[Oe List ...] [Dialogue] health care reform

[McCabe, Terence W]

Here is something I heard on NPR from a guy who spent two years comparing healthcare around the world:
The nations that have private insurance companies playing a significant role in their system have one thing in common (except the US model): All the health insurance is non-profit. The companies must make their profit on all the other kinds of insurance that they sell. They try their best to offer the most effective health care in order to get all the other insurance business they can. Sounds good to me.
Terry McCabe
________________________________________
From: oe-bounces at wedgeblade.net [oe-bounces at wedgeblade.net] On Behalf Of Geri Tolman [gdtolman at comcast.net]
Sent: Friday, August 28, 2009 2:12 PM
To: 'Order Ecumenical Community'
Subject: Re: [Oe List ...] [Dialogue] health care reform

Helping my 93-y.o. mom navigate her way thru doctors/pharmacies/insurers I've gathered many illustrations of fraud, waste, and abuse in the system.  I could have a full-time job exposing the inflated charges her Florida doctors submit to Medicare....and they know we track their bills carefully.   Imagine what they submit for the Octogenarians and Nonagenarians who have no family around them.

A brief look at the history of insurance companies, the businesses they've retreated from (e.g., State Farm and All State after Katrina), and what portions of their business they are growing (medical, long-term care), shows that they have known for a long time where their greatest profits come from.  That their allegiance is to their stockholders should not surprise anybody.  We've always known this - look at every city's high-rise buildings.....Kemper didn't give us that building out of the goodness of their hearts - the tax write-off was good for their bottom line.  We milked that all over the world for all the in-kind donations we could scrape up!

After having us wait another 15 minutes while his nurse-practitioner met with those cute young pharmacy sales-reps in the waiting room, mom's cardiologist told us that "if Obama's medical reform goes thru, you won't be seeing me any more.  I'll quit.  I can hardly afford to stay in business as it is."  (He's one of those cardio guys who spends every Thursday at the hospital doing "stent" procedures.)  He tries to get her to take a "treadmill stress test" annually - he owns the equipment - nice return on his submission to Medicare on that one.  The last 2 years, she's told him her back is too sore!  (I told her she's my "Rosa Parks")
I tested him a bit to see if he knew how many different bills were floating around the House and the Senate, and what was actually being proposed.  He said he didn't have time to read all of that detail, but that the AMA keeps him up-to-date on what's happening.  At the risk of endangering mom's rapport with him, I shut up.

When dad was still alive, a Florida eye doctor diagnosed mom and dad with "early-stage glaucoma".  I've discovered it's known among eye-doc circles as "an easy $1,000/year" diagnosis.  Requires quarterly check-ups & purchase of expensive eye drops (from the doc's office!)  My eye doctor examined them both - no glaucoma.  Mom's been asking around among her neighbors who are also his patients ..... you know the rest of this story.

I, too, was repulsed at those folks who were being so disruptive at town meetings on the topic of health-care reform; then I was reminded that it was Saul Alinsky (whom we lauded as a great community reformer) who developed those tactics a few decades ago.  Can't cry "foul" on that;  have to establish better environments in which useful debate can flourish.

It's difficult to build and maintain a productive dialogue when all discussion is dissolved into sound bites and creative ideas are pounced on and shredded before given a chance to expand and mutate into useful threads.  We all know how setting the context (laying the ground rules) for a brainstorming session is so crucial......when respectful listening, ruminating, and a group's expanding and building on individual ideas is cut off by vitriol and grand-standing, everyone loses.

Remember "no clean hands"?
Remember "trans-establishment"?
Remember starting with confession, first....

We need outside-the-box thinking - Corptocracy (thanks, George) has taken over every aspect of our lives, from our local sports arenas to our grocery store shelves (see: The End of Overeating by Dr. David Kessler; also King Corn, documentary and/or book) and hospitals.   See also the website www.storyofstuff.com<http://www.storyofstuff.com> or view exerpts on You Tube (just Google: "The Story of Stuff"), or send them a $15 donation for the CD, expose your kids and grandchildren to it.  My kids were offended; my grandkids were fascinated.  It speaks to the fact that business and government have teamed up - that government no longer sees its role as "protecting the consumer", and that our government is no longer Of, By and For the People.

NPR's NewsHour last evening had a very informative segment on Health Care Reform - they had two myth-busters who were also available online to answer questions afterwards - one guy was from FactCheck.org - we need a lot more of that - but then there's the conundrum that folks who listen to Rush Limbaugh don't listen to NPR.

Was our nation ever as polarized as it is now?  Civil War years....yes, but mass media magnifies it so much more.....remember the Viet Nam War years?  What did we learn from the divisiveness of those years that can help us in this current debate?  Those of you who get out and go to the meetings in your towns have probably noticed this.....the same folks are there every time.  Another example of preaching to the choir.

Randy's 3rd paragraph gets to the heart of the matter, for me.  We're at a tipping point on this issue.  We need for Obama's Administration to pull off some meaningful reform before the next election changes the make-up of the House and Senate.  Hopefully that reform will be good enough to convince the nay-sayers that it was needed, and a stronger health-care system can continue to mutate from there.

And what George said about people who like their insurance probably haven't had to use it.....so true.  One wealthy guy we know uses the term "self-insurance".  In other words, he doesn't have an insurance policy - he goes to the best doctors and pays directly.  Wait until he's brought to an Emergency Room!  For now, he lives in his own little world, and doesn't give a damn about being his "brother's keeper".  And he's really pissed that Obama wants toraise his taxes!

Those of us who want to embody the trans-establishment on this divisive issue need a series of "short courses"  (our brand of "sound bite") which we can use in conversing with our neighbors.  Anyone want to start a list?  For instance, can someone elaborate on how the provision of healthcare for those who can't afford it is in the enlightened self-interest of those who can?  Many of you have worked within the healthcare system for years.  Can you help us out?
Is it enough to switch the focus to Health Insurance Reform?

Hopefully,
Geri Tolman
( gdtolman at comcast.net<mailto:gdtolman at comcast.net> )

________________________________
From: oe-bounces at wedgeblade.net [mailto:oe-bounces at wedgeblade.net] On Behalf Of R Williams
Sent: Friday, August 28, 2009 11:13 AM
To: Order Ecumenical Community
Subject: Re: [Oe List ...] [Dialogue] health care reform

Another strand of the contradiction is good old American individualistic overemphasis.  No doubt extravagant healthcare costs in this country can be laid at the feet of the greed of the insurance companies and the pharmas, and the inefficiency of the medical data management system and of government--not just the feds but the states and (at least in Texas) counties as well, just to name a few.

But if all that should get solved there will still be people who cannot afford adequate healthcare whatever the cost.  Anyway you slice it universal healthcare is going to increase the tax burden, and that's where the individualism kicks in, expressed frequently these days in the form of rants at healthcare town meetings with the sentiment, "Mine works and if yours doesn't, screw you."  As George suggested, those who like it probably haven't had to use it.

As a nation we have not bought into the proposition that we are our brothers' and sisters' keepers, that healthcare is a birthright, that the provision of healthcare to those who cannot afford it is in the enlightened self-interest of the those who can, that this is indeed a moral issue, and that community finally works only when everyone promotes and protects the common good.  The point is, there are workable (not perfect) solutions out there if we as a nation but have the political will and moral courage to change what we know does not work.

There is precedent.  As a nation we also lacked political will and moral courage to pass civil rights legislation in 1964, but MLK got LBJ by the scruff of the neck and drug him to the promised land, and then got voters' rights legislation passed on top of that after Johnson said all his political capital was gone.  I had hoped that President Obama would be able to form some kind of bi-partisan coalition to get healthcare solved, but that doesn't appear to be the case.  A healthy Teddy Kennedy may could have done it, but that possibility is gone as well.  The President is going to have to see, that as desirable as compromise and consensus may be, the priority is getting the system reformed.  I believe he will come to that conclusion very soon, if for no other reason than political expediency.

Randy Williams
rcwmbw at yahoo.com<mailto:rcwmbw at yahoo.com>

--- On Fri, 8/28/09, George Holcombe <geowanda at earthlink.net> wrote:

From: George Holcombe <geowanda at earthlink.net>
Subject: Re: [Oe List ...] [Dialogue] health care reform
To: "Order Ecumenical Community" <oe at wedgeblade.net>
Date: Friday, August 28, 2009, 9:06 AM

Another part, and I'm not sure of the statistics, is medical care for the poor and the "undocumented."  I have occasion to visit the emergency rooms of Austin hospitals several times a month and they are always filled day or night with women and children.  Wait times are extended.  Some of the emergency physicians I have known tell me they are giving up or are moving to other states, because most of the work is pediatric and GP medicine.  A couple of the hospital administrators I've met tell me the costs are killing them.  Giving people tax credits to purchase health insurance will hardly cover people who don't make enough to pay income taxes.

I've also noticed news items reporting hugh profits of the health insurance companies and hugh compensation for CEOs.  I wonder what that contributes to health or wellness care.  I keep receiving more and more beautiful magazines and  a steady stream of statements and other advertisements in the mail from the health insurance company we use, and we seldom make use of its services.  It has no option to receive all this through email.  That's got to cost a lot of money.  We've also received bills for lab tests after the insurance company said they were paying the cost, and we have to fax them their own agreement, sometimes more than once to prove the point.  It's always a hassle. In shopping for specialists, some of the doctors they claim on their lists, tell us they are not on that insurance. When you try to verify or get information from the companies, you are put on hold, sometime the call is dropped, and you wind up repeating your information 3 or 4 time as you are shuffled to the "right" person.  It's a mess.  People who like their insurance, probably haven't used it.

The last time I was in a doctor's office there were three pharma salespersons working the group of doctors, which added about 30 or 40 minutes wait time.  They were all very young, very attractive ladies, probably just out of college, and one wonders just how much medical information that brings to the system, but assistants were filling up closets with their samples.

We write, email, call our congress people, read, try to get educated but I'm not sure yet what's in the bills.

I think some kind of government health care like in Europe or Japan would be preferable to this mess.  But whether we get a chance to vote on that one way or another, seems remote.  We live in a Corptacracy and participating in it and changing it appears to have rules few know.  Much of what gets decided is found out years later.  This is perhaps the contradiction.

George Holcombe
14900 Yellowleaf Tr.
Austin, TX 78728
Home: 512/252-2756
Mobile 512/294-5952
geowanda at earthlink.net<http://us.mc593.mail.yahoo.com/mc/compose?to=geowanda@earthlink.net>


On Aug 28, 2009, at 12:09 AM, Don Elliott wrote:

Marshall,

You are exactly right in your analysis of the proposed health legislation, it doesn't deal with the
major reasons for the high costs.  Former Senator Bill Frist made his fortune from for-profit hospitals,
Senator Edwards made his fortune suing doctors and hospitals.  Any health plan that refuses to deal
with high drug costs and leaves out tort reform cannot lower costs significantly.

Charles Krauthammer writes:  "When a neurosurgeon pays $200,000 a year for malpractice insurance
before he even turns on the light in his office or hires his first nurse, who do you think pays? Patients,
in higher doctor fees to cover the insurance.  And with jackpot justice that awards one claimant zillions
while others get nothing -- and one-third of everything goes to the lawyers -- where do you think that
money comes from?  The insurance companies, which then pass it on to you in higher premiums.

But the greatest waste is the hidden cost of defensive medicine: tests and procedures that doctors order
for no good reason other than to protect themselves from lawsuits.  Every doctor knows, as I did when
I practiced years ago, how much unnecessary medical cost is incurred with an eye not on medicine but on the law."

http://www.washingtonpost.com/wp-dyn/content/article/2009/07/23/AR2009072302723.html

The much touted Medicare drug benefit passed under Bush, provided for obtaining drugs at the prices
set by the drug companies, no volume discounts, no negotiating for price reductions.  The Canadian
Health Service buys these same American drugs for a fraction of what Medicare pays, and now we
find out the current administration has cut a deal with PhRMA that continues this arrangement.  At
first a deal was denied, then admitted.  There really shouldn't be a secret WH deal with PhRMA.  Congress
is presumably writing the legislation.  Will Obama refuse to sign a bill that provides for negotiating for
lower drug prices for Medicare after promising PhRMA there will be no negotiating?

See these links.  www.huffingtonpost.com/.../phrma-walks-back-claim-of_n_256111.html<http://www.huffingtonpost.com/.../phrma-walks-back-claim-of_n_256111.html>,
www.huffingtonpost.com/.../internal-memo-confirms-bi_n_258285.html<http://www.huffingtonpost.com/.../internal-memo-confirms-bi_n_258285.html>

How about a piece meal overhaul, starting with drug prices and tort reform?  And then consider insurance regulations.
Medicare has already cut hospital and physician reimbursement significantly, now other sectors need work.


Don Elliott

-----Original Message-----
From: W. J. <synergi at yahoo.com<http://us.mc593.mail.yahoo.com/mc/compose?to=synergi@yahoo.com>>
To: oe at wedgeblade.net<http://us.mc593.mail.yahoo.com/mc/compose?to=oe@wedgeblade.net>; dialogue at wedgeblade.net<http://us.mc593.mail.yahoo.com/mc/compose?to=dialogue@wedgeblade.net>
Sent: Thu, Aug 27, 2009 1:26 pm
Subject: [Dialogue] health care reform

Colleagues,

I've been continually amazed at your silence on the wildfire 'debates' on health care 'reform' in the USA. We did hear from Bob Rafos up in Canada, but very little else.

Especially with the travesty of 'town meetings' across the country this month, which were highjacked by the right wing nut cases eager to exploit the obvious lack of a participatory methodology for real proposals for reform. Where were the ICA types when we needed them??

Enjoying our 'retirement', you say?

Well, what about being part of the Medicare generation (at last), with the widespread fears that 'death panels' (thank you, Sarah) will ration health care at the end of life, and that extracting bloated, inflationary expenditures from the only government-run sector of the system (apart from the VA and Medicaid) will reduce the quality of senior care? Still asleep on that one?

My own view of what sustainable health care will have to look like has evolved to the point where Obamacare looks like a rerun of Hillarycare--a complex hodgepodge of Bandaid fixes designed to keep the present system up and running, maintain a robust private for-profit sector that skims Medicare/Medicaid, include more people under the private insurance 'umbrella' (remember the travesty of The Travellers/CitiCorp merger?), and still preserve access to healthcare as a privilege of citizenship/economic affluence rather than a human right available without 'co-pays' to all who enter the system, including those who sneaked across our borders to harvest our food for minimum wage and no health benefits, and who get deported (via expensive international Med-Evac flights) to third world shacks rather than treated for expensive health conditions by our public hospitals, our healthcare safety net of last resort.

Yeah, I know that was a long, complex sentence, but the new healthcare reform bill is gonna be long and complex too.

If you want a fairly understandable example of the problem, in which the highest health care bills are extracted from one of the poorest populations in the nation, please read:

http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

More later, but this is a start.

Marshall

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