Governement Healthcare...

[PrincessFiona]

I keep thinking, "is everyone so completely tuned out that they just don't see what is going on?"

Yes.

[Deebs]

I think people do know what's going on (at least in my upper-middle class, well educated suburb), but don't know exactly what to do about it. When DH went to the Hill this spring to advocate for meaningful health care reform, the docs that were there were "bumped" off of schedules so that our elected officials could instead meet with college football athletes. Those they did meet with couldn't understand why a specialist wouldn't want to cover ED call or how there could be a shortage of hand and neurosurgeons responding to emergency call. They had such little understanding of any of the issues, it was appalling (although not surprising).

We have a good friend who is commercial real estate and went to the Hill to talk about small businesses not being able to get loans for development, and the response was basically one of confusion. You mean the stimulus plans are not forcing banks to lend???

Anyone that we are in direct contact with who has truly made an effort to work with reform has basically been met with a brick wall. I am the person who actually calls and writes my elected officials, and have the education and background to have meaningful input towards health care reform. I'm just not sure that my voice makes any difference. How's that for sad?

[PrincessFiona]

Deb,

I don't have the education to add anything meaningful to the discussion. LOL I find it very difficult to read the House bills and keep up with everything going on. To me, it feels like the process has become intentionally muddled and difficult to understand. I don't understand what this *reform* is going to look like anymore and I am someone who really has believed in some form of universal health coverage.

At this point, I feel resigned to sit back and let it happen. It is going to happen and there are many people touting the "something is better than nothing" philosophy. We STILL haven't figured out the new medicare drug plan years later and haven't closed the donut hole ... and it looks like things are going to get more expensive and complicated and that benefits to providers will continue to be cut.

Doctors will lose control of what they can and can't do....the way it is with medicare now, medicare won't pay if a pt is re-hospitalized after discharge for a treatment....like they get an infection, are non-compliant and don't heal, etc....There is just one payment. There will become more incentive to accept less sick patients, not accept govt. insurance and provide quicker less personal care.

[radwife]

I've just spent the last several minutes trying to type a thoughtful level-headed response, but I just keep getting worked up then have to hit the delete button...

It really feels like the doctors are being targeted. One of the things that concerned me during Obama's speech to the AMA was his position that was basically pay-for-performance. It very much sounded like he wanted a doctor's compensation based upon "curing" people or having them hit health targets. It's like just setting the docs up for failure. There are so many people out there who don't want to help themselves. Doctors can talk to them until they are blue in the face about losing weight, but they can't be there to pull the food out of their hand! There are some people out there who have access to health care, but choose not to pay for it. Then they go into into the hospital and yell at my husband for narcotics. I don't think taxing doctors and other high income individuals to pay for it is the answer.

I really do think that all people should have coverage, but I don't think the way they are going about it is right. I think there is more focus on hitting the deadline of passing something rather than making sure they pass something that works.

Ugh, I could go on, but basically, I find the whole situation very scary.

[GrayMatterWife]

I don't have the education to add anything meaningful to the discussion. . . .

At this point, I feel resigned to sit back and let it happen. It is going to happen and there are many people touting the "something is better than nothing" philosophy.

I doubt constructive participation in this debate requires a level of professional expertise that you lack. Personally, I think a little more common sense and a little less ginned-up "CRISIS!!" mode from the so-called experts would be helpful. But that's how they get things done--call it a crisis, keep repeatedly stating that "Americans are demanding this get fixed" (regardless of actual punblic consensus), then forecasting the horrible future should their solution not come-to-pass. (It kind of reminds me of the "population growth" scare on the 60's-early 70's. Remember the "Population Bomb" that predicted mass starvation and catastrophe by the end of the centry if we didn't stop repopulating?)

Something is NOT better than nothing. Doing nothing is better than doing something WRONG. "Change" with a misguided vector is merely...going in the wrong direction. Be heard. Call your Representatives. Call your Senator. Write to your papers. Donate to policy groups. And VOTE in 2010. Hold people accountable. Remember, the reform that is being proposed does not go into effect until 2013. The taxes do not go into effect until 2011. We can always undo the stupidity being rammed through right now.

[PrincessFiona]

It really feels like the doctors are being targeted. One of the things that concerned me during Obama's speech to the AMA was his position that was basically pay-for-performance. It very much sounded like he wanted a doctor's compensation based upon "curing" people or having them hit health targets. It's like just setting the docs up for failure. There are so many people out there who don't want to help themselves. Doctors can talk to them until they are blue in the face about losing weight, but they can't be there to pull the food out of their hand!

Actually, this brings up the devil we already have which is the health insurance industry (which, imo needs reformed). There are lists here published regularly of physicians who meet targets for a1c levels in their diabetic patients, etc. Basically, docs that continue to see patients who are non-compliant or struggle to keep sugars under control are at the bottom of the list, while doctors who are able to stream-line their practices and dump the bad ones are at the top. They are targeted for bonuses based on a1c levels. You can teach a patient what they need to do, but doctors are already being dinged for poor patient compliance and that is through private industry.

[scrub-jay]

It really feels like the doctors are being targeted. One of the things that concerned me during Obama's speech to the AMA was his position that was basically pay-for-performance. It very much sounded like he wanted a doctor's compensation based upon "curing" people or having them hit health targets. It's like just setting the docs up for failure.

And what about the many medical specialties that are more about maintenance and less about finding a "cure"? *sigh*



-C

[Vishenka69]

I completely agree with Deb, majority of the elected officials don't know first thing about healthcare. I have no idea how they can be trusted to pass anything on the topic they know nothing about. Last year McCain came to DH's hospital to learn about how it works, etc. DH said that he asked such basic questions that it was clear he had no clue. The hospital also sends people to the Hill as part of some committee/lobby and they all complain that nobody in DC has any idea or really want to learn.

Many docs here are scared that in a few years there'll be an end to PP and everyone will be forced to be a hopitalist on a base salary. I don't see how this will benefit anyone, as none of them will be enticed to see 20 patients or do 10 surgeries a day. There'll be huge wait lists to get anything done and we'll be back to relying on ER's.

There was a great article on rationing health care in NY Times last week. I agree with the author that many Americans who point to countries with socialized medicine as the great example we should follow, forget that every single one of them rations care. Until we're prepared to do the same, the cost won't come down.

[oceanchild]

I keep thinking, "is everyone so completely tuned out that they just don't see what is going on?"

Look, I'm not going to spend a ton of time posting a huge long response that will change none of your minds, but it drives me crazy when people assume that everyone who doesn't agree with them is completely oblivious.

Yes, some people still support what the president would like to do. And some of those people are doctors. Yes, they read the news. Yes, they pay attention. And they are not stupid just because you disagree with them.

[PrincessFiona]

Look, I'm not going to spend a ton of time posting a huge long response that will change none of your minds, but it drives me crazy when people assume that everyone who doesn't agree with them is completely oblivious.

Yes, some people still support what the president would like to do. And some of those people are doctors. Yes, they read the news. Yes, they pay attention. And they are not stupid just because you disagree with them.

Change my mind! I have been one of the biggest supporters of universal healthcare that I know.

I did not end up supporting Obama in the end but I have also not criticized his performance at all over the last 6 months in an effort to give all if this a chance.

I don't think believing in what Obama us trying to do makes someone "stupid". The devil is in the details here. How are the criticisms of this current health card initiative wrong? Quite frankly, I want to be proven wrong.

Someone put me in my place!

I had dinner last week with 3 docs who campaigned for Obama. They each expressed disappointment and dismay at the current direction.

[MrsC]

Look, I'm not going to spend a ton of time posting a huge long response that will change none of your minds, but it drives me crazy when people assume that everyone who doesn't agree with them is completely oblivious.

Yes, some people still support what the president would like to do. And some of those people are doctors. Yes, they read the news. Yes, they pay attention. And they are not stupid just because you disagree with them.

ITA!!

In reference to some of the comments that have been made, I want to point a few things.

- I grew up in a country with social healthcare and it certainly has it's problems. Name one that doesn't! But I have actually EXPERIENCED it and KNOW what it is like. I've had several relatives with cancer and other serious illnesses and they received treatment on time just as they would have here (if they had adequate insurance of course). I don't know one person who cannot afford medical care there. Middle class families have additional private medical insurance with a tiny premium ($500 a year). They can go to private hospitals to avoid waiting for elective procedures.

- What people are afraid of is the following - not having a hotel suite/hospital room during their stay, not being able to schedule that CT scan every time they have heartburn or endoscopy every time they have a tummy ache, not being able to see a different specialist for every ache and pain. It's disgusting how resources are wasted in the practice of defensive medicine and for no reason at all. If doctors have to brush up on their clinical skills so be it. I can't count how many times DH has had to cancel an expensive CT scan or MRI that was completely unnecessary because a physician was too lazy to perform a physical exam.

- Obama's plan may not be perfect but he's trying to do something. As far as I can see, the only people complaining are those with good jobs and good health insurance. My friend who earns $23,000 a year and has no dental insurance and can't afford it would be delighted at the chance of continued dental care. Apparently it's ok for only the wealthy and poverty stricken to receive healthcare. Those of us who are middle class are screwed if we lose our jobs/medical insurance right now.

- For those of you who don't think that this is a urgent matter...tell that to the millions of families who are filing for bankruptcy because of medical expenses. Do they deserve it? Did they ask to get sick? Did they have less of a right to healthcare as anyone else? It's a basic human right not a damn privilige. Anyone who disagrees with this needs to pull their head out of their asses and stop thinking about me, me, me.

[Pollyanna]

Look, I'm not going to spend a ton of time posting a huge long response that will change none of your minds, but it drives me crazy when people assume that everyone who doesn't agree with them is completely oblivious.

Yes, some people still support what the president would like to do. And some of those people are doctors. Yes, they read the news. Yes, they pay attention. And they are not stupid just because you disagree with them.

Let me be clear, my statement was a statement of feeling, not one of fact or judgment. I have ALWAYS said that I can respect someone's opinion if it is well thought out. I may not agree with it but I can respect differing opinions. Nothing I said was ment to be personal. If you would like to express your opinion then I say, "go for it!" Will it change minds? Maybe and maybe not, but that is the fun of debate.

Anyone who disagrees with this needs to pull their head out of their asses and stop thinking about me, me, me.

Now that is not an effective use debate. Simply because someone does not agree with the administrations plan for healthcare reform does not make them selfish. I believe there are other ways to reform healthcare than to tax the hell out of everyone and destroy the economy in the process. But my name calling the debate gets shut down. Healthcare is a complex issue, one that cannot be reformed in a matter of weeks and pushed through by one side of the aisle.

Debate away, I am off to a family reunion!!

[DCJenn]

I was going to stay out of this for a number of reasons but here I go.

As near as I can tell, there isn't a plan that's possible that's going to satisfy everyone. There are far too many conflicting interests. and the ugly reality is that for most of the players, the patient is the least of their concern- it's all about the all-mighty dollar.

Big Pharma, the doctors, the unions, the hospital systems, there isn't a player involved who doesn't want to make money for their consituents

I don't care what kind of plan it is. Honestly I don't. I want my friends who make 30k to be able to have health insurance. I want them to be able to actually accept a raise rather than stay at the income level they need to get CHIP. (because once they don't qualify, they can't afford out-of pocket insurance for their kids). I would like my clients to have their medical care covered beyond their pregnancies. I would like to see substance abuse and mental health services to be covered because we're spending billions in wasted dollars jailing and hospitalizing people who really 'just' need therapy and treatment.

I don't care if my taxes increase to cover more people. Everyone needs to step up and accept that we have a responsibility to each other. Do I want to cover every drug addicted addict in the universe? No. But it's no different than covering the obese smoker, the brittle diabetic or the child with cancer. You can't pick and choose who is covered and everyone deserves basic healthcare.

and you shouldn't be able to opt out because you don't feel like spending that money. I don't feel like covering emergency surgeries for someone who doesn't get preventative care, either.

There isn't going to be a perfect plan. In fact, I would suggest that whatever plan we do come up with is pretty much going to suck but something's better than nothing as far as I can tell. There is no real downside to actually providing care to people to help them not get sick(er).

Get strung up on semantics or ideas or suggestions or flow charts isn't going to do anything. If you have suggestions or recommendaitons then I'd recommend writing them down and sending them to the players. If you want your Congress to know what you think you have to tell them. If you think the big players are right or wrong, you have to tell them. Sitting back and complaining because you don't like what people are suggesting is doing nothing. If you're passionate about it, then do something. If you're complaining but unwilling to put yourself out there to effect change on your own micro level then you have abdicated your responsibility as a member of a dynamic Democracy.

(and in that I include taking responsibility for your own health and the health of your family.)

Jenn

[GrayMatterWife]

Did they have less of a right to healthcare as anyone else? It's a basic human right not a damn privilige. Anyone who disagrees with this needs to pull their head out of their asses and stop thinking about me, me, me.

I would suggest that it's not that people don't think that the uninsured don't need healthcare. I think we could all concede that everyone needs healthcare. I think the issue is whether that need gives rise to a "right" that must be protected and satisfied by the government.

Currently, in most situations, healthcare is not a right and there is no legal entitlement to it, with certain exceptions (can't be turned away from an ER, can't be denied Medicare/Medicaid benefits if you qualify, entitlements through VA, etc.). Currently, healthcare is a service for purchase. If you convert the need for healthcare into an entitlement to such care (that is, entitling everyone, regardless of income, to the same level of care), then you must necessarily change the purpose of providing medicine: from a venture that makes money to a venture that provides everyone with the same level of care. But, in doing so, you cannot provide everyone the level of care available to people who can afford the best. That is not economically feasible. If we want to make excellent healthcare with lower wait times and more available procedures less available to most, so that we can give everyone the same level of care, then we should all be prepared for certain cost/benefits, including less competition in care, less R&D, and eventually a lower standard of living.

I personally don't think it is an entitlement or a human right. Just because we can provide it doesn't mean that everyone gets to have it. I believe healthcare is a service and a business, and that we should keep it that way, because capitalist competition produces the highest quality of that service. It's why people don't travel to England for cutting edge procedures--they travel here, because our system promotes competition and allows us to push the envelope of improvement. But, that being said, I also believe that we have a moral obligation to care for the less fortunate and that we as a society should use our resources (which are byproduct of living in our capitalist society) to provide care for the less fortunate. But I don't think the solution lies in forcing everyone into the same system--essentially "dumbing down" the system.

I assume--maybe wrongly--that the remark that anyone who doesn't agree with you just has his "head up his ass and just being selfish" was just a little hyperbolic venting. Most of the time, I suspect both sides have something legitimate to add to the argument, even if they don't agree on the fundamentals.

[PrincessFiona]

I have lived in countries with socialized medicine and have been covered under the public plans as well, so I will both agree and disagree with some of what you have said.

-rates of cancer deaths are higher in europe and Canada than the US with all of our problems

Concord Working Group, "Cancer survival in five continents: a worldwide population-based study,.S. abe at responsible for theountries, in s chnologies, " Lancet Oncology, Vol. 9, No. 8, August 2008, pages 730 - 756; Arduino Verdecchia et al., "Recent Cancer Survival in Europe: A 2000-02 Period Analysis of EUROCARE-4 Data," Lancet Oncology, Vol. 8, No. 9, September 2007, pages 784 - 796.

U.S. Cancer Statistics, National Program of Cancer Registries, U.S. Centers for Disease Control; Canadian Cancer Society/National Cancer Institute of Canada; also see June O'Neill and Dave M. O'Neill, "Health Status, Health Care and Inequality: Canada vs. the U.S.," National Bureau of Economic Research, Working Paper No. 13429, September 2007. Available at http://www.nber.org/papers/w13429.

There are others studies I have which related to wait times for things like radiation and heart surgery, I'm happy to post those too.

~I actually don't believe that most americans are afraid of not getting suites and CTs for every little gas pain. My honest belief is that the majority of Americans want a system in place where they will NOT be bankrupted by their chemotherapy, or surgery and will have some options. I believe most Americans want lowered costs, access to preventative care, affordable drugs and catastrophic coverage.

THAT, however is not what the health care legislation being crammed through as quickly as possible is about.

1. No Torte reform is being passed. You know as well as I do that in the UK it isn't possible to sue the doctor over everything. Here it is. Anything is fair game. If lawsuits weren't an inevitability in some specialties, there would be fewer CTs, MRIs and endoscopies etc ordered. A lot of medicine practiced in America is defensive or cya (cover your ass) medicine.

2. There will be no effort made to make deals with the pharmaceutical companies to reduce the costs of prescription drugs. Although taxpayer dollars fund much of the research that goes into new meds, another little secret is that the pharm. industry sells these drugs at a GREATLY reduced cost to Canada, Mexico and the UK...hence...attempts to import drugs from these countries (which has resulted in all kinds of legal hoopla).

3. It will not be mandatory to enter into a health insurance plan at this time. That means that if you are young and feel healthy you can opt out and not have to pay in at all. IF...ooops, you have a bad accident, get cancer, MS or some other terrible illness, you can opt in after not having paid before.

4. That's ok, because the average Joe will not be expected to foot the bill. Those nasty, rich, bastard doctors will still be expected to pay back their student loans of more than $150k, because no educational debt reform is a part of this new bill. That is unlike the UK where medical education is essentially free and residents are compensated for call nights.

5. Also, even though we wasted a boatload of money on a war that never should have been waged and our economy seems to perhaps be stable (but is showing signs of a jobless recovery) we CAN invest in health care because we will ask anyone making over $250k to fund it. So...your cardiac surgeon that came in at 3am can make less money, pay educational loan debt until he retires AND also pay more in taxes for you to get your middle-of-the night procedure. That's wrong, in my eyes. My husband is not a sugeon, btw and I don't mind paying more to get health care for everyone...as long as everyone has to step up to the plate and not just those earning above a certain amount.
In the UK when we lived there, we all paid for services in the from of relatively high taxes. MrsC, that is not a burden that the average american is willing to take on. And by average, I mean middle class or upper middle class. I know plenty of people who think that basic human right means that it gets paid for by other people.

6. In the UK it is not uncommon at all to have private insurance to get access to specialists that the regular guy might not get to see for months if not a year or more.

~Obama is trying to do something and I applaud it. It is long overdue. In my eyes though, something is not better than nothing. Pushing through obtuse health care reform that congress and union members will opt out of and is so confusing that none of the pundits even quite get it....is not ok. We still haven't gotten things right with medicare reform.

~Absolutely, this is an urgent matter. I believe as you do that access to healthcare is a human right. I do not, however, believe that this current bill addresses the major problems that have gotten us here. In america, the poor are covered by medicaid, the elderly by medicare and those of us inbetween are covered by various different HMO and private plans. The uninsured and underinsured are a huge issue that needs to be addressed...for sure.

Why can't they just open up the congressional plan to the average american? Address litigation and reduce the cost of care and health insurance? Regulate the health insurance industry?

The dems are just as in bed with the industry as the republicans. This is not the change that I think people wanted to believe in.