I watched President-Elect Obama’s speech from the concert on the steps of the Lincoln Memorial. Boy, what a downer. All that talk about crisis and lost jobs and war, about enormous tasks, long roads and steep climbs and hard work, and pulling together, about going beyond oneself to improve the entire country – and this after what looked to be a pretty fun, upbeat, enjoyable albeit chilly cavalcade of stars in one of the most scenic spots in the District (that’s what we former residents call Washington DC).
In fact, it sounded more like a speech setting the stage for national health reform than one following Mary J Bligh (although ‘Lean on Me’ does lend itself to the topic…).
Perhaps that’s because I watched Mr Obama after reading Bob Laszewski’s latest post, wherein he continues his effort to inject a healthy – and all too necessary – counterpoint to the “we’re gonna get health care fixed before the Cherry blossoms bloom” position.
As much as I’d like to believe the battle for health reform will commence soon and while tough and unpleasant, end soon thereafter, experience teaches otherwise. I’d suggest that anyone who thinks this will get done quickly recall DC pundits’ statements about the Civil War (lets watch the fun at Bull Run, win the war, then ride home for dinner), the First World War (trench, what’s a trench?), or for those more current on their history, the Iraqi conflict (they’ll welcome us with open arms).
Health care reform will require all of us give up things we hold dear; income, stock options, long-held beliefs, positions of influence and importance, status, profits. It is going to be brutally difficult.
Darn that Obama; he certainly harshed my mellow.
But he also revealed the depth of his understanding. For a guy who’s a few years younger than me, he has wisdom beyond his years.
Don’t take this as bad. Rather, realize that we are fortunate to have as President a person who is walking into this with his eyes wide open. He knows what a tough uphill slog it is going to be, with big pharma, the AMA, the AHA, insurance companies and device manufacturers, pundits and bloggers, Republicans and Democrats, all working as hard as they can to make sure their side wins. And the heck with the rest.
What does this mean for you?
Until and unless there is broad consensus about health reform, it isn’t going to happen.
Until. And Unless.
Jan
20
What if Obama focused on marginal expansions of federal health coverage programs and challenged the states to introduce their own programs such as MA did? And then wait for a consensus to emerge?
What I want to know is,who are these people who set up these “deadlines”. Yes, it needs to be changed, but if it is rushed, it can be made worse than better. How about a period of 2-3 years to identify the problems, see how they can be fixed, the proper way to go about making the changes, and having the infrastructure ready to go once the change is implemented. I fear that rushing this thing will turn out to be a disaster.
Let’s let someone else try to fix it (like states or private industry?). Let’s take some time to identify the problems because rushing “this thing” may turn out to be a disaster (like we don’t already know most of the problems and this isn’t already a disaster?). I guess JFK heard the same thing when he went for the moon in less than one decade. Most people aren’t willing to be a part of the solution or are only concerned about their situation. We have become a nation of victims and finger-pointers. Although I may have played a part in our current situation, I’m willing to work to change it now.
Wake up people.
George, I have three letters for you: CBO. And a name: Wennberg.
The steps you advise have already been done, and subsequent action is long overdue. Knowing that, re-read what Joe wrote.
The problem isn’t with identifying the problem — there are several, but it’s mostly that medical costs are too high because third parties pay for too much inefficient, inconsistent, unnecessary and/or duplicative activity. Knowing which solution to apply is not a mystery either, as the CBO just recently presented a list of 140 reform solutions, their likely impacts, and the CBO’s best estimation of the true cost of each.
The only hurdle that stands in the way is mastering the politics. There are multiple stakeholders, none of whom are willing to see their ox gored for the good of the herd.
Thanks for a great post Joe. You’re entirely right.
Obama was saying “Grow up America.” (The time has come to put childish things away.)
Last winter, IHI’s Don Berwick said to me, “Sometimes I think this country is just too immature to reform the healthcare system.”
We do know what the problem is–and how to fix it.
But no one wants to give anything up. Patients don’t want to give up the over-priced, ineffective treatments. (And this isn’t a third-payer problem; even when they have to pay themselves, uppper-middle-class Americans will pay 20% of a $100,000 round of chemo. Americans are in love with technology and believe that with hi-tech medicine they can beat death.
When someone dies it must be because the doctor made a mistake; the hospital made a mistake;the HMO wrongly denied the life-saving treatment. Death is an “error.” It’s a wonder that immortality isn’t listed on the Patient’s Bill of Rights.
Then ,as Rick says, the health-care industry doesn’t want to give up high profits–and affluent shareholders don’t want to see drug prices drop either.
The best paid physicians feel aggreived that they are making “only $2 million”–in contrast to the $15 million that some CEOs make–and they certainly don’t want their income reduced to expand primary care, palliative care, pediatric care . .
Hospital CEOs want to hold into their surpluses so that they can buy more flat-screen TVs for the private rooms–and expand the cath lab.
Forget about palliative care, smoking cessation clinics, or the other things that would improve patient care.
Those who have been insisting that Obama will roll out universal coverage this year should read his speech. Nowhere does he refer to “universal coveage” or “healthcare for all”.
Instead he refers to the need to “reduce spending” and “lift quality”—twice.
He knows that we can’t throw billions into a wasteful broken system unless we make the necessary reforms–which means everyone giving something up.
Our Health Care System
The following are facts that are believed to exist regarding the present U.S. Health Care System. This may be why about 80 percent of U.S. citizens understandably want our health care system overhauled desperately due to the inadequate health care they receive and access:
The U.S. is ranked number 42 related to life expectancy and infant mortality, which is rather low.
However, the U.S. is ranked number one in the world for spending the most for health care- as well as being number one for those with chronic diseases. About 125 million people have such diseases. This is about 70 percent of the Medicare budget that is spent treating these terrible illnesses. Health Care costs are now well over 2 trillion dollars of our gross domestic product. This is three times the amount nearly 20 years ago- and 8 times the amount it was about 30 years ago. Most is spent with medical institutions, as far as health expenditures are concerned. One third of that amount is nothing more than administrative toxic waste that does not involve the restoration of the health of others. This illustrates how absurd the U.S. Health Care System is presently. Nearly 7000 dollars is spent on every citizen for health care every year, and that, too, is more than anyone else in the world.
We have around 50 million citizens without any health insurance, which may cause about 20 thousand deaths per year. This includes millions of children without health care, which is added to the planned or implemented cuts in the government SCHIP program for children, which alone covers about 7 million kids.
Our children.
Nearly half of the states in the U.S. are planning on or have made cuts to Medicaid, which covers about 60 million people, and those on Medicaid are in need of this coverage is largely due to unemployment. With these Medicaid cuts, over a million people will lose their health care coverage and benefits to a damaging degree.
About 70 percent of citizens have some form of health insurance, and the premiums for their insurance have increased nearly 90 percent in the past 8 years. About 45 percent of health care is provided by our government- which is predicted to experience a severe financial crisis in the near future with some government health care programs, it has been reported. Most doctors want a single payer health care system, which would save about 400 billion dollars a year- about 20 percent less than what we are paying now. The American College of Physicians, second in size only to the American Medical Association, supports a single payer health care system. The AMA, historically opposed to a single payer health care system, has close to half of its members in favor of this system. Less than a third of all physicians are members of the AMA, according to others.
Our health care we offer citizens is the present system is sort of a hybrid of a national and private health care system that has obviously mutated to a degree that is incapable of being fully functional due to perhaps copious amounts and levels of individual and legal entities.
Health Care must be the priority immediately by the new administration and congress. Challenges include the 700 billion dollars that have been pledged with the financial bailout that will occur, since the proposed health care plan of the next administration is projected to cost over a trillion dollars within the first year or so of the proposed plan to recalibrate health care for all of us in the U.S. Yet considering the hundreds of billions of dollars that are speculated to be saved with a reform of the country’s health care system, health policy analysts should not be greatly concerned on the steakholders who may be affected by this reform of our health care system that is desperately needed. Tom Daschle leads this Transition’s Health Policy Team. And we also have Ed Kennedy, the committee chair and a prolific legislator. So if the right people have been selected for this reforming team, the urgency and priority regarding our nation’s health care needs should be rather overt to the country’s citizens.
Half of all patients do not receive proper treatment to restore their health, it has been stated. Medical errors desperately need to be reduced as well, it has been reported, which should be addressed as well.
It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the public health. This specialty makes nearly 100 thousand less in income compared with other physician specialties, yet they are and have been the backbone of the U.S. health care system. PCPs manage the chronically ill patients, who would benefit the most from the much needed coordination and continuity of care that PCPs historically have strived to provide for them. Nearly have of the population has at least one chronic illness- with many of those having more than one of these types of illnesses. A good portion of these very ill patients have numerous illnesses that are chronic, and this is responsible for well over 50 percent of the entire Medicare budget.
The shortage of primary care physicians is due to numerous variables, such as administrative hassles that are quite vexing for these doctors, along with ever increasing patient loads complicated by the progressively increasing cost to provide care for their patients. Many PCPs are retiring early, and most medical school graduates do not strive to become this specialty for obvious reasons. In fact, the number entering family practice residencies has decreased by half over the past decade or so. PCPs also have extensive student loans from their training to complicate their rather excessive workloads as caregivers.
Yet if primary care physicians were increased in number with the populations they serve and are dedicated to their welfare. Studies have shown that mortality rates would decrease due to increased patient outcomes if this increase were to occur. This specialty would also optimize preventative care more for their patients. Studies have also shown that, if enough PCPs are practicing in a given geographical area, hospital admissions are decreased, as well as visits to emergency rooms. This is due to the ideal continuity in health care these PCPs provide if they are numbered correctly to treat and restore others. Also, the quality improves, as well as the outcomes for their patients. Most importantly, the quality of life for their patients is much improved if there are enough PCPs to handle the overwhelming load of responsibility they presently have due to this shortage of their specialty that is suppose to increase in the years to come. The American College of Physicians believes that a patient centered national health care workforce policy is needed to address these issues that would ideally restructure the payment policies that exist presently with primary care physicians.
Further vexing is that it is quite apparent that we have some greedy health care corporations that take advantage of our health care system. Over a billion dollars was recovered for Medicare and Medicaid fraud last year through settlements paid to the department of Justice because some organizations who deliberately ripped off taxpayers. These are the taxpayers in the U.S. who have a fragmented health care system with substantial components and different levels of government- composed of several legal entities and individuals, which has resulted in medical anarchy, so it seems.
Thanks to various corporations infecting our Health Care System in the United States, the following variables sum up this system as it exists today. Perhaps the United States National Health Insurance Act (H.R. 676) is the best solution to meet our health care needs as citizens, it appears. We would finally have, as with most other countries, a Universal Health Care system that will allow free choice of doctors and hospitals, potentially, and health care for all completely. It should and likely will be funded by a combination of payroll taxes and general tax revenue which is realistically possible. Because the following needs to be corrected regarding the U.S. Health Care System:
Access- citizens do not have the right or ability to make use of this system as we should.
Efficiency- this system strives on creating much waste and expense as it possibly can.
Quality- the standard of excellence we deserve as citizens with our health care is missing in action.
Sustainability- We as citizens cannot continue to keep our health care system in as it is designed at this time- as it exists today.
http://www.mckinsey.com/mgi/publications/US_healthcare/index.asp
Dan Abshear
This reform means a great deal to me, infact, my life and that of others who have long confronted the indifference of some health care plans.
After four years of investigating the unethical business practices of both Coventry legal and Carelink, a subsidiary of Coventry, I am not surprised to learn of Coventry’s problems. Like ENRON, this corporation has a public and a private image. Are you aware that the regulatory agency NCQA, that accredits health plans, was formed in 1976 by HMOs? That the accreditation is based solely on information provided by the health plan? That US News and World Report uses this incomplete data to annually rate the top health plans?
You can understand my bewilderment when Carelink Health Plans of West Virginia received an excellent accreditation in 2008. The innocent public is unaware of the WV Insurance Commission’s Final Order 06-AP-024 on December 14, 2006, that mandated radical change in service because of “egregious” deeds. Nor are they aware of the civil lawsuit that will be prosecuted in 2009 in the Ohio County District Court. ERISA preemption was thrown out in the WV Federal Court. A recent motion to silence my blog was also denied.
It’s not a pretty story, but one that repeats itself too often when the rightful benefits are denied the consumer, especially the most vulnerable – the elderly and mentally ill. The culture may not be different inside the walls of Coventry as many employees describe online the shocking conditions of offices throughout the country.
Reform will like have a better chance with more transparency and a new boldness to tell the truth. And, yes, some of us will have to make sacrifices. It looks like sacrifices are now inevitable.