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."

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.