In Sickness and In Pelf
« on: 2009-06-26 04:42:29 »
Op-Ed Contributor: Shifting America from sick care to genuine wellness
Source: Yahoo.com Authors: Sen. Tom Harkin (D-Iowa) Dated: 2009-06-25
Sen. Tom Harkin (D-Iowa) is a senior member of the Senate Health, Education, Labor and Pensions Committee and chairs the Senate panel that funds medical research and health care.
With the Senate health committee convening daily to craft a comprehensive health reform bill, the basic outline of this landmark legislation is now clear.
Yes, it will ensure access to affordable, quality care for every American. But, just as important, it will hold down health care costs by creating a sharp new emphasis on disease prevention and public health.
As the lead Senator in drafting the Prevention and Public Health section of the bill, I view this legislation as our opportunity to recreate America as a genuine wellness society – a society that is focused on prevention, good nutrition, fitness, and public health.
The fact is, we currently do not have a health care system in the United States; we have a sick care system. If you’re sick, you get care, whether through insurance, Medicare, Medicaid, SCHIP, community health centers, emergency rooms, or charity. The problem is that this is all about patching things up after people develop serious illnesses and chronic conditions.
We spend a staggering $2.3 trillion annually on health care – 16.5 percent of our GDP and far more than any other country spends on health care – yet the World Health Organization ranks U.S. health care only 37th among nations, on par with Serbia.
We spend twice as much per capita on health care as European countries, but we are twice as sick with chronic disease.
How can this be so? The problem is that we have systematically neglected wellness and disease prevention. Currently in the United States, 95 percent of every health care dollar is spent on treating illnesses and conditions after they occur. But we spend peanuts on prevention.
The good news in these dismal statistics is that, by reforming our system and focusing on fighting and preventing chronic disease, we have a huge opportunity. We can not only save hundreds of billions of dollars; we can also dramatically improve the health of the American people.
Consider this: Right now, some 75 percent of health care costs are accounted for by heart disease, diabetes, prostate cancer, breast cancer, and obesity. What these five diseases and conditions have in common is that they are largely preventable and even reversible by changes in nutrition, physical activity, and lifestyle.
Listen to what Dr. Dean Ornish told our Senate health committee: “Studies have shown that changing lifestyle could prevent at least 90 percent of all heart disease. Thus, the disease that accounts for more premature deaths and costs Americans more than any other illness is almost completely preventable, and even reversible, simply by changing lifestyle.”
It’s not enough to talk about how to extend insurance coverage and how to pay for health care – as important as those things are. It makes no sense just to figure out a better way to pay the bills for a system that is dysfunctional, ineffective, and broken. We also have to change the health care system itself, beginning with a sharp new emphasis on prevention and public health.
We also have to realize that wellness and prevention must be truly comprehensive. It is not only about what goes on in a doctor’s office. It encompasses workplace wellness programs, community-wide wellness programs, building bike paths and walking trails, getting junk food out of our schools, making school breakfasts and lunches more nutritious, increasing the amount of physical activity our children get, and so much more.
I am heartened by the fact that the major players in this endeavor – Democrats and Republicans alike – all “get it” when it comes to prevention and public health. We all agree that it must be at the heart of reform legislation.
As President Obama said in his speech to Congress earlier this year: “[It is time] to make the largest investment ever in preventive care, because that's one of the best ways to keep our people healthy and our costs under control.”
No question, comprehensive health reform is an extraordinarily ambitious undertaking. But what makes me optimistic is that all the major groups are playing a constructive role, including those that opposed the 1993-94 heath reform effort. Everyone agrees that the current system is broken.
Winston Churchill famously said that “Americans always do the right thing – after they’ve tried everything else.” Well, we’ve tried everything else, and it has led us to bad health and the brink of bankruptcy.
Comprehensive health reform legislation is our opportunity to change the paradigm. We are going to extend health insurance to every American. And we are going to give our citizens access to a 21st century health care system – one that is focused on helping us to live healthy, active, happy lives.
With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
Re:In Sickness and In Pelf
« Reply #1 on: 2009-07-21 23:30:36 »
Reform of U.S. health care is a must
Source: SouthEast Missourian Authors: Will Richardson Dated: Saturday, July 18, 2009
Will Richardson is director of outreach and education at the SEMO Alliance for Disability Independence in Cape Girardeau.
Well-financed opponents have launched a blitzkrieg of public disinformation in an attempt to derail reform of health care in America. They employ a host of scare tactics, including the overused friend in Canada or relative in England who finds all kinds of fault in those countries' health-care systems. Of course, we also hear that people in those countries would not trade their systems for ours. But discussing other countries' success or failure misses the point and diverts attention from our real challenge: providing quality affordable health care to all Americans.
It is claimed that our health-care system is the best in the world, and it is -- if you are rich. Health-insurance premiums in Missouri are increasing at a rate four times that of wages, and private insurance for a family of four now averages over $12,000 a year. More than 200 Missourians and more than 14,000 Americans lose health-care coverage every day. Where 63 percent of workers used to be covered by employer-provided health care, the number has dropped to 56 percent and is falling fast. A recent report revealed that 62 percent of bankruptcies in our country are related to health-care costs, an increase of 50 percent from 2001 to 2007. Most families affected were middle-class homeowners with good-paying jobs and private health insurance coverage but were still overwhelmed by medical expenses. In another study, it was found that 25 percent of people had put off or failed to get vital health care when they needed it due to cost.
Families who planned well and thought they were covered by employer-provided or self-paid private insurance find themselves dumped by insurers after they become ill. In California, the state has sued numerous large insurers for unfair denial of coverage, and millions of Americans are rejected for coverage due to previously existing conditions. The Missouri State Insurance Department reports that of more than 2,700 formal complaints in the first half of 2009, most involved denial of claims by individual insurers.
Opponents of health-care reform are quick to deny these statistics and claim most Americans don't want reform. Yet polls from Quinnipiac, CBS/New York Times and NBC/Wall Street Journal all show overwhelming support for a public health-care option.
But statistics don't tell the entire story. At SEMO Alliance for Disability Independence, we see the pain and suffering of those affected by this crisis every day, including a growing population that has found itself in a devastating health-care black hole. These are people ages 55 to 65 who have worked hard all of their lives and find themselves out of work. They lose employer-provided insurance, can't get Medicare until they are 65, can't afford COBRA on unemployment benefits and, tragically, learn that age is treated as a pre-existing condition by private insurers who will soak them on premiums or refuse to cover them at all. Many face losing their homes and retirement benefits in order to pay medical bills. [ Hermit : Which might explain why suicide is the 11th leading cause of death in the US - and why the fastest growing group of suicides are those over 65 ]
Industry lobbyists portray private insurers as some sort of David threatened by the Goliath of a public health-care system. They claim competition would be eliminated, costing millions their health-care coverage. Yet, according to a study by the American Medical Association, health insurance is already a near monopoly in most markets, and "health insurers are posting historically high profit margins, while patient health-insurance premiums continue to rise without an expansion of benefits." Another favorite scare tactic of lobbyists is the notion that the government wants to dictate where, how and by whom you are treated and ration health care. But isn't that what private insurance companies are already doing?
A recent article rationalized the soaring cost of health care by saying we should expect to pay more because health care today is filet mignon compared to the hamburger that we use to get. But starving people do not insist on filet mignon. Right now, millions of Americans would be grateful for the hamburger of basic health care at a reasonable cost. If only filet is available, only the rich will eat, and increasingly the average American is priced out of the health-care market by soaring insurance premiums, overpriced durable medical equipment and outrageous prescription drug costs. Many are simply excluded by insurers who have a free hand in deciding who gets coverage and who isn't profitable.
America's health-care system can be compared to the sinking Titanic. The third-class passengers (the poor) on the lower decks have already drowned. The second-class passengers (the middle class) in the center of the ship are being inundated as the water rises higher. For the moment, the first-class passengers (the rich) are dry and happy on the upper deck, claiming the ship isn't sinking. A few passengers are lucky enough to occupy the life rafts (Medicare). All will sink if something isn't done.
To be sure, the shortage of primary-care physicians, out-of-control malpractice litigation [ Hermit : This is a perpetual myth malpractice insurance and litigation costs are between 1% and 2% of costs to a practice. ] and societal issues such as obesity, smoking and overuse of emergency rooms are issues that also cannot be left to fester. But lobbyists for the health insurance, durable medical equipment and prescription drug industries and others who reap huge profits from the existing mess are spending millions of dollars each day to steamroll Congress into maintaining the status quo. This is a fight that Americans cannot afford to lose to special interests. Their good health literally depends on it.
With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
Re:In Sickness and In Pelf
« Reply #2 on: 2009-07-26 02:44:58 »
Barack Obama's health reform plans are a bitter pill for his personal doctor
President Barack Obama's personal doctor for more than two decades is bitterly disappointed by the health care reforms being pushed through Congress at the urging of his former patient.
Source: The Telegraph Authors: Leonard Doyle Dated: 2009-07-25
Dr David Scheiner remains a big fan of the man he treated for 22 years in Chicago. But does not believe the planned overhaul goes far enough to help the poor and uninsured, and will cost too much because of pressure from the health care industry.
The 71-year-old physician, who has treated low income patients for his entire career in the city's Hyde Park neighbourhood, believes Mr Obama favours an NHS-style "single payer" system, but backed away under pressure from the health industry.
"He's a pragmatist, he wants to get something done" Dr Scheiner told The Sunday Telegraph. "But this time he should have pushed back hard against the health care lobby."
He is bitterly disappointed in the way the reforms are being organised and says he was bounced from the invitation list to a White House event because of pressure from the health lobby.
"I was all set to go to an event, I got an email from the White House the Sunday before and then suddenly I was told 'there were too many people' coming," he said. "I think they knew I was going to ask an awkward question about the single payer option."
He contends that the reforms winding their way though Congress "could bankrupt us because there are no real cost controls and the big beneficiaries will be private hospitals and insurance companies".
Dr Scheiner argues that Americans have been terrified by the advertising campaigns of what he calls the "medical industrial complex" into believing that they will lose their own health care coverage if a government-run plan is created.
Dr Sheiner's concern is for the 46 million Americans who are uninsured today and who will be covered by a government-backed insurance scheme.
He says the system being created will be far more expensive than it needs to be, as a result of pressure from the health care industry, he says. "The insurance companies will also play a major role in the administration of the new public plan'," he said "and that's going to be disastrous."
"I'm not sure he (Obama) really understands what goes on in primary care," Dr Scheiner said. "He doesn't see all the pain; it's so tragic out here. Obama's wonderful, but on this one I'm not sure if he's getting good advice."
The "single payer" system would cover everyone's health care and eliminate the huge profits of specialists, hospitals and insurers, Dr Scheiner believes. It was doomed from the outset by being labelled "socialised medicine," however. [ Hermit : Dr Scheiner is a smart man. ]
He said that Mr Obama was always "in magnificent health" and during the election campaign last year he vouched for the candidate's "excellent" condition.
With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
Re:In Sickness and In Pelf
« Reply #3 on: 2009-08-04 14:22:55 »
Health Care Protests Grow Like Weeds in August Lobbyists and tea party protesters team up during congressional summer recess Source: NBC Philadelphia Authors: Sara K. Smith Dated: 2009-09-04
August is usually what the Media Elite like to call a "slow news month," but maybe this one will be different, because every day some news organ will be able to run comical footage of legislators getting harassed to death by angry (and occasionally fake) constituents who don't like all this talk about healthcare reform.
Across the nation, the same conservative lobbying groups that brought you the infamous teabagger protests are organizing to flood town hall meetings with outraged yokels shouting about socialism.
Some legislators have already faced the terrifying spectacle of bestickered mobs chanting "Just Say No!" or reciting the Pledge of Allegiance (which, you will recall, was written specifically by Thomas Jefferson to secure a citizen's fealty to a free-market health care scheme).
Americans for Prosperity, the conservative interest group, recently had tea party protesters show up at a town hall meeting being held by the staff of Missouri Senator Claire McCaskill. Groups like this plan to spend August doing the same thing, dozens of times over, while they simultaneously flood the airwaves with ads picking apart reform legislation, bit by bit.
And, according to a memo [PDF] written by a volunteer for the Tea Party Patriots, many more politicians can expect this treatment in the near future.
The objective is to put the Rep on the defensive with your questions and follow-up. The Rep should be made to feel that a majority, and if not, a significant portion of at least the audience, opposes the socialist agenda of Washington. They need to leave the hall with some doubts about their agenda.
So whereas August used to be the month in which congresspeople and senators could return to their home districts for quiet, thoughtful sit-downs with voters, it will now be the month when they confront carefully coached gaggles of protesters whose stated objective is to raise the suspicion that a majority of voters in their district don't want health care reform, regardless of whether that's true or not.
Of course, it's every citizen's right to attend whatever town halls they want to, and to shout whatever they feel like at whomever they want. Our federal lawmakers are, by and large, grownups, and should not wilt under a fusillade of talking points from astroturfing wingnuts. Right?
With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
Ah, health care reform. The subject has been debated for so long that it's devolved into minutiae, and for some reason those minutiae are being debated by fuckheads with deep financial ties to the status quo. Because the media frowns on terms like "fuckheads", they have dubbed these people "Blue Dogs". So I think it's important to take a step back and remind these Blue Dogs, and the people who might be able to exercise power and influence over them, why we're bothering to reform health care in the first place. And that reason is, if you need health care in America, you're fucked.
For-profit health insurance will fuck you. The real problem with private health insurance in America is that it's largely a complete fucking sham. I mean, insurance in general is a bit of a con job and a shell game, but health insurance is by far the worst in that regard. The whole idea behind insurance is a bit like voluntary, for-profit taxation. Everyone who gets insurance from a private company pays into that private company. In turn, that private company pays out to anyone who needs it. The private company makes a profit because most people don't need the payouts most of the time.
If you have car insurance, you can go years and years and years without having an accident. And the longer you go without an accident, the less your car is worth, so if you eventually do have one, the payout is even smaller. Home insurance is the same way. The insurance company takes in money all the time, but only gives out money when problems happen. And in most cases, the odds are that the insurance companies can turn a profit by only fucking over a small percentage of their customers. Of course, they can make BIGGER profits by being evil bastards, and many of them are, but it's still possible to run an auto insurance or home insurance business profitably and vaguely, sort of, ethically.
Health insurance is a different beast. Everyone gets sick. Not only that, everyone gets sick over and over again. And the older they get, the more likely they are to get sick. You know who the ideal health insurance customer is? Someone who starts paying premiums at 18 and gets run over by a bus, killed instantly, at age 30. And those people make up a very small percentage of the population. Ergo, for-profit health insurance will fuck you.
They may not have fucked you yet. They may not fuck you tomorrow. But at some point, when you become a threat to the profit margin, they will find a way to fuck you. It's inevitable. It happens constantly. The only way to get out of being fucked by health insurance is either to have enough money to pay for everything anyway, or to be important enough that they don't dare fuck you. This is why Blue Dogs and Republicans can somehow manage not to see the need for comprehensive health care reform. First, because they have great coverage. Second, because they have a lot of money. And third, the health insurance companies know the instant some low-level bureaucrat in the claims department denies coverage for Max Baucus' Viagra prescription, the Congress will pass European-style single-payer before you can finish saying "socialized medicine murders the elderly". The rest of us, with no power to fuck the insurance companies back? We're fucked.
If you're uninsured, you're fucked. Maybe you can be "lucky" enough to be poor enough to qualify for the current medical safety net, but since they'll never raise taxes to keep up with the cost of coverage, you will eventually get fucked the way all the poor people in California are about to get fucked. Otherwise, you're not covered at all, in which case you're fucked, because you will eventually get sick, and when that happens, you will either go bankrupt or die or, most likely, both. Good luck with that!
If you're insured, you're probably underinsured, either because you yourself can't afford a decent plan, or your employer is trying to control costs. Which means eventually, sooner rather than later, you'll get sick with something they won't pay for, and then you'll go bankrupt or you'll die, or, most likely, both. Good luck with that, too.
If you happen to be one of those rare middle-class people with a decent employer-based plan, you're fucked. Why? Because eventually you will get sick. And then you'll have a pre-existing condition, which means you'd better hope you work at that job for the rest of your life, staying on the same plan, because if you get laid off, or get hired by a different company with a different insurer, they won't pay for the treatment of the pre-existing condition, and then you will either go bankrupt, or die, or most likely, both. Again, I wish you the best of luck with that.
And if you're happy with, and able to, stay at that job and with that provider for the rest of your life after you get sick, eventually, you will get so sick that they will find an excuse to stop paying to treat you, because that's what they do. That's what they spend the money on that you and your employer send them. Accountants and administrative types who tweak the rules so that they can get away with fucking you once you get too expensive. And once you get too expensive, you will either go bankrupt, or die, or most likely, both. Luck doesn't really enter into it anymore.
And the best part? All this fucking? All this death and bankruptcy? It all exists for one reason. So that a bunch of assholes at the head of companies like United HealthGroup can make more money in a week than you will make in your entire life. Isn't that wonderful? Doesn't that make you feel warm and tingly inside? If you feel warm and tingly inside for more than four hours, don't consult your doctor, because odds are your policy doesn't cover that.
This is why we need a government option, since we can't even consider a single-payer system for some reason. Because even if the government health plan fucks us, through bureaucratic indifference, incompetence, and even rationing? Even if the government plan is as bad as the Republicans say it is, and we all get pushed out on ice floes to die when we turn 70? At least we won't get fucked for money. At least people won't end up bankrupted to buy some CEO another yacht. At least the government won't pay an administrative person $50,000 a year to figure out how to deny $50,001 a year in coverage so that some upper management asshole has a buck to tip his caddy with.
Even if NOTHING ELSE changed about the health care system, I would consider it valuable reform if, at a bare minimum, people weren't getting rich off all the horror and the tragedy and the nightmares people are going through in America every time they fall ill. Is that too much to ask? It is when the rich assholes are the ones with a dozen Blue Dogs in their back pocket. Any version of "health care reform" that doesn't address the systematic fucking over of the American people in the pursuit of pure profit is a sick joke at all our expense, no matter how "bipartisan" it is.
Re:In Sickness and In Pelf
« Reply #5 on: 2009-08-07 21:14:48 »
What this country needs is a huge outburst of common sense
[ Hermit : Apropos of something, that was a lovely rant you posted Mylon. I wrote a long response to it, but I see now it was somehow lost on the way to the server. Here is more along the same lines, taking an analytic look at the hysteria overwhelming the Repugnican sheeple. ]
If ever there were a time for comprehensive health care reform, it's now, and yet the forces of darkness are lining up against this urgent need, buttressed by lies, mobs inflamed by those lies and millions of dollars changing hands and changing votes in Washington, D.C.
The idea that doing nothing and going on without changing the way this country's health care is delivered works to the benefit only of the insurance companies, the giant health care providers and the big pharmaceutical companies.
That industry is now pouring $1.4 million A DAY into lobbying — read that buying or renting members of Congress — to water down or delay or preferably kill health care reform and hope it goes away for another 20 years or so.
Part of that high-dollar industry budget is going to the low end of Washington's K Street lobbying corridor, the firms and the folks who specialize in dirty tricks, panicking the uninformed and most vulnerable citizens, financing the creation and spread of lies written, spoken and spread like viruses by robot dialing machines.
The Republican Party, on life support itself, somehow sees an opportunity in encouraging and participating in this flim-flam operation. It ought to, and should, seal the GOP's fate.
Each night for the past week, we've been treated to the sight of mobs screaming and ranting and shouting down town hall meetings where congressional representatives had come to answer their constituents' questions.
No questions got answered. No information got provided. No one left more informed than he or she was when he or she arrived.
That's because they and their organizers were following on-line playbooks that are telling them where to go, where to sit, how to make it appear as if there are more of them than there are and, above all, to stop the program and allow no discussion of this issue.
They scream that any government-run health care is socialism or Communism. But look at them; look at their gray hair and thickened waists. At least half of them probably depend entirely on Medicare, a government-run program and a damned good one, for their own health care.
They scream that the bills still being written and amended in Congress will deny vital treatments for older Americans and doom them to an early and unnecessary death. Some dare call it euthanasia.
What utter, unadulterated BS.
The only outfits in America that have the right to refuse you treatment for an illness or deny you an organ transplant are the health care corporations, if you're unlucky enough to have to depend on that wonderful private insurance the right wingnuts are so loudly praising and defending.
This is the same wonderful health coverage that's driven hundreds of thousands of American families into bankruptcy because their private insurers refused to pay for urgently needed surgery or cancer treatment, or simply cancelled their coverage.
Why is that?
It's because those same corporations have, in just one decade, driven their profits and overhead (hiring those lobbyists and buying those congressional critters and building their fleets of private jets) from 5 percent to nearly 20 percent.
In other words, the corporate bite has gone from 5 cents of every dollar paid in premiums to 20 cents of every premium dollar.
It's good old unregulated American greed of the same stripe that drove this country into its current economic meltdown. Wall Street loves these guys.
We desperately need a government-run health care program that can, by good old American competition, force private health insurers to get off their pirate ships and back in the real world. The 46 million or so uninsured Americans need somewhere to get their health needs tended. The millions more in dire danger of losing their jobs and their private insurance need some alternative immediately available.
All of us need some people in Congress who haven't been bought or rented by the pirates, liars and thieves to speak out in favor of filling those real needs.
Wonder how much Big Pharma donated to the key committee members who amended the health care legislation to prohibit any government-run health program from negotiating lower drug prices with the price-gouging drug companies of, you guessed it, Big Pharma?
What we need right now is a huge outburst of common sense and enlightened self-interest.
Those gray-haired Medicare recipients who're playing angry mob need to stop screaming and start listening and reading, separating fact from fiction and learning who’s manipulating them and why.
Follow the money trail back to the pirates and thieves and their handmaidens, the greasy liar lobbyists and those in Congress who're slurping at their troughs.
With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
Re:In Sickness and In Pelf
« Reply #6 on: 2009-08-07 21:22:34 »
Expanding Health Coverage May Not Improve Access
[ Hermit : Here is a highly analytical article based on the linked report pointing to the facts I have been attempting to highlight since the late 1990s, that significant components in the catastrophic collapse in and soaring cost of American healthcare are not only related to the usurious margins of insurers and inflated administrative costs, but even more the total lack of a first tier care system as much as the protectionist measures which have been used to control the number of general practitioners and manage competition in the drug industry. It isn't the health care system that is morbid, but the political system that sold the people it was supposed to represent down the river for a handful of goodies. ]
Even if Congress extends health coverage to the nation's 46 million uninsured Americans, there's no guarantee that everyone will have access to care -- unless payment reforms and new models of care are adopted, some experts say.
Significantly expanding coverage without reforming health-care delivery is "a recipe for failure," said Alwyn Cassil, a spokeswoman for the Center for Studying Health System Change in Washington, D.C. "You won't be able to sustain the expanded coverage because it will just bankrupt us."
Spending on health care this year is projected to reach $2.5 trillion, or 17.6 percent of the U.S. gross domestic product, according to a Kaiser Family Foundation analysis of Medicare and Medicaid data. That's up from 7.2 percent in 1970, and by 2018 it could swell to one-fifth of the GDP, which is a measure of all goods and services produced in the United States.
Meanwhile, a worsening shortage of primary-care providers and rising demand for certain specialists will continue to strain the system, perhaps creating long waits for appointments.
The existing health-care delivery system cannot seamlessly respond to a surge in demand for services, said Jeffrey Bauer, a medical economist.
This is "one of the Achilles heels of reform," said Bauer, management consulting partner at Affiliated Computer Services Inc. and leader of the health futures practice at ACS Healthcare Solutions in Chicago.
"People are already strapped to get a doctor," Bauer said. "As more people have insurance, they will try to get appointments with more doctors, and that will lead to dramatic increases in the time it takes to get an appointment."
Depending on the coverage people have, where they live and whether they have an existing relationship with a physician, some Americans could encounter long delays in getting in to see a doctor.
In Boston, the average wait time for an appointment with a family physician is 63 days -- the highest among 15 metropolitan markets surveyed by the national physician recruitment firm Merritt, Hawkins & Associates in Irving, Texas. The 15-city average was 20.3 days.
Boston's long wait times may be driven by Massachusetts' 2006 health reform legislation, which expanded health insurance coverage to nearly everyone in the state, Merritt, Hawkins noted. Many health policy experts worry that similar access problems will be experienced nationwide if Congress enacts legislation extending health insurance coverage.
Patients on Medicaid already have difficulty accessing health-care providers, according to a recent national online consumer survey by PricewaterhouseCoopers (PWC) Health Research Institute. Nearly a third of Medicaid patients reported waiting 30 days or more for an appointment with a doctor.
What's more, many Americans still use the emergency room inappropriately. According to PWC's consumer survey, more than half of those who went to the emergency room in the last year did so for non-emergency reasons.
"One of the key things that we have found is that the emergency room turns out to be the front door for many folks trying to gain access into the health-care system," said Dr. David Chin, a principal in PricewaterhouseCoopers and leader of its Health Research Institute.
The Institute's findings appear in a new report, "Jammed access: Widening the front door to healthcare".
To improve access without boosting the cost of care, some health-care organizations across the country are experimenting with different models of care, the report finds. One is the use of online consultations for patients who don't require a face-to-face visit.
"Many insurers now are, in fact, engaged in pilots to pay for electronic visits," Chin said.
Another is the growing use of mobile electronic devices to monitor, say, a patient's blood sugar or blood pressure and transmit the results by cell phone to the patient's doctor.
The report also spotlights growth in retail and work-site clinics and notes that some health organizations are exploring a model of care in which a team of health-care providers works collaboratively to address a patient's health-care needs.
But creating a system of care that encourages coordination-of-care will require a shift away from the traditional fee-for-service method of reimbursement, Cassil noted. "How we address payment reform will have everything to do with how the delivery system becomes more efficient."
With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
Re:In Sickness and In Pelf
« Reply #7 on: 2009-08-09 07:13:07 »
The Me-First, Screw-Everyone-Else Crowd
Source: TruthDig.com Authors: David Sirota Dated: 2009-08-07
David Sirota is the author of “Hostile Takeover” (2006) and “The Uprising” (2008). His blog is at http://www.OpenLeft.com.
I know I should be mortified by the lobbyist-organized mobs of angry Brooks Brothers mannequins who are now making headlines by shutting down congressional town hall meetings. I know I should be despondent during this, the Khaki Pants Offensive in the Great American Health Care and Tax War. And yet, I’m euphorically repeating one word over and over again with a big grin on my face.
Finally.
Finally, there’s no pretense. Finally, the Me-First, Screw-Everyone-Else Crowd’s ugliest traits are there for all to behold.
The group’s core gripe is summarized in a letter I received that denounces a proposed surtax on the wealthy and corporations to pay for universal health care:
“Until recently, my family was in the top 3 percent of wage earners,” the affluent businessperson fumed in response to my July column on taxes. “We are in the group that pays close to 60 percent of this nation’s taxes. ... Think for a second how you would feel if you built a business and contributed more than your share to this country only to be treated like a pariah.”
This sob story about the persecuted rich fuels today’s “Tea Parties”—and I’m sure you’ve heard some version of it in your community.
I’m also fairly certain that when many of you run into the Me-First, Screw-Everyone-Else Crowd, you don’t feel like confronting the faux outrage. But on the off chance you do muster the masochistic impulse to engage, here’s a guide to navigating the conversation:
What They Will Scream: We can’t raise business taxes, because American businesses already pay excessively high taxes!
What You Should Say: Here’s the smallest violin in the world playing for the businesses. The Government Accountability Office reports that most U.S. corporations pay zero federal income tax. Additionally, as even the Bush Treasury Department admitted, America’s effective corporate tax rate is the third-lowest in the industrialized world.
What They Will Scream: But the rich still “pay close to 60 percent of this nation’s taxes!”
What You Should Say: Such statistics refer only to the federal income tax. When considering all of “this nation’s taxes” including payroll, state and local levies, the top 5 percent pay just 38.5 percent of the taxes.
What They Will Scream: But 38.5 percent is disproportionately high! See? You’ve proved that the rich “contribute more than their share” of taxes!
What You Should Say: Actually, they are paying almost exactly “their share.” According to the data, the wealthiest 5 percent of America pays 38.5 percent of the total taxes precisely because they make just about that share—a whopping 36.5 percent!—of total national income. Asking these folks to pay slightly more in taxes—and still less than they did during the go-go 1990s—is hardly extreme. [ Hermit : Much more significantly, under 1% of Americans now hold over 80% of the wealth in the US, while the US now holds over 90% of the world's wealth. The fact that much of this wealth is notional based on derivative valuations does not affect the reality that this tiny population effectively exercises control of the world's financial system and thus the world. ]
Stripped of facts, your conversation partner will soon turn to unscientific terrain, claiming it is immoral to “steal” and “redistribute” income via taxes. Of course, he will be specifically railing on “stealing” for stuff like health care, which he insists gets “redistributed” only to the undeserving and the “lazy” (a classic codeword for “minorities”). But he will also say it’s OK that government sent trillions of dollars to Wall Streeters. [ Hermit : In which case it may be worth asking what it is when wealthy people get tax breaks on houses that the poor people cannot afford and thus have to rent - while paying some of the taxes subsidising the wealthy? ]
And that’s when you should stop wasting your breath.
What you’ve discovered is that the Me-First, Screw-Everyone-Else Crowd isn’t interested in fairness, empiricism or morality.
With 22,000 of their fellow countrymen dying annually for lack of health insurance and with Warren Buffett paying a lower effective tax rate than his secretary, the Me-First, Screw-Everyone-Else Crowd is merely using the argot of fairness, empiricism and morality to hide its real motive: selfish greed.
No argument, however rational, is going to cure these narcissists of that grotesque disease.
With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
Re:In Sickness and In Pelf
« Reply #8 on: 2009-08-19 05:25:33 »
This Is Reform?
[ This really should go on the "dismal failure" thread, but I'll hold off until the date rape of America is complete. ]
Source: New York Times Authors: Bob Herbert Dated: 2009-08-17
It’s never a contest when the interests of big business are pitted against the public interest. So if we manage to get health care “reform” this time around it will be the kind of reform that benefits the very people who have given us a failed system, and thus made reform so necessary.
Forget about a crackdown on price-gouging drug companies and predatory insurance firms. That’s not happening. With the public pretty well confused about what is going on, we’re headed — at best — toward changes that will result in a lot more people getting covered, but that will not control exploding health care costs and will leave industry leaders feeling like they’ve hit the jackpot.
The hope of a government-run insurance option is all but gone. So there will be no effective alternative for consumers in the market for health coverage, which means no competitive pressure for private insurers to rein in premiums and other charges. (Forget about the nonprofit cooperatives. That’s like sending peewee footballers up against the Super Bowl champs.)
Insurance companies are delighted with the way “reform” is unfolding. Think of it: The government is planning to require most uninsured Americans to buy health coverage. Millions of young and healthy individuals will be herded into the industry’s welcoming arms. This is the population the insurers drool over.
This additional business — a gold mine — will more than offset the cost of important new regulations that, among other things, will prevent insurers from denying coverage to applicants with pre-existing conditions or imposing lifetime limits on benefits. Poor people will either be funneled into Medicaid, which will have its eligibility ceiling raised, or will receive a government subsidy to help with the purchase of private insurance.
If the oldest and sickest are on Medicare, and the poorest are on Medicaid, and the young and the healthy are required to purchase private insurance without the option of a competing government-run plan — well, that’s reform the insurance companies can believe in.
And then there are the drug companies. A couple of months ago the Obama administration made a secret and extremely troubling deal with the drug industry’s lobbying arm, the Pharmaceutical Research and Manufacturers of America. The lobby agreed to contribute $80 billion in savings over 10 years and to sponsor a multimillion-dollar ad campaign in support of health care reform.
The White House, for its part, agreed not to seek additional savings from the drug companies over those 10 years. This resulted in big grins and high fives at the drug lobby. The White House was rolled. The deal meant that the government’s ability to use its enormous purchasing power to negotiate lower drug prices was off the table.
The $80 billion in savings (in the form of discounts) would apply only to a certain category of Medicare recipients — those who fall into a gap in their drug coverage known as the doughnut hole — and only to brand-name drugs. (Drug industry lobbyists probably chuckled, knowing that some patients would switch from generic drugs to the more expensive brand names in order to get the industry-sponsored discounts.)
To get a sense of how sweet a deal this is for the drug industry, compare its offer of $8 billion in savings a year over 10 years with its annual profits of $300 billion a year. Robert Reich, who served as labor secretary in the Clinton administration, wrote that the deal struck by the Obama White House was very similar to the “deal George W. Bush struck in getting the Medicare drug benefit, and it’s proven a bonanza for the drug industry.”
The bonanza to come would be even larger, he said, “given all the Boomers who will be enrolling in Medicare over the next decade.”
While it is undoubtedly important to bring as many people as possible under the umbrella of health coverage, the way it is being done now does not address what President Obama and so many other advocates have said is a crucial component of reform — bringing the ever-spiraling costs of health care under control. Those costs, we’re told, are hamstringing the U.S. economy, making us less competitive globally and driving up the budget deficit.
Giving consumers the choice of an efficient, nonprofit, government-run insurance plan would have moved us toward real cost control, but that option has gone a-glimmering. The public deserves better. The drug companies, the insurance industry and the rest of the corporate high-rollers have their tentacles all over this so-called reform effort, squeezing it for all it’s worth.
Meanwhile, the public — struggling with the worst economic downturn since the 1930s — is looking on with great anxiety and confusion. If the drug companies and the insurance industry are smiling, it can only mean that the public interest is being left behind.
With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
Nearly 45,000 people die in the United States each year -- one every 12 minutes -- in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday.
"We're losing more Americans every day because of inaction ... than drunk driving and homicide combined," Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Harvard, said in an interview with Reuters.
Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage.
The findings come amid a fierce debate over Democrats' efforts to reform the nation's $2.5 trillion U.S. healthcare industry by expanding coverage and reducing healthcare costs.
President Barack Obama's has made the overhaul a top domestic policy priority, but his plan has been besieged by critics and slowed by intense political battles in Congress, with the insurance and healthcare industries fighting some parts of the plan.
The Harvard study, funded by a federal research grant, was published in the online edition of the American Journal of Public Health. It was released by Physicians for a National Health Program, which favors government-backed or "single-payer" health insurance.
An similar study in 1993 found those without insurance had a 25 percent greater risk of death, according to the Harvard group. The Institute of Medicine later used that data in its 2002 estimate showing about 18,000 people a year died because they lacked coverage.
Part of the increased risk now is due to the growing ranks of the uninsured, Himmelstein said. Roughly 46.3 million people in the United States lacked coverage in 2008, the U.S. Census Bureau reported last week, up from 45.7 million in 2007.
Another factor is that there are fewer places for the uninsured to get good care. Public hospitals and clinics are shuttering or scaling back across the country in cities like New Orleans, Detroit and others, he said.
Study co-author Dr. Steffie Woolhandler said the findings show that without proper care, uninsured people are more likely to die from complications associated with preventable diseases such as diabetes and heart disease.
Some critics called the study flawed.
The National Center for Policy Analysis, a Washington think tank that backs a free-market approach to health care, said researchers overstated the death risk and did not track how long subjects were uninsured.
Woolhandler said that while Physicians for a National Health Program supports government-backed coverage, the Harvard study's six researchers closely followed the methodology used in the 1993 study conducted by researchers in the federal government as well as the University of Rochester in New York.
The Harvard researchers analyzed data on about 9,000 patients tracked by the U.S. Centers for Disease Control and Prevention's National Center for Health Statistics through the year 2000. They excluded older Americans because those aged 65 or older are covered by the U.S. Medicare insurance program.
"For any doctor ... it's completely a no-brainer that people who can't get health care are going to die more from the kinds of things that health care is supposed to prevent," said Woolhandler, a professor of medicine at Harvard and a primary care physician in Cambridge, Massachusetts.
With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
Just before the Senate Finance Committee wrapped up for the long weekend, members debated one of Sen. Jon Kyl's (R-AZ) amendments, which would strike language defining which benefits employers are required to cover.
Sen. Debbie Stabenow (D-MI) argued that insurers must be required to cover basic maternity care. (In several states there are no such requirements.)
"I don't need maternity care," Kyl said. "So requiring that on my insurance policy is something that I don't need and will make the policy more expensive."
Stabenow interrupted: "I think your mom probably did."
With or without religion, you would have good people doing good things and evil people doing evil things. But for good people to do evil things, that takes religion. - Steven Weinberg, 1999
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