|
By Charlie Eisenhood
|
|
Friday, 10 July 2009 10:30 |
Today, the participants give their final thoughts on the vast and complex issue of health care reform.
I'd like to thank all of the debaters for their thoughtful insights and discussion this week. Each of them clearly spent a good deal of time on a tricky policy issue. Of course, there's no simple answer, and a discussion like this could go on for weeks, but I hope you gained some new knowledge and perhaps new perspective on this very important subject.
Please let me know what you thought of the format by leaving a comment below or sending me an email at
This e-mail address is being protected from spambots. You need JavaScript enabled to view it
. Would future discussions like this on other topics interest you?
Day 3 of the debate is here. Day 2 is here. Day 1 is here.
 Todd Sandman serves as director of public and government relations for Presbyterian Healthcare Services, a New Mexico, not-for-profit healthcare system of hospitals, physicians and a health plan.
Thank you to Charlie Eisenhood for engineering this discussion and all the contributors this week. I think it was a good conversation, and highlighted much of the complexity (and frustration) of today's healthcare system.
Whether or not our country has the healthcare system we want, it's important we understand that we have the healthcare system we created. When our nation wants to create more equality, we introduce Medicare, Medicaid and other public programs. When we value choice and patient autonomy, we regulate managed care and lift barriers to care. When it's innovation we're after, our government subsidizes pharmaceutical company research with tax credits. When we think it costs too much, we slash the budget and ask providers to make due with less. The U.S. doesn't have just one approach to healthcare.
So let's create a system that works for us. If there's one theme I've tried to stick to in my posts this week, it is that how we pay for healthcare determines what kind of healthcare we get. The way we pay for healthcare today is fee-for-service and, as a result, we get a lot of service. We don't necessarily get a lot of health.
I'm hopeful that our policy-makers will re-balance the payment system to emphasize prevention and management of chronic conditions. Imagine a primary care physician (some of the lowest-paid providers) reimbursed for the number of patients with diabetes she manages and given incentives for the number of patients in good control of their disease. How quickly would a primary care office reorganize its practices to better manage their population of these patients? We could spend less money on diabetes care and end up with healthier patients. And we could do this across the healthcare spectrum of disease and illness just by dramatically changing the payment incentives we have today. This would make healthcare more affordable for the long-term, which is exactly what is needed.
Too much of the current healthcare reform debate is focused on who we'll tax, who will see their reimbursement cut, and whether or not the government will take a bigger role in health insurance. To me, the impact of any of these tactics will be short-term. If we want to fundamentally improve healthcare, let's stop being distracted by these issues and work for a system that produces the health and healthcare we want.
Vicki L. Perrigo, M.D., MACP, FAAD, received her bachelor's degree in Biology from the University of Southern California in 1972 and her M.D. from UC Davis in 1976. Ms. Perrigo did her Internal Medicine residency at UCI/Long Beach VA from 1976-1979 and her Dermatology residency at the University of New Mexico from 1980-1983. She is licensed to practice medicine in California and New Mexico.
We have had the opportunity to think deeply about some of the failures of our health care system this week. From my own life experience, I believe that much of the increase in the cost of medical care is due to the practice of defensive medicine. We are trained in medical school to recognize that "if it has hoofbeats, it is probably a horse, not a zebra". In today's world, we have to order tests in order to rule out every single zebra. This leads to huge expense because the zebras are rare. If all states pass a law comparable to the law in Texas, a $250,000 cap on malpractice awards, and if the malpractice insurance companies are able to lower their premiums for us, then we will be able to order fewer tests and the cost of medical care will decrease. Lowering premiums would also lead to the additional benefit that many of us would reasonably be able to work part time; it's not possible to do so now, as the high cost of premiums added to the overhead costs make part time practice prohibitively expensive. The last time I signed on to work part time I eventually realized that I was losing money every day. In which case, why work? My education, training, and experience are then not put to use. Is this not a waste?
Emergency care and wellness advice should be available for all Americans. Care for chronic diseases, if uncomplicated, would best be handled through a one-on-one relationship with a single physician who could coordinate a patient's care, or if complicated, by a cooperative group of specialists who would periodically meet together to discuss the patient's case. These are reasonable objectives. The levels of administration existing now, between patient and doctor, at the hospital/insurance/government level could be trimmed. Changing patient's perceptions of what is possible and what is not, within the limits of our expertise and technology, would be useful. Not everyone can or should be saved. Death really is inevitable.
A system of reimbursing people for reaching wellness goals, as is in place at the Cleveland Clinic, would be encouraging. A system of docking people's pay if they don't reach their goals could be helpful with regard to patient compliance.
In an ideal nation, health care of similar quality would be available for similar problems in similar communities. Is this possible in this country? Perhaps. Just providing more funding won't fix us. Providing more realistic care, with less interference, might.
Regarding funding, we might still consider the decriminalization of marijuana. People obtain and use marijuana every day in this country. Why not sell it and tax them and use those funds for health care? Why are we so afraid of this? Why not also increase the tax astronomically on cigarettes, and alcohol? And maybe processed food?!
Oh, and Mr. Schneider, it's the proof of accident vs. negligence that varies. If firm definitions of what constitutes an accident as compared to negligence were set up and followed nationally, we might see a difference. I think physicians are often called negligent when in truth the episode was an accident. What level of physician care can be considered ‘acceptable risk?' Fully accountable just means, how much can we get out of the system, which is comparable to what is happening from the other side when hospitals and/or physicians soak Federal programs for additional funds.
We would definitely see a difference if once again, patients had a relationship with their doctor. When you know someone over time, you often know when something is not right. When you see a different doctor every time you go in to the clinic, there is no continuity of care and no ability to follow the course of a patient's life. Also I am not complaining about paperwork - the paperwork is just part of the practice of defensive medicine - but it costs.
And, Mr. Burgos, really, you believe patients can solve their medical problems through a Google search? That patients can now run their own care just using information online? Wow. Who is liable if THAT doesn't work...
 Mario Burgos writes about local and national politics at his blog. He can also be frequently found hacking it up on a golf course. His hobbies include running an advertising agency, political consulting and growing a professional services firm, which provides project management support for construction, engineering and IT projects. Mario earned his B.A. from NYU and an M.S. from CalState Northridge. He resides in Cedar Crest with his first wife and their two sons, but has lived in more places than he count on one hand.
I always appreciate the dialogue. It is only through dialogue that we can achieve understanding and ultimately resolve the problems that face our society of which access to healthcare is only one. More often than not, arriving at a solution involves compromise because there is very rarely a silver bullet answer. However, every once in awhile, solving a problem does not require fixing a current system, but instead means dismantling it. To do so, you need to step back and look at how we got to where we are and understand if where we are headed is where we really need to go.
My friend, Brian Colon, asks, do I have any suggestion on how to fix our health care crisis? Well, let's look at that. There is only a "health care crisis" for those who are unhealthy without access to health care. We all read and hear reports about the large and ever-growing number of Americans without health insurance. However, first it must be acknowledged that health insurance and health care are two very different animals. One does not automatically mean that you get unlimited access to the other. Second, no one ever seems to ask the question, what percentage of those are unhealthy? If they are not sick, they don't need access to health care, an often forgotten point especially once government gets involved.
I am forty years old. I have been to a medical doctor, not including getting my teeth cleaned or eyes examined, once in the last 18 years. It is also worth noting that for both my teeth and eyes I paid out of my pocket, not using insurance. At one point in my life I was a teacher. I had "great" insurance. Every year I was entitled to go get a new pair of glasses for "free" not a penny out of my pocket. I did. It's been years now since I had that benefit. In fact, I'm pretty sure my current glasses are more than five years old. I replaced them only when they are broken. The difference is simple. I now pay for the glasses. I don't really need a new pair every year. A perfect illustration to Paul Gessing's often made point.
Why, do I go so infrequently to a medical doctor? Because I'm healthy. In fact, I go out of my way to keep healthy. Do I do so to lower my costs? No, I do so because it is in my best interest. It just happens to also lower my costs. Now, many might argue that I should be going for an annual exam - my mother does frequently - otherwise I may miss the development of a fatal disease. That might happen, or it might not. That's a choice I get to make for myself. Do I have health insurance for my family? Yes, I do. However, I have the equivalent of catastrophic insurance. If tomorrow my family were to all come down with the plague - we live in the mountains, it could happen - could the health care we need be financially devastating? Quite possibly yes. Would that mean the end of our life? No, it would just mean yet another trade off and adjustment. Life is filled with them.
So, how do I suggest we fix the health care crisis? I think we do it on a case by case basis. Medical institutions that are ineffective will eventually close their doors, assuming the government doesn't try and bail them out. They will then be replaced by effective ones. People who don't have easy access to healthcare will two choices. They can take care of themselves or die. Maslow's hierarchy of needs seems to indicate that if there is not someone out there to take care of them, they will ultimately take care of themselves. Darwin's studies indicate that over time those who do take care of themselves will over time produce others who will be genetically and socially inclined to take care of themselves.
I think we also need to change the paradigm. Sometimes technological and systemic advances are a good thing. Sometimes, they are not. The doctor-patient relationship has devolved over the years as third parties have been introduced into the system. People will naturally care for one another especially in this country where charitable giving is like no other. If you want to provide healthcare to many who are not getting it, don't look to the government to do it. Start with the individual.
 Brian S. Colón is Chairman of the Democratic Party of New Mexico. Mr. Colón was raised in Valencia County. He received his Bachelor's Degree from New Mexico State University in 1998 and graduated from the University of New Mexico School of Law in 2001. In 2004, Mr. Colón was named Outstanding Young Lawyer of the Year by the New Mexico State Bar Association and one of New Mexico's Forty Under 40 Power Brokers by the New Mexico Business Weekly. He was elected to his first two year term as Chairman of the Democratic Party of New Mexico in April of 2007. He was re-elected without opposition to a second two year term in April 2009.
Thank you to all the readers and posters who participated in this important discussion. As I said earlier this week, it is clear the vast majority of Americans know we cannot wait any longer to reform our broken healthcare system.
I want to be clear about what the Democratic Party supports as we move forward in this important discussion about fixing our healthcare system in America. We want the reform that achieves the following necessary outcomes: 1) a reduction in rising healthcare costs for families, business and government; 2) patients have a choice in their doctor and healthcare coverage; and 3) high quality and affordable healthcare is available to all Americans.
Any reform must meet these goals. Fortunately, President Obama has pledged to work with all stake holders to insure we have the best possible reform package to fix our broken health care system. He has also made it clear he believes reform must have a strong public option.
I'll leave you with the words of New Mexico's senior Senator, Jeff Bingaman, as he wrote in an op-ed in the Journal not too long ago. The following quote from Senator Bingaman really sums up the need for reform at this critical time:
"It has been clear for years that our health care system is broken. The burden of paying for health care continues to grow. Tens of millions of Americans lack coverage and tens of millions more live with financial insecurity because the coverage they have doesn't meet their needs.
"We must not miss this historic opportunity to rein in health care costs and to expand and improve health care for New Mexicans and all Americans."
Thanks again for participating in this online discussion about an issue that is critical to the future of our families.
 Barbara Wold has been providing news and opinion on local and national politics on the Democracy for New Mexico blog since 2004. She was the Democratic National Committee's official state blogger from New Mexico during the 2008 Convention in Denver, and is involved in Democratic Party politics and progressive grassroots activism.
So where do we stand at the end of our online debate? The basic right-wing position is that we should treat health care like any other product in the marketplace. We should be "allowed" to buy our own care directly from providers, shopping around for quality and cost savings like we do when we want to purchase a lawn mower. The right supports "health care savings accounts" where folks can park their extra (tax-free) money and save up to buy whatever health care "products" they need. No mention is made of what happens to people who don't have extra money to save, who lose their jobs, or who can't afford to purchase expensive drugs or procedures they need.
It's the law of the jungle. Only the financially well off get all the care they need, and survive. Nobody owes anything to anyone else or to the community at large. There is no concept of the common good or any responsibility to our fellow citizens. It's everyone for themselves. Mario Burgos goes so far as to suggest he'd be willing to prematurely die rather than depend on the insurance pool contributions of his fellow Americans for life-saving treatments.
We heard about the plight of Presbyterian Healthcare Services. Todd Sandman claimed they are paid too little to cover the costs of Medicare patients. He noted that PHS provided almost $25 million of "free" care to the uninsured last year. Despite these kinds of complaints, health care entities like PHS generally defend the status quo, which features vast sums of money being filtered through their organizations before they go to pay for services. Outfits like PHS usually agree that we can make the system cheaper, but mostly through encouraging patients to adopt healthier lifestyles and improving administrative and technical systems. PHS operates like a vast cost-shifting mechanism -- jacking up prices for regular insurance customers to cover the shortfalls created by indigent patients, as well as perceived underpayments from Medicare and Medicaid. You would think such systems would be supportive of universal coverage because it would eliminate the "free" care they provide to the uninsured, but they're generally lukewarm, at best, about the concept.
Sandman seemed most concerned with increasing Medicare payments to PHS to match the levels paid in places like Miami or Houston, where the cost of living is markedly higher than it is here in New Mexico. He strongly defended the expensive Medicare Advantage program -- a privatized arm of the basic Medicare program that pays private insurers generous sums to offer their own plans as a voluntary choice to Medicare patients. Medicare Advantage plans do usually offer some attractive benefits not available through the regular plan. However, it's difficult to discern why these options can't be offered through the regular Medicare program -- eliminating the need to give private insurers a cut of the cash. It's always cheaper to eliminate the middle man.
Dr. Vicki L. Perrigo focused heavily on medical malpractice suits. She believes they drive costs up by causing physicians to order unnecessary tests, and add extra expenses in terms of high-dollar court awards and rising malpractice insurance fees. Dr. Perrigo advocated for caps on damages awarded in malpractice cases. She also complained about the costs of care for people who don't live healthy lifestyles. She didn't really address the larger questions of reform.
Finally, Brian Colon and I talked about the health reform measures currently being debated in Congress. The aim is to provide universal coverage, rein in cost increases, and provide high quality care to all Americans. The Senate HELP Committee's current proposal would ensure that those who like their current coverage could keep it, but they could also opt to choose another private plan offered in their area or select coverage via a nationwide public option administered by the government. Nobody could be turned down for coverage due to illness or pre-existing conditions. Provisions in the bill ensure that coverage would be affordable for everybody. Despite the right's never-ending campaign to create hysteria about the dangers of "socialized medicine," we made it clear that nothing of the sort is on the table. Congress is deliberating on a variety of ways to provide universal, cost effective, high quality health care with a goal of preserving what's good about our system and improving what's not. Period.
As you read through four days of posts and comments, I hope you'll note whether the contributors provided specific, practical fixes for our broken health care system or offered only generalities or self-serving remedies too narrow in scope to make a significant difference. Keep an eye out for claims that aren't supported by data or links to respected sources. Beware of anecdotal tales with no documentation. Watch for "straw man" arguments that seek to change the subject and argue against things like "socialized medicine" that really aren't part of the discussion at all.
Most of all, think about what it will mean if we do nothing to reform and repair our current system. Reforming health care will be costly at first -- as investments in the future usually are -- but doing nothing will cost even more. If we don't extend coverage to all, millions of Americans will suffer and sometime even die because they can't get the care they need. If we don't include important elements like a public option and mechanisms to provide incentives to encourage "best practices," preventive care and wellness training, health care costs will continue to skyrocket with no end in sight. Can we really afford NOT to reform health care?
 Paul Gessing became the first full-time President of the Rio Grande Foundation in March of 2006. Since joining the Foundation, Gessing has been a prominent voice for limited government and individual liberties in policy areas including: taxes, health care, education, and transportation.
Good debate this week. I hope the Journal and City-Seeker blog will do more of these. I know that I'd be happy to participate.
In conclusion, I'd like to urge all proponents of health care "reform" - no matter what they mean by that term - to offer specific solutions for the problems facing American health care. Too often, terms like "universal coverage" are thrown about without any specific details about how we are to get from where we are now to that future goal.
When it comes to government involvement in health care (such as Obama's "public option"), does government which forcibly collects taxes and faces no pressure to make money really compete on an even playing field with private business? What is the federal government's track record when it comes to keeping its promises about being limited in particular ways?
Does the federal government generally do things - whether that be building warships or delivering the mail - efficiently and at a reasonable cost? Will our experience with health care be any different? As unpopular as health insurance companies are, what - aside from a lack of profits - will government contribute in terms of efficiency or will we just face ever-greater tax burdens to pay for health care?
Government already purchases approximately 50% of the health care in the United States. The ratio is quite a bit higher in New Mexico (which has the highest uninsured rate in the nation). We already have a heavily-socialized health care system and yet everyone in this debate agrees that there are major problems with the system. Before we move further down that path, can we at least give freedom a try?
Make your voice heard in the comments section below.
|
|
Last Updated ( Friday, 10 July 2009 10:30 )
|
|
|
Latest Twitter Feed
From Journal Police Reporters
APD Traffic Tweets
Latest Tweets from @ABQJournal
Dan Mayfield Tells You...
Dan McKay's City Hall Beat
|
