Is healthcare a right or a privilege?
Depending on how you view this determines how you feel about the recent healthcare reform which was signed by President Obama.
As a doctor, I firmly believe that having healthcare is a right.
As a nation, we agree that individuals should be accountable for their actions. People often argue that those who are reckless with their bodies by ingesting chemicals via cigarettes or drug use and who subsequently develop cancers shouldn't be subsidized by others insurance premiums as the latter group works hard at staying healthy by exercising, maintaining an acceptable weight, and eating generous portions of fruits and vegetables. Some how it isn't fair.
Unfortunately life and good health aren't quite that easy or predictable.
Children who haven't had time to abuse their bodies do develop cancers, type 1 diabetes requiring insulin, or are born with genetic problems, like cystic fibrosis, that require expensive medical therapies that potentially are lifelong. Once diagnosed, these children are now plagued with the "pre-existing" label and unable to get health insurance. Over the past many years, the leading cause of personal bankruptcy for individuals and families is due to medical expenses. As a parent with an ill child could you simply walk away?
Non-smokers do develop lung cancer (note Dana Reeves, Christopher Reeves' wife). Individuals without a family history do get afflicted with other aliments. Healthy people do get heart attacks.
In other words, life happens. Good health can require a little luck as well. While individually one can decrease risk by not smoking, eating healthy foods, losing weight, and exercising, it isn't a sure thing. Bad things can happen to good people.
About 1 in 10 Americans or thirty-two million citizens, roughly the entire population of Canada, don't have health insurance . As a country, is it acceptable for us to walk away from them?
Even today, Americans believe in the American dream - work hard and you can be successful. The wild card is that having good health can be a finicky thing. Do everything right and you could or a family member could be stricken with a serious illness. Prior to healthcare reform, this situation not only could bankrupt you but your family.
Let's be clear. The legislation isn't perfect. It isn't so much true healthcare reform, but health insurance reform. The program phases in over a number of years. It doesn't address healthcare delivery or costs, which will likely occur in 2011. Nevertheless, it is an important start.
Despite the heated rhetoric from both parties, Americans are still a society that welcomes diversity, provides compassion and help to fellow human beings, believes in justice, fairness, and the opportunity to succeed with dogged hard work. This healthcare reform legislation, though far from ideal, is a good first step to ensure the American dream can still exist for current and generations to come.
Showing posts with label President Obama. Show all posts
Showing posts with label President Obama. Show all posts
Sunday, March 28, 2010
Sunday, January 24, 2010
Lack of Healthcare Reform Means that the American Dream is Dead.
It appears that the American Dream is dead as the Democrats have essentially no chance in passing some sort of healthcare reform package. The stunning loss of the senate seat held by the late Ted Kennedy has now given the Republicans the ability to filibuster any significant healthcare legislation.
More disappointing is that Americans seem willing to accept the fact that they can live without healthcare. In a blog at US News and World Report titled 21 Things We're Learning to Live Without, besides abstaining from cable TV, a home phone, prepared foods, and lattes, healthcare was also on the list. Millions of Americans are apparently "simply hoping they don't get seriously ill or hurt." How can this happen is supposedly the wealthiest nation in the world? Too many Americans as a result are literally one illness or accident away from financial ruin as medical costs are the leading cause of personal bankruptcy.
While President Obama and the Democrats no doubt will try to salvage what they can from their hard work over the past year, they need to be thoughtful about their future proposals. Though the public doesn't like the thought of insurance companies turning away those with pre-existing conditions, the fact is that this practice exists because we don't mandate everyone have health insurance. As George Halvorson, CEO of Kaiser Permanente, noted to make healthcare affordable a double mandate must apply - everyone must sell (that is health insurers must sell coverage to everyone who desires it) and everyone must buy (all consumers must purchase). Otherwise, those who are healthy would not participate and instead would wait until they needed it. Those who are already ill will purchase health insurance. As a result, insurance companies would only receive payments from those who need medical care, which can't possibly cover costs of chemotherapies and hospital stays which are in the tens of thousands per treatment. Since the healthy don't subsidize the sick, insurance companies would simply go bankrupt.
With the President and his Democratic party concerned about a Republican resurgence, he has already refocused his attention on large institutions like banks and redirecting the populace anger there rather than working on meaningful change. He may try the same tactic on insurers in an effort to get some healthcare reform passed.
In doing so, he may simply ignore the truth of the double mandate and make insurers not only cover everyone but also have the federal government set the rates. President Obama knows of course that it would only be a matter of time that the government would take over healthcare as insurers would have no choice but to pull out in this financially unsustainable model. If a single payer system occurs be prepared for rationing of medical care. Imagine long waiting lists to see a specialist, getting surgery done, or wondering if a treatment might be approved. Certainly some of these problems occur already with private insurers, but envision if the healthcare system was run by the DMV. Is this actually better?
It's equally as unfortunate and more disappointing that the Republican party over the past year essentially only had one mission - derail any proposals from the Obama administration. Without healthcare reform to make insurance coverage more affordable to employers, families, and individuals, America will no longer be viewed as the vibrant superpower nation it has been over the past couple of decades but a country unable to provide the basic healthcare needs to its populace because its politicians were too paralyzed to do anything but score political points for the next election. Because of their failure to lead, it is increasingly clear that in the United States healthcare coverage isn't a right but a luxury.
If Americans and employers are constantly worried about saving money for a future expensive illnesses or medical problems, then when will they ever feel secure enough or freed enough to take risks, invest, and dream?
More disappointing is that Americans seem willing to accept the fact that they can live without healthcare. In a blog at US News and World Report titled 21 Things We're Learning to Live Without, besides abstaining from cable TV, a home phone, prepared foods, and lattes, healthcare was also on the list. Millions of Americans are apparently "simply hoping they don't get seriously ill or hurt." How can this happen is supposedly the wealthiest nation in the world? Too many Americans as a result are literally one illness or accident away from financial ruin as medical costs are the leading cause of personal bankruptcy.
While President Obama and the Democrats no doubt will try to salvage what they can from their hard work over the past year, they need to be thoughtful about their future proposals. Though the public doesn't like the thought of insurance companies turning away those with pre-existing conditions, the fact is that this practice exists because we don't mandate everyone have health insurance. As George Halvorson, CEO of Kaiser Permanente, noted to make healthcare affordable a double mandate must apply - everyone must sell (that is health insurers must sell coverage to everyone who desires it) and everyone must buy (all consumers must purchase). Otherwise, those who are healthy would not participate and instead would wait until they needed it. Those who are already ill will purchase health insurance. As a result, insurance companies would only receive payments from those who need medical care, which can't possibly cover costs of chemotherapies and hospital stays which are in the tens of thousands per treatment. Since the healthy don't subsidize the sick, insurance companies would simply go bankrupt.
With the President and his Democratic party concerned about a Republican resurgence, he has already refocused his attention on large institutions like banks and redirecting the populace anger there rather than working on meaningful change. He may try the same tactic on insurers in an effort to get some healthcare reform passed.
In doing so, he may simply ignore the truth of the double mandate and make insurers not only cover everyone but also have the federal government set the rates. President Obama knows of course that it would only be a matter of time that the government would take over healthcare as insurers would have no choice but to pull out in this financially unsustainable model. If a single payer system occurs be prepared for rationing of medical care. Imagine long waiting lists to see a specialist, getting surgery done, or wondering if a treatment might be approved. Certainly some of these problems occur already with private insurers, but envision if the healthcare system was run by the DMV. Is this actually better?
It's equally as unfortunate and more disappointing that the Republican party over the past year essentially only had one mission - derail any proposals from the Obama administration. Without healthcare reform to make insurance coverage more affordable to employers, families, and individuals, America will no longer be viewed as the vibrant superpower nation it has been over the past couple of decades but a country unable to provide the basic healthcare needs to its populace because its politicians were too paralyzed to do anything but score political points for the next election. Because of their failure to lead, it is increasingly clear that in the United States healthcare coverage isn't a right but a luxury.
If Americans and employers are constantly worried about saving money for a future expensive illnesses or medical problems, then when will they ever feel secure enough or freed enough to take risks, invest, and dream?
Sunday, October 18, 2009
How to make your health insurance count as if your life depended on it
Five years ago, I penned an opinion piece which appeared in the San Francisco Chronicle titled, "How to make your health insurance count as if your life depended on it".
The most disturbing and troubling aspect of the piece is that if it was published today it would still be completely accurate. Healthcare quality still varies dramatically over the past decade despite the Institute of Medicine's 1999 landmark report "To Err is Human".
Even as many expect President Obama to have healthcare insurance reform bill requiring universal coverage signed by the end of this year, the reality is that it will still be a full decade before meaningful improvements in the healthcare system will be seen. That's optimistic to say the least.
What should you do? Make sure you make the right choices today so you will be around for years to come because it isn't clear even five years later after my opinion piece that the healthcare system is in any hurry to fix itself soon.
Who pays for this inertia? You do. But with some education (and even the critical insider tips from my book), you can get the best healthcare American medicine has to offer without overspending).
The op-ed piece follows.
How to make your health insurance count as if your life depended on it
It's that time again, and every year I dread this activity almost as much as April 15, or trying to find my wife the "perfect" Christmas gift. Typically, autumn is open-enrollment time for choosing a health-insurance plan. Though we gripe about increasing out-of-pocket costs, for most of us, health insurance is a hassle, a formality and not worthy of much attention. But we could be dead wrong. Unlike other products and services we purchase, health insurance makes it difficult for consumers to adequately determine whether it is worth their hard-earned dollars. As a result, many of us chose the plans based on cost or whether our doctors participate in the plan. This ignorance could cost you your life.
The National Committee of Quality Assurance estimates that this year, 79, 000 Americans (nearly twice the number who died of breast-cancer) died prematurely -- not because of hospital errors, misdiagnoses or negligence, but because they chose the wrong insurance plan. Had they selected a high- quality program, the simple things like controlling high blood pressure, lowering cholesterol and managing diabetes to levels recommended by the American Heart Association or the American Diabetes Association would have been reached and their lives prolonged.
When NCQA compared the performance of the top 10 percent of health plans with the national average on certain measures like breast-cancer screening, advising patients to quit smoking, immunization rates for flu shots, it discovered variability among plans exceeding 20 percent. If one used similar criteria to compare the safety performance of the top 10 percent of airline carriers with the national average, the quality gap was far less than 1 percent. The same applied for banking and manufacturing. How safe would you feel about flying if among the various airlines there was a quality variance of more than 20 percent? Yet, when it comes to health care, consumers don't appear to be concerned.
An additional frightening fact is that only 25 percent of all insured Americans have health plans that voluntarily provided their performance data for review by the NCQA . This means you have an increased chance of not knowing whether you're choosing a poor-quality health plan this year.
As if that weren't enough, during this enrollment period, the term "consumer-driven health plans" is the new catchphrase for cost containment. In an effort to save money, employers are less likely to provide comprehensive coverage, but rather directly give you the dollars to manage and spend on health care. Now you, not the health-insurance plan, will decide what tests, treatments and procedures you can afford. For your nagging sciatica, should you pay for an MRI of the spine or a CT scan to rule out a herniated lumbar disc? For your sake, with the burden of financial responsibility and the lack of consistency among health plans, you'd better hope you never ever get ill.
So what can you do? Although there is no national urgency to fix the problem, you aren't completely powerless. First, check out the NCQA Web site (http://www.ncqa.org/) and see if your health-plan options are accredited and approved by NCQA for providing high-quality health care. If not, consider talking to your human resources department and getting NCQA accredited programs on your roster next year. It's your money. Don't you deserve the best value and quality?
Next, take charge of your health now, get the overdue preventive screening tests done, and work with your doctor on getting the right treatment, not necessarily the newest.
Finally, do the boring but simple stuff: Get control of your blood pressure, lose weight, lower your cholesterol and stay active. These interventions really do save lives. How do I know? I am employed by one of the health plans highly rated by NCQA. My hope is that with hard work and some luck, you might just be around long enough to see an American health-care system that is known not as the most expensive, but the best at promoting a healthy and productive quality of life for us all.
The most disturbing and troubling aspect of the piece is that if it was published today it would still be completely accurate. Healthcare quality still varies dramatically over the past decade despite the Institute of Medicine's 1999 landmark report "To Err is Human".
Even as many expect President Obama to have healthcare insurance reform bill requiring universal coverage signed by the end of this year, the reality is that it will still be a full decade before meaningful improvements in the healthcare system will be seen. That's optimistic to say the least.
What should you do? Make sure you make the right choices today so you will be around for years to come because it isn't clear even five years later after my opinion piece that the healthcare system is in any hurry to fix itself soon.
Who pays for this inertia? You do. But with some education (and even the critical insider tips from my book), you can get the best healthcare American medicine has to offer without overspending).
The op-ed piece follows.
How to make your health insurance count as if your life depended on it
It's that time again, and every year I dread this activity almost as much as April 15, or trying to find my wife the "perfect" Christmas gift. Typically, autumn is open-enrollment time for choosing a health-insurance plan. Though we gripe about increasing out-of-pocket costs, for most of us, health insurance is a hassle, a formality and not worthy of much attention. But we could be dead wrong. Unlike other products and services we purchase, health insurance makes it difficult for consumers to adequately determine whether it is worth their hard-earned dollars. As a result, many of us chose the plans based on cost or whether our doctors participate in the plan. This ignorance could cost you your life.
The National Committee of Quality Assurance estimates that this year, 79, 000 Americans (nearly twice the number who died of breast-cancer) died prematurely -- not because of hospital errors, misdiagnoses or negligence, but because they chose the wrong insurance plan. Had they selected a high- quality program, the simple things like controlling high blood pressure, lowering cholesterol and managing diabetes to levels recommended by the American Heart Association or the American Diabetes Association would have been reached and their lives prolonged.
When NCQA compared the performance of the top 10 percent of health plans with the national average on certain measures like breast-cancer screening, advising patients to quit smoking, immunization rates for flu shots, it discovered variability among plans exceeding 20 percent. If one used similar criteria to compare the safety performance of the top 10 percent of airline carriers with the national average, the quality gap was far less than 1 percent. The same applied for banking and manufacturing. How safe would you feel about flying if among the various airlines there was a quality variance of more than 20 percent? Yet, when it comes to health care, consumers don't appear to be concerned.
An additional frightening fact is that only 25 percent of all insured Americans have health plans that voluntarily provided their performance data for review by the NCQA . This means you have an increased chance of not knowing whether you're choosing a poor-quality health plan this year.
As if that weren't enough, during this enrollment period, the term "consumer-driven health plans" is the new catchphrase for cost containment. In an effort to save money, employers are less likely to provide comprehensive coverage, but rather directly give you the dollars to manage and spend on health care. Now you, not the health-insurance plan, will decide what tests, treatments and procedures you can afford. For your nagging sciatica, should you pay for an MRI of the spine or a CT scan to rule out a herniated lumbar disc? For your sake, with the burden of financial responsibility and the lack of consistency among health plans, you'd better hope you never ever get ill.
So what can you do? Although there is no national urgency to fix the problem, you aren't completely powerless. First, check out the NCQA Web site (http://www.ncqa.org/) and see if your health-plan options are accredited and approved by NCQA for providing high-quality health care. If not, consider talking to your human resources department and getting NCQA accredited programs on your roster next year. It's your money. Don't you deserve the best value and quality?
Next, take charge of your health now, get the overdue preventive screening tests done, and work with your doctor on getting the right treatment, not necessarily the newest.
Finally, do the boring but simple stuff: Get control of your blood pressure, lose weight, lower your cholesterol and stay active. These interventions really do save lives. How do I know? I am employed by one of the health plans highly rated by NCQA. My hope is that with hard work and some luck, you might just be around long enough to see an American health-care system that is known not as the most expensive, but the best at promoting a healthy and productive quality of life for us all.
Thursday, September 10, 2009
President Obama's Address to Congress and the American Public
President Obama showed a clear understanding of the problems in the current healthcare system. To reform it will require political leadership to outline the goals and physician leadership among others to make it happen. The real question is whether either group is up to the task.
If either group fails, then America will simply have a nation less healthy, costing more, and unable to compete in a global marketplace. In the meantime, what will we do (as well as those millions underinsured or uninsured) between now and implementation in 2013?
In other words, over the next three years each of us will still need to navigate a healthcare system that increasingly is expensive bankrupting businesses and families without making us healthier compared to other industrialized companies that pay far less.
Even with reform, it will still take years for the reality of a healthcare system that is the envy of the world to take hold. What will each of us do between now and then to ensure that we stay healthy, live longer, and spend wisely?
The President's speech in its entirety.
If either group fails, then America will simply have a nation less healthy, costing more, and unable to compete in a global marketplace. In the meantime, what will we do (as well as those millions underinsured or uninsured) between now and implementation in 2013?
In other words, over the next three years each of us will still need to navigate a healthcare system that increasingly is expensive bankrupting businesses and families without making us healthier compared to other industrialized companies that pay far less.
Even with reform, it will still take years for the reality of a healthcare system that is the envy of the world to take hold. What will each of us do between now and then to ensure that we stay healthy, live longer, and spend wisely?
The President's speech in its entirety.
Sunday, August 2, 2009
Healthcare Debate - Common Misconceptions and the Truth
Associated Press released an excellent article - "FACT CHECK: Distortions rife in health care debate" which unfortunately won't be taken as seriously as 30 second soundbites that sadly distort the truth significantly.
As a doctor who is trained in scientific thinking and bases diagnoses and treatments on research, watching the robust discussion and the spin occurring is not only disappointing, but disheartening.
It's too easy to say single payer, malpractice reform, "evil" pharmaceutical and insurance companies, and "greedy" doctors, when the entire healthcare system needs overhaul. Frankly that is why the debate is so difficult. Perhaps as a result, we should be optimistic that with enough people engaged in the dialogue that the right set of answers and solutions will occur. That will only occur, however, after a painful but important conversation we must all have to advance our country forward.
The entire Associate Press article follows.
By CHARLES BABINGTON, Associated Press Writer Charles Babington, Associated Press Writer – Sun Aug 2, 12:58 pm ET
WASHINGTON – Confusing claims and outright distortions have animated the national debate over changes in the health care system. Opponents of proposals by President Barack Obama and congressional Democrats falsely claim that government agents will force elderly people to discuss end-of-life wishes. Obama has played down the possibility that a health care overhaul would cause large numbers of people to change doctors and insurers.
To complicate matters, there is no clear-cut "Obama plan" or "Democratic plan." Obama has listed several goals, but he has drawn few lines in the sand.
The Senate is considering two bills that differ significantly. The House is waiting for yet another bill approved in committee.
A look at some claims being made about health care proposals:
CLAIM: The House bill "may start us down a treacherous path toward government-encouraged euthanasia," House Republican Leader John Boehner of Ohio said July 23.
Former New York Lt. Gov. Betsy McCaughey said in a July 17 article: "One troubling provision of the House bill compels seniors to submit to a counseling session every five years ... about alternatives for end-of-life care."
THE FACTS: The bill would require Medicare to pay for advance directive consultations with health care professionals. But it would not require anyone to use the benefit.
Advance directives lay out a patient's wishes for life-extending measures under various scenarios involving terminal illness, severe brain damage and situations. Patients and their families would consult with health professionals, not government agents, if they used the proposed benefit.
CLAIM: Health care revisions would lead to government-funded abortions.
Tony Perkins of the Family Research Council says in a video, "Unless Congress states otherwise, under a government takeover of health care, taxpayers will be forced to fund abortions for the first time in over three decades."
THE FACTS: The proposed bills would not undo the Hyde Amendment, which bars paying for abortions through Medicaid, the government insurance program for the poor. But a health care overhaul could create a government-run insurance program, or insurance "exchanges," that would not involve Medicaid and whose abortion guidelines are not yet clear.
Obama recently told CBS that the nation should continue a tradition of "not financing abortions as part of government-funded health care."
The House Energy and Commerce Committee amended the House bill Thursday to state that health insurance plans have the option of covering abortion, but no public money can be used to fund abortions. The bill says health plans in a new purchasing exchange would not be required to cover abortion but that each region of the country should have at least one plan that does.
Congressional action this fall will determine whether such language is in the final bill.
CLAIM: Americans won't have to change doctors or insurance companies.
"If you like your plan and you like your doctor, you won't have to do a thing," Obama said on June 23. "You keep your plan; you keep your doctor."
THE FACTS: The proposed legislation would not require people to drop their doctor or insurer. But some tax provisions, depending on how they are written, might make it cheaper for some employers to pay a fee to end their health coverage. Their workers presumably would move to a public insurance plan that might not include their current doctors.
CLAIM: The Democrats' plans will lead to rationing, or the government determining which medical procedures a patient can have.
"Expanding government health programs will hasten the day that government rations medical care to seniors," conservative writer Michael Cannon said in the Washington Times.
THE FACTS: Millions of Americans already face rationing, as insurance companies rule on procedures they will cover.
Denying coverage for certain procedures might increase under proposals to have a government-appointed agency identify medicines and procedures best suited for various conditions.
Obama says the goal is to identify the most effective and efficient medical practices, and to steer patients and providers to them. He recently told a forum: "We don't want to ration by dictating to somebody, 'OK, you know what? We don't think that this senior should get a hip replacement.' What we do want to be able to do is to provide information to that senior and to her doctor about, you know, this is the thing that is going to be most helpful to you in dealing with your condition."
CLAIM: Overhauling health care will not expand the federal deficit over the long term.
Obama has pledged that "health insurance reform will not add to our deficit over the next decade, and I mean it."
THE FACTS: Obama's pledge does not apply to proposed spending of about $245 billion over the next decade to increase Medicare fees for doctors. The White House says the extra payment, designed to prevent a scheduled cut of about 21 percent in doctor fees, already was part of the administration's policy.
Beyond that, the nonpartisan Congressional Budget Office said the House bill lacks mechanisms to bring health care costs under control. In response, the White House and Democratic lawmakers are talking about creating a powerful new board to root out waste in government health programs. But it's unclear how that would work.
Budget experts also warn of accounting gimmicks that can mask true burdens on the deficit. The bipartisan Committee for a Responsible Federal Budget says they include back-loading the heaviest costs at the end of the 10-year period and beyond.
As a doctor who is trained in scientific thinking and bases diagnoses and treatments on research, watching the robust discussion and the spin occurring is not only disappointing, but disheartening.
It's too easy to say single payer, malpractice reform, "evil" pharmaceutical and insurance companies, and "greedy" doctors, when the entire healthcare system needs overhaul. Frankly that is why the debate is so difficult. Perhaps as a result, we should be optimistic that with enough people engaged in the dialogue that the right set of answers and solutions will occur. That will only occur, however, after a painful but important conversation we must all have to advance our country forward.
The entire Associate Press article follows.
By CHARLES BABINGTON, Associated Press Writer Charles Babington, Associated Press Writer – Sun Aug 2, 12:58 pm ET
WASHINGTON – Confusing claims and outright distortions have animated the national debate over changes in the health care system. Opponents of proposals by President Barack Obama and congressional Democrats falsely claim that government agents will force elderly people to discuss end-of-life wishes. Obama has played down the possibility that a health care overhaul would cause large numbers of people to change doctors and insurers.
To complicate matters, there is no clear-cut "Obama plan" or "Democratic plan." Obama has listed several goals, but he has drawn few lines in the sand.
The Senate is considering two bills that differ significantly. The House is waiting for yet another bill approved in committee.
A look at some claims being made about health care proposals:
CLAIM: The House bill "may start us down a treacherous path toward government-encouraged euthanasia," House Republican Leader John Boehner of Ohio said July 23.
Former New York Lt. Gov. Betsy McCaughey said in a July 17 article: "One troubling provision of the House bill compels seniors to submit to a counseling session every five years ... about alternatives for end-of-life care."
THE FACTS: The bill would require Medicare to pay for advance directive consultations with health care professionals. But it would not require anyone to use the benefit.
Advance directives lay out a patient's wishes for life-extending measures under various scenarios involving terminal illness, severe brain damage and situations. Patients and their families would consult with health professionals, not government agents, if they used the proposed benefit.
CLAIM: Health care revisions would lead to government-funded abortions.
Tony Perkins of the Family Research Council says in a video, "Unless Congress states otherwise, under a government takeover of health care, taxpayers will be forced to fund abortions for the first time in over three decades."
THE FACTS: The proposed bills would not undo the Hyde Amendment, which bars paying for abortions through Medicaid, the government insurance program for the poor. But a health care overhaul could create a government-run insurance program, or insurance "exchanges," that would not involve Medicaid and whose abortion guidelines are not yet clear.
Obama recently told CBS that the nation should continue a tradition of "not financing abortions as part of government-funded health care."
The House Energy and Commerce Committee amended the House bill Thursday to state that health insurance plans have the option of covering abortion, but no public money can be used to fund abortions. The bill says health plans in a new purchasing exchange would not be required to cover abortion but that each region of the country should have at least one plan that does.
Congressional action this fall will determine whether such language is in the final bill.
CLAIM: Americans won't have to change doctors or insurance companies.
"If you like your plan and you like your doctor, you won't have to do a thing," Obama said on June 23. "You keep your plan; you keep your doctor."
THE FACTS: The proposed legislation would not require people to drop their doctor or insurer. But some tax provisions, depending on how they are written, might make it cheaper for some employers to pay a fee to end their health coverage. Their workers presumably would move to a public insurance plan that might not include their current doctors.
CLAIM: The Democrats' plans will lead to rationing, or the government determining which medical procedures a patient can have.
"Expanding government health programs will hasten the day that government rations medical care to seniors," conservative writer Michael Cannon said in the Washington Times.
THE FACTS: Millions of Americans already face rationing, as insurance companies rule on procedures they will cover.
Denying coverage for certain procedures might increase under proposals to have a government-appointed agency identify medicines and procedures best suited for various conditions.
Obama says the goal is to identify the most effective and efficient medical practices, and to steer patients and providers to them. He recently told a forum: "We don't want to ration by dictating to somebody, 'OK, you know what? We don't think that this senior should get a hip replacement.' What we do want to be able to do is to provide information to that senior and to her doctor about, you know, this is the thing that is going to be most helpful to you in dealing with your condition."
CLAIM: Overhauling health care will not expand the federal deficit over the long term.
Obama has pledged that "health insurance reform will not add to our deficit over the next decade, and I mean it."
THE FACTS: Obama's pledge does not apply to proposed spending of about $245 billion over the next decade to increase Medicare fees for doctors. The White House says the extra payment, designed to prevent a scheduled cut of about 21 percent in doctor fees, already was part of the administration's policy.
Beyond that, the nonpartisan Congressional Budget Office said the House bill lacks mechanisms to bring health care costs under control. In response, the White House and Democratic lawmakers are talking about creating a powerful new board to root out waste in government health programs. But it's unclear how that would work.
Budget experts also warn of accounting gimmicks that can mask true burdens on the deficit. The bipartisan Committee for a Responsible Federal Budget says they include back-loading the heaviest costs at the end of the 10-year period and beyond.
Monday, July 20, 2009
Just Say NO to a Public Healthcare Plan
First let me be entirely clear. I agree that healthcare should be available to all and affordable. I agree that the current healthcare system is fragmented, not patient or doctor friendly, and is out of control (that is why I wrote my book to help every individual navigate our current nightmare we call the US healthcare system).
The problem is that fixing the healthcare system isn't simple and certainly shouldn't be done by the government. Plenty of myths exist including the following.
1. Medicare works. Why not expand Medicare for all?
One of the biggest myths is that Medicare is a success.
Hardly.
Medicare will become insolvent if nothing is done over the next 10 years. Patients who are on traditional governmental Medicare and not some complementary version of it via an insurance company (supplemental plan or Medicare HMO aka Medicare Advantage) are finding fewer and fewer doctors willing to take straight Medicare. Why? It doesn't reimburse enough to pay the bills. The program Medicaid, which serves the poor, is even worse. If patients do find a doctor who is taking straight Medicare or Medicaid there is often an intolerably long wait to be seen.
2. Government can squeeze costs out of the healthcare system by offering competition.
Sure, by playing hardball and setting prices which may be artificially low. The Obama administration should be commended for tackling the difficult problem of providing universal coverage (not to be confused with nationalization of healthcare) as well as making it affordable. President Obama can get there by setting reimbursement rates to fit his agenda. Whether the rates reflect reality is another question. This is why insurance companies are so concerned about a public plan.
Also, realize this. If there was an insurance company that was able to offer great coverage at a lower price, then why wouldn't it do so already? Typically low cost goods and services which are comparable to more expensive options do well in the marketplace. Why not with health insurance? Simple. Because there is no individual mandate, that is everyone needs to buy health insurance, health insurance is pricey as the young and healthy don't subsidize those who truly need it. As a result, the only purchasers are those who will use it causing costs to skyrocket.
If the government is so good at squeezing costs out, then why don't we have the government produce cheaper cars and set up an airline?
If the government wishes to expand healthcare, it must do the following at a minimum.
Simply offering a public insurance plan is not the answer and will drive insurance companies out of business.
When the government needed to step up and help citizens of Hurricane Katrina, it failed miserably and although it could be argued it was due to incompetence of certain individuals, the reality is that FEMA doesn't know how to move goods and people quickly and efficiently.
Who succeed to do their jobs exceedingly well and become the unlikely heroes? The private sector - specifically Fedex and Wal-mart, two organizations whose livelihood depend on getting things moved quickly and reliably.
President Obama should be commended. His goal should focus on changing the parameters which the healthcare system operates. It should not however have a new public plan as that would be a disaster.
As a side note, the Republicans are in complete disarray arguing that the healthcare system doesn't need fixing. It is broken. Simply saying no, doesn't help anyone deal with a crisis that left unchecked will bankrupt our country.
The problem is that fixing the healthcare system isn't simple and certainly shouldn't be done by the government. Plenty of myths exist including the following.
1. Medicare works. Why not expand Medicare for all?
One of the biggest myths is that Medicare is a success.
Hardly.
Medicare will become insolvent if nothing is done over the next 10 years. Patients who are on traditional governmental Medicare and not some complementary version of it via an insurance company (supplemental plan or Medicare HMO aka Medicare Advantage) are finding fewer and fewer doctors willing to take straight Medicare. Why? It doesn't reimburse enough to pay the bills. The program Medicaid, which serves the poor, is even worse. If patients do find a doctor who is taking straight Medicare or Medicaid there is often an intolerably long wait to be seen.
2. Government can squeeze costs out of the healthcare system by offering competition.
Sure, by playing hardball and setting prices which may be artificially low. The Obama administration should be commended for tackling the difficult problem of providing universal coverage (not to be confused with nationalization of healthcare) as well as making it affordable. President Obama can get there by setting reimbursement rates to fit his agenda. Whether the rates reflect reality is another question. This is why insurance companies are so concerned about a public plan.
Also, realize this. If there was an insurance company that was able to offer great coverage at a lower price, then why wouldn't it do so already? Typically low cost goods and services which are comparable to more expensive options do well in the marketplace. Why not with health insurance? Simple. Because there is no individual mandate, that is everyone needs to buy health insurance, health insurance is pricey as the young and healthy don't subsidize those who truly need it. As a result, the only purchasers are those who will use it causing costs to skyrocket.
If the government is so good at squeezing costs out, then why don't we have the government produce cheaper cars and set up an airline?
If the government wishes to expand healthcare, it must do the following at a minimum.
- Require everyone to purchase health insurance. With everyone participating, the costs of those who truly need it is spread across those who are healthy. Without an individual mandate, health care will be too expensive.
- Change the reimbursement structure on how doctors are paid. Massachusetts learned with their universal coverage that having insurance doesn't mean access and certainly doesn't mean better costs because doctors are paid to do more. A state panel recommended that doctors get paid a salary.
- Think seriously about capping damages for medical complications, malpractice, and misdiagnoses. Patients and families who are harmed should be adequately compensated, but not outrageous fees collected by lawyers, rather via an arbitration system. Too often, extraordinary damages may make the individual and family feel better, but often drive doctors out of the state. Many states have critical shortages of specialists for these reasons.
- Standardize benefits packages across the states. A health insurance plan for a healthy individual shouldn't vary significantly from San Francisco to New York any more than a car purchased on the different coasts are similar, but not identical. The large difference in health insurance costs for the same coverage is due to varying state requirements and simply adds more administrative costs and hassles with little benefit.
Simply offering a public insurance plan is not the answer and will drive insurance companies out of business.
When the government needed to step up and help citizens of Hurricane Katrina, it failed miserably and although it could be argued it was due to incompetence of certain individuals, the reality is that FEMA doesn't know how to move goods and people quickly and efficiently.
Who succeed to do their jobs exceedingly well and become the unlikely heroes? The private sector - specifically Fedex and Wal-mart, two organizations whose livelihood depend on getting things moved quickly and reliably.
President Obama should be commended. His goal should focus on changing the parameters which the healthcare system operates. It should not however have a new public plan as that would be a disaster.
As a side note, the Republicans are in complete disarray arguing that the healthcare system doesn't need fixing. It is broken. Simply saying no, doesn't help anyone deal with a crisis that left unchecked will bankrupt our country.
Wednesday, June 10, 2009
Cancer Causes Personal Bankruptcy
From the Today show both financial expert Jean Chatzky and chief medical correspondent Dr. Nancy Snyderman discuss the disturbing truth about the healthcare crisis that those with insurance are going bankrupt, particularly with cancer diagnoses.
I particularly thought that Ms. Chatzky should be commended for calling attention to that fact that people do spend more time researching vacation rather than understanding their health insurance benefits! They neglect their health not understanding that having good health is the most powerful financial asset they own.
If you are healthy you can always earn more money. If you are ill, you can have all the money in the world and never get back good health. The public doesn't get the right preventive care 1/2 the time in this country. Cancer caught early can be less costly with better survival.
The complex relationship between the ability to pay and the ability to get well is only going to get worse. That's why I wrote my book Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America's Healthcare System.
Medical costs are the leading cause of personal bankruptcy in this country. There is a financial reason that healthcare reform must occur. It is highly likely that President Obama will make it happen.
What it will look like is another story.
Visit msnbc.com for Breaking News, World News, and News about the Economy
I particularly thought that Ms. Chatzky should be commended for calling attention to that fact that people do spend more time researching vacation rather than understanding their health insurance benefits! They neglect their health not understanding that having good health is the most powerful financial asset they own.
If you are healthy you can always earn more money. If you are ill, you can have all the money in the world and never get back good health. The public doesn't get the right preventive care 1/2 the time in this country. Cancer caught early can be less costly with better survival.
The complex relationship between the ability to pay and the ability to get well is only going to get worse. That's why I wrote my book Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America's Healthcare System.
Medical costs are the leading cause of personal bankruptcy in this country. There is a financial reason that healthcare reform must occur. It is highly likely that President Obama will make it happen.
What it will look like is another story.
Thursday, May 21, 2009
Regulation Increases Health Insurance Costs. California Cheaper than New York.
I recently tried to help a relative purchase individual health insurance. He is in his 20s and lives in New York City. His current job does not provide health insurance benefits. He is healthy, does not smoke, and unfortunately since he is a college graduate he no longer qualifies for health insurance under his parents plan.
So naturally he asked me for help. What is absolutely shocking is how health insurance premiums very dramatically between the states. Using www.ehealthinsurance.com, I punched in his date of birth, smoking status, and ZIP code. He only had 12 choices of health insurance coverage with the least expensive being offered by Empire Blue Cross and Blue Shield at $151 per month and this is just for and indemnity plan.
A more comprehensive health insurance plan and the least expensive was $310 per month. This was being offered by Atlantis health plan which is a regional health plan, essentially restricted to the people of New York city. Because this insurance plan is so small, unfortunately, there isn't a lot of information externally about the quality of care delivered. The benefits however was that the co-pays were reasonable at $20 and there was no deductible. The down side is there is no prescription drug coverage. For that option it would be an additional $46 per month.
The next option, was offered by Oxford health plans. For a mere $372 per month, my relative could get a PPO plan but would have a $2850 deductible that would need to be met before health insurance kicked in. If there is any blessing in disguise, then it is that this program is attached to health savings account also known as an HSA. This is where people can defer money tax free, invest tax free, and spend tax free on qualified medical expenses.
If my relative moved to San Francisco, his health insurance rates will be far better with better options. Given the same information, he would have 115 choices with the least expensive being offered by Blue Shield of California at $52 per month, PPO plan with a $2900 deductible, 40% coinsurance, and $40 office visits. The next offering was from Aetna at $61 per month, PPO plan with a $5,000 deductible, 30% coinsurance, and $40 office visit. The first plan offers prescription drug coverage for generic medications, but not brand name. The latter covers both with generic medications at $15 and brand-name at $35, and those brand names nonpreferred list must meet a $500 deductible for medications before paying $50 per prescription.
Kaiser Permanente's least expensive offering was at $141 per month for a $1500 deductible, $30 office visit.
Why is this important? Although we live in the same country, and one could argue that the cost of living in San Francisco and in New York City are comparable, health insurance premiums vary wildly. This is most likely due to state regulations. Both New York and New Jersey have some of the most expensive health insurance plans in the nation. What if people in New York could get coverage at rates comparable to those in California? What would that mean to those who are uninsured, as well as reimbursement for doctors, hospitals, drugstores in New York?
What is even more critical to understand is that regulation although some well-intentioned can often increase costs and result in less than desireable outcomes. The huge variation in costs between health insurance and California and New York is more likely due to coverage and benefits insurers must offer in the latter state.
President Obama with his vision of improving the healthcare system, which I completely agree with, and his administration must be very careful on how it approaches that goal. For example, with the recent passage of credit card bill and increased regulation, we can expect fewer people to have access to credit. Don't believe what politicians are saying. Since two thirds of the U. S. economy is based on consumer spending and with tightening of credit due to increased regulation, we can expect that the insatiable appetite for goods and services will fall. Although the economy will ultimately turn around it will never be like it was in the past decade.
Good intentioned regulation may in fact increase healthcare costs. If the government tries to impose benefits and mandate an artificially low price, then we will find ourselves not with a privately run healthcare system but one run by the federal government. That would be a critical mistake.
So naturally he asked me for help. What is absolutely shocking is how health insurance premiums very dramatically between the states. Using www.ehealthinsurance.com, I punched in his date of birth, smoking status, and ZIP code. He only had 12 choices of health insurance coverage with the least expensive being offered by Empire Blue Cross and Blue Shield at $151 per month and this is just for and indemnity plan.
A more comprehensive health insurance plan and the least expensive was $310 per month. This was being offered by Atlantis health plan which is a regional health plan, essentially restricted to the people of New York city. Because this insurance plan is so small, unfortunately, there isn't a lot of information externally about the quality of care delivered. The benefits however was that the co-pays were reasonable at $20 and there was no deductible. The down side is there is no prescription drug coverage. For that option it would be an additional $46 per month.
The next option, was offered by Oxford health plans. For a mere $372 per month, my relative could get a PPO plan but would have a $2850 deductible that would need to be met before health insurance kicked in. If there is any blessing in disguise, then it is that this program is attached to health savings account also known as an HSA. This is where people can defer money tax free, invest tax free, and spend tax free on qualified medical expenses.
If my relative moved to San Francisco, his health insurance rates will be far better with better options. Given the same information, he would have 115 choices with the least expensive being offered by Blue Shield of California at $52 per month, PPO plan with a $2900 deductible, 40% coinsurance, and $40 office visits. The next offering was from Aetna at $61 per month, PPO plan with a $5,000 deductible, 30% coinsurance, and $40 office visit. The first plan offers prescription drug coverage for generic medications, but not brand name. The latter covers both with generic medications at $15 and brand-name at $35, and those brand names nonpreferred list must meet a $500 deductible for medications before paying $50 per prescription.
Kaiser Permanente's least expensive offering was at $141 per month for a $1500 deductible, $30 office visit.
Why is this important? Although we live in the same country, and one could argue that the cost of living in San Francisco and in New York City are comparable, health insurance premiums vary wildly. This is most likely due to state regulations. Both New York and New Jersey have some of the most expensive health insurance plans in the nation. What if people in New York could get coverage at rates comparable to those in California? What would that mean to those who are uninsured, as well as reimbursement for doctors, hospitals, drugstores in New York?
What is even more critical to understand is that regulation although some well-intentioned can often increase costs and result in less than desireable outcomes. The huge variation in costs between health insurance and California and New York is more likely due to coverage and benefits insurers must offer in the latter state.
President Obama with his vision of improving the healthcare system, which I completely agree with, and his administration must be very careful on how it approaches that goal. For example, with the recent passage of credit card bill and increased regulation, we can expect fewer people to have access to credit. Don't believe what politicians are saying. Since two thirds of the U. S. economy is based on consumer spending and with tightening of credit due to increased regulation, we can expect that the insatiable appetite for goods and services will fall. Although the economy will ultimately turn around it will never be like it was in the past decade.
Good intentioned regulation may in fact increase healthcare costs. If the government tries to impose benefits and mandate an artificially low price, then we will find ourselves not with a privately run healthcare system but one run by the federal government. That would be a critical mistake.
Wednesday, May 13, 2009
Medicare Won't Cover Virtual Colonoscopy - the Right Decision
In a clear blow to CT device manufacturers like General Electric, the Centers for Medicare and Medicaid Services (CMS) has decided not to cover virtual colonoscopy, which is a non-invasive way of screening for colon cancer.
It's the right decision. Although virtual colonoscopy was recommended by the American Cancer Society (ACS) as a reasonable alternative to the more invasive flexible sigmoidoscopy and colonoscopy, the issue with virtual colonoscopy is radiation exposure when other ways of screening already exist. Certainly from the perspective of ACS, which is an organization focused on increasing cancer screening and awareness, I understand the reason for adding virtual colonoscopy as an option.
But in the reality of the healthcare crisis and the goal of President Obama to make healthcare more affordable for all, decisions like this are inevitable where someone won't be happy with the outcome, in this case CT device manufacturers. With the announcement earlier this week that hospitals, insurers, doctors, device manufacturers will decrease the rate of health care expenses by 1.5% per year over the next decade, tough decisions will be made. Private insurers often follow CMS decisions, so don't expect to have virtual colonoscopy covered by your insurance company to screen for colon cancer.
The funny thing is this decision by CMS will be one of the easier decisions to make because other, although less comfortable procedures exist to screen for colon cancer. (Note that the preparation for all three procedures is the same. One needs to take a laxative to clear the colon of stool so that colon polyps can be visualized).
The other is that CMS will be using guidelines from the US Preventive Services Task Force in basing decisions. USPSTF bases recommendations on scientific evidence and tends to be the most conservative of any organization, like the American Heart Association, American Cancer Society, and various physician organizations.
CMS left the door open for reconsideration of virtual colonoscopy in the future, which is reasonable. Certainly the technology may evolve where radiation exposure is minimal to justify exposing people of average risk to a modality that potentially could increase other forms of cancer.
Review my March entry - Virtual Colonoscopy - Just Say No.
The entire article from the Associated Press follows:
Tue May 12, 10:18 pm ET
WASHINGTON – Medicare won't pay for the so-called virtual colonoscopy procedure, concluding Tuesday that there's inadequate evidence to support the cheaper, less intrusive alternative to the dreaded colonoscopy.
Some experts had hoped that popularizing the X-ray procedure would boost screening for colon cancer, the country's second leading cancer killer. Screening to spot early cancer or precancerous growths has resulted in fewer deaths over the last two decades.
But in a decision posted on its Web site, the Centers for Medicare and Medicaid Services said that the test does not qualify for Medicare coverage. The memo noted that the procedure is performed on people without symptoms and cannot, in itself, rid a patient of precancerous growths, like a regular colonoscopy can.
Medicare does cover regular colonoscopies, in which a long, thin tube equipped with a small video camera is snaked through the large intestine to view the lining. Any growth can be removed during the procedure.
CT colonography, also known as virtual colonoscopy, is a super X-ray of the colon that is quicker, cheaper and easier on the patient, but involves radiation. Both procedures involve preparation to clean out the bowels.
The Medicare memo notes that the virtual colonoscopy has shown better precision in detecting larger polyps than smaller ones.
There's been some division of opinion in the medical community over the virtual colonoscopy. Some doctors question its utility since, if a polyp is found, a regular colonoscopy would typically have to follow, anyway.
Others support it, saying it can result in early cancer detection. The American Cancer Society recommends it as an alternative to a regular colonoscopy.
A concern for Medicare officials, according to their decision Tuesday, was the effectiveness of the procedure for the Medicare population — people 65 and older — as opposed to younger patients. More data is needed to answer that, Medicare said.
The U.S. Preventive Services Task Force opted last fall not to give its stamp of approval to the virtual colonoscopy, citing the risk of radiation among other factors. Medicare said it took that decision into account in reaching Tuesday's determination, which is final.
Some private insurers cover the virtual procedure but others don't. Colonoscopies cost up to $3,000 while the X-ray test costs $300 to $800.
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