Health Care Reform: Live Blog Discussion

18 08 2009

I had a lively discussion today defending the “public option” component of health care reform.  Below is what transpired; I thought the different view points were quite interesting and well worth sharing.  Please contribute your own thoughts below! (Note: I am not personally committed to one side of the fence or other, but today I defend the ‘public option’.)

Medicare overhead: 4%. avg private insurance co: 30%!! Sickening! And you don’t want a public option? Bloat FAIL.
4 hours ago via Selective Twitter Status · Comment · Like
HD: Nope!!!!!!  My friend’s Uncle lives in Italy (public health care) and was in an accident recently. He broke his pelvis and both arms. His wife broke her hip and arm. They sat in the hospital for almost THREE weeks before they were even seen by a doctor!!!!!!!! No, No….funk NO!!!!!!!!!!
CB: If the Freekin politicians would BEGIN health care reform with TORT reform, we could immediately see a 30%plus decrease in rates. But, the vast majority of politicians ARE lawyers and lawyer make up the LARGEST lobbying bloc in Washington, I guess everyone BUT lawyers are going to be screwed by the rising costs of health care. What we need is the BOOTH health care reform plan, Tort reform, portability of policies, competition across state lines, and an assignment pool for newcomers to the system based on the health of the individual and spread out proportionally over all insurance providers. Then since no one can MAKE someone go to the Dr. for checkups and Preventive care (much cheaper than care once you are sick) I would give tax credits to those families and single users who provide proof hat they GO for physicals. My son Kevin fell and cut his head, (no swelling) and they gave him THREE G.D. MRI’s because they were afraid of laysuits.
MW: No.. from what I hear. If we had this wonderful health care system when Madison was sick.. she wouldnt be here today..We wouldnt have had to choice to go to A.I dupont nor have the pediatricain who saved her life. it would also fine small business if someone doesn’t have health ins. offered by them… oh and ppl are asking will I be able to have my doctor(s) and Obama says yes but he forgets to add in but only for 5 years… and yes its sickening on how much private ins companies make and what I have to pay out of pocket and that I have to fight w/ BCBS all the time and I have to pay more because of the ppl who dont have ins . But I want to have to choice to have the best …not you get what you get .things do need to change but its within the ins companies
LC: I honestly don’t know enough about the healthcare that Obama is proposing but, as a person who lives with public healthcare – no thanks. It’s not the doctors or nurses, it’s the way the health department is managed by the gov’t and, at least in Ireland, they are doing a shit job.
RM: Sigh. I am doing a rotation at the NHS in scotland right now. Their heatlhcare is miles ahead of what Americans receive. Let’s clarify a few myths. They don’t put you out to pasture at 70 yo, you do have a choice of what doctor you want to go to. You don’t have to wait months for medically urgent procedures (ie breaking your pelvis and arms). It’s sad how misinformed most americans are about how health systems are run. Devaluing publically funded (NOTE: not publically run) systems and overvaluing our lack of system we have now.
As it goes for preventive care. I recognize that this will not reduce costs, but will make our population healthier for longer. Increasing our societal gain and for that I am for it.
ME to HD: Do you know who has the public option right now in these very united states? Every old person and every war veteran. I can tell you from personal experience, that the folks at the VA get treated just as fast as anyone else does, and certainly not like your experience in Italy. People that are against health care reform are using scare tactics and are fraking outright lyinhg about what would happen. So let me be clear again, a public option already exists in the VA and with medicare and what is being proposed would be an expansion of that, and would NOT be the complete rehashing of health care into an italian system.
CB: Her dad spent most of the last 18 months of his life in and out of the VA in montrose, and if that is an example of what ObamaCare will be, Just shoot me like a dog first. IT WAS HORRIBLE
ME to CB: I totally agree with you on all counts, except the last. Tort reform is needed and is blocked by the lobby.
For me portability is the SINGLE MOST IMPORTANT THING to the success of health care in America. I cannot stress that enough… The reason Insurance companies dont cover yoga and gym memberships but will pay for freaking gastric bypass is because everyone is locked into the same insurance company that their job picks, if they switch jobs, which most ppl will almost certainly do, then that company has no reason to pay for primary prevention because they will never see the fruits of their labor. FAIL.
The point of contention I have is this assigning of ppl to health insurances in a distributive manner. i think this is FAIL (if i understand you completely) because that totally does away with competition all together, right? we need competition to drive down costs.
tax credits for going to check ups is sticky issue. i agree that most ppl in america are fat and lazy and
about an hour ago · Delete
ME to MW: my understanding is that the public option is just that, an option. if you want to stay with your superior and therefore more expensive health care insurance provider you can. thats the beauty of the open market. and by providing a cheap alernative to everyone- that way everyone can have at least ok health care and your costs might go down in an effort to compete with the national option. ultimately you will always have the choice, or at least your employer will ;)
Also i think it’s important to point out this: at the VA if someone can’t get the treatment they need THEY WILL ABSOLUTELY SEND YOU WHEREVER YOU NEED TO GO TO GET THE PROPER TREATMENT. so if things go as planned youd have been fine still- public option does not mean AT ALL that you wouldnt get the right treatment. that’s simply not true and im basing that on 6 years of direct exposure to the public option at the VA…
ME to LC: it does depend on the govt doing a not-shit job but that’s why i posted the original comment. 4% overhead vs 30% overhead… who’s doing the shittier job? The VA and medicare system work really well over here. but, of course, we need to be cognizant of slipping into a faulty european style system…
ME to CB: what was so bad about it? here in albany it is staffed by the same residents and the conferences are the same ppl… the only difference is that 1) you can still smoke inside at the VA and 2) the VA has an awesome EMR system in place… lol
CB: The Publc “option” will end up taking away everyones private insurance. Why would companies want to waste their resourses in HR and elsware dealing with insurance problems. a small raise to the employee, pay your own ins to the gov’t and i wash my hands from the problems and expense.
And the VA Sucked, make an appointment to see a Dr. and he isn;t even there, thinds stolen or misplaced from the rooms. Can’t find Sharons dad, because he ewas sent somewhere else without telling anyone….. sucked.
AF: All I can say is that now being a UK citizen (as well as US…)and having being made redundant recently I thank god that I am living in the UK and have the right to the NHS…..the system is not perfect but you do have the right to care without any cost which is pretty difficult for most Americans to believe – plus if you are in an emergency, the emergency care is state of the art – I still have the right to COBRA under the US system to extend my private health insurance but it is expensive….I’m lucky that I can still afford it, but what if I could not? If I were in the US I would be out of luck…you hear often that the US provides the best health care in the world which is simply not true – you just need to look at the US system from an outside perspective to really understand this…
ME to CB: im not sure i follow your logic in the first paragraph, but ill say this: if the public option causes private insurance cos to go out of business, i say good eff them, they are the most bloated effing worthless pieces of crap (aside from the tobacco lobby) that i can think of. one of the HMO CEO’s is like the 6th richest man in the world… and for what?what? what do health insurance companies actually do? You got ity NOTHING. The whole POINT of a public option is to foster competition which would in turn force insurance companies to tighten their wastebands to compete. and the glorious thing about competition is that, as in michelles case above, you still have the option of paying for your stupid expenizve health care that will give you yearly body scans and treat your brain cancer when you are a 100 fraking years old… knock yourself out! lol.
BUT as it stands, with the public option, your employer could choose it or could not, if they do because there is less paperwork then, damn, those other companies better cut down on the paper work. health insurance is evil and bloated, competition will force them to suck it the eff up. that 30% overhead is OVER A TRILLION DOLLARS so cutting that fat would in itself pay for the whole public option. that money is going to ppl that dont do anything that dont deserve your money and dont give you your care.
I think your experience with the VA is unfortunate, but i can absolutely assure you of this: that TOTALLY happens at every hospital, and although it does happen, it would be unusual for any hospital including the VA…
ME to AF, your comments are well-received.
Cobra is obscene. how anti reofrm proponents cite that as an option is ludicrous, nobody can afford it.
also, “america provides the best health care” is a phrase totally misused.first, anti-reformists use it to stir nationalism in feeble-minded americans cuz america is just the best at everything… except for modesty and self-awareness ;) second, we do have the best doctors, no doubt, but that’s cuz we pay them the most (which i am ok with). BUT. Third its the most bloated health care system- the throw money at a problem solution is bunk and wasteful. there are more MRI machines in seattle than in all of canada… srsly wtf.
10 minutes ago · Delete
ME: Additional comment for everyone: I don’t mean to be insensitive and im not suggesting the old person death farms that ppl are being so overdramatic about but, let’s be honest: grandma’s alzheimers is going to get worse and kill her for sure, and your cousin in the motorcycle accident is not going to come out of that coma after 40 years… as a doctor i realize the difference between hope and selfishness, its too bad patients families generally don’t…

Opening Statement: From CNN this morning – “Medicare overhead: 4%. Average private insurance company’s overhead: 30%” – and you don’t want a public option?

Person 1: No!  My friend’s uncle lives in Italy (public health care) and was in an accident recently. He broke his pelvis and both arms. His wife broke her hip and arm. They sat in the hospital for almost THREE weeks before they were even seen by a doctor! Absolutely NO!

Response: Do you know who has the public option right now in these very United States? Most retired folks and just about every war veteran. I can tell you from personal experience, that the folks at the VA get treated just as fast as anyone else does, and certainly not like your experience in Italy. People that are against health care reform are using scare tactics and are in some cases out-right lying about what would happen. So let me be clear again, a public option already exists in the VA health care plan and with medicare and what is being proposed would be an expansion of that, and would NOT be the complete rehashing of health care into an Italian (or Canadian for that matter) system.

Also, it should be noted, that with VA healthcare, the hospitals and clinics are also run by the government.  So this is different than just government-run health care, this is government-provided health care, which, obviously comes with its own set of issues.

Person 2: If politicians would BEGIN health care reform with TORT reform, we could immediately see a 30% plus decrease in rates. But, the vast majority of politicians ARE lawyers and lawyer make up the LARGEST lobbying bloc in Washington, I guess everyone BUT lawyers are going to be screwed by the rising costs of health care. What we need is the MY health care reform plan: Tort reform, portability of policies, competition across state lines, and an assignment pool for newcomers to the system based on the health of the individual and spread out proportionally over all insurance providers. Then, since no one can MAKE someone go to the Dr. for checkups and Preventive care (much cheaper than care once you are sick) I would give tax credits to those families and single users who provide proof hat they GO for physicals. My son fell and cut his head, (no swelling) and they gave him THREE MRI’s because they were afraid of lawsuits- ridiculous.

Response: I totally agree with you on all counts, except the last; I agree that tort reform is needed and is blocked by the lobby.

For me, portability is the SINGLE MOST IMPORTANT THING to the success of health care in America. I cannot stress that enough. The reason insurance companies don’t cover things like yoga and gym memberships but will pay for gastric bypass is because everyone is locked into the same insurance company that their job picks.  If they switch jobs, which most people will almost certainly do at some point, then that company has no reason to pay for primary prevention because they will never see the fruits of their labor.

The point of contention I have with your statement is this assigning of people to health insurances in a distributive manner. I think this may not be a good idea because that totally does away with competition all together, right?  We need competition to drive down costs.

Finally, as far as tax credits for going to check-ups is sticky issue. i agree that most people in America are not good at following up on things in general, and bribing them with tax credits might work, but I think that is a dangerous precedent to set (like paying kids to get A’s- it apparently works, but I feel is morally questionable).

Person 3: No, or at least not from what I hear. If we had this wonderful health care system when my daughter was sick, she wouldn’t be here today.  We wouldn’t have had to choice to go to A.I Dupont, nor have the pediatrician who saved her life.  It [the plan] would also fine small businesses if someone doesn’t have health insurance offered to them.  In addition, people are asking if they will be able to keep their doctor(s) and while Obama says, “yes”, he forgets to add in,  “but only for 5 years”. Finally, yes it’s sickening re: how much private insurance companies make and what I have to pay out of pocket and that I have to fight with BCBS all the time and I have to pay more because of the people who don’t have insurance, but I want to have to choice to have the best  and not just what you get.  Things do need to change, but it’s within the insurance companies.

Response: My understanding is that the public option is just that, an option. If you want to stay with your superior, and therefore, conceivably more expensive health care insurance provider, you can. That’s the beauty of the open market. and by providing a cheap alernative to everyone, everyone can have at least OK health care, and your costs might go down in an effort to compete with the national option.  Ultimately, you will always have the choice, or at least your employer will, which is a different problem all together.

Also, I think it’s important to point out this: at the VA if someone can’t get the treatment they need THEY WILL ABSOLUTELY SEND YOU WHEREVER YOU NEED TO GO TO GET THE PROPER TREATMENT.  So, if things go as planned you’d have been fine still.  The public option does not mean AT ALL that you would not get the right treatment. That’s simply not true, and I’m basing that on 6 years of direct exposure to the currently established ‘public option’ type prototype at the VA.  Again, care for vetrans at VA hospitals is compounded by the fact that it is government-run provision as well.

Person 4: I honestly don’t know enough about the healthcare that Obama is proposing but, as a person who lives with public healthcare (in Ireland), I say, “no thanks”.  It’s not the doctors or nurses, it’s the way the health department is managed by the gov’t and, at least in Ireland, they are doing an awful job.

Response: It does depend on the gov’t NOT doing an awful job, but that’s why I posted the original comment: 4% overhead vs 30% overhead- who is doing the worse job? The VA and medicare system work really well over here for the most part, but, of course, we need to be cognizant of slipping into a faulty version of an European-style system.

And again, I will reiterate, that a single payer system is an AWFUL idea.  That would create a veritable monopoly, and we would wind up with the same problems as the Canadian system, which, if you ask many Canadians, is not good either.

Medical Student 1: Sigh.  I am doing a rotation at the NHS in S right now.  Their heatlhcare is miles ahead of what Americans receive.  Let’s clarify a few myths.  They don’t put you out to pasture at 70-years-old, you do have a choice of what doctor you want to go to.  You don’t have to wait months for medically urgent procedures (i.e.: breaking your pelvis and arms).  It’s sad how misinformed most Americans are about how health systems are run. Devaluing publicly funded (NOTE: not publicly run) systems and overvaluing our lack of system we have now.

As it goes for preventive care- I recognize that this will not reduce costs, but will make our population healthier for longer. Increasing our societal gain and for that I am for it.

Person 2 Post 2: [re: his personal experience with the VA] My father spent most of the last 18 months of his life in and out of the VA, and if that is an example of what “ObamaCare” will be, just shoot me like a dog first. IT WAS HORRIBLE.

Response: What was so bad about it? Here, in Albany, the VA is staffed by the same residents, features the same education/ conferences, the care is very evidence-based and, also, the VA has a well-developed EMR system in place, that’s arguably the best in the business.

Person 2 Post 3: But the public “option” will end up taking away everyone’s private insurance.  Why would companies want to waste their resources in HR and elsewhere dealing with insurance problems.  It’s like- a small raise to the employee with resulting expectation pay your own ins to the government is just the answer, and then everything else will be all right?

Also, the VA was awful in our experience. We made an appointment to see a doctor and who never showed up; we had things stolen or “misplaced” from the rooms. Can’t find our dad, because he was sent somewhere else without telling anyone… just, awful.

Response: I’m not sure I follow your logic in the first paragraph, but I will say this: if the public option causes private insurance companies to go out of business, because they refuse to remain competitive, then I say, “Good, screw them.”  As things stand now they are so bloated that they are truly having a negative impact on patient care. I’m not sure about this, but something like this is true: one of the HMO CEO’s is like the 6th richest man in the world, for doing essentially nothing to treat the patient.  I am all for private business and entrepreneurship, but you have to stop and say to yourself at some point, “enough is enough!” When 50 million Americans don’t have health care for whatever reason, this desparity has to at least raise an eyebrow.  In my opinion, the whole POINT of a public option is to foster competition which would in turn force insurance companies to tighten their waste-bands to compete; and, the glorious thing about competition is that, as in Person 3′s case above, you still have the option of paying for your expensive private health care that will give you yearly body scans and treat your brain cancer when you are a 100 years old… Go ahead, knock yourself out! lol.

BUT, as it stands, with the public option, your employer could choose it or could not.  If they do choose it because there is less paperwork (as you specifically mentioned) then, well, those other companies better cut down on the paper work. Health insurance, while it is meant to be good and behind-the-scenes, is, in practice, of questionable moral character and is overall bloated; It is viable competition that will force them to suck it up! That 30% overhead I mentioned before amounts to over a trillion dollars a year. Cutting that fat alone could pay for the whole proposed health care reform bill (in reality it wouldn’t work like that, but, the point remains valid). That money is going to people that don’t give you your care and no longer act as your advocate, IMHO.

I think your experience with the VA is unfortunate, but most doctors would agree: similar occurrences happen at every hospital, and those occurrences are the exception, not the rule at both public, private and VA hospitals.  Also, I am not really trying to defend a government-run facility.  If the government ran all the hospitals and clinics, I really do think that would negatively impact patient care in the long run, and also possibly dissuade doctors from coming to practice here in this system, and in the long run that could be quite detrimental to the health care system as a whole

Person 6: All I can say is that now being a UK citizen (as well as a US citizen) and having being made redundant recently, I thank God that I am living in the UK and have the right to the NHS.  The system is not perfect, but you do have the right to care without any cost which is pretty difficult for most Americans to believe.  Plus, if you are in an emergency, the emergency care is state of the art.  I still have the right to COBRA under the US system to extend my private health insurance but it is expensive.  I’m lucky that I can still afford it, but what if I could not? If I were in the US, I would be out of luck.  You hear often that “the US provides the best health care in the world”, which is simply not true.  You just need to look at the US system from an outside perspective to really understand this.

Response: your comments are well-received.

Cobra is for many people, even those with steady incomes, cost prohibitive. How anti-reform proponents cite that as a feasible an option seems unfair, and at the same time, its citing by proponents is also senseless.

Also, to respond to the “America provides the best health care” comment: it is a phrase totally misused, IMHO.  First, anti-reformists use it to stir nationalism, aka “America is just the best at everything” (except for modesty and self-awareness ;) ). Second, we do have the best doctors, no doubt, but that is because we pay them the most (which, as a doctor, I can’t say that I am totally adverse to that ;) ), and at the same time it’s the most bloated health care system around.   Does the fact that there are more MRI machines in Seattle than in all of Canada really improve the delivery of care, or health care outcomes? I seriously doubt that.





Will Obama’s Health Care Plan Work?

9 04 2009

I know we just met, so why am I talking about religion, politics, or money?  Well, regardless of your specialty, the much talked-about future health care dream has the potential to effect us all; therefore it needs to be discussed.  Sure, we’ve all heard the droning of pundits on the 24-hour cable news networks, but what about us?  What about the people that will be directly effected by the proposed sweeping change in American health care policy? I’ll try and be (1x) objective…

First, let’s take what the president said: here in speech form, and here in pdf bullet points.  The plan is broken into three main parts: lowering costs, universal coverage, and primary prevention.

Lowering Costs.  I think it’s impossible to argue that health care in America is cost-efficient, but I’m not writing to decry capitalism; actually, quite to the contrary.  This country is built on capitalism, the land of opportunity, and I think it is important that this be maintained.  That being said, pro-business does not equal anti-regulation, ever.  In fact, regulation is key to the success of capitalism.  Why?  Well, if people are allowed to cut corners, they will; it is only human nature.  So the government’s contribution should be closing the loopholes and making sure people are getting compensated appropriately.  Clearly that is not happening right now.  Most egregious has to be HMO’s and insurance companies.  The fact that the CEO’s of one of the first HMO’s could be one of the richest men in the world is at least a little bit sickening.  That’s not to say that we don’t need insurance companies or that insurance should be handled by the government (as we all know government also equals overhead), it does mean that competition is very important.  The problem is that people are essentially tied into the health care plan offered by their jobs.  One of Obama’s bullet points promises to change this.  This only works if either insurance is similarly and competitively priced, or if there is a set amount of reimbursement expected from the employer.  We’ll see.  

The first bullet point is actually about EMR’s.  This is some nifty forward-thinking.  Of course nobody would really be against this, but I am glad it is a priority.  Apparently, at least one estimation quotes an annual savings of $77 billion.  I’m sure everyone reading this is behind that one.

He also talks about allowing importing of cheap meds, and reducing the overall cost of brand-name meds.  My only qualm with this is if it would stifle R&D by removing some incentive to push the limits of science.  Realistically, I don’t think this will stop anyone, but I think it’s something worth keeping an eye on.

Finally, Obama’s plan includes tort reform (a no-brainer), and a soft “general cleaning” of the system. 

Universal Health care.  I’ll come clean at the get-go.  Health care should be a right.  For whatever reason, you can agree or disagree, that’s just how I call it.  However, a single-payer system is NOT the answer.  Health care should be available to everyone, and to some degree everyone should do their part to support their fellow American.  This is not only important morally, but fiscally.  A tremendous amount of health care dollars are wasted in the ER.  If everyone had health care, these pro-bono ER check-ups should decrease significantly.  I remember in medical school, the administration essentially told us that 30% of our $50,000 tuition went to pay for treatment of those without health care; they could have been lying, but I’ll never forget that.  So, available care would not only get everyone covered, but it would also decrease cost.  But why not a single payer?  Well, that is a monopoly.  We physicians already have a difficult time with reimbursement.  With a single payer, there’s no competition and we’d be forced to accept whatever was offered as payment.  FAIL.  Obama’s plan is clever in this way.  He would create coverage for everyone, but allow you to keep your own health care if you have it.  That may stratify treatment into a two-tier system, but anything is better than no health care at all. In his own words:

“The Obama-Biden plan both builds on and improves our current insurance system, which most Americans continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under the Obama-Biden plan, Americans will be able to maintain their current coverage, have access to new affordable options, and see the quality of their health care improve and their costs go down. The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.”

Promoting Primary Prevention.  This is another no-brainer and includes educational programs about everything from AIDS to obesity and should not be under-played, but for the purposes of this blog, let’s just agree that it is a good thing, that may or may not actually happen or may or may not impact people and achieve it’s stated goal.  I think it does, however, fulfill the purpose of rounding out a complete plan.

Finally, how do we pay for this? I mean that’s the trillion dollar question.  I can not begin to speculate on this.  Obama says money will come from increased taxes on rich people and repealing of tax cuts and from the reform of the bloated health care administration sector.  I think if anyone claims to know how this will play out is talking out their arse.  There are simply too many variables to calculate with any certainty how much it would cost and how much money would be saved/raised under this plan.  Here’s what Obama said in Illinois:

To help pay for this, we will ask all but the smallest businesses who don’t make a meaningful contribution today to the health coverage of their employees to do so by supporting this new plan. And we will allow the temporary Bush tax cut for the wealthiest Americans to expire. But we also have to demand greater efficiencies from our health care system. Today, we pay almost twice as much for health care per person than other industrialized nations, and too much of it has nothing to do with patient care. That’s why the second part of my health care plan includes five, long-overdue steps we will take to bring down costs and bring our health care system into the 21st century – steps that will save each American family up to $2500 on their premiums. 

First, we will reduce costs for business and their workers by picking up the tab for some of the most expensive illnesses and conditions. … Second, we will finally begin focusing our health care system on preventing costly, debilitating conditions in the first place. … Third, we will reduce the cost of our health care by improving the quality of our health care. … Fourth, we will reduce waste and inefficiency by moving from a 20th century health care industry based on pen and paper to a 21st century industry based on the latest information technology. … Finally, we will break the stranglehold that a few big drug and insurance companies have on the health care market. 

In conclusion, there are big positives and potential big negatives.  I just hope that we get universal care while keep capitalism and competition in play so everyone gets care, and I can still pay my loans back…

Agree? Disagree? Sound off below…








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