OK, so before I start, I have a lot of opinions on the topic. But, I should, after practicing as a physician for the past 24 years. I have actually
delivered cost effective care in the most difficult of circumstances, unlike the overwhelming majority of the Health care ‘wonks’ in the current administration (or the last two administrations). So, first a disclaimer:
- My bias is that
Republicans would fix healthcare by assembling a group of CEOs from Pharma and HMOs to put together a plan. The
Democrats would get together the Trial Attorneys lobby to fix the problem. You may remember that
Hillary Clinton’s Health Care Panel in the 90’s had more lawyers than doctors …hmm!
- My experience of actually delivering care comes from practicing as a Medical Oncologist and Hematologist in a small city and the surrounding rural region of Central Washington. I set up outreach clinics to get high quality care to smaller towns in the region and I spearheaded research efforts to bring the earliest treatment trials to our rural setting.
- I perceive that we as Americans have become progressively willing to expect
someone else to pay for our indulgences: we smoke, become obese, don’t exercise, then we feel that the world ‘owes’ us some medical care. We no longer seem to feel that we are first responsible for our own health.
- In the U.S., we have begun to move a large number of ‘social issues’ into the health care expense column: domestic violence, unplanned pregnancy, gang violence, homelessness, illegal immigration, etc.
- Finally, is is
very clear that our current system is not sustainable. A combination of confusing regulations, unnnecessary rules, excessive profiteering, an underregulated drug industry, stunning governmental inefficiency, perverse infuences of lobbying, an abusive tort system and lack of leadership, have all led to the current gridlock and exorbitant in healthcare.
So, I have tried to understand the proposals taking place on Capital Hill. It is not easy. Most are cloaked in political bargaining and back-room deals. The players are Congressmen (and woman), their aides, the lobbyists, the trial lawyers, the HMOs, the Hospital organizations, big Pharma, AARP, etc. These groups are far removed from actual care of people at the bedside, the outpatient clinic, the small town or the home. I get depressed when I recognize that these are many of the same organizations who are responsible for the current mess we are in:
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Congress has largely been responsible for the morass of rules which have made Medicare and Medicaid the unwieldy programs they have become (conflicting mandates, micromanaging what they do not understand, creating poorly thought out rules which never get changed, creating additional programs to fix problems with other programs, creating new bureaucracies, and most often doing these things as the result of politically expedient compromises). Examples of the programs created and now failing include: Medicare, Medicaid, Postal Service, Army Corps of Engineers, … shall I continue?
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Lobbyists are of course just as pervasive now as ever. Nothing really seems to have changed – just different lobbies have the inside track compared to two years ago. But, in some instances the same people are representing the ‘new’ interests.
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Trial lawyers have been assured, by Obama, that
he will do nothing to address meaningful reform for the pervasive medical-legal costs we all must pay. In a statement that I felt showed he had no real spine, Mr. Obama stated, “I recognize that … doctors feel like they are constantly looking over their shoulder for fear of lawsuits.” However, “… I’m not advocating caps on malpractice awards.”(in his meeting with the AMA).” Unfortunately, tort reform is ignored by the current administration apparently because it would limit what lawyers would earn on lawsuits and trial lawyers are the biggest contributor to the Democratic Party. As a result, we all pay the extra cost, as physicians, hospitals and health care systems ‘do everything’ to limit there medical-legal exposure – DEFENSIVE MEDICINE. There are no other countries in the world with so pervasive a trial lawyer influence forcing up the unnecessary healthcare costs which America experiences (all the countries sited by the administration as having improved health care outcomes or systems have much less unnecessary costs experienced from defensive medicine).
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HMOs have for years had a selective tendency to pick and chose what they want to cover. Often, under the guise of ‘evidence-based guidelines’ (commonly made up in-house by physician panels who are not expert in the diseases or conditions which they oversee) they paint themselves on the moral high ground and fail to acknowledge that they are really interested in the ‘cheapest care.’ Oh, and did I forget to mention the extremely high salaries and bonuses for their CEOs (and returns for their investors).
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Pharma has always had a pervasive influence in Congress. Even when physicians and hospitals had to cope with cutbacks on a year to year basis, Congress refused to ‘control’ the prices pharmaceutical companies could charge. A drug that offered a 5% improvement over an existing drug would cost 500% more than the drug it replaced – no questions asked! Virtually all other countries (including those the backers of the current reform efforts site) do negotiate prices. The recent articles about the
‘side deals' between the Obama administration and ‘big Pharma’ leave me angry!*
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Hospitals are often portrayed as the do-gooders in the community. In many communities (including mine) physicians can no longer stay afloat financially as a result of the excessive regulations imposed by state and federal governments. More and more doctors are becoming ‘hospital employed.’ An unfortunate result is that the charges for the doctors services go up dramatically once they are in the hospital setting. These same hospitals (some under the ‘not-for –profit’ umbrella) drive other small practices out of business. The hospital can enjoy preferential tax treatment while competing with the small practice. The hospital lobby is also very powerful.
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AARP several years ago was responsible for side deals with the Insurance industry and created a nightmare for physicians and other health care providers in the late ‘90s. They are at it again, in their current lobbying. AARP wants to allow a blatantly
age discriminatory policy to go forward in Congress. True, they would limit it to maybe having 50-somethings pay
no more than twice the premium of younger people for the same coverage. Of course, AARP rakes in an enormous income from its
supplemental insurance business. It only makes sense for them to help gouge the 50 and over crowd before they are eligible for Medicare … you figure it out. Profits over people - it's the American way.
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This is what is being proposed as the
areas of reform by Congress and the Administration:
- Expanding access to coverage
- Individual mandate
- Employer requirements
- Expansion of public programs
- Premium subsidies to individuals
- Premium subsidies to employers
- Tax changes related to health insurance
- Creation of insurance pooling mechanisms
- Benefit design
- Changes to private insurance
- State role
- Cost containment
- Improving quality/health system performance
- Prevention/wellness
- Long-term care
- Other investments
- Financing
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These
reform areas sorta sound innocuous,. However, I just don't think that, given their track record, the above parties are really up to the task of setting aside what is in their own best interest and instead doing what is best for the entire country. All of these groups are best at spending other peoples money!!