Tag: Health Care Reform

Health Care Reform: What do People Really Want?

Aug 20, 2009• 101

By HUMPHREY TAYLOR

Humphrey Taylor is Chairman of The Harris Poll. Prior to joining Harris, Taylor worked in Britain where he conducted all of the private political polling for the Conservative Party and was a close adviser to Prime Minister Edward Heath in the 1970 campaign and subsequently to Margaret Thatcher.

What do people really think about health care reform? When political issues are difficult and complicated, published polls sometimes confuse rather than enlighten the debate. And health care reform is fiendishly complicated, with many different issues and many different proposals for addressing them. No wonder that the debate is generating more heat than light. This is surely one of the times when political leaders should lead rather than follow public opinion. As Winston Churchill once said, “The problem with politicians who keep their ear too close to the ground is that it is difficult to look up to them in that ungainly posture.”

While policy makers have to address the details of the proposed policies, most people do not. They know what they want, or don’t want, but have only a very limited understanding of which policies will actually achieve their aims. They are often strongly influenced by political rhetoric that varies from the accurate to the simplistic to the completely false. Many different words and phrases are used to describe different policies. It is unreasonable to expect the public to understand the details of the proposed reforms or how they work in practice.

However, if you study all the polls, as opposed to cherry picking them as many politicians do, a clear picture of public opinion emerges:Continue reading…

Are Cooperatives a Reasonable Alternative to a Public Plan?

Aug 20, 2009• 10

By TIMOTHY S. JOST

Jostt First, a word about history. We have tried cooperatives before.
During the 1930s and 1940s, the heyday of the cooperative movement in
the United States, the Farm Security Administration encouraged the
development of health cooperatives. At one point, 600,000 mainly
low-income rural Americans belonged to health cooperatives. The
movement failed. The cooperatives were small and undercapitalized.
Physicians opposed the cooperative movement and boycotted cooperatives.
When the FSA removed support in 1947, the movement collapsed. Only the
Group Health Cooperative of Puget Sound survived. Over time, moreover,
even Group Health, though nominally a cooperative, has become
indistinguishable from commercial insurers-it underwrites based on
health status, pays high executive salaries, and accumulates large
surpluses rather than lower its rates.

The Blue Cross/Blue Shield movement, which also began in the 1930s,
shared some of the characteristics of cooperatives. Although the Blue
Cross plans were initiated and long-dominated by the hospitals and the
Blue Shield plans by physicians, they did have a goal of community
service. The plans were established under special state legislation
independent from commercial plans. They were non-profit and, in many
states, exempt from premium taxes. They were exempt from reserve
requirements in some states because they were service-benefit rather
than indemnity plans and because the hospitals and physicians stood
behind the plans. They were exempt from federal income tax until the
1980s. In turn, they initially offered community-rated plans and
offered services to the community, such as health fairs. In some states
their premiums were regulated and they were generally regarded as the
insurer of last resort for the individual market.

The Town Hall Effect

Aug 18, 2009• 21

By HARRIS MEYER

We’ve all been reading a lot about the congressional town hall meetings around the country, where protesters rail about President Obama’s health reform plan. News reports and video clips indicate that half or more of the protesters yelling about socialism and a government takeover are of Medicare age.

I’ve wondered about these senior citizens and other protesters. They look like ordinary working- and middle-class people who probably have the same problems with the U.S. health care system as millions of other Americans. How can they just say no to legislation that would help them personally, or that would give others the kind of guaranteed coverage they already enjoy?

Ditching the Public Option

Aug 18, 2009• 53

By ROBERT LASZEWSKI

It looks to me like the popular objections to a health care bill being expressed by voters this month are concentrated in two primary areas:

A concern about “government control of the health care system”—mostly around the public plan option.
The trillion-dollar cost of a health care bill at a time deficits are swelling and worries about who will really end up paying for it.

As a result of the first concern, we are getting the first indications that some Democratic leaders are ready to ditch the robust Medicare-like public option and are beginning the process of talking the party out of demanding it be included in a health care bill.

This from Politico today:

After the toughest week yet for health reform, leading Democrats are warning that the party likely will have to accept major compromises to get a bill passed this year – perhaps even dropping a proposal to create a government-run plan that is almost an article of faith among some liberals…"Trying to hold the president's feet to the fire is fine, but first we have to win the big argument," former President Bill Clinton said Thursday at the Netroots Nation convention, a gathering of liberal activists and bloggers who will prove most difficult to convince. "I am pleading with you. It is OK with me if you want to keep everybody honest. . . .But try to keep this thing in the lane of getting something done. We need to pass a bill and move this thing forward."

It has been clear to me for months, and I have been saying so on this blog, that the public option has not had the votes even among Democrats to make the finals. With all the heat “a government takeover” of health care has attracted from those at the town hall meetings either the Democrats ditch it or get used to the idea they have no chance of passing health care reform.

I am shocked, shocked that Rick Scott would twist the truth

Aug 16, 2009• 12

By Matthew Holt

Surprise, surprise, the British women who appear in the so-called Conservatives for Patients’ (so-called) Rights” propaganda are complaining that their words were twisted completely out of context. ‘We were duped’: Two British women tricked into become stars of campaign to sabotage Obama’s healthcare reforms. Further the British oncologist featured was told that he was appearing in a documentary, not in a right wing advertising campaign.

And most disingenuously of all—whether you agree with it or not—at no point have the Congressional leaders running the process or Obama introduced legislation calling for either serious single-payer (Canadian-style) or nationalized government provided care (UK-style).

So Rick Scott is conning people to twist their stories to run adverts to oppose something that no one is proposing.

Perhaps there should be $1.8 billion dollar fines for misrepresentation…

Enthoven’s ABCDs and why that socialist Gingrich is wrong on standardized benefits

Aug 16, 2009• 4

By Matthew Holt

Here's Alain Enthoven's four part plan for fixing healthcare. As THCB regulars might guess, it's familiar and very sensible stuff. (Here’s the PDF)

A. Create an exchange with standardized plans, make individuals buy through the exchange and limit outside subsidies to the value of the lowest cost plan.

B. Tax health benefits (starting with those over the value of the cheapest plan)

C. Phase in the same system for Medicare

D. Phase out employer based insurance, giving everyone a voucher for the lowest cost plan based on a dedicated tax like a VAT.

Meanwhile in the LA Times, Newt Gingrich, who continues to smell blood in the Palin-infested waters, spouts BS that would destroy any sensible Enthoven-style reform. Apparently in Newt-world a regulated insurance package of standardized benefits is government bureaucracy run amok.

Voices from the deserving mob

Aug 15, 2009• 15

By Matthew Holt

From the (UK) Independent. Real quotes from real people attending the free care in LA this week:

“I had a gastric bypass in 2002, but it went wrong, and stomach acid began rotting my teeth. I’ve had several jobs since, but none with medical insurance, so I’ve not been able to see a dentist to get it fixed,” she told The Independent. “I’ve not been able to chew food for as long as I can remember. I’ve been living on soup, and noodles, and blending meals in a food mixer. I’m in constant pain. Normally, it would cost $5,000 to fix it. So if I have to wait a week to get treated for free, I’ll do it. This will change my life.”

***

She works for a major supermarket chain but can’t afford the $200 a month that would be deducted from her salary for insurance. “It’s a simple choice: pay my rent, or pay my healthcare. What am I supposed to do?” she asked. “I’m one of the working poor: people who do work but can’t afford healthcare and are ineligible for any free healthcare or assistance. I can’t remember the last time I saw a doctor.”

***

“You’d think, with the money in this country, that we’d be able to look after people’s health properly,” she said. “But the truth is that the rich, and the insurance firms, just don’t realise what we are going through, or simply don’t care. Look around this room and tell me that America’s healthcare don’t need fixing.”

And that last one is the money quote.

Tale of Two Health Crises

Aug 14, 2009• 25

By MARIA FOSCARINIS

Maria IJT CURRENT Twenty two years ago I received shocking news: I had Hodgkin’s disease, a cancer of the lymphatic system that affects primarily young people. At the age of 30 I began a long and to date successful effort to fight the disease and regain my health. I was lucky: I had good health insurance, access to top doctors, friends and family with the wherewithal to help. I also had a good education that helped me navigate the health and insurance systems and also remain employed. I also had a home to go to after each round of chemo and, three years later, after hospital treatment for a recurrence. “Scott” is not so fortunate. Twenty-seven years ago, at the age of 21, he lost his left leg after a car hit him. A month earlier, he had lost his job as a forklift operator, and with that, his health insurance. Unable to afford his own home, he was living with his mother. The money he recovered from the driver of the car that hit him barely covered hospital expenses and the lawyer’s fees.

How to Rein in Medical Costs, RIGHT NOW

Aug 11, 2009• 114

By GEORGE LUNDBERG

I believe that there are still many ethical and professional American physicians and many intelligent American patients who are capable of, in an alliance of patients and physicians, doing “the right things”. Their combined clout is being underestimated in the current healthcare reform debate.

Efforts to control American medical costs date from at least 1932. With few exceptions, they have failed. Health care reform, 2009 politics-style, is again in trouble over cost control. It would be such a shame if we once again fail to cover the uninsured because of hang-ups over costs.

Physician decisions drive the majority of expenditures in the US health care system. American health care costs will never be controlled until most physicians are no longer paid fees for specific services. The lure of economic incentives to provide unnecessary or unproven care, or even that known to be ineffective, drives many physicians to make the lucrative choice. Hospitals and especially academic medical centers are also motivated to profit from many expensive procedures. Alternative payment forms used in integrated multispecialty delivery systems such as those at Geisinger, Mayo, and Kaiser Permanente are far more efficient and effective.

Fee-for-service incentives are a key reason why at least 30% of the $2.5 trillion expended annually for American health care is unnecessary. Eliminating that waste could save $750 billion annually with no harm to patient outcomes.

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Currently several House and Senate bills include various proposals to lower costs. But they are tepid at best, in danger of being bought out by special interests at worst.

So, what can we in the USA do RIGHT NOW to begin to cut health care costs?

An alliance of informed patients and physicians can widely apply recently learned comparative effectiveness science to big ticket items, saving vast sums while improving quality of care.

Intensive medical therapy should be substituted for coronary artery bypass grafting (currently around 500,000 procedures annually) for many patients with established coronary artery disease, saving many billions of dollars annually.
The same for invasive angioplasty and stenting (currently around 1,000,000 procedures per year) saving tens of billions of dollars annually.
Most non-indicated PSA screening for prostate cancer should be stopped. Radical surgery as the usual treatment for most prostate cancers should cease since it causes more harm than good. Billions saved here.
Screening mammography in women under 50 who have no clinical indication should be stopped and for those over 50 sharply curtailed, since it now seems to lead to at least as much harm as good. More billions saved.
CAT scans and MRIs are impressive art forms and can be useful clinically. However, their use is unnecessary much of the time to guide correct therapeutic decisions. Such expensive diagnostic tests should not be paid for on a case by case basis but grouped along with other diagnostic tests, by some capitated or packaged method that is use-neutral. More billions saved.
We must stop paying huge sums to clinical oncologists and their institutions for administering chemotherapeutic false hope, along with real suffering from adverse effects, to patients with widespread metastatic cancer. More billions saved.
Death, which comes to us all, should be as dignified and free from pain and suffering as possible. We should stop paying physicians and institutions to prolong dying with false hope, bravado, and intensive therapy which only adds to their profit margin. Such behavior is almost unthinkable and yet is commonplace. More billions saved.

Why might many physicians, their patients and their institutions suddenly now change these established behaviors? Patriotism, recognition of new science, stewardship, and the economic survival of the America we love. No legislation is necessary to effect these huge savings. Physicians, patients, and their institutions need only take a good hard look in the mirror and then follow the medical science that most benefits patients and the public health at lowest cost. Academic medical centers should take the lead, rather than continuing to teach new doctors to “take the money and run”.

Physicians can re-affirm their professionalism and patients their rights, with sound ethical behavior without undue concern for meeting revenue needs. The interests of the patients and the public must again supersede the self interest of the learned professional.

George D. Lundberg MD, is former Editor in Chief of Medscape, eMedicine, and the Journal of the American Medical Association. He’s now President and Chair of the Board of The Lundberg Institute

Palin: Obama Health Plan “Evil”

Aug 10, 2009• 128

The strange plot of the national debate over health reform this took another twist over the weekend, after (now suddenly ex- Alaska governor) Sarah Palin posted a statement on her Facebook page on Friday denouncing the Obama administration’s plan to reshape the healthcare system as “downright evil.”

In a statement referencing Ronald Reagan and the economist Thomas Sowell, Palin warned of bureaucratic “death panels” that would decide “if my parents (or yours) or my baby with Down Syndrome” are “worthy of healthcare based on their level of productivity in society.”

The full text of the post:

“As more Americans delve into the disturbing details of the nationalized
health care plan that the current administration is rushing through
Congress, our collective jaw is dropping, and we’re saying not just no,
but hell no.

The Democrats promise that a government health care system will reduce
the cost of health care, but as the economist Thomas Sowell has pointed
out, government health care will not reduce the cost; it will simply
refuse to pay the cost. And who will suffer the most when they ration
care? The sick, the elderly, and the disabled, of course. The America I
know and love is not one in which my parents or my baby with Down
Syndrome will have to stand in front of Obama’s “death panel” so his
bureaucrats can decide, based on a subjective judgment of their “level
of productivity in society,” whether they are worthy of health care.
Such a system is downright evil.