An Addition to the Discussion on Health Care Coverage
Thu, 01/15/2009 - 15:41 | 
carol white
A continuation of the discussion on Healthcare Reform -- promoted by roxy
Although I support a single-payer health system, I believe that the step-by-step approach discussed by Tom Daschle in his book, What We Can Do About the Health-Care Crisis, written in collaboration with Scott S.Greenberger and Jeanne M. Lambrew, the probably a better approach to achieving it than that of the Conyers bill (HR 676). Daschle's proposal would allow for a mix of private and public insurance, with strong regulatory controls.
It is astonishing to read a speech Harry Truman made to a joint session of Congress in an unsucessful attempt to get legislation passed that would mandate universal health care. It could have been made today.
Millions of our citizens do not have a full measure of oportunity to achieve and enjoy good health. Millions do not have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protect. People with low or moderate incomes do not get the same medical attention as those with high incomes. The poor have more sickness, but they get less medical care. People who live in rural areas do not get the same amount or quality of of medical attention as those who live in our cities. (1)
Despite the fact that medical care for Americans is woefully inadequate, the costs of the care per capital are nearly double that paid by other advanced sector economies that offer some form of universal health care system. Daschle cites the report It's the Prices, Stupid: Why the United States is so Different from other Countries (12):
One recent study found that Americans paid more for prescription drugs, hospitals and dotors' visits than people in comparable nations. The study concluded that it is this price gap that drives U.S. health-care costs, and not that Americans utilize medical care more frequently. (12)
This is substantiated by the report:
U.S. per capita spending was $4,631 in 2000, an increase of 6.3 percent over 1999. The U.S. level was 44 percent higher than Switzerland's the country with the next highest expenditure per capital. 83 percent higher than neighboring Canada; and 134 percent higher than the OECD median of $1,983. Although the United States can claim some success during the mid-1990 in its attempt to control health spending with managed dare, over the entire 1990-2000 period the spending gap between the United States and OECD Median actually widened slightly.
In his book, Daschle proposes two major steps that can be taken quickly to cut through the Gordian Knot. The first initiative has already been included in the Obama stimulus package--a universal computer system so that all medical records are computerized so that they can be easily available to patients and their doctors. Second the establishment of a quasi-indepndent medical review board that would establish uniform quality and cost controls for a ll federal insurance programs and therby set a standard for private insurers as well.
While Congress would have broad oversight powers over the Board it would function in a largely independant manner, under the control of a board of medical experts and community representatives. This would remove lobbyists from the loops and prevent a situation such as has occurred with Medicare, where lobbyist pressures on House and Senate members prevented them from imposing adequate regulatory standards for affordable, high-qulaity medical care. Such a system would unify government programs such as Medicare, Medicaind, and the VA, and serve as a model for private insurers. Currently these programs have disparte benefits and quality standards, and cannot use their joint strength , even though they cover roughly 100 milion people, to control costs (as in the case of pharmaceuticals)
More than 30 percent of adults in the United States--a higher percentage than in comparable countires--have problems with coordination of care, meaning test results or medical records were not available at hte time of a scheduled appointment; patients received duplicate tests or procedures; patients received conflicting information; or some combination of these problems (33)
He discusses why he believes a mixed public/private system is probably the way to go:
A federal Health Board would have political and practical benefits. It would help us break the legislative log jam that has blocked previous attempts at comprehensive reform, and it would establish a strong public framework for a strategy--that is, the government directly or through insurers, is responsible for paying doctors hospitals and other healthcare providers. Supporters say single-payer is brilliantly simple, ensures equity by providing all people wiht the same benefits, and saves billions of dollars by creating economies of scale and streamlining administration But a pure single-payer system is politically problematic in the United States, at least right now.
... snip ...
So insteady of creaiting a 'pure model' system we should build on the one that we have. Nearly 80 bpercent of Americans are covered through the employe-based system, Medicaid, the STate Children's Health INsurance PRogram, and Medicare. WE should maintain and strengthen these kinds of coverag. But to reach everybody else, I believe that we should expand the Federal Employee Health Benefits program. or create a group purchasing pool like it. (143,144,145)
Moderator's note by Roxy:
This is a continuaiton of the discussion on Healthcare Reform. Please see the links below for further reading on this important discussion.
Previous pieces:
by Connecticut Man1:
- Be Still My Single Payer Heart
- How do you know Obama's health plan is bad for YOU?, Tue, 01/13/2009
- All That I Want..., Wed, 12/24/2008
- Single Payer Health Care Would Help Auto Industry, Tue, 11/18/2008
by DrSteveB:
- The Most Complete & Honest Comparison of Health Proposals...so far, Tue, 01/13/2009
Others:
- Open Thread -- Checking Up On the CDC Edition, by Open Thread -- 01/09/2009
- Art Imitates Life, Life Strikes Back, by rba -- 10/23/2008
- Economic Triage: Euthanizing Hope and Promise in the U.S., by GreyHawk -- 07/10/2008
- AWOL: Soldiers and Suicide, by Dopeman -- 05/21/2008
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Tags: Conyers, Daschle, Universal Health Care
I appreciate your doing a write up on this
Submitted by Connecticut Man1 on Thu, 01/15/2009 - 21:14.since, until yesterday when I read that Daschle statement, I had no idea which way he was going.
This, obviously, is the long road to the real solution. In this freakishly and radically right wing country (at least, the politicians are - not the people) it is a step in the right direction. Good? Yes.
BUT, right here and right now, we have an opportunity to take the short cut to the promised land. I am still going to push hard for what I, and almost all of you would agree, is the best answer. A real "New New Deal". A mark in time that generations' future will look back at our's and say: "At least they got one thing right." for all of the other things we royally fucked up (pardonez moi?) and left for them to clean up and fix.
Whichever way it goes...
Submitted by carol white on Fri, 01/16/2009 - 08:54.I think there is a need for a regulatory agency that will set standards, providing there is a strong community input. Because of lobbying from the pharmaceuticals industry we have the situation now where Doctors are induced through backdoor financial pressure to prescribe high-priced drugs which may or may not be needed. and may have been insufficiently tested The FDA is limited by lack of financing and lack of regulatory authority from adquately reviewing new meds. For example, they are not permitted to require that new drugs on the market will be more effective than less costly over-the-counter remedies.
Personally I also take issue with the medical need of most men for pills like Viagra, or the desirability of insuring cosmetic surgery except in cases of reconstructive surgery or disfigurement.
Every time I see a Doctor - or
Submitted by Connecticut Man1 on Fri, 01/16/2009 - 09:36.health care professional - for something, I ask them if they have a couple of minutes to discuss something. Most of the time they do and I ask them straight up about single payer. What do they think of it? About 90% of those that have responded said they supported it.
Often they get into their disappointment with "Hillary care" - with my prodding, of course. Not that it wasn't a completely bad idea, but that it did not get the kind of support it might've had because the control of it was too lopsided towards government control. More Doctors (and Nurses) might have gotten behind it at the time if it had more input from the medical professionals.
I agree with that being a real problem. Do you want politics deciding what money would be spent on? With abortion debates, and fights over whether PTSD exists or not, and so many other political fights - it has the potential to be a disaster for everyone. Government should provide some oversight, but the science of medicine should be heavily weighted in setting prorities for what should be covered and who should receive treatment when - balanced a bit by the costs and effectiveness of treatments.
Problems with the medical system includes other aspects too
Submitted by carol white on Fri, 01/16/2009 - 12:23.Hospitals also need to be regulated. Real estate costs figure in with them (they are hotels of a sort) and they also pay a stiff price for up-to-date diagnostic equipment. It is uneconomical when beds are empty or expensive equipment lies idle, thus not producing revenue to offset their high overhead.
Then there are the high fees charged by insurance companies doctors need to pay for medical malpractise suits. That's a thorny issue with many pros and cons.
Finally the high costs of a medical education and years of post-graduate internist, residency etc., fall on the doctor, who likely toook out stiff loans to get through the steps of qualifying. After graduation he or she has to establish a practise and attract clients, also costly. And finally there is the waste imposed by paper work required by insurers etc., each with its own different coding and other specifications.
Single Payer
Submitted by Connecticut Man1 on Fri, 01/16/2009 - 14:24.provides some remedy for this:
Then there are the high fees charged by insurance companies doctors need to pay for medical malpractice suits. That's a thorny issue with many pros and cons.
Typically, since the government is responsible for the provision of the service, the liability is lower in that the government will provide the needed service to right the wrongs (if they can) and there are caps on "financial penalties". The result becomes a mix of a bit of money and harsher responses by the medical licensing boards.
The reality is that accidents happen, even if the most prudent of care is given, and that risk needs to be shared in a fiscally responsible way under a government sytem. You cap the financial aspect - but increase penalties for irresponsible and incompetent actions through the medical board, thus lowering the risk of these things happening again.
In this way, the government can afford to become the "liability insurer" and the costs are shared by all as well as the risks. And providers are no longer driven out of business by ridiculous costs attributed to frivolous lawsuits as well as legitimate one's.
Does that make sense?
Yup!
Submitted by carol white on Fri, 01/16/2009 - 15:39.Of course it does.
What confuses me ...
Submitted by roxy on Fri, 01/16/2009 - 12:52.[warning - personal experience] I get a bill for $1,500.00. The provider wrote off $998.00, the insurance pays around $350.00 and I am left with the balance as a co-pay. Now, for those that are uninsured, the bill would have been $1,500.00. Where is the equity in that?
There is something really astonishing in that
Submitted by carol white on Fri, 01/16/2009 - 13:03.It seems from what we can gather (also from personal experience going out of the Kaiser system to consult a specialist or using emergency rooms. BTW Kaiser did pick up the tabs ex post facto), insurance companies pay a vastly reduced fee which they negotiate with provciders, both for doctors services and pharamceuticals (and I suppose for hospital stays as well). As a result the poor sucker who has no insurance is hit with over-inflated bills on top of it all.
One think I learned that was fascinating. If my insurer covers a particular service I am not required to pay anything above my co-pay, ie I do not have to make up the difference in pricing. Apparently you didn't need to either. However, some labs etc. try to get the money out of the individual by dunning them etc. I had an experience like that and it went on until we sent a lawyer's letter.