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The Changeover: Health Care Prescriptions
AIR DATE: Tuesday, January 6th 2009
As the new administration takes shape in this New Year, we're beginning a series looking at the new Cabinet members, their likely policies, and how those policies will affect life in the Northwest. And we're starting with health care.
The incoming Obama administration will include Tom Daschle as the new Secretary of Health and Human Services. Daschle, a former U.S. senator from South Dakota, will also take on the recently created title of Director of the White House Office on Health Care Reform.
When it comes to health care policy, reform efforts abound. Senator Ron Wyden (D-OR) has his own plan to get coverage for every American. Change is afoot at the local level as well. The Oregon Health Fund Board created a road map for statewide reforms that could affect how Oregonians access health care in the future. Among the priorities laid out by the board are an expansion of Medicaid benefits and the creation of a new state entity known as the Oregon Health Authority.
How will federal and state reforms overlap? What are your concerns as a patient or provider?
GUESTS:
- Ron Wyden: Democratic U.S. Senator from Oregon and author of the Healthy Americans Act
- Mitch Greenlick: Democratic state representative representing Oregon?s 33rd district and chair of the House Health Care Committee
- Ron Maurer: Republican state representative representing Oregon?s 3rd district and co-owner of the Rogue River Health Clinic
- John Kitzhaber: Oregon Governor 1995-2003 and founder of the Archimedes Movement
Photo credit: ernstl / Flickr / Creative Commons
Tagged as: changeover · medicare · medicine · universal care
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A short story about our existing health care system.
My health care plan allows for a physical every two years. I had a physical about four years ago.
In October 2007, I was immunized for a trip to Guatemala. At the time I also received advice about various health issues for travel in Guatemala. I was not examined.
In July 2008, I received a physical exam.
Regence (BlueCross/BlueShield) denied coverage for my July 2008 exam because the immunization visit had been coded ?like a physical.? The Regence representative asked the hospital which provided the immunizations to revise the billing code. The hospital said they would not. Regence told me the denial of coverage for the (actual) physical exam would stand.
In addition to the time handling flexible spending accounts and other billing issues between various providers and my insurance company, I see a new skill is needed. I need to learn billing codes.
I have appealed and now expect to invest more time to prove that vaccinations and warnings about untreated water are not the same as what was once an annual physical exam. -
After working in the healthcare profession for 20+ years (both with physician groups and hospitals) I feel that the only way the US will be able to afford to provide healthcare to all its citizens is to adopt a single payer system. Eliminating the ?middle men? health insurers would allow the country to save a tremendous amount of money. The health insurers add no value to the delivery of healthcare. In fact, with all of their processes such as ?pre-certification,? ?referrals,? or ?authorizations,? they actually prevent people from receiving the care that their physician provider may recommend. Their whole focus is to save themselves money which means denying healthcare to patients.
Those promoting a single payer system should not use the phrase ?Medicare for All? since the name ?Medicare? may not have a positive affiliation for everyone. That said, Medicare is tremendously efficient in paying physicians for services rendered. Where most health insurers have administrative costs of 10% - 18%, Medicare is able to function with administrative costs of around 3%. They pay claims within two weeks (many health insurers take 45+ days) and they pay claims correctly (which many health insurers do not).
CMS (Center for Medicare and Medicaid Services) currently uses a limited number of ?contractors? located around the US. For example the Oregon region uses Noridian located in North Dakota. A single payer system could do exactly the same. Medicare?s contractors have obviously achieved economies of scale which allow them to function more efficiently than small, local health insurers. -
I have worked for some of the largest pharmaceutical companies in the world, most recently with AstraZeneca. Their lobbying organization is so powerful (in third quarter alone, they spent $1.3 million on lobbying alone). They feel that any change to the payor-payee system will threaten their profit margin and they will spend whatever it takes to defend that. Unless Congress and Pres-Elect Obama is willing to reject the drug company PAC money and stand up to this organization, I fear that the status-quo will remain in place.
One thing though... the drug companies provide MUCH better health insurance than any other industry that my husband or I have ever worked for. Premiums of $17/month for both of us that is a very high level of coverage, no discrimination between generic and branded drugs, great preventive care (on-site mammograms, skin cancer checks, bloodwork, etc.). I certainly wish I still had that coverage! -
I would like to thank the panelists for their good will
for the Oregonians and Americans they would like to
help.
Politics is a matter of bending to the winds of change
and the money wind has just become a breeze when
it had been a gale.
Change is coming
In the global marketplace our competitors, including
China have universal healthcare. It is a government
benefit and is not conditional upon employment.
If we want to keep our manufacturing base, we must
do the same. Period.
Our health care system is causing firms that have been
in business for a long time to go bankrupt so they can
dodge the health costs of older folks, their retirees.
This kills the pensions for millions of Americans.
The ECONOMICS requires we go to single payer, and
get off the sham the health care in the 'insurance model'.
If you look at the population as a whole, there is no Risk,
of sickness, it is a certainty, a definite probability depending
upon the malady. In the long run it will save 30 cents of
every medical dollar to treat medicine as the service model
and not the business (profit) model. The facts prove it.
If I were born in Canada I would expect to live two years longer
and pay half as much in health care as I do here in the US.
Some may say Health Care is an employment engine. While
it is the biggest sector of our economy, it is not Economically
productive any more than we can all get rich gambling upon
our housing. We will not get rich taking in each others laundry.
But if our health CARE system cares for everyone, the that system
will create a lot less stress and sickness than our current denial
management - bankruptcy engine.
Thank you. -
As a registered nurse, my ongoing concern regarding our health care systems is that we have chosen not to invest in services designed to support an individual in maintaining good health. Specialty services such as cardiac surgery and high cost admissions to the emergency department for diabetes that is out of control are paid for while services such as self management programs were historically vigorously by the health insurance companies for many years.
I believe that health is a responsibility of the individual, her or his provider and whatever third party pays the bills. Each is equally responsible and our state's and nation's goal should be to promote health. Unfortunately our population has relied on health care (drugs, surgery, dialysis) to correct lwhat is often the result of lifestyle choices, our reimbursement policies have not supported primary and preventive health care services and we have not yet become brave enough to eliminate our duplicative, inequitable and overly expensive system in favor of a single system which offers essential health services to all.
I look forward to a new opportunity to achieve policy changes in the 2009 Oregon legislature and the possibility that Congress and the Administration will begin the journey toward comprehenisve reform
Susan King MS, RN -
PLEASE ELIMINATE EXCLUSIONS DUE TO PRE-EXISTING CONDITIONS!
My wife and I have both avoided medical checkups or treatment at times because we do not yet have stable jobs and don't want to find a pre-existing condition before having health insurance.
Also... I have heard from multiple sources folks avoiding getting tested for STIs for this reason as well as the fact that even getting tested for STIs out of simple courtesy for a new partner has caused some to be denied coverage.
Many of us are avoiding maintenance and preventatice care, which ultimately can result in greater costs. -
Is there any chance of creating an early buy-in to Medicare? This could be a partial quick fix. My husband was recently laid off at 58. I am 60.We have "pre-existing conditions." It is likely in this economy that neither of us will be able to find a job with health care benefits. We have an income that we could probably live on from self employment if we didn't also have to cover the full cost of health care.
-
Having universal coverage will help in so many ways. Besides just being the moral thing to have in our society, one way or another, we all end up paying for people to get medical care, because when people get ill without coverage, they may end up not being able to pay their bill, thus requiring those bills to be recovered through higher fees for those who are paying. They may also have resisted getting treatment earlier, or preventative treatment, because they did not have coverage, costing more later. They may be causing stress and deprivation to their families with lost time from work, and the mounting bills.
As far as employers go, I think this would be a huge benefit to smaller employers. Small businesses are hurt more acutely by lost time due to illnesses (considering that early care ends up in less lost time), for one thing. Another thing is I believe that it helps small businesses be more competitive as an employer, because the insurance would be automatic. For me, I could never consider working for a small firm of 6 or 7, because their insurance costs for my family would not be possible for me to take. They are too small to get good group rates, or to be able to cover my family. -
Most health problems are preventable and could be avoided with lifestyle choices. We depend too much on the medical/insurance industry for THEIR solutions of drugs and surgery. We could take more personal responsibility for our health, and I don't mean getting in for testing for cancer, high cholesterol, high blood pressure etc. What about eating right, exercising, not living at high risk with smoking, excessive drinking and such. The overall ingoranace of the American people about what is a healthy lifestyle is appalling.
-
Ban Insurance; ALL insurance.
Then instill legal responsibility by forcing the "lawyer" that loses any case to pay for the total costs of all parties involved in their frivolous actions.
The cost of living as a whole not just Health care will quickly correct to sustainable levels. -
I am a senior, recently retired, now living in the Portland area.
Seniors are being terribly mislead by AARP, a rich organization that purports to represent our best interests. In the "health care" issue, they are a huge part of the problem. They have a hand in continuing insurance as it is - note their AARP insurance and Rx programs.
They are lobbying against our best solution, a single-payer system.
I urge all seniors to become familiar (quickly) with single-payer, and write Daschle, Obama, all who have power to change the sick system we now suffer under. -
For several years now I have been a member of the Archimedes movement here in Oregon. The Archimedes plan is to implement a state-wide health care program designed after the K-12 educational program. Everyone would be entitled to the basic health care package. Beyond that it would be up to individuals to purchase insurance to cover what is not in the basic plan. It would be missing a great opportunity should the Federal Government choose to ignore the groundwork that has already been laid. Why design and implement an untried program on a national level when the concept of the Archimedes movement is that the design of a successful program in one state can be used as a template for wider reform. There is no reason to incur the expense of an experimental nation-wide program. I think the Federal Government could provide nominal resources to support the proposed Oregon program and see if it works. If it does, then it would be time to implement it on a broader scale.
-
How about Congressman John Conyers, Jr. health care plan. I think he has some real good ideas. Take a look at it online. Thank you, Bill Baxter
-
Thank you. This is so true and very frustrating that Kitzhaber never mentions that a plan already exists that meets and even exceeds many of the ideas and values that he claims to support. It addresses financing but it also addresses delivery and has a focus on prevention. I think it is a shame that this program did not have some one to speak to Conyers bill HR 676 which has 93 co-sponsors in the house. This is a single payer legislation and is the only bill that keeps everyone in and leaves nobody out.
-
I appreciate Senator Wyden raising the point that health care availability in the United States is a moral dilemma. I believe strongly that a nation should take care of its citizens. I currently do not have health care...my COBRA just expired and I was denied individual insurance because of a pre-existing condition that I will always have (scoliosis). I am relatively young (32), healthy (non-smoker, no major family health problems, light drinker, healthy weight, etc.), highly educated (master's degree) woman who happens to be unemployed. I'm working on getting health care through OHP because I made it into the lottery. Who, in our society, can say that we should deny people access to health care because of their employment status - who, in our society, can say that they will never need government provided services. I certainly never thought I would be applying for OHP.
-
What a great show! Wyden and Kitzhaber-two very healthy people (gym users, who don't eat junk) Two pioneers who have and are guiding Oregon's health issues. I grew up with a father who got up at all hours to go to someone's home and provide medical care. Today, one goes to an emergency room, where one waits because the beds are full of regular patients who can't get a room. You can't determine the cost, because of insurance companies policies. People talk about bureaucracies, the Government is a collection of the people of a nation, an insurance company is a massive, unresponsive bureaucracy! We need to get rid of the middlemen and the money obsessed lobbyist. What ever happened to dedicated and concerned people and volunteers? Secondly, medical tests have become too expensive, because massive corporations thrive on million dollar scanners and sales commissions. Third, the poisonous drug companies who want us hooked on endless, expensive prescriptions that create as many problems than they solve. We need to provide health care to our citizens, not profit to our Military Industrial Complex. Lastly, we need to stop the processing and chemical treating of packaged food, and promote and subsidize a diet that is fresh and healthy, and promote exercise!
Robert -
John Kitzhaber and his Archimedes Movement group have done the most thorough thinking through of these problems and ought to be considered by anyone working on legislation.
OK, Governor Doctor Kitzhaber is just inspiring! His and their use of the Scientific Method and Critical Thinking Skills is a remarkable example in our Modern Times. -
There is universal acknowledgement that our health care system is broken and that we are not getting value for our health care dollars. The public demand for change has been demonstrated in Oregon by the election of Representatives and Senators who prioritized health care reform in their campaigns this fall, and the ouster of those who fought against improving access, quality and affordability. Oregonians showed up in droves to tell the Oregon Health Fund Board we are ready for change. The Oregon Legislature will have an incredible opportunity this spring to pass a package of reforms that can improve the lives of Oregonians struggling with health care costs, and provide a boost to our state economy. The political will is building, as demonstrated by Representative Greenlick?s legislation to implement the Health Fund Board?s recommendations, but the citizens of Oregon will need to continue to put the pressure on our elected officials in 2009 and ensure that they make health care their first priority. Simply put, health care reform should be job #1 of the Oregon Legislature, and their work this session will be judged by their success or failure. A grassroots movement can provide a substantial presence at the Capitol this session, and telling our health care stories will help keep a human face on the health care crisis. I personally got involved in working on health reform after being rejected for health insurance for an inaccurate diagnosis by the insurance company (not my doctor!) and realizing how sick the system really is. I now work with a statewide organization, Oregonians for Health Security, which coordinates grassroots efforts to change the health care system. Anyone listening to this show that would like to get more involved with the citizen movement for health reform should visit our website www.oregoniansforhealthsecurity.org and sign up for email updates and share your story.
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The real reform will come when we look at reimbursements. We need provider buy in first. This will help reduce the stigma Medicaid and Medicare/Dual Eligibles face when trying to find treatment providers.
-
Wyden,
Talks about insurance for everyone. A person on minimum wage earning full time 40 hours earning 1344 per month paying 600 for insurance has 744 to pay for transportation to work, food, household utilities and there is no way to mandate someone to pay when they have no money left.
The US spends on avg 7000 per person per year. In Sweden they cover everyone in an excellent system with better results for $3200. There is no way we should spend more money. We must figure out how to get it out of the current systme -
I think it is embarrassing that Cuba, an alleged failed state, has a more effective health-care system than the US.
-
Just curious:
1.) What did we do to pay for health care prior to 1950? Were we much "healthier" as a nation then compared to now? Why do we need insurance companies to pay for us anyway? How did this all begin to twirl out of control? Was it during the "Great Society" years with Medicare introduction, or did it happen earlier than that? I think we need to know why costs have ballooned to really get at the root cause.
2.) Why has no one talked about price controls on doctors and hospitals? Is this taboo, or do they also have a large lobby like the pharmaceutial industry does?
3.) Frivolous lawsuits also account for much of the cost problem as well---well-meaning doctors try to protect themselves from us! We need to prevent a law suit at the drop of a hat from occurring, so that we don't have to spend unnecessarily for extra "care" we don't need, in order that the doctor feels protected. We have created too much "victim" mentality in the past 30 years and this is part of the cost of that, in my opinion. I enjoy the freedom to have a second opinion, just don't "over-doctor" me! -
Comments are now closed.
http://www.cbo.gov/ftpdocs/91xx/doc9184/05-01-HealthCare-Letter.pdf (CBO comments in PDF format)
I know that Senator Wyden refused to endorse either of his Senate colleagues for President, hoping that he could work with whoever won. And while its clear that he will play a role, now that Obama is president-elect, it's becoming clearer what the real fly-in-the-ointment will be for HAA: it's too closely associated with Senator Wyden. Here just one of dozens of stories online that sugguest that the power brokers pay little heed to HAA:
http://thehill.com/leading-the-news/baucus-kennedy-healthcare-powow-set-for-tuesday-2008-11-17.html (Comments from Senators Kennedy and Baucus from thehill.com)
[quote]Kennedy has signaled that Democrats will base their health reform legislation on Obama's proposals, and Baucus's outline is largely consistent with that approach. By being first out of the gate with concrete principles [b][i](sic!)[/i][/b], Baucus aims to assert a prominent role in next year's effort.
?This is probably going to be the bible that everyone is going to look at,? Baucus said of his white paper. Broadly, the proposal seeks to strengthen the current health insurance system while increasing government spending, regulation and organization to increase coverage.[/quote]
(Baucus' proposal was first?)
Willamette Week uncovered one of those Obama proposals:
http://wweek.com/editorial/3427/10974/
[quote]Obama: I have expressed some concerns about the feasibility of shifting so quickly away from the employer-based system to a system in which each individual is responsible for buying their own health care. But I think the idea of portability is one that is important.[/quote]
What I suspect will happen is that in spite of the years of effort invested in HAA, effort that has the support of over a dozen senators spread almost equally across both parties, the Senate seniority system will win out and instead of tweaking HAA, we're faced with starting from scratch based on Baucus' white paper.
http://finance.senate.gov/healthreform2009/home.html ("A Call to Action" from Senator Baucus)
How depressing.