Such a simple solution

There is a simple solution for Catholic hospitals, universities, and social service organizations when it comes to the religious liberty claim as it applies to including contraceptive coverage in their employee health plans: hire only Catholics, with Catholic spouses. Then nobody’s religious liberty is being affected.

Oh wait! Most Catholic women use contraceptives. If these institutions hire non-Catholics, what about the religious liberty of those employees?

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There’s bureaucracy and then there’s bureaucracy

I still retain some hope that health care and health insurance reform can be enacted this year.  We are in a crisis situation — one that has been in the making for a generation or more.

One of the scare tactics that the GOP has used to gin up opposition is the specter of government bureaucrats “getting between you and your doctor.”  In my experience, those government bureaucrats would be a welcome change from the insurance company bureaucrats.  Too often, once you get past the automated “answering system” and are connected with a real person, you find that you’re talking to Dingbat Number 47 or her evil twin.   From there you’re passed from one person to the next while all you want is the answer to a relatively simple question — from someone who is SUPPOSED to know the answer.  Given that experience, it’s not particularly surprising that people can be made to expect that dealing with government bureaucrats will be even worse.

However, there are two main government bureaucracies that all of us will deal with, if we live long enough.  When I signed up for early Social Security, I did it online.  It was very straightforward.  It took about 15 minutes to enter the required information into the Social Security Administration database.  Once I’d finished, I had an opportunity to review the information and make any corrections before submitting it.  The next day, I received a phone call from my local Social Security office.  A very nice person took a few minutes (no more than 10) to review my application, informing me that my information had been verified and giving me the date each month when my checks would be automatically deposited into my checking account.  And they have been.  Each and every month since then.  When I become eligible for Medicare, I will be enrolled automatically!  When my husband applied for Medicare, the individual he spoke with asked if he was still working, if he had a projected retirement date, and answered his questions about how Medicare interfaces with his employer-based insurance.  As part of the same phone call, the Social Security bureaucrat volunteered information about when to apply for fully Social Security benefits and gave him precise information about the implications of receiving Social Security while still working.  When he did apply, by telephone rather than online, the individual asked to speak to me.  While we were not married when I applied for benefits, the bureaucrat informed me that my own checks would increase by about $100 a month due to the fact that we are now married.  It was simple, straightforward, proactive and professional.

I’m not alone in this experience.  I urge you to read this.  It represents the experience of so many.

As I’ve written before, my mother-in-law is in failing health.  She spent 10 days in the hospital last summer after a serious fall, followed by three weeks in a rehab facility before she moved to an assisted living facility.  As part of that transition, her durable power of attorney for health care came into play.  During her hospital stay, we (my husband, his sister and I) had the opportunity to meet with a team of health care providers, including a case manager and social worker, to explore options for her care upon discharge.  During her stay in the rehab hospital, she progressed from transferring between a wheelchair and the bed, and she progressed from the wheelchair to the walker she had been using before her fall.  That stay allowed her to become ambulatory again, and while she was clearly no longer safe to live alone, she was sufficiently mobile to participate in the activities and social interactions that the assisted living facility provide.  The move to assisted living was emotionally difficult for her, as it would be for most of us.  It represented a huge loss of independence and control over her life.

Her hospitalization and subsequent weeks in rehab was our first direct experience with Medicare, and it was and has continued to be wonderful.  She has a “Medigap” policy and long-term care insurance that covers a portion the assisted living costs and will provide even more benefits should nursing home care become necessary.  She is fortunate.  Between her own pension and Social Security benefits and her long-term care insurance, her current costs are covered almost in their entirety.  She is on hospice care because her medical situation will continue to deteriorate.   She will not recover.  Hospice covers some things under Medicare that we would otherwise have to cover.  But we have not had to wrangle with insurance providers.  And that has been a great relief.  End of life care is difficult at best.  It is emotionally draining watching a loved one reach the twilight of their life.  President Obama has spoken on several occasions of the challenges and worries that his mother faced as she battled both her cancer and her insurance providers.  We’ve been spared that.  And so have millions of older Americans.  It is beyond my comprehension that we, as a nation, are so afraid of providing everyone with the same peace of mind that our family is experiencing with “government-run” healthcare.

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Is anyone listening?

My current Congressman is a conservative Republican… not so conservative that he falls into the wingnut category, but close.  I’m what someone called a faint blue light in a sea of red.  So I make a point to communicate with him fairly regularly, if only to remind him that he also represents people with views that don’t conform to his own.  And if I get any response, it’s a blanket canned one repeating all the GOP talking points.  It’s as if he doesn’t have an original thought in his head but simply responds out of obligation, using the same pre-recorded message to everyone.

My most recent communication was on health care.  I use the term recent rather loosely, because I had forgotten what I said.  After reading through the tirade on how we must protect the insurance industry from the inevitable collapse that would result from “government-run” health care — at least he’s gotten off the death panel bit — my blood pressure was rising, so I fired off a response.

I pointed out to him that when he first ran at least 5 terms ago, he promised to serve only 2 terms.   So much for that promise.  I also pointed out to him that he was already receiving government run health care as he is eligible for Medicare.  Whether he also uses one of the health insurance plans available to Congress and all other federal employees, he is automatically enrolled in Medicare Part A.  I challenged him to give up his government-funded, government-run health care programs.  Will he?  Certainly not!  So I asked how he figured he could in good conscience participate in something that he obviously didn’t think his constituents were worthy of.

I’ve probably had a wider range of experiences in the health care system than he has.  I benefited from the federal health care system for a number of years, thanks to my former husband’s employment as a civil servant.  I’ve had employer-provided health insurance (and paid my portion of the premiums).  I’ve been in the private insurance market, with its high-cost-low-benefit policies, been denied coverage, had coverage canceled after filing a claim, and been uninsured.  I have experienced first hand the limitations of “managed care” with its gatekeepers, limited choice of providers and the like.  And next year, my husband’s company has eliminated choice of plans altogether — there is one insurance plan for all employees.  In contrast to my own experiences, this summer I’ve seen how Medicare with a private supplemental policy works, thanks to my mother-in-law’s health crisis.

If I had a vote on health care reform, it would be Medicare Part E (for everyone).  It is a system that has been in operation for over a generation — i.e., no new bureaucracy and a proven track record.  Participants pay a monthly premium of about $100 and most supplement that with a secondary, private plan.  By bringing millions of additional people, many of them healthier than the senior population, into the system, per capita costs would automatically go down.  Everyone would be covered.  And the insurance companies would be able to sell those supplement policies to a huge pool of people.  Just as they do with the current Medicare supplements, insurance companies would compete with each other in that secondary market.

Medicare cannot refuse people because of a pre-existing condition — nor can the insurance companies who provide Medicare supplements.  And they cannot cancel your coverage when the bills start coming in.  Everyone 65 or older is included now.  Why not simply remove the age restrictions?

It is true that reimbursement rates for Medicare are lower than for other insurance plans.  But doctors would be able to streamline their administrative activities.  The bills would automatically go to CMS for payment.  Currently, doctors must maintain a billing department whose function is to deal with insurance companies — getting prior approval for treatment and fighting for payment afterward.  That cost of doing business would go away, more than making up for the reduced reimbursement rates.

Younger people argue that they are paying for the care of the elderly because their own medical costs are low.  True, UNLESS you get into an accident or contract an illness.  And if they do have a medical catastrophe, those who are uninsured can still get treatment.  If they can pay, they are generally bankrupted.  If not, the providers absorb the costs.  And those of us who are insured pay for the care of the uninsured — to the tune of about $1000 each per year in increased premium costs.  Every rational person admits that the current system isn’t working.  The challenge becomes how to have a real discussion — looking at what is best for the American people, rather than how to preserve campaign contributions.

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Bipartisanship or obstruction?

From what we’ve been seeing from Republicans supposedly “negotiating” on health care reform, it’s reasonable to ask if they are negotiating or obstructing.  Negotiating presumes a willingness to compromise.  Each side gives something to arrive at a solution.  While nobody gets all they want, neither do they have to give up everything.  But compromise seems to be operative only among Democrats.  Republicans, on the other hand, continue to throw up roadblock after roadblock each time the Democrats show any signs of compromise.  Is compromise viewed as weakness among Republicans?  It would seem so.

Perhaps this debate has brought into focus a fundamental difference between today’s Democrats and Republicans.  I saw the first indications of it during a GOP governor’s first term in New Mexico nearly 20 years ago.  But the mantra can be characterized by Ronald Regan’s pronouncement that government is the problem.  A Republican who had run a successful business ran for and was elected governor of New Mexico.  As owner of a business, he was accustomed to getting his way, to having people do what he asked them to do.  After all, if they didn’t, he could fire them.  But he quickly discovered that governing is an entirely different activity, requiring both the ability and the willingness to negotiate and to compromise.  And therein lies the difference.  It appears that Democrats truly want to govern, while Republicans prefer ruling.

The kind and tone of the opposition has made it apparent that the only “reform” the GOPers are interested in is no reform.  Oh, they mouth words that say they support reform, but they aren’t contributing anything positive to the debate.  They talk privatization, letting the market rule.  Well, just look at the financial collapse last fall and you have a really good assessment of how well unregulated markets work.  Why, even Alan Greenspan, that beacon of free-market capitalism, has admitted that it didn’t work very well.

Finally, a member of Congress has called it like it is in an op-ed piece in USA Today.  He says it’s time to forget bipartisanship and use the tools available to make the large Democratic majorities in both houses of Congress work like they’re supposed to.

The Gang of Six seems to be crumbling.  Yesterday there were hints that even without a public option, the GOP members of the group were demanding additional concessions.  Sen. Grassley (R-IA) allowed as how he wouldn’t vote for anything but a “perfect” bill.  By today he is saying that bipartisanship is impossible. Also today, Sen. Jeff Bingaman (D-NM) suggested that the reconciliation process might be the only path to reform.  That is unfortunate, but without cooperation from Republicans, it’s the only way.

It’s time to listen to the American people instead of the corporate shills.  The shills have stirred up enough trouble, enough hate and discontent.  In case you’re still laboring under the impression that “ordinary Americans” are populating those raucous town hall meetings, ask yourself why they only show up at meetings held by Democrats.  Then, look at the chart below, which was published today by the Campaign for America’s Future.

We’ve been waiting for health care reform for decades.  It’s time to stop letting Sen. Grassley’s perfect become the enemy of the good.  Let’s pass it, see how it works, then tinker with the parts that need improvement.  Otherwise, we’ll continue to see the numbers of uninsured rise along with costs.  Republicans cried that Social Security and Medicare were socialism.  Democrats ignored the naysayers and passed both.  Now, they are integral parts of our social safety net, programs that while imperfect, are considered essential by all but the most reactionary people among us.

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Health care — the view from inside

We spent about 8 hours in the ER of our local privately-owned hospital overnight.  Arriving shortly after 3 a.m., we were ushered in quickly.  An irregular heartbeat with atrial fibrillation tends to get people’s attention.  Spouse has employer-based health care and we’ve made use of it in the past, what with a valve replacement and subsequent major complications leading to multiple bionic parts beyond the valve itself.  During that entire sequence of events four years ago, including several visits to the ER, we received good to excellent care with truly minimal out-of-pocket costs beyond the usual co-pays for doctor visits and medications.   Because last night’s incident didn’t lead to a hospital admission, there will be a co-pay of $100-200 depending on how much they’ve gone up in the past four years.  Things are fine, and they sent us home with nothing more than advice to follow up with the regular cardiologist.  Whew.  Seems it was most likely the result of a drug interaction that is easily avoided in the future through nothing more than timing when to take certain prescribed meds.

But during the time spouse was hooked up to monitors, waiting for the insurance to determine whether we would see the regular cardiologist or one from the HMO, we were able to watch the ambulance entrance while patient after patient was brought in with a series of complaints.  Fortunately, none were immediately life threatening.  But the delay in being able to determine which cardiologist would be “approved” to see us meant that the bed spouse occupied was unavailable for others.  Meanwhile the aisles grew crowded with gurneys and EMTs, who could not leave their patient until a bed was freed up.  They assured us that what we were seeing was better than usual.  The ER is often so full that the line of gurneys flows out the door into the parking lot — and this in a desert where daytime temperatures in the summer often top 100 degrees, where winter nights are below freezing and where wind speeds often top 35 mph year round!  I couldn’t help consider the time and money that those idle EMT’s (2 to a patient) and paramedics represented and compare that to the cost of simply seeing our regular cardiologist, clearing out and freeing up the bed for someone else, which would allow the paramedics and EMTs to respond to other calls.  Meanwhile a single ER doc and a handful of nurses tried to tend to the flow of patients in a timely and compassionate manner.

We took the opportunity to talk briefly with the nurses who attended to spouse about our health care system.  All agreed that the status quo is unsustainable.  Since our area is primarily quite conservative, opinions were voiced carefully, and they varied.  But none suggested that we do nothing. The area of difference was confined to whether a full-fledged socialized system like the VA, or a Medicare-for-all system like the Canadian one, or some other solution was the right one.   But there was agreement that having insurance companies standing between providers and patients isn’t working for anyone’s benefit but the bottom line of the insurance industry.

We hear horror stories — almost all false — about the Canadian system, which is quite similar to our Medicare system.  Our area is experiencing a shortage of doctors, especially primary care and emergency room docs.  One of the nurses related how a group of Canadian docs came to this hospital, figuring that the US system would be a financial boon to them.  Within a year, all declared bankruptcy and returned to Canada.  And yet we continue to hear that we have the best system in the world.  We have talented providers, and many of our hospitals have access to great equipment.  But that doesn’t equate to good health care.   We spend nearly twice as much per capita for care as any other industrialized country but don’t achieve equivalent outcomes.  We waste vast sums of money.  Drugs in the US are more costly than the same drugs are on the open market in other countries.  Yet we cannot legally re-import them nor can the government negotiate lower costs for Medicare Part D, the prescription drug benefit.

This debate is or should be, at its core, about people — millions of people who are not being well served by the current system.  Health care should be a right, not a privilege.  We should be talking about how to get the best care and the best options to people at a cost that we can afford, both individually and as a society.  Societies are judged in the final analysis by how we treat the weak among us, not by how we treat the powerful.

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“Our health care system is just fine…”

That is the argument being advanced by the GOP.  However, we need to look at the consequences of retaining the status quo. An article by Jonathan Alter in Newsweek caught my attention.  Actually, the title is what caught my attention. “What?!?!?” I thought.  Actually, it was more like “WTF?!?!?!?!”  But I read on.  The article should be required reading for every American who thinks the system is just fine or that it doesn’t need more than a minor tweak.   Unfortunately, given the results of the survey that showed that conservatives tend to think that Colbert is one of them, its sarcasm may be missed by the very people who need to understand just how broken the current system is.

Alter points out the risks of the status quo to all of us, whether we have insurance or not.  If you know anyone who has had a serious illness (or even one that wasn’t serious), anyone who cannot recall each and every doctor they have ever seen or procedure they have ever had, anyone who has been turned down for coverage, anyone who has been uninsured for even a short time, anyone who has had a claim rejected, anyone who wants to provide insurance to their employees but cannot afford it, then you understand the reasons we need reform.  And not just minor tweaks to the system.

The current furor over a “government run plan” is a smoke screen.  We already have government run systems in place that function quite well.  They are known as Medicare and the VA system.  Are they perfect?  Of course not.  There is room for improvement.  But comparing 2-3% administrative costs as with the 30% or more that characterize insurance companies tells us that the bulk of money goes to patient care, rather than a concerted effort to deny care.

The industry, its lobbyists and its minions in Congress are running scared.  They know that they’re on the wrong side of the American people in this debate.  So, they’re resorting to the most cynical distortions and scare tactics to try to retain their influence.  And, unfortunately, it seems to be working.  It’s time for some fact checking.

There are understandable concerns about costs.  Wringing costs out of the health care system and exchanging cost for quality are important principles.  Costs that do not contribute to overall health should be looked at especially carefully.  Unfortunately, the scoring system used by the Congressional Budget Office is tilted more toward the costs of a new system without giving equivalent credit to overall savings to be gained from the changes.  And it doesn’t consider the savings in the overall system that are currently being borne by businesses, consumers, and health care practitioners in the form of higher premiums and unreimbursed costs.

The “fee for service” practice should be scrapped.  It encourages physicians to order additional tests and procedures, knowing that each one pads their bottom line without necessarily contributing to patient outcomes.  Several of our best medical centers and teaching hospitals pay doctors a salary, rather than the fee for service model.

Our health care system should be results oriented.  What practices lead to better overall health and thus lower costs?  One suggestion that keeps coming from the right is that of tort reform.  While there are certainly lawyers who use class action suits against drug and medical device manufacturers to line their own pockets, while providing little relief to consumers, we need to structure any reform so as to protect consumers from bad doctors and inadequate testing and quality control.

Similarly, we need to figure out how to make sure that all the providers caring for a person have access to the same information.  Electronic medical records will help ensure that all providers have access to all the information about a patient.  This will result in cost savings in that tests won’t be repeated unnecessarily, each ordered by a different provider.  There are privacy concerns but appropriate consequences, i.e., job loss for a first offense, can minimize the risk.

Then there was NY GOP Rep. Peter King who claims that health care reform isn’t a priority for Americans.  If ranked as the 3rd most important issue doesn’t make it a priority, I’m not sure what does.

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Houston, we have a problem

As the administration gears up to attempt a reform of the American health care system, we’re hearing a lot from some quarters about how President Obama wants to impose socialized medicine, how government bureaucrats will be making medical decisions instead of doctors.  Yet, these claims are inflated at best, misrepresenting the proposed reforms, while ignoring the crisis in the present system.

America’s current health care system is broken.  It’s way past being on life-support. As a nation, we pay more per person for medical care than any other industrialized nation while other nations far surpass us in outcomes.  In simple terms, despite hearing that our system is the best in the world, the facts show otherwise — that we’re not getting our money’s worth.  Infant mortality rates are often used as the indicator of a nation’s overall health.  According to the CIA, the United States ranks behind 42 other countries, including not only all the industrialized nations of Europe and Asia, but also behind Canada, Australia, New Zealand,  the Czech Republic, Slovenia (both former Soviet bloc nations) and even Cuba.  Our infant mortality rate is double the leader (Singapore).  Is it pure coincidence that a commitment to universal health care seems to be a common factor among the nations that surpass us in this metric?  Probably not.

For at least four years, we’ve heard that the number of uninsured Americans has topped 45 million people, with some estimates placing the number at 47 million.  A new report makes the shame of that even more clear.  Some 87 million Americans went without medical insurance at some point during the past two years.  That is an eye-popping number, especially when you consider that number compared to the total number of Americans under the age of 65, when Medicare kicks in.  It represents 1/3 of the under 65 population.  Medicaid covers those who fall below the poverty line.  So that 87 million represents a huge percentage of people in the middle — people who are under 65 but not so poor that they receive publicly funded medical care. And it does not include the millions more who are underinsured — people who find that their insurance coverage is inadequate when a medical situation occurs.  Medical bills are the single biggest cause of bankruptcy — greater than foreclosure.  And with another nearly 700,000 American jobs disappearing in February, the number of uninsured Americans rises.

People without insurance but who do not qualify for Medicaid often forgo basic medical care.  And preventive care is often the first thing to go.  Trying to save money, they wait until the situation becomes an emergency.  The result is that they are sicker and their care is costlier than it would have been had they sought care earlier. Hospital emergency rooms are closing due to the demands being placed upon them, putting ever more strain on those that remain.

Costs have escalated far more than can be explained by inflation alone.  In this time of economic stress, the one bright spot is the relative health of for-profit health insurance companies.

During his campaign, and in the principles that will guide the reform efforts, President Obama repeatedly stressed that for those people who are satisfied with their current medical coverage and care, the reforms will not bring change.  What he is proposing is a multi-faceted approach that will ultimately bring choices to the millions who are not satisfied — choices that will increase the number of people receiving employer-based coverage, additional choices within the private insurance system for those who do not have access to employer-based programs, and coverage for the remainder under a Medicare-for-all program. So, the fear-mongering about “socialized medicine” is a red herring.  Many health care professionals and many Americans, perhaps even a majority, prefer a single payer system.

The most widely-heard criticism of the Clinton era health care reform proposal was that it removed choice from consumers.  Remember those ads featuring Harry and Louise?

Another of the rallying cries of those opposed to the current proposal (and which began as part of the stimulus package critiques) is that bureaucrats — presumably government bureaucrats — would be making critical decisions about our care.  Just how do these critics explain the insurance company gatekeepers?  Are they not also bureaucrats making critical decisions about our care?  Do the critics not see the connection?  Or do they assume that the American public doesn’t?

Some years ago, my husband dislocated his shoulder on a ski trip to Canada.  Following an overnight hospital stay, the services of doctors, nurses, an anesthesiologist, and all the related services including meals, medications, and splints, his bill came to $100.  The hospital apologized, saying that were he a Canadian citizen there would have been no cost.  Upon his return home, he submitted the bill to the insurance company, who initially refused to pay it because it was not itemized.  When he called the hospital to request an itemized bill, he was informed that one night in the hospital, with all required medical services, cost $100 and that the hospital did not provide itemized bills.  After much additional discussion, his insurance company covered the $100 bill.

There is a lesson in this. Many companies have learned that their employee travel costs were lower when they established a per diem rate for hotels, meals and incidentals based upon the destination rather than requiring employees to itemize their expenses.  The difference?  The time saved by this method more than made up for the possible savings achieved by itemizing.  Is it unreasonable to think that the same would apply to medical costs rather than having to account for each and every aspirin and band-aid?  Administrative costs for most insurance companies and HMOs run in the range of 30% — that means 30% less that can be actually spent on health care.  Medicare’s administrative costs run a fraction of that at around 6%.

As employer-based coverage costs rise, companies are forced to drop plans altogether or to pass more of the costs on to their employees.  Those people who have relied on private insurance find the premiums, deductibles and co-pays increasingly unaffordable while the amount of coverage declines.  Additionally, many people with pre-existing conditions are unable to purchase private insurance at any price.

As the debate continues, we must be mindful that there are two very powerful interest groups who will fight like pit bulls to retain the current system — the insurance companies and the pharmaceutical industry.  We, the American people, will be watching.

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