[Dialogue] Health care thoughts

[Karen Snyder]

In response to thoughts about health care, I am attaching (and  
printing below) Jim Troxel's take on it to add to the stew.  If you  
want to respond to him, please write him directly at troxel at consultmillennia.com 
.



Jim says:  I have been more than a little frustrated at the civic  
discourse surrounding the health care reform ideas that are  
circulating right now.  So, I decided to do a little of my own  
research into trying to uncover the truth behind some of the  
allegations.

Regardless of where you stand philosophically, it is important that  
all American citizens try to educate themselves and be able to know  
the difference between rhetoric and facts.  We can’t let a term like  
“death panels” go unexamined, for example.  It’s too inflammatory,  
does not lend itself to healthy debate, and does not represent the  
truth of the matter, as I try to address in this attached piece.

The goals of health care reform are lofty and may not be attainable in  
any Congressional bill.  But we have to find ways to curb the rising  
cost of health care and find a way to provide health care to the 46  
million Americans who do not have any, which, right now, includes  
Jonathan and Liz, now that he has been let go by his employer due to  
state budget cuts.  Meanwhile, due to my “prior conditions” (cancer  
and heart disease), the amount of money we fork out of pocket is –  
well, you don’t what to hear about it.

If anyone has a better collection of fact sources than I, I would  
appreciate your sharing them with me.  I am trying to make this as  
accurate as possible.

Enjoy -

Jim

What follows is also attached:

Frequently Uttered Misconceptions about Health Care Reform

1)         The United States has the BEST healthcare system in the  
world!

Unfortunately, no, it doesn’t. In fact, for the amount of money we  
spend, we have one of the worst amongst the industrialized nations of  
the world.  We rank 37th by the World Health Organization in terms of  
Health system performance. Countries that outperform us include every  
single Western European nation (France, Germany, Italy, Switzerland,  
Belgium, Canada, United Kingdom, Italy etc...), Middle Eastern  
countries (Saudi Arabia, UAE, and Israel), Latin American countries  
(our ‘poor’ neighbors to the South, Columbia, Chile, and Costa Rica)  
and even a few African countries. We just barely beat Slovenia and Cuba.

The irony is that we spend more on health care per capita than any  
other UN member nation.  And, a greater fraction of our national  
budget is spent on health care than Canada, Germany, France or Japan.   
In 2004 the US spent 92.7% per person more than any other G7 country  
on health care.  In a report that was quoted by the San Jose Mercury  
News (August 20, 2009), The US spent $2.4 trillion, or roughly 15% of  
GDP, on health care in 2008, 50% more per capita than any other  
industrialized nation.

As Peter Morici, a University of Maryland business professor and a  
former chief economist at the U.S. International Trade Commission,  
says in a commentary in the August 13, 2009, issue of the Chicago  
Tribune, “The U.S. spends about 18 percent of its gross domestic  
product on health care, while Canada and prosperous European nations  
spend about 12 percent.”  In addition, he says, “The U.S. has tens of  
millions of people who either can't get or afford health insurance.”

2)         The Current Health Care Bill Will Mandate Euthanasia.

No, it doesn’t and it won’t. There is nothing in any health care  
reform bill before Congress that would require people to "decide how  
they wish to die." Yet Conservative talking points from activists and  
legislators, including Sarah Palin, have suggested otherwise,  
misrepresenting the proposal as government “death panels”.

Section 1233 of the House bill would allow Medicare for the first time  
to cover patient-doctor consultations about end-of-life planning,  
including discussions about drawing up a living will or planning  
hospice treatment. Something anyone who is in their later years would  
naturally be interested in. These counseling sessions are not  
mandatory. Patients would, of course, seek out such advice on their  
own -- they would not be required to. The provision would limit  
Medicare coverage to one consultation every five years.
The contention that Democratic-sponsored healthcare bills would  
encourage euthanasia has circulated on the Internet for weeks. The  
nonpartisan group FactCheck.org, a project of the Annenberg Public  
Policy Center at the University of Pennsylvania, has refuted the claim  
as false and dismissed it as a distortion.  The allegation appears to  
be based on a provision of a House bill requiring Medicare to pay for  
end-of-life counseling sessions, on a voluntary basis, for  
beneficiaries who want the service. Medicare already covers hospice  
care. And legislation passed by Congress in 1990 requires that  
patients be asked if they have a living will.

The AARP and the AMA have come out in support of Section 1233 of the  
House bill.

Here is a link to the New York Times research into the source of the  
“death panel” distortion that appeared in their August 13, 2009,  
edition: http://www.nytimes.com/2009/08/14/health/policy/14panel.html?_r=1&hp 
.


3)         With Healthcare Reform, Americans Will Lose Their Private  
Insurance.

No, they won’t. The bill does not force private insurers out of  
business or force people onto the public plan.  The Congressional  
Budget Office, in fact, estimates the House bill would result in a net  
increase of 3 million Americans with employer-provided care.  In  
truth, it would be a GOOD thing if private insurers did go out of  
business, because their private profit is predicated on a diseased and  
sickened America trapped into going to their outrageously expensive  
‘resources’ for care (the ultimate captive market), but,  
unfortunately, that is not what is in the bill. Not even close.

4)         The Health Care Legislation Mandates Taxpayer Dollars Pay  
for Abortions

No, it doesn’t. In fact, the House Energy and Commerce Committee  
adopted an amendment, proposed by Rep. Lois Capps (D-Calif.) that  
would prohibit taxpayer dollars from funding abortions.  "Private  
health care providers are free to cover abortion, but not with federal  
funds," -- U.S. News and World Report.

5)         Americans Don't Want a Government-Run Health Care Plan

Yes, they do. Republicans have consistently berated the proposal for a  
government-sponsored health insurance plan, or "public option," as  
unpopular.

But, in fact, a CBS/ New York Times poll shows that, even though  
doubts have grown in recent months about Mr. Obama's health care  
proposals, 66 percent of Americans still want the government to  
provide a health insurance plan like Medicare to compete with private  
health insurers.

Another irony, though, is that the US system already has substantial  
public components. Of every dollar spent on health care in the US, 45  
cents comes from some level of government.  Furthermore, health care  
spending in the U.S. is also highly concentrated. In 1996, 5% of the  
population accounted for more than half of all costs.

Some funny things are showing up in some of these town hall meetings.   
At a recent one in a South Carolina suburb, for example, a man stood  
up and sternly told Republican Rep. Robert Inglis to "keep your  
government hands off my Medicare."  As Commentator Clarence Page says,  
“No wonder so many anxious Americans are so agitated about the  
possibility of ‘government health care.’  They don't even realize when  
they already have it.”   Actor Craig T. Nelson of the old TV series  
“Coach” threatened on Glen Beck’s Fox Network broadcast to stop paying  
his income taxes out of rage against government freeloaders. "I've  
been on welfare and food stamps...did anyone help me?" Nelson said,  
perhaps unaware that welfare and food stamps are two forms of help  
from taxpayers.

Having said all this, I must confess I resonate with Peter Morici, a  
University of Maryland business professor and a former chief economist  
at the U.S. International Trade Commission who said in a commentary in  
the August 13, 2009, issue of the Chicago Tribune, “Americans fear a  
moribund bureaucracy, akin to the post office, will be making critical  
decisions in their lives, and they will be left with the kind of  
recourse they now enjoy in tax disputes with the Internal Revenue  
Service.”   I believe those fears are genuine and are not being  
satisfactorily answered.  In my book, Government Works: Profiles of  
People Making a Difference (1995: Arlington, VA: Miles River Press), I  
cited 16 case studies of how the public sector CAN be responsible,  
effective and efficient.  But, as my niece Laurie recently pointed  
out, it’s only selling on Amazon.com for less than a $1.00.  Not a big  
call, is it?

By the way, according to a study published in the San Jose Mercury  
News in August of 2009, Medicare operates with just 8% overhead and  
cares for the vast majority of senior citizens of this country.  The  
average for private health care providers’ overhead ranges from 25% to  
35% over the last ten years.  Ergo, publically-provided health care  
CAN BE more cost efficient than Privately-provided health care.

6)         Healthcare Will Be Rationed With A Health Care Reform.

Healthcare will not be rationed. One of the misleading buzzwords in  
the health care debate is "rationing" -- the idea that patients will  
have limited treatment options if the government becomes more involved  
in health care delivery.

In fact, while a public plan would not be able to cover all  
procedures; private insurance plans do not either. The difference is,  
actual health needs will determine the priority on who gets care, not  
someone’s ability to pay. If you have the money, of course, you can  
always pay extra and get your nose job or breast implant done  
privately, pronto, rather than waiting behind the long line of  
critical care and cancer patients (for example) who will have priority  
in a public system.

 From Clarence Page: Rationing" is one of the scariest words in the  
health care debate.   It conjures up apocalyptic nightmare images from  
"Soylent Green," the sci-fi thriller about a future in which the old  
and weak are quietly lured into early extinction for the sake of  
future generations.   What the scaremongers don't like to talk about  
is how much our private insurers ration now -- mostly for the sake of  
their own profits.  They're clever enough to avoid using the R-word.  
They use other words, like "Read the fine print on your policy."

7)         Health Care Reform Is Not Urgent. We Should Take More Time  
To Study Matters.

Urgency is in the eye of the beholder. 46 million Americans currently  
have NO health insurance, which means something as simple as an auto  
accident could bankrupt them. During the span of Congress' three-week  
vacation this August, 43,250 people will lose their health insurance  
coverage, 53,507 people will file for bankruptcy because they can't  
pay their medical bills, and 1,265 people will die because they lack  
coverage.

8)         The Blue Dog Democrats Are Honestly Interested In Cutting  
Government Costs in Health Care Reform

No, they aren’t. Our so called ‘Blue dogs’, those self described  
fiscally conservative Democrats are in the back pockets of the drug  
and health insurance companies. Follow the money. When Blue Dog  
Democrats negotiated a compromise with Democratic leadership over  
certain elements of health care reform, they required the government- 
sponsored health insurance option that would be created to negotiate  
its own payment rates, rather than using Medicare payment rates, which  
will dramatically increase the costs to the American taxpayer. They  
also refused to allow cheaper drugs from Canada to compete with US  
firms.

According to a Congressional Budget Office preliminary analysis, the  
cost of those two changes would almost completely offset the $100  
billion achieved in savings elsewhere. It’s not about being fiscally  
conservative, it’s about helping the insurance companies and drug  
companies maintain their profit thresholds—at the expense of America’s  
health.

9)         Health Care Reform Will Cost Us Nearly One Trillion Dollars!

No, it won’t. First of all, that's not a trillion every year, as most  
people assume -- it's a trillion over 10 years, which is the way that  
people in Washington talk about federal budgets. On an annual basis,  
that translates to about $140 billion, when things are up and running.

Even that, however, grossly overstates the net cost to the government  
of providing universal coverage. Other parts of the reform plan would  
result in offsetting savings for Medicare: reductions in unnecessary  
subsidies to private insurers, in annual increases in payments rates  
for doctors and in payments to hospitals for providing free care to  
the uninsured. The net increase in government spending for health care  
would likely be about $100 billion a year, a one-time increase equal  
to less than 1 percent of a national income that grows at an average  
rate of 2.5 percent every year.
10)         Congress and the Democrats Are Pushing Us toward a  
Canadian-Style (or European-Style) “Socialized Medicine”, the So- 
Called “Single Payer System”.

Two ads from related independent groups make claims about an overhaul  
of the health care system, saying Congress wants a government-run  
health care system:

One ad claims that “Washington wants to bring Canadian-style health  
care to the U.S.” But the health care bills moving through Congress  
don’t call for a single-payer system like Canada’s, and legislation  
that does support a purely government-run system is quietly dying in  
committee. Obama, too, has said repeatedly that he doesn’t back a  
conversion to a single-payer system.
Another ad, targeting specific members of the Senate, similarly claims  
that “Congress is rushing to take over health care.” It says that a  
government health insurance option would cause “tens of millions” to  
move from their current insurance to a government plan. That claim is  
on the mark, according to one study, which found that millions would  
move from private insurance to a much cheaper government option.
  A group called Patients United Now also points to Rep. John Conyers’  
"Medicare for all" legislation, a single-payer health care bill that  
the Michigan congressman has introduced for several years running.  
This year, Conyer’s bill, H.R. 676, was introduced in January and  
hasn’t moved from committee since. It quietly died in committee in the  
last Congress and in previous attempts.

For a synopsis on the Canadian health care system, see the end of this  
article.

11)         The New Legislation Will Double Your Private Health Care  
Premiums.

  An ad from the group Conservatives for Patients’ Rights claims that  
"new rules could hike your health insurance premiums 95 percent."  
That’s misleading.

The claim in the ad refers to only 5 percent of Americans who have  
health insurance – those who buy it on their own.   The claim comes  
from an analysis by a group that advocates for insurance carriers that  
sell policies in the individual market, among other areas.  That  
analysis also doesn’t take into consideration several elements of  
leading congressional legislation that other experts say will keep  
premium costs down – and in fact, lower premiums for some. Other  
independent studies show premium costs decreasing on average for  
Americans that currently have health coverage.

It’s not true that any of the health care overhaul measures that have  
been approved by committees in Congress would add "a trillion to the  
federal deficit," as the ad says. The Senate bill would add roughly  
$597 billion over 10 years, and the House bill that was approved by  
the Ways and Means Committee in mid-July would add a much smaller $239  
billion, according to the Congressional Budget Office.
12)         Abortions Will Trump Care For The Elderly In Public Plan.

An anti-abortion group’s TV ad shows a white-haired man fretting that  
under a federal health plan, "They won’t pay for my surgery, but we’re  
forced to pay for abortions."
“Will this be our future?” the ad asks, merging the fears of seniors  
worried about their health care with those of anti-abortion advocates.  
“Our greatest generation, denied care. Our future generation, denied  
life."

In fact, none of the health care overhaul measures that have made it  
through the committee level in Congress say that abortion will be  
covered, and one of them explicitly says that no public funds will be  
used to finance the procedure. Furthermore, none of the bills call  
explicitly for cuts in Medicare coverage, much less rationing, under a  
public plan.
Sources for the above include:

Appleby, Julie. "Universal care appeals to USA". USA Today, 2006-10-16 http://www.usatoday.com/money/industries/health/2006-10-15-universal-usat_x.htm 
.

Baicker, Katherine and Chandra, Amitabh.  "Myths And Misconceptions  
About U.S. Health Insurance: Health care reform is hindered by  
confusion about how health insurance works," Health Affairs, October  
21, 2008

Berk, Marc L. and Monheit, Alan C.  "The Concentration Of Health Care  
Expenditures, Revisited", Health Affairs, Volume 20, Number 2, March/ 
April 2001.

CBSNews. "Poll: The Politics Of Health Care" CBSNews March 1, 2007

Chicago Tribune – The Swamp Blog - http://www.swamppolitics.com/news/politics/blog/2009/08/obamas_healthcare_live_from_to.html

Congressional Budget Office - http://www.cbo.gov/

FactCheck.org a project of the Annenberg Public Policy Center at the  
University of Pennsylvania - http://www.factcheck.org/

Morici, Peter.  Commentary: “Health-care reform and divine rights:  
whom should Americans believe in the debate”, Chicago Tribune, August  
13, 2009.  http://www.chicagotribune.com/news/opinion/chi-oped0913healthaug13,0,7513838.story

Page, Clarence, Editorial columnist for the Chicago Tribune - http://www.chicagotribune.com/news/columnists/chi-oped0809pageaug09,0,1132739.column

White House website: Reality Check - http://www.whitehouse.gov/realitycheck/

Wikipedia.org - http://en.wikipedia.org/wiki/Health_care_reform_in_the_United_States

World Health Organization - WHO (May 2009). "World Health Statistics  
2009



Canadian Health Care System

  This was contributed to me by my friend and colleague, Robert Rafos,  
who has joint Canadian-USA citizenship, having lived in Canada much of  
the last 20 years:

Canada assumes that health care is a right and not a privilege.  It  
starts with everyone being covered.  When someone loses their job or  
changes companies they don't lose their health coverage.  There are no  
pre-condition restrictions for health care.

Hospitals are usually affiliated with a city or university with a few  
private clinics.  They receive some government funds, but also raise  
funds from the public to cover their cost.  Doctors are in private  
practice, and can have as many patients as they want to care for.   
Procedures and payment schedules are established by the government.   
Drug prescriptions are mandated to be the generic version, unless the  
doctor feels the condition requires a brand name.  Again, prices for  
drugs are established by the government.

Patients are free to choose any primary physician they want.  When  
specialists are required the primary physician will recommend several  
choices, and the patient chooses.  For urgent and emergency conditions  
the treatment is immediate and top notch.  For non-emergency  
procedures, for example I have had cataract and arthroscopic knee  
surgeries.  I had to wait a reasonable time to get them done.  There  
is a strong emphasis on preventative care with tests and screening  
prescribed.  Some of those are EKG, colonoscopy, bone density,  
mammograms, chest x-rays, annual physical, complete blood and urine  
workup, PAP test, PSA, colon screening, annual eye-exams etc.  We pay  
nothing for our drugs and nothing for our medical procedures.

Many people have supplemental health insurance through their employer  
or union.  This coverage supplements things like private room in a  
hospital and massage, chiropractor, acupuncture, eye glasses, dental,  
and for those under 65 drug supplements.

Each province administers its own plan, and also receives some funding  
and support from the Federal government.  The cost is paid from the  
provincial tax receipts along with transfer payments from the Federal  
government.  I acknowledge that taxes are higher in Canada and health  
care is one component of that cost.  However, I gladly pay it so that  
I can sleep at night knowing I, my family and fellow citizens have  
access to some to the best health care in the world.

*****     *****     *****

  In order to get the conversation back to real issues rather than  
made-up ones, I offer my own 14 point plan.  Please feel free to edit,  
amend, argue for or against, add others and I will be glad to keep a  
running list on this.   Jim Troxel


Features of a Health Care Reform Bill

Overall goals:
1.       Curb the rising tide of health care costs.  Lower the costs  
for those who have medical coverage already.
a.       Factoid: According to a study published in the American  
Journal of Medicine on June 5, 2009, the biggest reason for one going  
into personal bankruptcy is medical debt accounting for 62% of all  
bankruptcies.
b.      Factoid: According to the World Health Organization in their  
May 2009 Statistical Yearbook, the US health care system is the most  
expensive in the world.
2.       Provide coverage for the 46 million Americans (1/7 th of the  
population) who have no insurance at all)
a.       Factoid: According to the Institute of Medicine of the  
National Academy of Sciences, the US is the “only wealthy  
industrialized nation that does not ensure that all its citizens  
health care coverage.” (Report issued January 14, 2005.)

Specific components:
1.                   Shore up the Medicare subsidies for prescription  
drugs (that is, reduce the gap between what pharmaceuticals charge and  
what Medicare currently covers)
2.                   Allow for a menu (cafeteria style service  
options) of insurance coverage options
3.                   Make it harder for insurance companies to limit  
coverage based on pre-existing conditions
4.                   If someone already has health insurance, continue  
to keep the government out of one’s health care decisions.  If you  
like your doctor, you can keep your doctor. If you like your health  
care plan, you can keep your health care plan.  Getting health  
insurance should be a matter of choice; if you don’t want it, fine.   
If you do want health insurance, you should be able to get affordable  
health care.
5.                   Stop health insurance companies’ practice of  
cherry-picking who they cover; hold insurers to higher standards for  
what they cover.
6.                   Limit the amount your insurance c company can  
force you to pay out-of-pocket health care costs
7.                   Stop the practice of health insurance companies  
denying coverage because of a pre-existing condition, previous illness  
or injury.  A 2007 national survey shows that insurance companies  
discriminated against more than 12 million Americans in the previous  
three years because they had a pre-existing illness or condition. The  
companies either refused to cover the person, refused to cover a  
specific illness or condition or charged a higher premium.
8.                    Require insurance companies to cover routine  
checkups, preventive care and screening tests like mammograms and  
colonoscopies.
9.                   If you are laid off a company that provided you  
health insurance coverage, have government pay the ex-employee COBRA  
match for 18 months (the maximum length of COBRA requirements) or  
until you have employment again.
10.               Extend the number of years an adult child could be  
covered by their parents’ health insurance until the child has reached  
the age of 30.
11.               Institute tort reform – limit (cap) the damages paid  
out to plaintiffs who win their medical malpractice suits which,  
according to one study, accounts for 57% of the rising cost of health  
insurance.   For starters, impose caps on non-economic losses and  
punitive damages, as well as on "contingent fees", or fees set by the  
plaintiff's attorney as a percentage of damages awarded to the  
plaintiff.  (Tort reform is a complicated issue and probably will not  
get addressed in the current health care reform bill debate.  However,  
it is one that nonetheless needs to be addressed.)
12.               Debunk the myth that the reason prescription drugs  
cost more in the US is because the US bears the cost of research and  
development on behalf of rest of the world.  This is the excuse  
pharmaceuticals give for the high cost of drugs in America.  It is  
also the reason why many Americans have elected to purchase their  
drugs from Canada or Mexico.
13.               Reduce the costs of prescription drugs.  The U.S.  
spends the most on pharmaceuticals per capita in the world.  National  
expenditures on pharmaceuticals accounted for only 12.9% of total  
health care costs, compared to an average of 17.7% for other highly  
industrialized countries.  Some 23% of out-of-pocket health spending  
by individuals is for prescription drugs.
14.               One of the ways that has been proposed to cover the  
uninsured is to increase those covered by Medicaid to include a wider  
range of American citizens.  The key advantage to this approach is  
that does not require the establishment of another new bureaucracy in  
federal government, but rather takes one that works already and  
expands it.



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