The only thing that would have made attending a luncheon with a senior advisor to the president to hear my views on health care reform cooler is if it had actually been held at The White House. (I would have totally pinched some hand lotion from Obama’s bathroom. I bet he uses the good stuff.)

Jenn says:

So glad that your voice has been heard and that you can be the face of what so many of us are dealing with; I can’t think of a more perfect person to do so.

I’ve been up all night, each night, trying to figure out what we are going to do-we self-pay our insurance, and the rates are going up, again, with less coverage. We came to the conclusion that we are going to have to go without so that we can keep our house. Unbelievable. Still can’t process it.

I hope your words and your work will prove to be a voice of reason in this awful nightmare of a mess and help move along some sort of change–it’s so badly needed.

Much love and admiration, as always.

Eugenia adwoa says:

We really need this healthcare reform. I had an experience today that has affected my day badly today. We relocated from a different state to Ga as ihave lost my job. My two kids got sick at the same time and because my husband healthcare has not kicked in for us i WAS REFUSED A HEALTHCARE FOR MY KIDS AT ONE OF THE CHILDRENS HOSPITAL CLINICS IN DULUTH GA. I wept bitterly as I was holding my younger child and holding my older one did not know where to go so the patient rep asked me to go to the gwinett health system. Is this the america that we live in that we care about money more than human beings. I migrated from an african country here, I thinkI will be better off if i go back as it will have been beter for me and they would not have treated me that way

FreakyPete says:

Beautifully written, Loralee and very entertaining. As an outsider (Australian), I am constantly amazed at the latitude given to big business in the US – at how bad things have to get before government intervention becomes essential. The global financial crisis is just another symptom of this same illness.

K.B. says:

While I disagree that we need THIS BILL RIGHT NOW as some are want to chant, healthcare certainly does need reformation. Like I’ve said in private conversations with the author (that’s right suckers, I’m tight like that with HRH) unless tort reform is front and center, there is no true reform. There’s government monopolization, but not true reform. We have a wonderful standard of care in the US, it’s the costs that grow exponentially that is crippling. Serious, well planned tort reform is the answer to lower (dramatically lower) health care costs.

Like many in Congress, I have NOT read this bill. However, the fact that the WH refuses to even discuss tort reform should be a clarion call to the independents to pay attention and hold on to their ideals because a parade of purely partisan political ploys is headed their way (who doesn’t love alliteration!?) How many minority amendments have been attached to this bill? This is not a negotiated bill, this is a bill written by a party that has at will cloture in both houses.

Regardless of where you stand on socialized healthcare, level headed people from both ends of the spectrum can agree that once we open the door to government control of healthcare, that’s it! It can’t be undone. Just like social security or welfare, these things NEVER GO AWAY even if they don’t work. There is no crisis that requires sweeping definitive action within weeks. This issue requires thought, debate, and careful study. It’s the last issue that one should pull the trigger THEN aim on. Your life may depend on it!

To LL,

Congrats on the success of your blog and the notoriety! I wish you all the success in the world. Oh, and if Joe Klein from Time magazine calls, don’t curse him out and hang up on him! Sheesh! Some people’s children….

Doug says:

K.B., it’s a shame that article is on such a deeply partisan site, because most people will never read it.

I did, and for the most part, it’s a good start.

I would be loath to blame the current situation completely on Democrats, however. The Republican rhetoric on this issue is deafening, and as much as you believe that the Democrats don’t want to negotiate, from my POV, the other side (and their media allies) are intentionally sabotaging the debate just as much or worse. The whole “death panels” thing was absolutely ridiculous, and it gained all too much traction.

But you’re right – there’s no crisis that requires sweeping legislation within weeks. The problem with that is that this has been a debate going on since 1993 – 16 years. Do we have to wait until 2025 to achieve a resolution?

Thank you for the link, BTW.

Texan Mama says:

Sorry, in all that, I forgot to say, congrats on getting featured on the White House blog page! That is awesome.

And, if you ever felt that what you do is insignificant, well sorry sweetie but now that is just shot out of the water! :-)

YOU ARE A VOICE TO BE RECKONED WITH.

Alexander Dumat says:

Health Reform: Throwing Good Money After the Bad
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Read More: Barack Obama, Dr. Marcia Angell, Health Care, Health Care Reform, Health Insurance, Healthcare, Healthcare Reform, Marcia Angell, Massachusetts Health Care, Massachusetts Health Care Reform, Massachusetts Health Reform, Medicare, Obama Health Care, Obama Healthcare, Universal Health Care, Politics News

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Comments

It’s not just the right-wing crazies who oppose health reform. In addition, there are many sane Americans who worry about committing a trillion dollars to it. They have a point. We already spend more than twice as much per person on health care as other advanced countries, and our costs are rising faster. How much is enough?

Make no mistake, sky-high and rapidly rising costs are the core problem. If money were no object, it would be easy to provide full care for everyone. But even a perfectly designed system will fail if it is unaffordable, or rapidly becomes so.

So it’s crucial to ask just why we are spending so much more than other countries. Where is all that money going? Yet, that question is seldom asked in the current debate, even though it’s not logical to try to fix something without understanding why it’s broken.

In the trenchant words of Deep Throat, let’s follow the money. This year we will spend roughly $2.5 trillion on health care. Although about half that money comes from federal and state governments, most of the total is funneled to private insurers and entrepreneurial providers. Alone among advanced countries, we treat health care like a market commodity to be distributed according to the ability to pay, not like a social service to be distributed according to medical need.

For nearly two-thirds of Americans, we rely on hundreds of private insurance companies to set prices and benefits and pay providers. They profit by refusing to cover the sickest patients and limiting services to others. In fact, we have the only health system in the world based on avoiding sick people. Insurers cream 15 to 25 percent off the top of the premium dollar for profits and overhead (mainly underwriting) before paying providers.

Providers themselves have high billing and collecting expenses to deal with the Byzantine requirements of multiple insurers. The innumerable health facilities, both for-profit and nonprofit, also have high overhead expenses to cover their business costs, executive salaries, and the promotion of their profitable services. Altogether, overhead accounts for at least 30 percent of our health bill. If we spent the same percentage on overhead as Canada, we would save about $400 billion this year.

Our method of delivering care is no better than our method of paying for it. We provide much of it in investor-owned health facilities that profit by providing too many services for the well-insured and too few for those who cannot pay. Most doctors are paid on a piecework basis — that is, fee-for-service — which gives them a similar incentive to provide too many services for the well-insured. That is particularly true of specialists who receive very high fees for expensive tests and procedures (like cardiac angiography and MRI’s).

Not surprisingly, our ratio of specialists to primary care providers is much higher than in other countries. There is no way to know exactly how much money is wasted in medically unnecessary tests and procedures, but it is probably on the order of hundreds of billions of dollars per year. Many people point to technology as a cause of our high health costs, but the culprit is not technology per se (all advanced countries have the same technologies), but the flagrant overuse of it for financial gain.

In sum, the answer to the question, “Where is all that money going?” is that much of it is diverted to profits and overhead, and to exorbitantly priced and medically unnecessary tests and procedures. Any reform that has a prayer of containing costs, hence being sustainable, must deal with these two massive drains.
Yet, most reform proposals would leave the present profit-driven and inflationary system essentially unchanged, and simply pour more money into it.

That’s what is happening in Massachusetts, where we have nearly universal health insurance, but costs are growing so rapidly that its long-term prospects are bleak unless we drastically cut benefits and greatly increase deductibles and co-payments, or change the system. We’re learning that health insurance is not the same thing as health care; it may be too limited in what it covers or too expensive to actually use. It is ironic that the President is said to have looked to Massachusetts as a model for national reform, even though the state has the highest health costs on the planet.

To control costs, the President is pinning a lot on electronic records, disease management, preventive care, and comparative effectiveness studies. But while these initiatives may improve care, they’re unlikely to save much money because they don’t deal with the underlying problem — a system based on maximizing income, not maximizing health. Promises by for-profit insurers and providers to mend their ways voluntarily are simply not credible. Regulation of the present system is also unlikely to modify profit-seeking behavior very much, without a bureaucracy so large that it would create more problems than it solves.

Nearly every other advanced country has a largely nonprofit national health system that guarantees universal care. Even countries with private insurers, like Switzerland and the Netherlands, require uniform prices and benefits and limit profits. Not only are expenditures much lower in other advanced countries, but health outcomes are generally better. Moreover, contrary to popular belief, they offer on average more basic services, not fewer — more doctor visits and longer hospital stays, and they have more doctors and nurses and hospital beds. But they don’t do nearly as many tests and procedures, because there is little financial incentive to do so.

It’s true that there are waits for some elective procedures in some of these countries, such as the U. K. and Canada (although hardly the long lines of desperately ill patients depicted by the Republicans). But that’s because they spend far less on health care than we do. If they were to put the same amount of money into their systems as we do into ours, there would be no waits. For them, the problem is not the system; it’s the money. For us, it’s not the money; it’s the system. We already spend more than enough.

Judging by the current debate, it would seem that Americans think they have nothing to learn from other countries, or perhaps that we are all alone in the world. Still, we might be willing to learn from parts of our system that are similar to systems in other countries. Medicare is a single-payer program very much like the Canadian national health insurance system. (Some of the more vociferous town hall meeting protesters seemed not even to know that Medicare is a government program.) The Veterans Health System is a socialized program very much like the U.K.’s national health service. Both deliver better care at lower prices than our private system.

I believe our best bet now would be to extend Medicare gradually to the rest of the population. We could begin by lowering the eligibility age from 65 to 55, then after a few years, drop it to 45, and so on. Medicare is the most popular part of our health system; unlike private insurers, it offers free choice of doctors, it covers all eligible beneficiaries for a uniform package of benefits, regardless of medical history or how much care is needed, and it cannot be taken away by job loss or illness.

But it would need some changes. Its costs are rising almost as fast as those in the private sector, despite the fact that its overhead is much lower, because it uses the same profit-oriented providers. If Medicare were extended to everyone, it should be in a nonprofit delivery system. In addition, fees would have to be adjusted to reward primary care doctors more and specialists less, or better yet, doctors should be salaried. There is now a bill in Congress that calls for exactly that — H.R. 676 (“Expanded and Improved Medicare for All”), which was introduced by Rep. John Conyers of Michigan and has many co-sponsors. Unfortunately, given the power of the health industry lobbies, it’s unlikely to make it out of committee without strong public pressure.

In economic terms, health care is a highly successful industry — profitable, growing, and virtually recession-proof — but it’s a massive burden on the rest of the economy. I’m aware that phasing out private insurers would mean a loss of jobs. But I believe the job loss in that sector would be more than offset by job gains in the rest of the economy, which would no longer be saddled with the exorbitant costs of an industry that offers very little of value to justify its existence.

One thing is certain: We need a complete overhaul of our health system. Tinkering at the edges won’t do it. Expanding coverage through government subsidies and mandates, as advocated by the president, won’t either. Besides being a windfall for insurers and drug companies, that approach will just add to our soaring costs and be a temporary fix, at best. In my opinion, it makes no sense to throw good money after bad.

Marcia Angell, M. D., is Senior Lecturer in the Department of Social Medicine at Harvard Medical School. She was the first woman to serve as Editor-in-Chief of the New England Journal of Medicine, a post she stepped down from in June of 2000. She is also the author of the critically acclaimed book, Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case, as well as The Truth About the Drug Companies: How They Deceive Us and What to Do About It.

JC says:

Great post, and I like the civil tone that this discussion has taken. All of the screaming over this issue is really tiresome.

A couple of points. The first is that to date there isn’t “a” health care bill. There are several bills that have come from various committees in the House and Senate. None of these are final of course. The final bills produced by the House & Senate may look quite different from the committee bills after everyone gets done compromising.

The second thing I would like to add is that I live in Texas, and we have had tort reform since 2003. It has not done a thing to lower consumers’ medical bills. From what I understand it has increased the number of doctors in the state, which may lead to improved access to doctors. This is a laudable goal, especially in rural areas, but it has not resulted in reduced costs for consumers.

Another effect of tort reform that I have heard about is that some doctors have used the money saved on malpractice insurance to purchase new/improved equipment or invest in new, more expensive treatments or techniques. Again, this could possibly benefit some patients and/or result in better treatments or outcomes for some, but it has not translated to reduced costs for consumers.

leila says:

(reposting my comment from the end of Jon’s post. sorry, am too tired to write a new one.)

I was so interested to read your ideas about health care in this country, and I’m glad that you wrote so much. I would like my cookie, now, please.

Thank you for your point about tort reform, which I had not considered before. I will definitely look into this aspect of reform; I think that what you write makes sense. Certainly the litigiousness of American society amplifies the cost of what is necessary care.

The point about profit being an impetus for development in medical technology made me think of a documentary I saw last year, called “Sick Around the World”. Loralee has asked me to link to the PBS page:

http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

You can watch it online, but if you don’t want to sit through the whole thing, then the last “chapter”, about Switzerland, is the relevant part here.

It is made clear that before Switzerland switched over to a public option from a health-care system that resembled the USA’s, people’s fears that the profit-seeking insurance and pharmeceutical companies would lose their driving edge in efficiency, seeking knowledge, and developing technology were completely unfounded. (Sorry about that convoluted sentence.)

The point is, the loss of the profit motive has not impacted the scientific drive to produce health-related products. I think the profile of an example so close to America’s is a very important and comforting one. I recommend the whole documentary, though.

My personal opinion about health care, is—and I have to state this generally and briefly for love of my sleep—it’s that I think it is a basic human need. Therefore, it is a right. A human right.

In our industrialised western democracies, when someone is too poor to buy clothes, there is a charity or government institution that provides them, a Salvation Army or a shelter. For food, there is a similar set-up. These things don’t always work as hoped, but they’re there. People recognize that it is inhumane, below human dignity, to ignore the cries of the needy. Even in the legal profession, there is pro bono work.

I have no doubt that there are doctors and other medical professionals in the United States who work for free or who pay for medications themselves in order to serve others. But for various reasons, systematic and formal free medical care for those in need is not readily available in this country: neither charity nor (universal) government assistance exists.

Something needs to be there. SOMETHING.

Thank you again for your thoughts. I really like learning from others’ perspectives.

leila

lynsey says:

hi loralee,

this is lynsey…who you met today at sil’s. i got a chance to sit down and read your blog and must say that like so many others, i LOVE IT! you have an amazing talent for writing, humor, and being real and i’m totally drawn to bloggers who are like that. so, even though things were a little crazy at lunch, i just wanted to let you know…

i’m a fan of YOURS!

with love, lynsey

Becca says:

I know that you will probably never see this, as I am 5 days behind and there will now be 272 responses, but I have to say my peace.

You, and Jon (I read his piece first), are awesome.

I am that person you were talking about, I don’t fit anywhere. I am not truly a protected citizen of this country. I work for my state government, and yet I am still a member of the working poor. Yeah, and those doctor bills, they suck ass. I am trying to figure out how to find $8 before Monday so I can get my son’s meds now instead of then. I am also gay, I have been in a relationship unrecognized by our government for almost 3 years. If anything happens to her I have no say in how she is treated, who takes care of her, or if they will even let me see her. It scares the hell out of me daily. I have dreams that she is gone, and then they take our child from me because it is not enough that I lost her.

I big pink-puffy heart love you. I agree with what you said, and I respect you and your husband both so much for being able to have a coherent, educated argument. And to hear someone else say that they feel they have no place and they are not represented makes me feel a tiny bit better about daily life. I just want them to fix it.

MoDLin says:

You are such an inspiration! Way way WAY TO GO!

TheDivineIsInTheDetails says:

At the end of the day I highly doubt that anything I had to say will really change or mean anything for the greater picture.
******
That’s where you are wrong! I’m here because you made such an impression on Valerie Jarrett that she referenced you on the White House blog.After reading your blog I can understand why.I am adding yours to my favorites. Great that this created an opportunity for you guys to work through that issue. Now I’m off to read your husband’s blog. Wouldn’t it be funny if he enjoys the “silly” blog thing ? :)

Julie says:

I haven’t posted in a long time, but I just had to for this topic. I read Crunchy’s comment. I also live in BC, and share her views. I do watch the debate in the US closely, and with bewildered fascination. I had to take my mother-in-law to the hospital yesterday for a procedure where they put a camera down your throat to scope your digestive tract. Yes, we had to wait a few weeks for the appointment, which sucks, but on the other hand, if we had to pay the procedure she may not have gone at all. There are so many barriers in the US for preventative health care. In Canada, when I broke my ankle and had to have surgery, and stayed in the hospital two nights, I did not leave with a hefty bill that would cripple our single income family. We are a middle income family that pays our $108 a month for our basic health care. Any routine checkups, medically necessary surgeries or emergencies are covered. My husbands employer kicks in a percentage towards prescriptions and whatnot. So many families in the US are one medical crisis away from financial ruin. When you get right down to it, the current system has people praying that they don’t get sick or injured. The choice between medical care and paying your mortgage essentially puts a price tag on your life. Do you chance a lifesaving procedure at the risk of bankrupting your family? A large portion of divorces and bankruptcies are directly linked to a medical crisis.

Certainly, our Canadian system needs to be overhauled. I have heard many politicians trash our system because we don’t have the same technology. We may not have it at every hospital, but we can go to any hospital or doctor, any time. How many lives are jeopardized when a person has to gauge if their symptoms are serious or not?

PS-I must say that Fox News really shouldn’t be classifies as news. It’s propaganda. You don’t have to like the President (I do), but how can any one trust the content relayed to the viewers as remotely accurate when an anchor will refer to Michelle Obama as the President’s “Baby Mama”? Come on, that is not journalism. That is tabloid gossip poorly disguised as news. If they are willing to paint a woman that way for shock value, what else are they feeding us purely for ratings and political fear mongering. I get that there are other news networks that are just as guilty, for both sides, but that one was brutal.

Nick says:

Catholics in Alliance for the Common Good is trying to bring a personal face to the health care debate by collecting stories like this on an interactive map: http://www.catholicsinalliance.org/storymap

Just thought this might be something you and your readers would be interested in posting to as a way to share your perspective.

(We also are missing stories from Utah so far).

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Nova Radio says:

Keep up the good work – for sure i will check out more posts.