults die for lack of health care? Are we a humane country or are we a nation of the selfish elite who say, “I’ve got mine; now try to get yours.”?