In his State of the Union speech, President Obama devoted only a few minutes to health care reform. This might surprise some, but I think the president made a wise decision. There was little reason for him to spend more time on the issue. The Patient Protection and Affordable Care Act (PPACA) is now the law of the land. There is no reason for the President of the United States to debate it.
President Obama did allow that “anything that can be improved in the legislation” should be changed. I agree. As the law is implemented, experience will show us where adjustments should be made.
Extending a hand across the aisle, the President also said that “we can start now by reducing unnecessary bookkeeping burdens on small businesses,” referring to the provision in the heallth care reform legislation which requires that every business provide a 1099 for each vendor with whom it does more than $600 worth of business over the course of a year. This was a provision tacked onto the heath care bill, designed to reduce tax fraud. I applaud the motive, but when it comes to reforming health care, this is not an important plank in the legislation.
More importantly, President Obama made it clear that he would not bow to any effort to undermine the individual mandate: “What I am not willing to do,” he declared, “Is to go back to the days when insurance companies could deny patients because of pre-existing conditions."
President Obama is confident about the Affordable Care Act because he knows that, this year, health care reform already has begun to deliver benefis to a great many Americans:
— Small business owners are taking advantage of the tax credit and signing up for insurance for their employees
— Children under 26 are being covered by their parents’ insurance
— Medicare beneficiaries who fall into the “donut hole” (a gap in prescription drug coverage) are receiving $250 rebates, and in coming years, the hole will be eliminated
— Parents of children suffering from pre-existing conditions have discovered that, under the reform legislation, insurers can no longer deny their children coverage
–Patients who are seriously ill no longer have to lie awake trying to calculate when their insurers’ lifetime caps on reimbursements will mean that they no longer receive care. Under reform, those caps have diaapperaed.
Americans who benefit from these changes are beginning to understand and appreciate reform legislation. Next year, more of us will feel the impact of reform.
Conservatives who want to argue for repealing (or “de-funding”) reform should feel free to exercise both their lungs and their legal rights under the First Amendment. But, as I think President Obama realizes, they are shouting into the wind.
Insurance companies, when it comes to individual policies will continue their practice of declining people, due to notable health conditions, up until 2014, so no need to get too excited now!!
Insurance will still remain too expensive and many will not be able to afford it, despite the subsidies. In addition, tax payer dollars will go directly to insurance companies, thereby subsidizing an industry that is the source of the problem. Medicare for All.
Medicare Part D is the worst. It’s almost impossible, but for the first time this year an exception my doctor put in for was approved by United Health Care, so I think it’s already making a difference. Of course each of my co pays is $71 and my whole social security check (which could be used to improve the economy) has been going to the insurance companies, so I have no clue why anyone would be afraid of change when the status quo is killing poor people and seniors and the disabled as things are. Except for Congress and the Senate who have no skin in the game. I think the quickest way to change things is to take away those benefits and let them buy individual insurance from for profit companies on the open market….I know that would work!
Maggie referencing a few bullet points per 26 year olds etc completely misses the true burden created by this socialist attempt to take over 16% of our economy. The facts are that small businesses are getting crushed by huge renewal increases caused by the actuarial known 20% increase in costs caused by this legislation. We now face health care inflation of 15% per year – up from the prior legislation trend of 11%.
There are places to attack rising costs:
Disease management
Wellness programs
Removing state barriers to carrier competition
Tort reform.
We don’t need to add a trillion dollar burden to the economy to fix health care.
And, another footnote, in reference to the tax credit, a number of companies may be signing up for this, but keep in mind that the owner’s of the business, you know, the one’s that create the jobs, are excluded from benefiting from the credit!
We, the Progressive Group Leaders / Media / Activists are sitting in a stupor forgetting that the biggest and most urgent items for the well-being of ordinary Americans are totally unavailable and will stay so for 3-4 more years. I refer to subsidies and exchanges, pre-existing condition and even Medicaid expansion (Yes!, even as the benefit can be rolled out in months). Meanwhile 45,000 people will keep dying every year for lack of healthcare, hundreds of thousand bankruptcies will rob people of a meaningful life. I still can not accept that the President will congratulate himself on his compromising skills and a laundry list of legislation – in which the reforms meant to rectify major structural faults have been rendered toothless in compromises with Corporatist forces. How can we not see the lives being destroyed, the main point of the Obama campaign and Progressive campaigns on the street. It is almost as if the President wants that we would have never mobilized for universal health care in as big a way as we did.
Given that we spent a huge amount of sustained effort for over at least a year, I myself was viscerally feeling the disgrace of sitting smug in face of this inhumane circumstances of our fellow citizens. The social issues like 911 Responder Healthcare, DADT, Unemployment benefits (not for 99ers) etc do stand out in the Presidential Laundry list. But none of the euphoria being exhibited today can hide the disaster being visited upon people without Health Insurance as identified above. It is the same thing with 99ers who like the 200,000 destined to die are completely ignored by the President. It is unfortunate that the list of current limited benefits is disingenuously trotted out to hide the lack of availability of core benefits. It is such a pathetic idea that all but a handful of Dems refused to tout this so called “transformational reform”
Carol, Henry, Henry (your first comment), Lauren, Hoyt, Doubleseven
Carol–
Yes, insurers hear the hoofbeats of reform in the distance ,and some already are beginning to respond. (For instance, this year, Medicare Advantage insurers reduced premiums by an average of 1%–even though the government is now paying them less.))
I wonder why your co-pays are so high.
Are you buying brand-name rather than generic drugs?
Or perhaps you are taking a large number of drugs . . .You might wnat to go to a gerontolist (who specializes in caring for seniors), bring him a list of your medications (your pharmacy can give yuu a list) and ask him whether you really need to take all of these durgs.
A great many seniors on Medicare are over-medicated. Sometimes, two or three different doctors have prescribed the drugs.
And, as you get older, your body can’t tolerate such high doses–or too many drugs. That’s why
doctors who specialize in drugs (pharmacologists) argue that Medicare patients should go to a gerontologist
Henry–
The tax credit is not designed to make small business owners wealthy.
It is designed to, you know, help them provide insurance for their employees becuase they want to, you know, do the right thing.
In other words, the credit is designed for altruistic
small business owenrs– and VERY SMART small business owners who realize that if they offer better benefits, they will be able to attract better employees.
Meanwhile, Short-sighted realtively dumb employers are asking: “What’s in this for ME today.”
Henry– replyling to your first comment: insurance companies can no longer refuse to cover children suffering from pre-existing conditions.
Ask their parents whether this is something to get excited about.
And insurers now have to pay out 85% of premiums in reimbursements (when covering large groups) which gives them a new financial incentive to make sure that they are providing better care and keeping their customers healthier.
Lauren–
I don’t know where you got your information.
But you’re simply spouting opinions without evidence. This doesn’t help any of us learn about health care reform.
Hoyt–
Only a small part of heatlh care reform has taken effect, so the legislation is not responsible for current increases in the cost of care.
We’ll rein in health care inflation only when we excise the waste– the over-treatment and over-charging by hospitals, drug-makers, device-makers and doctors. That
is what makes health care so much more expensive in the U.S.
I’d urge you to subscribe to Health Affairs and read a year’s worth of issues. You would begin to understand what drives spiralling health care costs–and what doesn’t.
Doubleseven–
You indicate that you spent a year working for healthcare reform.
That’s good.
But do you realize how many people have been working for heatth care reform for 20 years, 30 years–or more?
If you’re policcally commmitted to change, then you should realize how hard change is, and how long it takes. (Read the history of the of the civil rights movement. Change means Moving People’s Minds from where they are to where they could be. This is hard.
Pgressive politics devoted to change is not for those who need immediate gratification.
Where were you in the early 1990s, when we were trying to pass health care reform?
It would have been so much less expensive then . . .
Where were you when the nation re-elected George W. Bush–Twice–killing any hope of Medicare reform, health care reform, or redistribution of income?
(I hope that you voted–and that you worked hard for the more liberal candidates.)
Today, health care reform is very, very expensive. We waited too long, and now the cost will be enormous.
I, for one, would have been happy to see Congress
kill the tax cuts for upper-middle class Americans (with joint income over $100,000) and use that money to speed up expansion of Medicaid.
But the majority of Americans earning over $100,000 would not agree with me. Many would say they just can’t afford signfiicantly higher taxes. And since we have a represenative government, Congress must represent their views.
In addition, if you have read the Acccountable Care Act carefully, you realize just how complicated health care reform is.
As Dr. Atul Gawande has written in the New Yorker, this is not something that you can do in a year–or even two.
If you try to do that, “people will die.” (a direct quote from Dr. Gawande, who knows more about the reality of heatlh care than you or I–he practices medicine every day.)
As for the number of people dying each year due to lack of health care, you are right,lack of good care takes a toll –though the biggest cause of premature death is not lack of health care (which accounts for only 15% of such deaths), but POVERTY.
Access to health care is not the cure-all that many on the left seem to assume. Did you know that each year, 125,000 Americans are Killed (inadvertently) by health care? (Far more than are killed by lack of access to care.) See all of the major medical jouranls for these numbers.
Medication mix-ups, complications following surgery, hospital-acquired infectoins, mis-diagnosis, over-treatment–kills 125,000 (and that’s the more conservative figure.). . .
Before throwing millions of people into a broken system, we need to improve patient safety, and weed out the over-treatment (the biggest problem)
This is another reason why it will take until 2014 before rolling out the final stages of health care.
In the meantime, this year we are offering hi-risk pools for those who cannot get insurance (because of pre-existing condtions), and this year, insurers can no longer refuse to cover sick children.
In other words, we’re trying to help the sickest and the youngest first.
But in this country, we all need to understand that poverty is the real killer.
Poverty leads to depression, anxiety, anger, and self-medication (alcohol, drugs tobacco, etc.)
Poor people don’t have safe places to exercise. And they don’t have good access to affordable, nutrious food (fish, fruit, vegetables, etc.)
If you look at public health studies, you will find that for most of us, most of the time, what we eat and whether we exercise is far more important than how often we see a doctor.
I hope you are supporting a new war on poverty–which would mean integration of our schools by class (with wealthier suburban schools opening their doors to poor students). This is already working in a number of communities, but needs to happen nationwide.
To fight poverty we also would have to hike tax hikes for the upper-middle-class ( housholds with joint income over $100,000) and upper-class (families with joint incomes over $100,000) bringing taxes up to European levels.
In Western Europe, the percent of children living in poverty is signficiantly lower than in the U.S. And the upper middle-class pay much higher taxes.
It is easy for people who are left of center to call for the government to do more. Or to say that Obama should be doing more. (IN many agrees, I would agree. But when it comes to healthcare, he has done as much as he possibly could do in this environment.)
Here is the bottom-line question: are you, personally, willing to make the sacrifices needed to make heatlh care reform happen–and more importantly, to close the income gaps between teh poor, the middle-class, the upper-middle class and the wealthy?
Are you willing to realize that overtreatment is a big problem, and that if we’re going to have universal coverage we’re going to have to say “no” to ineffective treatments including: PSA tests, many angioplasties, many bypass surgeries, a great many back surgeries, many MRIs,
etc. etc. etc.?
Sorry for the rant, but it is just so exasperating when people on the left refuse to study the problem, and understand the problem. They seem to feel that if they voted for Obama, American society and government should ahve been instantly transformed.
If we’re serious about bending the medical cost growth curve, we are going to have to work on changing the culture of patient expectations and the sense of entitlement to even futile end of life care at someone else’s expense. Here is a classic example of what I’m talking about from Dr. Bob Wachter’s most recent post on The Healthcare Blog:
“One patient – a woman in her late 80s with dementia, bowel ischemia, serious cardiac disease, recurrent cancer, and ventilator dependence for weeks – ate up huge resources in the ICU with only a small chance of getting back home. We had lengthy discussions with the family on an almost daily basis, and they felt strongly about continuing with aggressive care despite our concern about her poor prognosis and the burdens/benefits of care. I found myself wondering whether every American (including me and my family) is entitled to this kind of very expensive/marginally effective care for free, when so many patients do not have access to basic preventive healthcare and clearly effective medical treatment.”
I wouldn’t want this for myself or any family member and I’m not willing to pay ever higher taxes to cover it for others. If people want to pay for it themselves, fine. I wonder, though, how these cases are handled in Europe and Canada.
Barry:
Hospitals and the healthcare industry are in the business of selling a service regardless of the diminishing returns of success. In any case, both demand a maximum dollar return in spite of the return. It is not the patient, it is the business . . . it markets the product/service well.
Snakeoil anyone?
Barry, Run 75441
Barry–
All of the research shows that health care is supply-driven, not demand-driven.
As you know, Anecdotes tell you about one individual; they don’t give you an overview.
Yes, some relatives demand that doctors do everything possible well beyond the point of diminishing returns.
But we know (from researchers, reports from relatives, pallaitve care specialists and others) that when patients are over-treated at the end of their lives, this is usuually because the hospital, an oncologist, a surgeon or another physician in charge of the patient continued to recommend more treatment.
I have talked to a number of palliative care specialists with many years of experience. They have seen a great many patients, and they all report how often the doctor in charge of the case refuses to let them counsel a patient. (Often the doctor in charge has the power to do this. If the patient asks for a palliative care consult, or hospice, the doctor says: “You’re no where near needing that!” Of course, the patient would like to believe this–
This is not necessarily because doctors are greedy. Many just have a very hard time acknowledging that their patient is dying. They see this as failure. They have been trained to “save lives”—and somehow, their med school training failed to emphasize that eventually, all of us die.
This is not the doctor’s fault. Still, even residents will say “Not on my watch”–keeping the patient alive for another 12 hours . .
As for hospitals . . . as
run 75441 points out:
“Hospitals and the healthcare industry are in the business of selling a service regardless of the diminishing returns of success. . . It is not the patient, it is the business . . .”
We need to make pallaitive care consults available to all patients. And we need to let patients know that palliative care exists.
With palliative care, a patient doesn’t have to “give up” hope of cure; he doesn’t have to give up treatment. But with palliative care management of pain, and palliative care counseling, many patients are able to think clearly about what THEY want (Quite apart from what relatives want or what their doctor wants.)
Palliative care specialists do not push the Patient to “give up.”
Palliative care specialists are trained to simply let the patient express and decide how he or she wants to di.
Palliative care specialists tell me that the marjority of patients don’t want to prolong the process of dying. The older they are, the more likely they are to accept death. And many are just very, very tired.
They would like to be comfortable–out of pain. They would like to say good-bye to close friends and relatives. And most of all, they would like to die at home–not in an ICU.
Barry, this really is the answer–give patients the power to decide what they want. a few will want to fight to the bitter, bitter end. Most won’t.
On care in Europe– please see what I say below in my reply to “Run 75 . .”
Run- 75441–
Thank you.
You put it very well.
As you say, this really is about business and profits.
In Europe, many fewer patients die in an ICU,
and health care providers are much less likely to urge “doing everything possible.”
The profit motive isn’t driving things– hospitals and doctors aren’t going to make a fortune on end-of-life treatments.
Maggie – I certainly agree about the need for palliative care specialists, especially at AMC’s that treat the sickest and most complex patients. Indeed, in Wachter’s post I referred to in my last comment, the doctor he is writing about in describing her observations after a 10 year absence from medical practice stated that UCSF’s palliative care program “changes the culture of medicine” (at least at that hospital).
Speaking of culture, I wish we would banish the term, “give up,” from the medical lexicon because it implies the patient is somehow weak and cowardly. I don’t like “fight” or “fighter” either as that suggests patients are brave and courageous when they often may be just clinging to false hope or going along with whatever the doctor orders.
It’s interesting to note the reports about Nelson Mandela today, which emphasize that he’s ‘not in any danger’. This language inplies that even at the age of 93 a natural death is somehow a ‘danger’…
Barry & Marc
Barry–I agree.Often, patients feel some pressure from family, doctors and nurses to show that they are a “good patient” by fighting.
This is such a terribly cruel thing to do to someone who is tired, weak, has lived a good life, and is now ready to “let go.”
I admire people who can make their peace with death at a certain age–by that I mean simply that they accept the fact that they will die.
On the other hand, there are people who are by nature and temperament, fighters—even at 88. That’s just who they are.
And a good palliative care specialist understands that you’re not going to change who someone is when they’re dying. Quite the opposite, who want to give people a chance to die with the integrity of their self-hood intact–
to die “in character” so to speak.
(I’m told that among people in their 70s and 80s,the number who want to fight is fairly small (assuming they’re given a chance to consider their options and express their wishes) so here we’re not talking about the cost of healthcare, just giving people patient-centered care.)
Marc–
Yes, that is interesting. It also strikes me as odd when very reglious people speak of being close to death as being “in danger”.
If you believes in an after-life, don’t you look forward to meeting your maker? I think some truly religoius people do, but others remain very afraid of death. ..