Uncategorized

Health Care’s Cold Truth: An Iowa Perspective – Michael Millenson

Obama_webI am writing this blog from Cedar Rapids, Iowa, grateful that the
temperature has warmed from brutally
cold to pleasantly sub-freezing.
Fortunately, the warm feelings left by the extraordinary victory of
Sen. Barack Obama, the candidate for whom I was knocking on doors and
making phone calls these last few days, has trumped the temperatures.

Talking to real voters in the suburbs and rural areas surrounding this
small city provides a nice change from  the insular health care policy
world. For one thing, it reminds you that most people don’t care about
“policy,” per se, of any kind. Successful candidates connect first with
the heart and then the head. We instinctively believe that if we trust
a candidate’s values and broad beliefs, we will trust that candidate’s
detailed policy decisions.

Yet the sad reality is that a vast number of citizens won’t even make
that small emotional investment, and they don’t hesitate to proclaim
their apathy when you knock on the door or call. As much as you may
have heard about voters disenfranchised from the Iowa caucuses,
many more simply didn’t care enough to participate. That, alas, makes
Iowa quite representative of the nation as a whole. While Democratic
turnout at this year’s caucuses was double that of four years ago, that
merely turned a “tiny” slice of registered voters into a “small” one.

More broadly, the primaries should remind us how disconnected the details of policy are from the politics that put into place the leaders who will make the final policy decisions. While we may wade through bullet-pointed detail of health care platforms, few real voters share our interest at this time. Polls and interviews clearly indicate that Republican primary voters did not care much in Iowa, and show no inclination of caring elsewhere, about universal coverage or any other sort of health care “reform.” Their main issues are the economy and immigration. If any health-related issue is at all salient, it is abortion, part of a larger social agenda. The Republican candidates have responded by promising that tax-credit tinkering, and a little bit of faith, will bring good health and good health care to all.

The Democratic electorate, meanwhile, wants “affordable” health care for all, and wonks would do well to pay attention to that first word. A nurse in Marion, Iowa, told me she liked Obama, but worried that his health care plan would raise her taxes. I assured her Obama’s plan was less expensive than that of his Democratic rivals and that phasing out the Bush tax cuts for the rich would pay for it. Those assertions are true, but, of course, not quite the whole truth I would tell if sitting at my computer rather than shivering at a stranger’s doorstep. Yet in those simplified truths there is shortcut wisdom, for they are a way of saying that this candidate connects with your concerns. And your concerns about health care have nothing to do with health IT, evidence-based medicine or a score of other technical issues.

On the phone, a woman in a working-class rural area told me of medication for her five-year old hemophiliac son that runs a stunning $80,0000 a month – “more than the cost of my home.” Fortunately, she has a job where the insurance covers the cost and doesn’t count it against her family’s lifetime maximum of $2 million. “I’m glad I like my job,” she said, and I figured it wasn’t the time to discuss the fine points of pharmaceutical pricing on innovative biological products.

President Bill Clinton got the sound bite version of health care reform precisely right in 1993 when his “Health Security Act” referred to “health care that’s always there.” That’s the essence of what Americans want; the rest is commentary.

Livongo’s Post Ad Banner 728*90

13
Leave a Reply

13 Comment threads
0 Thread replies
0 Followers
 
Most reacted comment
Hottest comment thread
9 Comment authors
jnnywllmsmarkBarry CarolMarianMichael Millenson Recent comment authors
newest oldest most voted
jnnywllms
Guest

IMHO, there are lots of tax loopholes to close that could help fund such a plan, and lots of tax loopholes congress could open to make the funding impossible. The campaign’s assertions are credible, but what the congress eventually does cannot be predicted. We instinctively believe that if we trust a candidate’s values and broad beliefs, and we will trust that candidate’s detailed policy decisions.
——————————-
jnnywllms
iowa drug rehab

Michael Millenson
Guest
Michael Millenson

Thanks to all who raised factual questions. Here is my response: The Obama Web site does have a specific cost estimate on the plan, but they don’t make it easy to find. After going to “Healthcare” under issues, you have to click on either the FAQ PDF or “Read the Plan.” See: http://www.barackobama.com/issues/healthcare/ According to the campaign: The cost would be $50-$65 billion when fully phased in. (Note: This is less than the estimates for the Edwards or Clinton plans.) The campaign says the costs will be paid in part by efficiencies enabled by the plan and the remainder by… Read more »

Barry Carol
Guest
Barry Carol

Many hospitals are just as bad as insurance companies, they are controlled by big Corporate Investment groups, that what to show a profit on Wall Street. This is just plain wrong, Mark. Approximately 85% of all hospital beds nationwide belong to non-profit institutions. In major Eastern markets like New York City and Boston, virtually all of the hospitals are non-profit, though a few of the most famous do have sizeable endowments. Moreover, the largest for profit chain, HCA, which went private a year or so back, had a profitability rate about in line with the average S&P 400 Industrial company.… Read more »

mark
Guest
mark

One of the problems I see from above is NO one really knows how much the treatments cost. I can tell you that from my experience, hospitals will put through whatever amount they can get from the insurance companies, usually padding the cost with other charges. Many hospitals are just as bad as insurance companies, they are controlled by big Corporate Investment groups, that what to show a profit on Wall Street. So people are charged differently all over the country, and when they can’t make huge profits, they move on. Insurance companies just say, this is what health care… Read more »

greylock
Guest
greylock

There is no real math on Senator Obama’s web site. Here’s all there is: “The additional revenue needed to fund the up-front investments in technology and to help people who cannot afford health insurance is more than covered by allowing the Bush tax cuts to expire for people making more than $250,000 per year, as they are scheduled to do.” That reinforces my point. One can’t redirect an already-expired tax cut to pay for new spending. One certainly can raise taxes to do so, but of course Senator Obama doesn’t want to say he’ll do that. At least John Edwards… Read more »

Barry Carol
Guest
Barry Carol

I suspect that the actual cost of the Factor 8 treatments are closer to $80,000 per year. See this 12 year old article.

elliottg
Guest
elliottg

It wouldn’t be the first time that someone made a mistake about their own treatment. Hell, most elderly with co-morbidities cannot report their durgs accurately when arriving at the ER (much less their cost) For all I know, this woman gets an EOB that shows the cost as 80,000 but you know that’s not a real number. There are just no clinically valid treatments of hemophilia that I am aware of that cost 80k per month. I really can’t imagine a clinically valid treatment for any chronic condition that costs that much even in the richest country in the world… Read more »

Marian
Guest
Marian

“Dr. Paul”—I wouldn’t emphasize the “Dr.” part too much, CT. Physicians aren’t exactly known for their political savvy or sense of foreign (or domestic) policy. They are more known for having gotten us into this mess in the first place due to their consistent and overwhelming recalcitrance on the subject of fee-for-service. That is the primary (perhaps the ONLY) reason we are in the health care mess we are currently experiencing. No one would expect Ron Paul, of all people, to help us get out of it.

Michael Millenson
Guest
Michael Millenson

One can go to the Obama Web site, to which this blog links, and see that the math on the tax cut revenues and the cost of an Obama health care plan is totally legitimate. What remains to be seen, to be fair, is what other social programs might have a claim on those revenues, as well. On the other hand, fairness also demands that certain government spending be seen as what it often is — an investment. This includes science education, building interstate highways, and a host of other expenditures. This blog is not about tax policy, so we… Read more »

CT
Guest

I’m a medical student who was doing the exact same thing – walking houses and making phone calls – albeit for a less successful candidate with far different ideas on health care than Senator Obama; Dr. Paul. But whoever you were out there in the four degree weather for, the apathy is real. And Michael has written a real reminder on how Americans vote (and it isn’t with specific policy platforms in mind). As an observation of the hundreds of Iowans I talked to not a single one listed health care as their primary concern heading into Jan 3rd. Obviously… Read more »

Greylock
Guest
Greylock

“I assured her Obama’s plan was less expensive than that of his Democratic rivals and that phasing out the Bush tax cuts for the rich would pay for it. Those assertions are true, but, of course, not quite the whole truth…” Not only is that assertion not quite the whole truth, it’s completely false. The Bush tax cuts are scheduled to expire at the end of 2010, which under even the most optimistic scenario is before anyone’s “health reform” plan would begin. So unless the Democratic Congress extends those tax cuts, there won’t be any “tax cuts for the rich”… Read more »

Brian Klepper
Guest

Elliott,
I asked the same question of Michael, and he told me that he asked that question as well of the woman. Apparently the child has a rare form of hemophilia and requires multiple injections per day of a recombinant form of Factor 8. That said, I’m not a clinician and don’t know for sure.
Brian

elliottg
Guest
elliottg

80,000/month is a typo or the woman does not know how much it really does cost.