Healthcare Cost Containment Part IV: Insurance Companies

Interspersed with posts about what is happening now, I have been posting a several part history of healthcare cost containment efforts and how it has essentially amounted to creating one straw villain after another in our attempts to find a quick fix. Part I dealt with the focus on Doctors overcharging insurance companies. Part II dealt with blaming the consumer. Part III dealt with malpractice suits.

In this final post on cost containment in what may be the waning days of this blog, since Congress may soon be making its decision, I'm not going to cover the current situation. We all know how insurance companies make a profit off not covering people, and regulating them may be the only thing opponents and proponents of reform agree on. This post will be about the time from about the late 1980s through the Clinton health reform plan when the insurance companies were being accused of coming between doctor and patient.

First, a little review. In Part I I noted how, by the late 1970s medical specialties were growing and most doctors were choosing these specialties over general practice. At that time the idea of the family doctor was disappearing. It was not unusual for individuals to have no real relationship with any one physician and to go directly to a specialist with a problem. Someone with a simple earache might go directly to an ear nose and throat specialist. Or someone who had suffered a heart attack, having no family doctor, after release from the hospital might use his cardiologist as his primary care physician.

After all the criticism of managed care, this may sound like Eden, but there were some big problems.

1. Paying a specialist for illnesses that could be easily treated by a GP was not cost-effective.
2. Specialists up on the newest methods were more likely to over-treat a problem like performing back surgery when physical therapy would have been less costly and as effective.
   
3. Patients were often forced to self-diagnose in order to choose which specialist to see.

It was in the early 80s, when employers first got serious about cutting medical costs, that it became common to offer a managed care plan. At the time these were usually HMOs, offered as perhaps a lower cost option, but not as the only plan as has become more common in recent years. HMOs were cheaper for a variety of reasons, but the one we'll look at for these purposes is the managed care approach. Participants in HMOs had to choose a primary care physician (PCP) from a list of HMO participating physicians. The PCP served as a gatekeeper of sorts. He/she was your first stop for any non-emergency illness. Whenever possible, the PCP would treat the problem. When necessary, the PCP would refer the patient to a specialist or surgeon who also participated in the HMO.

Unlike the traditional indemnity plan where patients had to meet a deductible plus a 20% copay, with HMOs the patient usually paid one small copay per doctor visit, say $15 or $25, often something larger for specialists, and maybe a fee for tests, after that everything was covered at 100%, at least from the patient's point of view. That's because they weren't responsible for anything over reasonable charges allowed the physician.

As time went on more and more employers began offering HMOs and PPOs exclusively, and insureds, used to seeing any specialist they wanted, and physicians used to working autonomously, started complaining that insurance companies were discouraging physicians from referrals to specialists as well as insisting that physicians see more patients than they could spend necessary time on. Indeed there were incentives for physicians to limit time with patients and referrals as HMOs paid contracting doctor's a certain amount per patient and the additional cost of referrals cut into everyone's profits.

While it was a shock to the system, reports of denied care were largely sensational and anecdotal. A system-wide study would have been helpful, but to my knowledge this wasn't done, but the hue and cry soon caused HMOs and PPOs to be more lenient about referrals, and instead to make profits on higher premiums, less adverse selection, and dropping people likely to accrue high costs.

However, insurance companies aren't the only ones profiting from your healthcare dollars today. Physicians who buy into imaging machines and out-patient surgical centers, for-profit hospitals, and drug companies all have a profit motive for providing more and more care at higher prices. Whether you call it managed care or rationing, without some oversight of the system, everyone will just continue to milk it for all they can get. This won't be the first time our "more is better" mentality will come back to bite us, but this time it's your life and not just your lifestyle that's at stake.

I agree that no for-profit industry should be in charge of decisions regarding your healthcare, but a nonprofit government agency that includes healthcare as well as financial professionals, that makes recommendations based on outcomes studies, can and should. No one wants to put a pillow over Grandma's face no matter how cost-effective, but when Grandma's heart is in failure and all her systems are breaking down, do we need to x-ray her swollen big toe? And it's not just end of life where we spend too much. Other countries with universal coverage spend less on healthcare, perform fewer procedures, and have healthier populations than we do.

By now it should be obvious, the clue to reforming healthcare isn't reigning in the providers or the consumers or the lawyers or the insurance companies. It's all of the above. What many don't realize in their support of the current status quo, is that the status quo is at the breaking point. Very soon all employers, large and small, will be dropping healthcare coverage or moving to countries where they can produce a product at a lower cost. Then none of us will have coverage.

Think about it.

Compare Healthcare Proposals

The woman I was collecting signatures with today clued me into this link comparing all the major and minor proposals. The major ones covered are the two Senate proposals and the general guidelines provided by President Obama. In addition there are other proposals that, to my mind, are head and shoulders above HR 3200 or any of the major proposals. They are essentially single payer. The amazing thing to me is these plans haven't gotten a second glance, and yet, of all the proposals they appear to be the only ones with the potential to contain costs, and a clear-cut method for paying for them. Some would require individual buy-ins, others simply impose an across the board tax.

Reading HR3200 Part I: The Missing 587 Pages

Yesterday I visited the website of my Congressman Jim Gerlach (R-PA) and found this:

"Looking for something to read in addition to a dog-eared paperback novel in the waning days of summer?"

I clicked "Read More Story." I'm not looking for something to read. I'm actually behind on my reading due to all this blogging and collecting signatures, but I was game.

It turns out Congressman Gerlach made copies of HR 3200 America's Affordable Health Choices Act of 2009 available in his offices and certain libraries throughout his district.

The Congressman notes:

"This 1,017-page tome may not be as exciting as the titles topping the New York Times Best Sellers List, but the public deserves a chance to read the legislation before Congress votes this fall,” Gerlach said. “That’s why I believe it’s important to make copies of the bill available throughout communities in the 6th District."

Something told me he wasn't really expecting anyone to read the darn thing, let alone understand it. That's why he mentioned the number of pages and "gave away" the ending.

"I hate to spoil the ending for readers. However, the plan House Democrat leadership proposes would allow the federal government, rather than doctors and patients, to make more decisions about treatments ranging from knee-replacement surgery to chemotherapy for cancer patients. The plan also will impose higher taxes and burdensome mandates on small business owners, family farmers and other job creators as they attempt to shrug off the effects of the worst recession in more than two decades. That’s why I oppose this attempt to usher in an era of government-controlled health care that the Congressional Budget Office, the nonpartisan researchers for Congress, concluded would fail to stem the rising cost of health care and balloon our national debt to staggering levels."

Well I decided to call the Congressman's bluff and his office, which is just a few miles from my house, to see about getting a copy of this thing. As noted here many times, I worked in benefits. I had to read and understand ERISA and various other arcane acts of Congress and amendments to the Internal Revenue Code so it didn't daunt me. Unfortunately, I would not have been able to take the copy away with me, which I knew I would want to do since I was sure it would refer to other laws I'd want to check out online, like Medicare. However, as the person who answered the phone helpfully pointed out, the Congressman's page included a link where I could read it online.

I'm about halfway through, and it is going quite well. I'm pretty impressed, and I will keep you posted on what I learn. However, I'm a little confused because the bill I'm reading is only 328 pages! Congressman Gerlach (and he isn't the only one) says it's over 1000 pages. It has been implied by some that the bill is so long and arcane as to cover up what they are really trying to do––which in and of itself is stupid because length leads to precision not the other way around. So what's the deal? If I add on the committee markups (all the specific amendments by House members who want to add things like Autism Awareness,etc) I get another 72 pages. If I include the CBO estimates they add on, say 20 pages. That comes to a total of about 430.

So where are the missing 587 pages that would add up to 1017? Beats me. In between my reading of the bill, which really isn't so bad when you consider about a third of it is tables of contents and about another third is boilerplate stuff, I will have to take a ride over to the Congressman's office and compare his version to the on online.

I'll keep you posted.

Senator Edward Kennedy: What More Fitting Memorial Than Passing Healtchare Reform

For all those whose cares have been our concern, the work goes on, the cause endures, the hope still lives and the dream shall never die.

Education and Healthcare Reform were two issues Senator Edward Kennedy felt and fought strongly about. Had his health not prevented him from adding his booming voice to this campaign, I wonder if it might not be going differently at this point. Some people are just too venerable to shout down.

Senator Kennedy could be the last vestige of an era in this country that will never return. The era ushered in by Franklin Roosevelt when it was taken for granted that those with money and power had a reponsibility toward those who had neither. Ending poverty was so entrenched in the American psyche that even Republican presidents like Richard Nixon accepted it as part of their legacy. That, of course, came to an abrupt end with Ronald Reagan and every president––Republican or Democrat––since. (Clinton presided over Welfare Reform that created a new class in our country, the working poor.)

Senator Kennedy summoned all his strength to appear at the last Democratic Convention. Though terminally ill, he was obviously energized by the Obama campaign as were other formerly prosaic speakers like John Kerry. Sadly, that energy seems to be waning, replaced by the old "appease the enemies of big government so I can get re-elected" strategy.

Senator Kennedy's death doesn't need to be an end. It can be a beginning. What could be a more fitting memorial to the man than reviving the moral argument for Healthcare Reform and putting behind it all the energy then candidate Obama used to raise the hopes of minorities, young people, and us Progressive Democrats who never thought our party would rise to its former glory. Or the President and Congress could pay the usual lip service then stop mentioning Senator Kennedy's name lest it push the Conservatives (for whom Kennedy was a huge pain in the you-know-what) farther away.

Kennedy believed Obama could usher in a new era, or more correctly, revive an older, better one. Maybe we should change that campaign cry to "I hope he can."

Healthcare Cost Containment Part III: Tort Reform Is Not Healthcare Reform

Interspersed with posts about what is happening now, I have been posting a several part history of healthcare cost containment efforts and how it has essentially amounted to creating one straw villain after another in our attempts to find a quick fix. Part I dealt with the focus on Doctors overcharging insurance companies. Part II dealt with blaming the consumer.

As frightening as it is to think of doctors making mistakes with impunity, we find something distasteful about making money off those mistakes. It is like putting a price, or worse, getting rich off the death or injury of a loved one. There is also a sense that by expecting doctors to perform these risky procedures it's a bit unfair to "punish" them when something goes wrong. After all, we all make mistakes at work, only our mistakes usually aren't life and death matters. And now, these frivolous lawsuits for "every little thing" are driving up our healthcare costs and in my state of Pennsylvania, so they claim, driving doctors out of business.

It sounds to many of us like the payouts on some of these malpractice suits are ludicrous, and we are often told that the bigger the payout the more the lawyer gets out of it. Law, especially litigation, is not my field so whether these payouts are "ludicrous" and whether most malpractice suits are "frivolous," I don't know. I do know that in a country where it so easy to end up without coverage for your medical costs, we are putting the cart before the horse when we ask people not to sue over an illness or injury caused by their physician or hospital that could end up costing them millions of dollars in healthcare costs.

If you suffer an illness or injury due to malpractice that forces you to leave your job, you are without coverage just like anyone else. You also now have a pre-existing condition. If you are able to hold onto your medical coverage, your costs could very likely exceed the lifetime cap and you could end up paying the rest out of pocket. All because your doctor made a mistake.

The American College of Obstetrics and Gynecology estimates that "obstetricians can expect an average of 2.53 medical malpractice lawsuits to be filed against them during their career." We always need to be careful with such statistics. That doesn't mean that every obstetrician will be sued at least twice in his career. Two or three could be sued 100 times and it would skew the average. Be that as it may, I have read that doctors who deliver babies are at far more risk of being sued and many have stopped doing it.

In the article I link to in the above paragraph they imply that the reason for so many suits is that everyone wants a healthy baby and normal delivery. When this can't happen we want answers, in other words, people sue out of anger and perhaps grief. Knowing intimately a family with a child who was severely brain damaged at birth I can give you another reason. Raising a severely disabled child can be difficult and expensive. Just the red tape of getting necessary services usually requires one parent to stay home full-time. Both those injured at birth and in later years by malpractice may have to purchase a new home that is more accessible, and even then it will require certain renovations. Special vans will be required for transportation, and while most of us assume our financial obligations to our children will end at some point when they go out on their own, these parents' physical and financial obligation never ends, not even at their death, when they must have some plan in place for the child's continued care.

Of the two people I know who filed a major lawsuit, one for malpractice and one due to an accident caused by an uninsured motorist, neither did it to get rich––and neither of them did get rich. They sued as a last resort to pay the bills. While I can't quote statistics, I'd bet that more often than not, whether it's a man who fell from his ladder while painting or a woman given the wrong medication in the hospital, the story behind the story, the story that will not be reported on CNN or Fox News or screamed about on the blogs, is that these people had medical bills they couldn't pay and suing to get someone else to pay was their only choice.

Certainly all the malpractice suits have had a detrimental effect on our healthcare. Some question how much they actually add to cost, but they have caused doctors and hospitals to cover their mistakes. If we recognize that mistakes will happen, it would behoove us to encourage healthcare providers to come forward with their mistakes as a way to eliminate them. However, until we live in a society where the victims will not be punished by huge costs, tort reform before healthcare reform is putting the cart before the horse.

Paul Krugman: All the President's Zombies

Krugman hits the nail on the head.

The Republicans have had a strategy over the past 30 year to push the moderates out of their party, while the Democrats' strategy has been to take them in.

The Public Option: The Backdoor Approach

This is a great article by Mark Trahant on two successful public health agencies most of us didn't even know existed. Maybe the administration needs to be a bit more cagey. Drop the Public Option and quietly expand the existing ones.

Healthcare Reform: What it is and what it isn't

This post isn't going to be a refutation of those silly lies about healthcare reform like it includes death panels or is the first step on a slippery slope to Communism. The people who buy into that, or say they do, have another whole agenda that has nothing to do with healthcare, and I doubt they'd read anything that didn't feed their venom anyway.

This post is for those who think they do support healthcare reform, but might not quite understand what's going on. Talking to some supporters I'm reminded of the time a group of pre-schoolers was arguing in my back seat about whether an absent classmate was "selfish." (They said "shell fish" but I knew what they meant.) With great pride I heard my daughter take the lone position jumping to the child's defense. At home later, after beaming at the praise I lavished on her for standing up for her friend, she asked me, "Mommy, what does shell fish mean anyway?"

While I'm thrilled every time someone signs a petition or contacts a senator in support of healthcare reform, on another level it bothers me that they might be doing it simply because the plan would mean another win for Barack Obama and not because of what the plan means for America. I believe there is no more room for knee-jerk Liberals than there is for knee-jerk Conservatives when it comes to participating in Democracy. So here, in a nutshell, are some of the aspects President Obama covered in his press conference the day it was overshadowed by the last question about the arrest of Henry Lewis Gates. All of this information comes from Howard Dean's Prescription for Real Healthcare Reform and President Obama's address to members of Organizing for America on Thursday August 21 (see below).

Employer Based Coverage
The proposed program would make essentially no changes in the system we now have where most Americans are covered under contracts through their employer with private companies. The only difference would be regulation of insurance companies so that they could not deny claims for pre-existing conditions, they could not rescind coverage once you've been accepted––meaning you couldn't be dropped when you needed it most––and all insurance would have to be community rated (everyone pays the same price regardless of past illness) rather than experience rated. There will be no lifetime or annual maximums on coverage, where covered individuals reach their maximum and then become responsible for all their costs.

Public Options
You'll notice this sub-topic is plural. That's because we already have public options that will remain in place. The best known and the one that covers the most people is Medicare that covers individuals over age 65. We also have Medicaid for low-income families and the SCHIP program to provide medical coverage for uninsured children. To these existing programs would be added another option, a pool of public and private insurers individuals can choose from. Those who buy from this pool will receive a subsidy from the government.

Cost containment measures
To my mind this is probably one of the weakest areas of the proposed program. It is why I preferred single payer, because it would have allowed for a total overhaul of our entire healthcare system. We need to reform, not only the way doctor's are reimbursed, but everything from the cost of a medical education (or how much of it students must shoulder), to how doctors do business and charge insurers, to limiting and covering individuals for mistakes made by thier doctors. If we are going to put more people into the system, we need more general practitioners. We already don't have enough, so we would need to incentivize medical students to go into less lucrative general practice. We also need to change the healthcare delivery system with one MRI machine, cancer center, heart surgery center, for every so many people

As I said in another post, as frustrating as it is to some of us, that overhaul simply isn't going to happen this time around. Obama promises some plans for cost containment, like covering more "wellness" and "prevention" care. I thought that was already in most plans, but I'm thinking of standard HMOs and PPOs. It stands to reason that if insureds have a high deductible they are waiting to go to the doctor until they are sick and require treatment, so that may bring modest savings. Pooling together small businesses may give them more bargaining power. Howard Dean talks about effectiveness studies, but the results would need teeth. Improving records sharing through information technology would certainly save a bit, and, of course, bringing more, probably younger people into the group should reduce costs as well. The largest percentage of our healthcare dollars are spent on end of life care. Much of it, I think, against the better judgement of doctors, patients, and families. It's just that right now, everyone is afraid to tell the other person what they are thinking for fear of the blowback. Covering a consultation for end of life care could actually save big bucks in the end.

What Healthcare Reform is not
I think there is a misconception among both opponents and supporters that the government will be taking a major roll in providing healthcare. Unfortunately, from my point of veiw, it will not. The idea that we'll be waiting in line at healthcare clinics to see the physician assigned to us by the government and only receive government sanctioned care, as opponents believe, couldn't be more off base. That the government will provide everyone with some form of healthcare, as some supporters believe, is wrong as well. You'll still pay for your coverage if you are uninsured. Only, the hope is that you will pay affordable costs for better quality coverage.

Medicare recipients seem concerned that healthcare will be funded through Medicare cuts. Where that came from I'm not sure. However, as a society I do believe at some point we must confront what Richard Dooling calls Health Care's Generation Gap where the elderly are often over-treated while children and their parents don't get the care they need.

There is much this reform bill is not, most of it what people like me would have liked it to be. But, in the words of Walter Cronkite, "that's the way it is."

Rumors of the Death of the Public Option Are Greatly Exaggerated

To hear the news you'd think the public option is dead in the water, but according to Democracy for America, it isnt. The house will need at least 218 votes to pass a healthcare reform bill and 64 Democrats have said they will not vote for a plan without a public option. That would leave only 198 Democrats, not enough to pass any kind of reform bill. While I've noted that the Congress would rather err on the side of doing nothing, they also don't want to appear to do nothing. They'd prefer passing a bill that kind of fades out like an old fifties pop song, but they know passing nothing will lead to death by a thousand cuts come election time. So the public option looks like the only alternative.

So, is the public option really so important? I agree with Howard Dean that reform without a public option is not real reform. It will just be another attempt at reform that sputters and dies. Think about it. Some are floating the idea of medical cooperatives, similar to Kaiser Permanente. In these cases doctors and other healthcare providers work for the coop as opposed to contracting with it as they do with HMOs and PPOs. Often these coops are contained within single buildings or several buildings throughout the area they cover. I think this is an excellent idea for providing low-cost healthcare. I really do, and if these coops had started organizing 30 years ago when President Carter proposed healthcare reform, they might have taken root by now. As it is, I can't imagine it is going to be very easy to incentivize enough healthcare providers in enough places to challenge private insurance companies soon enough to bring any relief to those of us chafing under the costs.

The other idea is health insurance coops. This, as best I can tell, is where the consumers, or the insureds, own the company, kind of like the venerable Green Tree that sold perpetual fire and homeowners. However as this article points out, they are difficult to start, difficult to keep going, and even harder to gain any real bargaining power.

In other words, these are smoke screens, exactly the kind of programs that will be rolled out with great fanfare as the Dems celebrate victory. Maybe even some money will be put behind them, but they won't get off the ground, and even if a few do, they will be the first budget items cut if/when another Republican administration comes in.

The real reason we need a public option is that it is the only way to make reform permanent. I'm old enough to remember the outcry against Medicare. Plenty of people then, including Ronald Reagan who was still just an actor, warned that it was a step toward Communism. Now that we have it, people can't think of living without it. Yes, Medicare has its funding problems, mainly because there was no way to predict how healthcare costs would rise and how different healthcare delivery to the elderly would become, and how long people would live. However, now that it is a fixture we continually find solutions to keep it going. We don't scrap it because without it tens of thousand of elderly would be bankrupted by their medical costs.

While Dean says it's a go, I do see signs of Obama caving. So much has been made of this being his Waterloo, that he may be finding it politically expedient to call whatever Congress passes a success. I think it's time to bring out the threats, like the Republicans did to Arlen Specter. The Dems need to get with the program, or as Dean warned, the Dems will put up more progressive primary candidates to run against everyone who voted against reform.

I hope and pray Howard Dean is right and the public option is not really dead. If it is, we are too.

Healthcare Cost Containment: A Short History Part II-It's the Consumer

Part II in my series on the villains of Heathcare Cost Containment. Part I was about the doctors.


By the early 1980s we were into the Reagan era––the era of individual responsibility. Just as the poor were responsible for being poor and needing only to be kicked off Welfare to end poverty for good, so healthcare consumers were seen as responsible for rising costs. Spoiled by employer-paid healthcare they had no notion of the expenses employers racked up on their behalf. Force them to shoulder a share of the costs and they'd pretty quickly turn into savvy consumers shopping for the best deal.

Accordingly we (yes, I cringe to admit, I was in on the design of such a plan) increased deductibles, though only to about $150, and by then that would be met with just a couple of doctor visits. A few employers required employees to pay a small part of their premiums each month. We also instituted some changes in plan design. Just like now, it seemed a good idea to focus more on prevention, so plans began covering routine medical exams and vaccines at 100%. Prior to that, believe it or not, some plans didn't cover routine physicals at all. We also covered second opinions with regard to surgeries at 100% and a third opinion if someone wanted "the best out of three." The idea was not to deny necessary surgeries but cut down on unnecessary and/or over-performed surgeries. Notice, this was an incentive, not a requirement and the anecdotal evidence at least is that it never caught on. Few patients wanted to go up against their doctors in asking for a second opinion, and when they did, physicians rarely broke ranks, so insurers ended up paying twice for the same prognosis and paying for the surgery anyway. There were also minor incentives for more out-patient procedures.

Just like now there was a great hue and cry against these changes as consumers and their physicians predicted people dying in the streets. Seems people are always more concerned about being under-treated than over-treated. This was also when the HMO offering became a popular option, though only as a second choice. More on HMOs and Managed Care in another post.

Yet again, the measures taken had little if any effect on containing costs. However, the possibly unintended consequence of causing consumers to participate more in healthcare choices, along with some studies being publicized in the press, was that patients began eying their doctors' decisions with a bit more skepticism. Maybe that young mom didn't need the hysterectomy that sent her hormones into a nosedive and deprived her of a third child. Maybe little Joey didn't really require that scary tonsillectomy. And then there were those disquieting rumors of doctors making mistakes––big mistakes––that cost lives and were swept under the rug like recent stories of pedophile priests.

Popular culture often provides a good indicator of political trends. Like Denzel Washington battling the evil insurance companies a couple of decades later in John Q. , the feel-good movie of 1982 was The Verdict in which down-and-out lawyer Paul Newman redeems himself with an early malpractice suit against a physician who, through routine error, sent a young woman into a permanent coma, financially ruined her next of kin, and caused a competent nurse to lose the job she loved because she knew too much. The climax that brings to mind the movie Babe, had audiences cheering as the jury foreman asks if it's possible to award more damages than the original suit requested. Don't believe me? Rent it.

Today many think the easiest and best way to solve our healthcare woes is tort reform. Would you say we Americans are a fickle lot?

There Is Still Hope of Reform: Maybe Quite a Bit

I spent Saturday collecting signatures in support of President Obama's plan for healthcare reform at a local farmer's market. We collected over 150 signatures in just three hours. We probably would have collected even more, but it was broiling hot and we couldn't set up our table in the shade, because we would be soliciting within the market, so we left about 45 minutes before closing.

Not only did we collect a lot of signatures, the people who signed were vehemently in favor, not just tepid. When I'd ask people if they wanted to sign, they'd often reply "Absolutely" after which I was always expecting a "not" that didn't come. Some people politely refused, and some few didn't even know what it was about, but I'd say 80% of the people I asked, signed.

There were a handful of vehement opponents. One fellow volunteer ran into a woman who argued for several minutes, but as often happens, her points were broad ones about too much government etc. etc. Nothing specific to healthcare reform, and she and her husband were pretty obviously Medicare recipients. Which I always find kind of odd. They will tell you what a mess Medicare is, but I don't see anyone saying they are willing to give it up.

Of course, I expected that my venue at a farmer's market might be a little more cushy than others. Frequenters of farmer's markets tend to be more liberal, but the point is, those people are out there, even if we aren't seeing them on TV, and the volunteer who was there last week said they didn't do nearly as well, which may show that all that anger is really moving people in the opposite direction. Supporters who took reform for granted are realizing they need to stand up to get noticed. Based on their zip code, the signatures will go directly to their senators and representatives. So now they don't need to sit through raucous meetings where their representative won't get to speak anyway.

Besides the numbers there were other things I found gratifying about my experience. Watching TV I had begun to believe most Americans were stupid. I didn't think these shouters were stupid because they disagreed with my point of view but because of their reasons. Things like death panels and calling the reforms socialized medicine or saying this is a step toward Communism had no connection, not only to the real bills before Congress, but to the real world. Yesterday, many of the supporters gave me real and solid reasons for their support, not just tag lines spewed by the administration.

Many of those signing my petition worked in healthcare. We had two physicians and several nurses and medical social workers. We also had a two men retired from the marketing side of the medical insurance industry.

I also appreciated those people who were undecided and asked reasonable and cogent questions. None of them signed my petition based on our discussion, but I knew they were weighing the facts not the hype. If they were the only people standing in the way of reform, at least I'd find it easier to accept.

But there was one very disconcerting moment when one young woman said she was glad to hear they were at least doing away with the "death counseling" for old people. "Of course, you know what that really is?" I asked (knowing she didn't). "If a person over 65, at any time, voluntarily wanted to be counseled about care options at the end of life, the doctor would be paid for that hour or whatever he spent with that person." Her reply was, "but to have it decided by a committee." I only hope she saw my look of utter disbelief before I told her, "there was never anything in the bill about committees. What I explained is all there was to it."

I don't know if I got through before her baby's fussing caught her attention. One step forward, two steps back.


If you want to help collect signatures or other things to help reform along, check out this site, but while it was set up by the many people behind the Obama campaign, remember, this is not about Barack Obama. Whether you were an avid or tepid supporter of his campaign, or voted for John McCain or voted for no one at all, this is about healthcare reform for all Americans, not just Democrats.

Interview with Howard Dean: There will be primaries

Frankly, I wish Obama had made Howard Dean healthcare czar. This guy knows the lay of the land, and he knows how to get things done.

O judgment! thou art fled to brutish beasts, And men have lost their reason

Several years ago I read an excellent two volume biography of Adolf Hitler by John Toland. Late into the night I read how pre-war Nazi thugs infiltrated union meetings and other leftist organizations, starting shouting matches that would turn into brawls where they would bring out their clubs and chains. We often wonder how a phemenon like Nazi Germany could have occurred in the modern age, but I realized then how much power unreasonable people can weild and how they can drive reasonable people underground making them afraid to express their opinions.

What I mean by "unreasonable people" is people who react out of all proportion to the situation or issue at hand and often against their own best interests, similar to the way some today are reacting to healthcare reform. So far, violence has broken out only in a few instances, however reasonable people understand that when unreasonable people take control, there is always the threat of violence, and at the very least, reasonable people will be forced into stressful angry situations with little chance of being heard or making a difference. So reasonable people go underground, and, at worst, give up, so that the decision makers think they don't exist and the unreasonable people get their way.

Not to be too abstruse, let me provide an example. At the beginning of this century (that still feels strange), I decided to put a pro-choice sticker on my car. At the time I saw a lot of pro-life stickers, and I wanted to proclaim where I stood. The result of taking that stand was that many friends and neighbors with whom I never discussed the issue took the time to voice their support. I kept the sticker for two years until my daughter got her driver's license and I read (and saw) that anti-abortion activists were posting photos online of license plates on cars parked at abortion clinics. I knew I had taken a slight risk placing that sticker on my car (several people called me "brave"). The question was did I want to place my daughter, who would be driving my car to her after school job, at risk. As a reasonable person, I weighed those risks and removed the sticker. I made a similar "reasonable" decision about protesting at Planned Parenthood clinics. As a mother with responsibilities to my family, I weighed the value of possibly putting my life at risk and decided against it.

That's not to say unreasonable people think healthcare reform is worth dying or killing for. They don't think at all, they just react, usually after being whipped into a frenzy by otherwise reasonable people who find them useful.

While Hitler's mental health has been brought into question, everyone around him wasn't crazy. They were intelligent people, possibly idealogues, , and like many, probably greedy for power and money, who saw in that little man the very useful ability to whip up anger and hatred amongst the unreasonable people.

Of course, the great benefit of using unreasonable people to do your bidding is that you can always deny responsibility if it goes too far. You can also, with a wink and a nod, scold them for their actions. At the same time when the unreasonable people are knocking themselves out fighting against their own best interests, you can step in and reap the profits and tell them you are doing it for them. And they are so unreasonable as to believe it.

Conservative members of Congress–-at least some of them––are far too intelligent to really believe Obama is acting like a Nazi or that these minor reforms to our healthcare coverage will lead even to socialized medicine let alone a socialist government. They know there is nothing in these bills that supports killing granny or euthenizing Downs Syndrome babies, but they are not above resorting to such nonsense to whip up the unreasonable crowds to do their bidding, which is to simply bring Obama down and get back the power they had come to believe they had a lock on.

The people yelling (the term protest is not accurate) at these town hall meetings do not look to me like CEOs of major companies who could pay more taxes if the Bush tax cuts are repealed. Nor can they all be employed by private insurance. They are the people who would benefit most by healthcare reform and have absolutely nothing to gain if it doesn't go through. Yet the conservatives have whipped them into thinking healthcare reform is just another a raw deal for the little guy. They believe it and so the unreasonable people go to these meetings, shouting down those who are trying to inform them, while reasonable people make the reasonable decision to stay home, since there is nothing to gain by being there.

The sad thing is, in the end, the unreasonable people will have lost and so will the reasonable people. The only winners will be the manipulators.

It's truly frightening.

Twitter Crashes: Brits tired of US Pols bashing NHS

The Brits are twittering back. It seems they are tired of US ads and blogs that give their National Health Service a black eye. Click on the title to read the article.

Single Payer Advocates: Why You Should Support ObamaCare

The problem with polls, or at least the way they are usually reported in the media is that they require a yes or no answer. With regard to healthcare reform, many of the contacts I've made through meetings and organizations don't support any of the current reform options, because they don't believe they go far enough. Many feel that a single payer plan is the only way to truly reform the system.

Until a few weeks ago, I was one of them, and I continue to prefer single payer and remain appalled that it was never even considered as an option. A single payer system involves more than the government simply picking up the tab for healthcare. At its best it would be an overhaul that would lead to an integrated system of healthcare delivery with oversight by a cabinet office or government agency. I still fear that anything less will not contain run away healthcare inflation or ensure delivery to under-served communities. Without cost containment and without the requisite number of doctors (particularly General Practioners) and hospitals to serve all those new insureds, I see a strong possibility for failure.

So it may sound odd that I am exhorting supporters of single payer to get on board with the Obama plan. The reason is what I stated in the beginning of this post. This is being cast both by opponents and our famously no-nuance media as a "for us" or "agin us" issue. If health reform goes down this time, no one is going to re-visit it and push for single payer. Congress will be only too glad to let this drop, hiding behind the excuse that the American people once again decided they weren't ready for change.

Real healthcare reform isn't one of those feel-good issues everyone can get behind, like just telling insurers to cover everybody. Real reform is complicated and requires major concessions from everyone involved (including consumers). Even a half-way measure like a public option means facing contentious issues like denying certain services and reconsidering end-of-life expenditures. Members of Congress today see their job more as a popularity contest and with Americans having notoriously short memories, they'd rather err on the side of doing nothing––which voters will soon forget––than facing the merest chance of a failure that could still be hanging over their heads at re-election time.

While I have my fears that the simple addition of a public option won't be enough, there's still the possibility it could turn into the opponents' greatest nightmare–– a success that will lead to even more changes. If, with the public plan, premiums are lowered and outcomes improved, individuals as well as businesses will vote with their premium dollars and we may achieve single payer by evolution rather than revolution. Once all the dust settles and citizens take the public option for granted as they do Medicare and no member of Congress worth his/her salt would threaten it, maybe it ccould be used as a platform for the next step.

If the public option fails now or eight years from now, it means the end of major healthcare reform, but if we let it fail now, we'll never know if it could have worked or at least served as a stepping stone. That is why it is extremely important for those who prefer single payer to step up and support the public option. Call your senators and representatives, show up at rallies, attend town hall meetings, and make your voice heard. If you are asked in a poll or on the street if you support the president's healthcare reform plan, say yes instead of no.

Don't let the perfect become the enemy of the possibly good.

Healthcare Cost Containment: A Short History Part I––The Doctors

When it comes to current events, Americans lack a sense of history. In the past 30 years I've seen run away healthcare inflation blamed first on the doctors, then on consumers, then lawyers, and then on the insurance industry, as though there can exist only one villain at a time, and forgetting that the prior set of issues were never remedied before we moved on to the next set. I'm now realizing that my career in medical benefits followed the trajectory of cost containment efforts. So here's a little bit of history on what brought us to this point.

In his book, Dr. Howard Dean makes the interesting point that most of the existing healthcare systems of the industrialized nations hearken back to the situations they found themselves in post-WW II. The UK, for example, had no remaining healthcare infrastructure while citizens were in dire need of medical care. The government had no choice but to take over the healthcare system, which they have since continued, not just out of tradition but because they made it work. In the US employers began offering healthcare coverage as a free benefit when wage controls prevented salary increases. Unfortunately for us, what seemed like a good idea at the time has turned into a failure.

When I began working as a medical claims examiner in the late 70s, first with New York Life and then John Hancock, the system that had been in place for some 30-plus years was just beginning to show signs of unraveling. With the exception of Blue Cross-Blue Shield, most employer healthcare products at the time were sold by life insurance companies. As they were not big money-makers they were bundled with more lucrative group life insurance plans.

Back then there were generally only two types of plans. One was straight "Major Medical," a plan with a deductible (standardly $100). After meeting that deductible (which sounds ludicrously low, but remember with lower costs it could take quite some time to meet), the insurer paid 80% of the charge, the insured, 20%. The second type of plan was a mix of "Basic" and "Major Med." Under these plans basic flat fees were paid for certain services according a schedule. E.g. an office visit might qualify for $15. Charges over that amount then fell into the Major Med portion subject to deductibles and coinsurance. Attesting to the vast changes in medical care in just three decades, we actually had a schedule listing a fee for just about every medical service, test, or procedure offered at the time. We rarely received a claim for anything not on the schedule, and the majority of services and procedures recurred so frequently that we were able to memorize the payments. The most important thing to note here, however, is that while the payments might be divided between insurer and insured, the provider always received 100% of the charge, usually without question.

Toward the end of the 70s, several factors came together causing insurance companies and the Carter administration to start looking for ways to contain medical costs.

• A new generation of doctors didn't know what it was to charge patients directly or wonder if they could pay. With faceless insurance companies picking up the tab, there was no reason for providers––doctors or hospitals––not to pad the bills a little here and there.
• With the growing use of antibiotics, development of vaccines, and new drugs and procedures being discovered every day, the public began to see doctors and hospitals as a way to a cure rather than pronouncers of imminent death. Consumers visited their doctors more regularly, underwent more surgeries, and became more demanding of services.
• New developments led to an explosion of new specialities, and more and more young med students began choosing the more lucrative and generally less demanding specialties (and in fairness, they were probably more mentally challenging as well), over general practice.

Employers' cheap added benefit was quickly turning into a very expensive one and they began leaning on insurance companies to do something about it. Thus were born the first "reasonable and customary" restrictions, complicated formulas imposed on charges––usually physicians' charges––to determine if they were too high. The problem was, it didn't have teeth. Only Blue Cross-Blue Shield required doctors to accept the reasonable and customary fee for assigned benefits (benefits paid directly rather than reimbursed to the patient), and many physicians began pulling out of the Blues because of it. Most insurers would simply send statements to the doctor and patient stating what charges were excluded.

I suppose the notion was that the insured would get wise to the physicians and call them out on it. Only, in those days arguing with doctors was like arguing with the Pope. They were considered infallible and they were not beyond excommunication. So patients usually picked up the charge after giving poor claims examiners like myself an earful. Or else the doctor would send some twenty-five page medical report to dazzle us with detail and get us to to reconsider, which, more often than not, is what occurred.

And that, my children, is how the first feeble attempts at healthcare cost containment failed. It is also why a favor a managed care or at least an outcomes-based component of any new reform plan.

Part II will be about the healthcare consumer as villain. However, in between I may not be able to resist focusing on some of the wild lies out there meant to scare people off reform.

Comments on Insurers Have Hill Defenders

Just a few comments on the article I posted in my sidebar about Hill Defenders of Insurance Companies. Sen. Nelson wants his colleagues to "tone down the rhetoric," but Susan Collins' warning "that creating a public, government-run insurance program to compete with private insurers could disrupt state-regulated insurance markets" sounds to me like as good an example of empty rhetoric as I've ever heard. What exactly does that mean? Disrupt in what way? And is disruption necessarily a bad thing? If investigators disrupt a terrorist plot, that's a good thing, right? That is the type of language often used by politicians to stir up fear by hinting that reeling in the profits of a certain industry will have a dangerous rippling effect through the entire community. Conspicuous in their absence are any specifics. Something like saying, "these lawsuits will completely disrupt the tobacco industry in this country."

"All four say Congress would need to include provisions to ensure that the government program would not have an advantage over private insurers." Say-wha? A plan with affordable premiums that does not deny coverage for pre-existing conditions and has lower administrative costs couldn't help but compete with private insurers. Do we really need a public plan that doesn't meet those criteria?

“I’m always surprised when I hear some of my colleagues describe the public plan as being needed to keep the insurance companies honest . . . when insurance carriers are regulated in every state in the nation,” Collins said. They are a heavily regulated industry.” But obviously still not regulated enough. The problem is provisions vary from state to state and most states still allow private insurers to get away with all or part of what I mention above. To her credit, Susan Collins' state of Maine has moved in the right direction in some areas as requiring individual policies " be written on a guaranteed issue basis, meaning insurance carriers are not permitted to deny you coverage due to unfavorable current or past health history." Looking at the website, however, I don't see anything that would prevent an insurer from finding an excuse to drop individuals suffering a major illness.

It doesn't really matter, though, whether Maine has that provision or not. Probably the best regulated and most efficient running health system in the country is the system created under Dr. Howard Dean when he was governor of Vermont. Only we can't all move to Vermont. That's why we need regulations that go beyond state borders and a public option anyone is free to choose.

Watch out for those who call themselve "moderates" who claim to be looking for a compromise and accuse reform proponents of being too "partisan." One public health plan competing against all the existing private plans is a compromise. It is not single payer or socialized medicine. Without a public plan there can be no reform, just some regulations that, like regulations on the financial industry that went into effect following the Great Depression can be repealed or ignored whenever the political tide changes.

Healthcare Reform: It's Your Problem Too

I promised my next post would be a history of cost containment efforts, but in response to what I'm hearing on the news and reading in my e-mails (I've been having trouble with comments here and my blog was blocked for a while, but I hope it is all fixed now), there are an awful lot of people out there who think healthcare reform is for "the other guy/gal" and that there's nothing in it for them but higher taxes. I noted in my blog description that reform is really about "good old American 'what's in it for me' thinking for both the uninsured and the currently insured who could find themselves uninsured at any moment."

I hate resorting to the same hyperbole that has recently framed this discussion, but get real people. Opponents of healthcare reform are using scare tactics to warn off the people––you the middle class––who will benefit most from reform. This isn't about the poor, they get Medicaid, and the wealthy have their gold-plated plans. It's about you and me, from the lower to the upper end of the middle class who are suffering, and if reform doesn't pass, the only winners will be the insurance companies, the politicians they keep in their pockets, and the high income people who have fine healthcare and now won't have to pay an additional penny in taxes so you can have yours. And if you think it's bad now, wait until these companies see no more obstacles in their way.

Or maybe you don't think it's bad. Maybe you are buying into the myth that we have the greatest healthcare system in the world. Well, I hope you are sitting down.

According to a report by Families USA 86.7 million people or 33% of the population under 65 went without health insurance for some or all of the the two year period of 2007-2008.
You've heard a lot about the 48 million uninsured, but they are the "chronically" uninsured. This higher figure includes those individuals who probably didn't think they had anything to worry about. People with employer-paid healthcare plans who lost their jobs. Divorced spouses who now have to pay full cost if they want to continue on the ex-spouse's plan or for whom the COBRA extensions have run out. Employees of small businesses where a spike in premiums left them no choice but to drop their coverage. Employees of large or small businesses that began requiring them to pick up part or all of their heathcare premiums, who, unable to afford it, had to drop their coverage all together.

25% of all uninsured under 65 during that two-year period remained uninsured for 24 months
Twenty-four months is a long time to keep your fingers crossed and hope you won't get sick, especially when dealing with the added stresses of looking for a job, trying to put food on the table, meet your rent or mortgage payments, probably doing more of your own home repairs––climbing ladders, doing electrical work. The mean cost of a hospital stay in the state of Nebraska (home of Mike Snider) is $21,865. That's just the hospital stay. It doesn't include things like rehab, special equipment––wheelchairs, crutches––medications following a hospitalization or for any ailment you might have already had like high blood pressure or even chronic sinus infections. Statistics vary, but from what I can find, the average cost of a visit to a doctor's office runs anywhere from $60 to a few hundred dollars. According to Blue Cross Blue Shield, the average cost of an ER visit (which is where most of the uninsured must go, because doctors don't take people who can't pay––though ERs don't always take them either), is $383.


The percentage of uninsured was highest among 19 to 24-year-olds and 25 to 44-year-olds
Let's say it looks like you're going to make it to Medicare age without going uninsured. Do you have kids? The standard health insurance plan covers children up to age 18 or up to age 23, if they are full-time students. So if you have a kid ready to graduate, chances are they will go uninsured for a good part of their lives. Sure, kids often don't see the long-term value in something like health coverage and turn it down even if they can afford it, but it is often too expensive to afford on the low salaries many young people receive (it costs $165 per month for my daughter), and fewer and fewer employers of young adults provide coverage. Many young people work in jobs that employ them just under the number of hours to be considered full-time. It pays businesses from restaurants to universities (many are now hiring large numbers of adjunct professors) to hire more part-time workers than fewer full-time workers who would be eligible for benefits. It's every parent's fear that a child will have an accident or suffer a major illness, but in this case the fear is two-fold. Most parents would want to help an uninsured child with healthcare expenses, and it could wipe them out.

These statistics showing how easy it is for the average person to end up uninsured at some point in their lives go on and on. You can read them yourselves. What many people don't realize, because it has become such a way of life in this country, is how we are held hostage every day by our current system.

Do you think you'd be more appreciated at Company Y than your current Company X? You'd better not have a pre-existing condition. Employer group plans have to accept everyone, but depending on state regulations, the new insurance plan can exclude coverage for pre-existing conditions for anywhere from three to twelve months. That means, if you have high blood pressure, they would exclude your meds, your doctor visits, and probably your heart attack if it could be shown as connected (which of course it could).

Do you want to indulge that entrepreneurial spirit American politicians so often praise? Be prepared to go uninsured if you have a pre-existing condition or pay higher premiums because of it. A few years ago, when my husband and I were looking for less expensive alternatives to our $1200/month plan, we expected a rate increase for his high blood pressure. We didn't think our daughter's mild dermatitis for which she used an antibiotic cream three years before would add to it as well.

Think your current premiums for individual coverage are too high and you want to look around?
If you've been in your current plan for several years, you'd better stick with it. When you see those people testifying before Congress about losing coverage the day before cancer surgery, you may think the company has a right to flag "fraudulent applications." If you haven't completed an application for individual insurance recently, you may not know that they ask you to list the exact date you sought treatment any time during the past 10 years. That includes colds, flu, sinus infections, prescriptions for seasonal allergies. No one keeps that information. So you fudge it or skip it. The interesting part is, the company doesn't investigate your application immediately. You could go on for years paying monthly premiums and being reimbursed for the usual minor costs. Then, bam, just when you need it most, they terminate your coverage because you didn't mention the time you visited your doctor for poison ivy in 1999.

Are you a divorcee who has met the new love of your life? He'd better have good coverage.
If you are covered under the COBRA provisions of your ex-spouse's plan, they end if you re-marry. If the new spouse doesn't have a plan, or you don't think you'd qualify, you'd better stay single. Often divorced spouses with serious health problems will take health coverage as their settlement. Because of the expense, they rarely get anything else, and, again, forget re-marrying.

We cannot go on calling ourselves the greatest country in the world when we are slaves to our healthcare carriers and when one illness could wipe out a lifetime of savings for hard working people.

Don't fall for their lies this time. It is too important and the opportunity won't come along again.

Reforming Healthcare: Can We Afford To Do It? Can We Afford Not To?

Twenty-some years ago a young couple, John and Mary, bought a house cheap knowing it needed certain repairs. They both had good incomes. Their investments were growing by the hour, so it seemed like a good plan. Only, they kept finding excuses not to spend money on the things that needed doing. In good times they didn't want to take large sums out of the market. In bad times they wanted to leave the money there until they made up their losses. Then there were so many other "smaller" expenses that ate up their income, like the flat screen TV they had to buy when it looked like the old set just possibly might go on the blink right before John's big Super Bowl party, and Mary's iPhone that was such a bargain, being a laptop and a phone in one, though she still replaced her old laptop when it crashed.

Twenty years later the chickens have come home to roost, almost literally as crows are entering through the gaping holes in their roof. The rusted out hot water heater not only doesn't heat water, it flooded their basement. The leaky dishwasher they figured they could live with as long as it washed the dishes, rotted a hole through the floor, and the windows they'd always meant to replace allowed water to seep into the walls, nurturing a spreading mold. Not only are the costs and damage worse than twenty years ago, now Mary lost her job and John will probably lose his. Their investments have tanked, and their 401(k) isn't even worth breaking into. John and Mary have no choice but to take a loan, and now...that health problem John's been putting off going to the doctor about just sent him to the ER requiring life-saving surgery.

John and Mary's predicament is very much like the situation the US finds itself in right now. For over twenty years–-and that includes the Clinton years––we've been told the best way to keep our economy going is to spend our money on consumer goods rather than taxes. That's a fun notion anyone would want to believe, even those of us with niggling doubts about just how all that money spent at the mall would trickle into the public sector, and certainly no sensible politician would go up against another one touting that dream of a free lunch. Only now our infrastructure is crumbling, libraries are closing, Medicare and Social Security are in danger, our air traffic control equipment is outdated––you name it and it needs fixing––right in the middle of an economic crisis some economists term the worst since the great depression. With the federal deficit exceeding $1 trillion without even making a dent in these burgeoning needs, many Americans understandably wonder whether now is the best time to tackle healthcare reform with an extremely expensive public option.

First, let's get the facts straight here. I happened to be watching one of those moderated he said/she said debates about healthcare reform on the Lehrer News Hour when news broke that the CBO had estimated the cost of H.R. 3200, the America’s Affordable Health Choices Act of 2009 would cost just over $1 trillion over the next 10 years. Everyone was suddenly struck dumb as, while to you and me 1$ trillion sounds like a lot of money, for the government, spreading that cost over 10 years isn't that big a deal, and everyone discussing it knew that. Since then, the $1 trillion figure has been bandied about quite a bit, without adding the time frame. When I write these posts, I try to go to the source rather than quoting articles about articles about the source, so I went to the CBO site, and as of the point I decided I was spending way more time than this short post warranted, I hadn't read a figure that exceeded a few hundred billion. If anyone wants to, or has, read the whole thing and wants to point it out to me, I'd be much obliged.

The second estimate picked up by the let's start a tempest in a teacup media was something to the effect that, without cost containment measures, a public plan would be unsustainable. Here again, I went to the actual CBO letter. From what I can gather, and it is pretty arcane, that came from projections beyond the next ten years, the accuracy for which the CBO will not vouch (that's a little convoluted), because projections beyond 10 years are even harder than 10 year projections. However, I assume all the hoopla is based on this point,

"As long as overall spending for health care continued to expand as a share of the economy, people’s share of insurance costs would continue to rise faster than their income, or the government’s subsidy costs would continue to rise faster than the tax base, or both."

Again, if anyone can find anything more specific that the media was referring to, I'd like to read it.

So what we have so far, as I see it, is that healthcare reform is doable and it can be affordable, but not without cost containment, and I'm betting not without tax increases either. That's something many of us have known all along. Only we've been trying to impose cost containment on our healthcare for more than 30 years and it's never stuck. As to increased taxes, well, you all know what a lead balloon that one is.

Next, a short history of healthcare cost containment efforts and why they haven't worked. You can find the history of taxes on your own.

Healthcare Coverage: Debunking some of the myths

Last week in The Inquirer, columnist Susan Estrich, who, while I despise labeling, would probably call herself liberal, came out against Obama's healthcare reform. The title of the piece was Don't risk your benefits. A known liberal columnist coming out against healthcare reform can hold a lot of sway, so as my first post I'd like to discuss some of her points and explain where I think she got it wrong.

Your benefits are not at risk–-at least not through a reform plan
Let's start with the title of the article. I find it strange that, over the last couple of decades since the advent of HMOs and PPOs, all the news seemed to be about patient disatisfaction with insurance plans that put obstacles between them and their healthcare providers. Now, suddenly, we are told most people are satisfied with their coverage and won't give it up for love or money. Well, the good news is, if people really are satisfied with their plans, they are free to keep them. I don't know how many different ways it can be said before people stop buying into the misinformation put out there by reform opponents. There is no plan in the House or the Senate or recommended by the Obama administration that would require anyone to involuntarily give up their current health coverage. Period.

Lest you think this blog will simply be an apology for the Obama plan, this is a good place to point out that I have strong doubts a competitive market system with the addition of a public plan is nearly enough to solve our current healthcare problems. I believe anything less than an entire system overhaul with more centralized control, what some might call single payer or, yes, socialized medicine, is required. More on that in other posts, but for now, suffice it to say, the prospects of that happening in the near future are nil. So this sudden love affair everyone seems to have adopted with their favorite insurance company can continue without interruption––at least the government won't interrupt it, whether your insurer or your employer interrupts it is another matter.

The best healthcare in the world
The US ranks 27th in the world for life expectancy. Our infant mortality rate is higher than the other industrialized nations. According to a study funded by the Commonwealth Fund of 14 Western European countries plus Canada, Australia, New Zealand and Japan, the US is now dead last (and by a wide margin) in reducing its "amenable mortality rate," that is, the number of deaths per 100,000 "from certain causes before age 75 that are potentially preventable with timely and effective health care." At one point we ranked fairly well on the scale, but while everyone has improved somewhat since the 1990s, the other countries have been improving at much higher rates.

I could continue listing statistics. The point is, opponents of healthcare can't continue hiding behind the myth that our system is too good to be tampered with. All the countries outranking us have some form of universal healthcare coverage, but it isn't only the uninsured and the underinsured whose health is suffering. In his book Prescription for Real Healthcare Reform in which he lays out the basics of the Obama plan, Dr. Howard Dean claims that the US "wastes as much as $700 billion a year on tests and treatments that cannot be shown to improve health." Dean notes that the Obama plan calls for establishment of an independent institute to research and review comparative effectiveness of treatments. (1)

The government coming between you and your doctor
Ms. Estrich seems to enjoy a good professional relationship with her doctor and fears a system where government will intervene in that relationship. I don't know what kind of coverage she has, but most of us already have insurance companies intervening between us and our doctors and they do it with profits in mind. Many physicians support healthcare reform. The AMA supports reform that will bring affordable healthcare to everyone, but pretty much under the system we now have. I'm not sure how that's going to happen. Other large groups of physicians support more systemic reform and the Physicians for a National Health Program are lobbying for single payer. However, they favor public coverage with private choice. I'm not sure I favor that much either.


These represent just the tip of the iceberg when it comes to the misunderstandings and misinformation flying around regarding healthcare reform. I have nothing against a spirited debate, but it has to be more than a rationale for the status quo by those who feel they, personally, have nothing to gain from a change, and it has to have some basis in fact rather than conjecture.

If you agree or disagree, I would love to read your comments. Please, keep it civil, try not to resort to name-calling, and try to focus your comments on this specific post. If you wish to discuss another aspect, chances are I'll cover it at some point, and if I don't, you can contact me. Maybe we can arrange a guest post.


Next: What you stand to lose from the status quo

(1)Dean, Howard, MD. 2009. Prescription for Real Healthcare Reform. Vermont: Chelsea Green Publishing Company.