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President Obama has been barnstorming the nation, pushing for passage of a health overhaul package. His Secretary of Health and Human Services, Kathleen Sebelius, recently singled out Oregon as one of six states where insurers are pushing for double digit premium hikes. Health insurance companies like BlueCross BlueShield of Oregon say their health care expenses are rising, and more healthy people are dropping coverage, leaving more expensive, sick members to provide for. Critics of Obama's health care proposal — in no short supply — say the bill Obama wants on his desk would not do what's needed to control costs.
Over the past year we've discussed many aspects of possible healthcare legislation on Think Out Loud, from the role of employers in providing health insurance to the region's low Medicare reimbursement rates. We've explored health promotion, doctors' salaries, and personal healthcare values. All that while the country debated the future of healthcare in this country. Now that's coming to an end. On Sunday night Congress passed a major overhaul of the nation's healthcare system. President Obama is expected to sign it into law on Tuesday. The Senate will take up some of the revisions probably this week. Oregon's four Democratic representatives voted yes on the bill. Republican Greg Walden voted no. Congressman Peter DeFazio had a particular hand in getting an adjustment in Medicare reimbursement rates that's kept them particularly low in Oregon. After the vote he told OPB reporter, Rob Manning:
When the administration knew we were serious, and they could lose the whole bill, we negotiated around the clock, and we got something that is justifiable, that’s been studied time and time and time again by experts and panels and commissions saying this system is not fair, it’s not equitable, it doesn’t work. And it penalizes the states that are doing a better job, and rewards states that are doing a worse job, and it’s costing the taxpayers money.
As the Senate races a midwestern storm to pass sweeping healthcare overhaul legislation by Thursday morning, we're taking an hour to look at what many months of wrangling and last-minute deal-making will mean for the our healthcare system. Whether you see this bill as a lump of Christmas coal or a progressive diamond, there are still plenty of outstanding questions. For example: after the Senate and House versions are reconciled, what will the final bill look like? Will it have a public option? Will the insurance exchange be set up on the state or federal level? How will funding for abortion be handled?
As often happens, we had a spirited conversation in the studio after a show last week. We'd been talking about the signing of the healthcare reform bill with John Evans, an anesthesiologist and the president-elect of the Oregon Medical Association, and Pam Mariea-Nason, the director of health policy and community engagement for CareOregon. John Evans was worried about a provision in the new law that will give a presidentially appointed board the ability to decide what will — and won't — be covered by Medicare. He and Mariea-Nason both spoke approvingly of Oregon's own historic efforts at healthcare prioritization and, more broadly, its culture of cost containment And they both agreed that — somehow — the cost of healthcare has to be brought under control. But they are not at all sure that the new law will do that. In short, they gave us the ingredients for another hour of radio.
If you are over 65 and looking for a doctor in Oregon, you may have a tough time. That's because of a federal calculation that reimburses Oregon doctors at a lower rate than most other states for Medicare patients. According to 2008 data, a typical visit was reimbursed at $74.81 in San Francisco, for example, but just $60.26 in Portland (and even lower at $57.11 in the rest of Oregon). The relatively low reimbursement means some doctors choose not to accept Medicare patients. Others decide not to practice in Oregon at all. But in the move to reshape healthcare in this country, all that may change. A number of Democratic lawmakers — including Oregonians David Wu, Earl Blumenauer, Peter DeFazio and Kurt Schrader — just reached a deal with the House leadership that would balance out the reimbursement rates across the country. The new formula would value quality of care, not just quantity of tests and procedures.
Few people disagree that the U.S. healthcare system is broken. What's a lot less clear is how to fix it. Last week we began our series on healthcare reform by exploring the disparities between healthcare costs and outcomes. This week we're taking another stab at the huge issue by asking: what role does keeping people healthy have in the future of healthcare? Smoking cessation, weight loss, diabetes education and nutrition programs: do these things actually have a place in the reform lawmakers are working on? Health Promotion Advocates say yes. And they're working hard to lobby Congress to say the same. Meanwhile in Oregon, lawmakers just passed a bill to create a new state agency to coordinate healthcare reform efforts here. What role will health promotion and disease prevention have in their planning? What exactly does health promotion mean? And what programs actually work?
Atul Gawande's New Yorker article about the disparities between healthcare costs and outcomes has certainly made the rounds since it was first published a few weeks ago: It found its way all the way to the Oval Office. The gist of Gawande's article is that sometimes spending more on healthcare actually buys us worse care. And while there are many possible factors for this, one of his arguments is that if we're going to reform the system in a smart way we're going to have to change the way we incentivize various services. For example: if primary or preventive care are crucial, should we reimburse them at higher rates than more specialized fields like cardiology or neurology* orthopedic surgery? Would this be a way to both get more young people into these basic care areas, and also to encourage an emphasis on the "right kind" of healthcare?
Is it moral to profit hugely from the illnesses and medical care needs of our fellow citizens?... Is the free market, or the profit motive, in fact always the best option? Or are there undertakings in the life of our communities and our nations that serve us better when done in common, that is, socially? We undertake fire protection, policing, and education in common, or socially. Why not health care?With various health care proposals in Congress, some watchers — and not just the insurance industry — are nervous about a "public option," and what it might mean for the economy at large. On the other hand, advocates for reform point to profit as one of the main reasons the current health care system is broken, citing rising costs and tens of millions of Americans who are un- or under-insured.
Oregon's two largest public employee unions just settled with the state on a contract for the next two years. Health insurance benefits often play a significant role in negotiations between unions and employers. But companies, especially small businesses, are becoming increasingly burdened with the rising costs of providing health care. It's unclear how the health care system will change if President Obama signs a new bill into law. It's hard to keep track of all the health care proposals working their way through Congress, but all of them would affect the way employers provide health insurance to some degree. A bill proposed by Democrats in the House would mandate employers cover employees but it would exempt small employers. A Republican plan does not include mandates but does provide tax credits to small businesses. If a public option is part of whatever plan is ultimately adopted, it's certain to impact employers, though there's little agreement about what that impact would be.
President Obama has made an overhaul of the healthcare system a central part of his domestic agenda. It has certainly became the topic of choice for town hall forums, and talk shows (like this one!) throughout the summer. But for all the talk, the President has so far been stymied much the way Bill Clinton was before him. Now Congress is back from its August recess, so the President is taking the opportunity to make an unusual address to a joint session of Congress to try to push legislation forward. Speculation abounds about whether he'll be able to pull it off. But at the very least, it's another chance for him to communicate to the majority of the Amercian people what they would gain by an overhaul of the system.