Universal Healthcare...an idea whose time has come??

[seacrestkristi]

What time is this show on please?
Punzy, just curious of your professional opinion on Hillary's health care ideas?

 

[rapunzel]

I just had a look at Sen. Clinton's website, http://www.hillaryclinton.com/issues/healthcare/ and I don't really see anything specific on which to comment. She just talks about her experience with the issue in the nineties, which was not impressive on the whole.

I will say that I think her initial plan in 1994 was terrible. Some of the reforms that she championed when it became clear the health plan would fail were quite good, though. She put in place the patients' bill of rights, and the CHIP program that covers children whose families are too poor to realistically afford health insurance but not poor enough to qualify for Medicaid was one of the best programs to come out of that administration. No one can argue that kids should be covered -- it's cheap, most providers will essentially donate their time, and it when I was involved in the initial roll out for Georgia in 1997 everyone was thrilled with the program -- except that even with access to a primary care physician, ER visits remained five times the rate of the average insured life rather than going down as we all expected. The best result of her work in the 90's was that for a few years it scared the bejesus out of the industry, and they checked themselves. Insurance companies became innovative and began offering a variety of products at various price points. Hospitals and physicians did not push for rate increases above and beyond the CPI for a few years there (the CPI increase for the healthcare sector before 1995 and again today for hospitals is roughly double the overall CPI).

There were major mistakes made, too. The biggest impact was on physicians, and the average patient encounter with their physician has change dramatically since 1994. The Medicare fee schedule and it's determination of a "relative value scale" for all physicians set price controls for physicians' services. The emphasis in medical practice turned completely away from being the best doctor to the most efficient. The managers will base evaluations on production, not patient feedback. The worst doctor commands the same fee as the best doctor in any market. This emphasis in turning over rooms has hurt the quality of medical care for most Americans. The worst thing by far, though, was the addition to the HIPAA law that mandated electronic submission of medical claims to Medicare and security practices that don't protect information from the only people that would really want to use it -- insurance companies. The unintended consequence of this law was the end of the small, independent medical practice. The software required to be compliant with the electronic filing costs $20,000 to $30,000 per physician every few years, plus $3000 per physician per year for maintenance, then they must pay fees to a clearinghouse that transmits the data to Medicare and insurers electronically. The security provisions are so non-specific that many healthcare administrators could intimidate the few independent doctors able to afford the software to still fear a huge fine and lawsuit. This caused most doctors to affiliate with hospitals, and therefore they were no longer able to send their patients to the hospital that was most cost efficient. The maddening thing about all of this is that the government developed the best billing and electronic medical records system for the VA hospitals. If the aim of HIPAA was really to increase efficiency and decrease cost, they would have made this software open source, which would have had the added benefit of having all the records on the same system so that they could have been interchanged more efficiently and there would have been no need for clearinghouses. The result was that the business of healthcare became too complex for the doctors to remain in control...and the healthcare and hospital administrators who assumed the reins lacked the doctors' compassion and are purely driven by profit.

I would like to hear her ideas for going forward, because I just don't think the strength of her record from the 90's is enough to stand on. I don't respect her ability to foresee and predict unintended consequences. In order to fix some small problems, she put in place policies that broke some of the things that were working best in the system.

 

[seacrestkristi]

Thanks for that very informative breakdown, Punzy esp the pt's bill of rights, CHIP, and scary bejesus part, making them check themselves :shock: ;-) I also did not realize how much the cost was for an independent physician to buy that medicare software alone . Maybe she could now do something to help alleviate those costs. After all she did make her other reforms after a plan that she admitted didn't work. If it weren't for mistakes progress would never be made. Right? ;-) Thanks again for all the sharing Punzy.

 

[Chickpea]

This has been a hugely informative and interesting thread. I will gladly cede that I do not know a quarter of a tenth of what some of you are posting here since this is not remotely my field but I can share some pretty basic thoughts. Excuse the stream of consciousness rambling but it is hard for me to be precise or even offer any viable solution ( I am only sharing anecdotal info)

Our family has been lucky, hell very very lucky and fortunate that none of us have ever really been sick. We have always had health insurance and to the extent that we can afford it we will hopefully always be able to purchase it. having said that I have known plenty of people who have gone without, some by choice and others because they could not secure it and others who have been very very sick. I also obviously understand the horrible heart-wrenching decisions doctors make all the time regarding continuing to practice, having to see too many patients so they can cover their operation costs, etc, etc.

I have lived in the US for now a little bit over 16 years and I still cannot get used to how health coverage is administered here (and let's agree that there is abuse on both sides - from patients as well as insurance companies and in some cases by doctors!

I absolutely abhor going to doctors here because primarily I have never had a great experience when I felt that I had my doctor's undivided attention and able to gain some of the benefit of his/her experience. It is generally always an unpleasant experience - yearly visits to ob-gyns are tedious, time consuming and impersonal - one has to fight for one on one time and very often the staff seems as frustrated and angry as the patients who are frustrated and angry and left waiting way past their appointment time. Same thing with pediatricians, Er doctors and list goes on - Easy to see cycle here. And I have no idea what possible solution could address this - would gov't do a better or worse job???

So how the hell do they do it and manage it in France? I grew up knowing that doctors came to your house when you were too tired to go out, when you made an appointment you were not always guaranteed your doctor would see you on time BUT you knew when your name was called you were ushered into a private personal office where you had one on one time with him/her and their undivided attention. One developed a great relationship with one's physician, could call them up, solicit advice anytime and it is as great and as wonderful as it sounds - so how come they have managed this for so well for so long (even if today most french recognize that this now may need to change, be overhauled because it is costing gov't too much - but it did work for decades). And by the way, physicians in France are amongst highest paid professions and as far as I can tell no-one seems to resent this!

Have one parallel interesting story to share. During my second pregnancy I was self employed and had health insurance. My Dr wanted me to get an ultrasound at 12 weeks - my insurance denied it and told me to wait to 16 weeks. Because i had had uneventful easy first pregnancy and second also was 'sympton-free' I did not fight it and decided to wait for that 16 week benchmark. BIG MISTAKE - should have paid for test myself. At 16 weeks docotors discovered a problem (no need for details) and I was scared to death, in a panic and frantic and had choice to make. Happened to be going to Paris to visit family and obviously decided to seek second opinion. Had hosts of tests on expensive machines and they concurred with doctors prognosis that I had received here - my point is: the exact same tests I had in France in hospital cost me under 100 euros whereas here they cost an absolute fortune.

I am sure my arguments are simplistic and idealistic - why is this so friggin hard and why does it cost so much?

 

[Bob]

lack of free market, greed, lobbyists,litigation,,ama, illegal immigration, worldwide glut of pinot grigio supply....take your pick

 

[6thGen]

6th Gen, I don't understand how you can rail against the FDA's cumbersome process when we can all pick up any newspaper and read about the Cox 2 inhibitors that have caused cardiac death in thousands of people. Now we have Evandia making news. The push to make AIDS drugs avaiable quickly in the early nineties provided a fast track for groundbreaking drugs. The process may still be cumbersome, but drugs that kill people are still getting through. Further, I don't understand how relaxing the FDA's requirements for getting a drug to market would make them universally available, since r&d budgets are generally about 30% of the marketing budget at any given pharmaceutical company.

As for universal healthcare, House Call with Sanjay Gupta on CNN today has a great look at each major presidential candidate's healthcare plan. It's a great crash course for voters who want to learn about the issue and various candidates positions.

I'll disclose that I've been an Obama donor. However, I have to say that Guiliani's plan is the only one I could really support. And I think he'd make a terrible president.

Rapunzel,
I am not in the industry, so my comment is largely on economic theory. First, I believe the fact that the FDA can't screen as well as they'd like is a reason to do away with them, not to keep them around. I don't believe Friedman mentioned this, although he goes into much more detail in his book on why the FDA should be abolished, but the FDA not only gives consumers a false sense of hope that whatever they take will be safe, it provides a safety net for drug companies, an insurance policy if you will. Consumers put less emphasis weighing the cons of a drug since they believe that the FDA has done that for them, so they strictly look at the pros. The companies are less likely to effectively screen drugs for market, they are more apt to screen to pass the FDA tests. In the end, the drug companies have a good bit of bad press if something goes wrong, but not near as bad since they have the excuse that the government thought it was safe so the blame is on some nameless white coat who's consequences for missing something are not as bad as the consequences for him if he worked for the drug company. Not only because he works for a government entity with limited accountability and incredible job security, but also because everyone has the ability to point fingers rather than accepting responsibility. Regardless, I realize that the argument is a political loser because too many see the state as something that should protect us, rather than something we should protect ourselves against.

 

[DD]

Haven't read this entire thread (maybe it's already been mentioned?) and not necessarily endorsing this but...

http://www.sicko-movie.com/

Hmmmmmm.........

 

[6thGen]

Haven't read this entire thread (maybe it's already been mentioned?) and not necessarily endorsing this but...

http://www.sicko-movie.com/

Hmmmmmm.........

Saying that Moore lacks credibility is as understated as saying that yellow flies might be biting on property near wetlands right now.

 

[scooterbug44]

In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA) and this act in conjunction with the Consolidated Omnibus Budget Reconciliation Act (COBRA) provide a safety net for anyone who has had healthcare coverage through an employer or an individual policy to continue that policy without being subject to medical underwriting or pre-existing condition exclusions provided they do not let a policy lapse for more than 90 days (or 30 days for ERISA and Individual policies). People who cannot get insurance at some point made an unfortunate decision that the COBRA or an individual policy was too expensive, and that is unfortunate.

As for not understanding how truly poor someone has to be to qualify for Medicaid, I have to laugh. I've had to assist so many people to sign up for Medicaid so that physicians and hospitals I've worked with could receive some sort of compensation. I have also had to help a lot of people apply for a special short-term Medicaid that many people can qualify for when they have an expensive ($18,000+) short term illness. Medicare is age-based, or kicks in with long-term disability. I don't want to pry, but did your grandmother not look into Medicare? Or was it that she required care in a long-term care facility? If someone is truly choosing between food and medicine, I am assuming that is because they have a condition for which there is no generic rx treatment available and are taking an expensive brand name medication. That proves my earlier point -- if everyone paid for their own drugs directly, would drug companies charge $200 for a thirty day supply? Or do the drug companies set the price at $200 because most people have insurance and will pay because a copay is a copay and there is no real competition? Regardless, if you know someone who is choosing between food and medicine please have them pm me and I will help them sign up for a prescription assistance program with the pharmaceutical company.

You state that $35 and $4 isn't what an office visit and a prescription cost. Well, that my not be the advertised price, but that is what they cost. Wal-Mart has a $4 formulary and there is an acceptable treatment for the overwhelming majority of conditions on it. People without insurance just have to ask providers for the same discounts they give to the insurers, I've never met one who was not willing to do so. There are also free clinics and indigent care facilities available. There are many, many resources available to those who fall between that cracks.

As for the $80,000 boob jobs. TThey are two of five surgeons performing these procedures in the world, and they are by far the best at it. They charge $80,000 but that is not what they are paid. They either lose money or operate for free on about 20% of their patients, they break even or make a very modest amount of money on 60-70% of cases, and make very good living off the other 20%. When I was hired, I was given the task of making sure they made as much money doing this world-class surgery as they would if they were popping implants in trophy wives all day. That was all that was asked of me. I did a bit better than that for them. They are world class surgeons, and deserve to make a good living. Frank Gehry is a world class architect, and deserves to make a good living as well.

Sorry, I had other posters FDA comments in my head and got confused. My vote is that they have stricter controls and more varied trials and reduce the number of years the drug companies get a patent fro.

The law you mention sounds great ..... but doesn't seem very all encompassing. Some of the examples other people posted obviously do not fit within that definition - lady who got divorced etc. Do you know how it works w/ people who get dropped from their plans? What about preexisting or hereditary conditions?

I have no idea what plan my grandmother is on (assume Medicare because there was a whole issue w/ part D), just know that it is practically a part time job for my mother to wade through the bureacracy and red tape to get her care and treatment. She is constantly on the phone trying to get explanations, fix errors, reconcile billing and ensure that Gma is actually getting care & the correct meds. It is a frequent occurrence for her to drive several hours each way so she can be present for appointments and be fielding calls even while on vacation to get a straight answer from a dr's office or the gov't. My Gma also has some of her children living w/ her who can drive her to appointments and help her w/ daily care. She does have a variety of health problems - mainly because she's in her mid 90s - but I wouldn't consider her an extreme or atypical case. She has never smoked, doesn't drink, and has had yearly checkups/preventative care, yet prepaying her funeral is just one of the "creative" ways my mother has found to make it affordable/possible for her to get care. I can only imagine what an elderly person w/o these resources goes through.

One friend has migraines - her prescription for 1 pill is $125. Another friend buys drugs from Canada because they are so expensive in the US and is considering a summer job at Starbucks because 1) they provide health insurance 2) her health insurance costs as a graduate student went up 40% after the deadline when the federal gov't requires you submit financial aid paperwork for the academic year. These are people WITH insurance!

I have never paid just $35 for an office visit or $4 for a prescription, and as previously stated I think I am in the upper tiers of health care/coverage. I think the Walmart plan is a great idea and a wonderful first step, but I doubt most people's specialized drugs fit in their "300 common prescriptions". I assume those medications that have been around a long time for minor chronic problems - antibiotics, asthma, birth control, allergy meds, pain pills etc.

I think it is both appropriate and fair that highly specialized/trained people make a good living, just wasn't buying the argument that folks who perform $80K surgeries are scraping by because of the parsimonious fees they receive. I applaud the fact that they are doing these types of surgeries, esp at reduced or pro bono rates .......especially since I'm sure most insurance companies/the government wouldn't cover the Walmart version.

 

[6thGen]

Scooterbug,
How do you suggest the FDA implements stricter controls, performs more tests and reduces the time that they do so? Thanks.