An unhealthy state of mind
If anybody out there thinks they know how to fix this country’s ailing healthcare system will they please contact Sen. Max Baucus, chairman of the Senate Finance Committee, at once?
The Democratic senator from Montana is said to be President Barack Obama’s most critical ally on healthcare reform and, by virtue of his seniority, is responsible for what could be the most significant breakthrough in a national health policy since the enactment of Medicare. Obama is looking for a bill with bipartisan support and backing from insurance and pharmaceutical companies, HMOs and other medical associations- the very folks that sank the Clinton Plan with all its boilers steaming (to use a stale nautical metaphor) in 1993.
These vested interests in the status quo have vowed to lower the outrageous rate of medical cost increases. Perhaps they understand that the nation is ready for reform and they would rather be at the table shaping change their way than simply obstructing progress.
The opposition, meanwhile, is gearing up for a fight; perhaps another ad campaign like the infamous “Harry and Louise” spots that helped scuttle the Clinton Plan. These preparations are underway even before the plan has been fully shaped and voted on in committee.
Code words and phrases are already springing up in rants on Fox News: Socialized medicine, rationing healthcare, government interference in doctor/patient decisions.
What they never say is that we already have interference between doctor and patient by insurers that decide what drugs a doctor may prescribe (the dreaded formulary) and how long a patient may stay in hospital for a given procedure. Some doctors have found ways to get around these regulations, but often they can’t.
For instance: the insurance company decrees a certain surgery must be “out-patient,” but the doctor knows it’s in the best interest of his patient to remain in hospital at least overnight. He sets up the procedure as “out patient” knowing he will have the patient admitted to the hospital for at least one night.
Insurance companies are even telling doctors what pain reliever to prescribe. Morphine, which is well tolerated by most patients, has been replaced by a newer and more expensive drug that regularly causes severe dizziness, nausea and vomiting. Why? Because when the patient stops hurling he can be sent home. Those given morphine may not be released for 24 hours. Insurance company saves; patients suffer.
Republicans and others who speak for the vested interests tell of long waits for treatment in countries with national health programs. They always bring up some Canadian who came here to get an elective operation because the wait list was too long. Funny they never talk about those Americans who travel to Mexico or India for surgical procedures that they can’t afford here.
Not long ago, PBS ran a remarkable report on a half dozen countries that have national health care. The reporter asked the same questions of providers and patients. Some countries used single-payer (government-run) plans; others had insurance-based care. However, those insurers were required by law to offer a basic tier of coverage to all, including those with existing conditions, at one low price. They were not allowed to make a profit on the basic plan, but they could offer profitable premium plans to those who wanted them. Seems fair to me.
Are there restrictions (rationing) on those basic plans? Of course. They don’t (for instance) cover liver transplants for 90-year-old alcoholics. But they do pay for preventative care (yearly checkups and such), which our Medicare doesn’t cover. In fact, doctors in some of those countries are paid to keep patients well but are not paid or paid less to cure illness. Interesting approach.
When asked how many people medical bills bankrupted, the answer was the same: None. One doctor said, “That would be a national embarrassment.” We all know the answer here where the majority of personal bankruptcies are caused by medical debt. Have we no shame?
In most industrialized countries, national healthcare is a given. Tax rates are higher, but people can easily see and appreciate what they get in return.
Are we unwilling to pay any kind of tax increase to fund basic health care for all? Can’t we accept some limits on elective procedures paid for by our tax dollars?
In return for their offer to slow the soaring rate of medical costs, insurance companies are refusing to accept competition from any government plan, including one that would cover those who can’t afford even a bare-bones policy. Sounds familiar. Didn’t Big Pharma agree to the Medicare prescription plan only if it banned price negotiations?
Baucus has been working hard on this and has floated some ideas. So far, Obama disagrees with at least one proposal: to limit the tax-free status of job-based benefits. And, in a nod to Republicans, Baucus says illegal immigrants won’t qualify for benefits under his legislation. But if they show up at hospital emergency rooms, as they do now, they will be treated. We all know how well that’s working out.
So how do we get a bill through Congress and to Obama that he can sign by the end of summer? We better focus on this and send our suggestions to Baucus because we can’t fix the economy or much of anything else until we fix healthcare.