Guest opinion: Health care reform still needs work
August 7, 2010
More than a year ago, a group of more than a dozen local residents gathered at my house to talk about the health care reform we wanted to see. What came back from Congress met some but not all of our goals, and certainly will do more than the do-nothing alternative.
Our group included doctors, lawyers, medical professionals, cancer survivors and informed consumers. We have lived the stories that make health care reform a necessity.
Then and now we have experienced first hand the tragedy of failed insurance coverage, denied claims, doctor shortages and the problems with prescription drug use, over use and unavailability. Some of us have experienced first hand a system that hustles sick people out of the hospital to contain costs, denies others coverage and uses the market to ration care.
We heard first hand of the heartbreak of coverage being pre-approved for treatment of breast cancer and later rescinded. We learned about drug coding that prevents locals from getting FDA approved drugs. And we heard from former insurance industry workers about the cost of the insurance bureaucracy.
After much open and heartfelt discussion, the group offered concrete suggestions for incorporation into health care reform. We had the following recommendations and stand by them today. The goals of last year are measured against the legislation adopted:
1. Preventive practice needs to be a first step. Our citizens recognize that care after the damage is done by over eating, smoking or chronic infection is expensive and ineffective. Regular checkups should be accessible and affordable along with programs to support good health habits.
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The president’s plan addresses this in part by providing certain free services for Medicare users and will soon require private plans to provide these services without deductibles and co-payments.
2. Shortages of doctors and medical professionals must be addressed. The cost of medical school is rising at three times the rate of inflation for public schools, the average debt for a doctor coming out of school is $145,000, and there are only 2.1 applicants for every medical school seat where there were once 22 applicants per medical school seat. Especially in rural areas, this means less medical care is available.
The plan provides increased loans and scholarships for primary care nurses and doctors in under-served areas. Whether this is adequate to alleviate the problem has yet to be seen.
3. An alternative to the present private insurance system is required. We support a government alternative to create competition, force efficiency and provide coverage to the uninsured. The present system consumes 15 cents of every dollar in administrative costs, twice the rate of state systems such as Washington state’s system. Insurance should be portable between jobs and should not be denied on the basis of pre-existing conditions.
Intransigent opposition form Republicans and Joe Lieberman killed off any possibility of a public alternative in competition to the present system. Sen. Michael Bennet gathered 35 signatures on a letter supporting the public option, but no vote was taken.
4. Prescription drug makers must be subject to the forces of the market. Government entities and insurance plans should be able to bargain for lower prescription drugs with pooled purchasing power. Safe, approved drugs sold at far lower prices in foreign companies should be available to U.S. consumers.
The new law does close much of the donut hole for seniors on Medicare, including a one-time payment of $250 this year. However, drug prices in a America remain the highest in the world and the industry continues to return 17 percent profit on revenue, higher than any other nation in the world. Competition is needed.
5. Drug companies should be at arms length from care givers. Doctors and patients, not insurers or pharmaceutical companies, should control what drugs are available. Doctors should not be paid or lobbied by the drug companies through payments or medical school presentations.
Not addressed. Medical associations may be in a better position to regulate this than the government as part of an ethical standard.
6. Medical records should be computerized and available to all care givers immediately. A patient walking into an emergency room or a doctor’s office should be able to share all treatment records and past data without spending an hour filling out forms and trying to remember what happened and when. Expensive diagnostic tests like X rays or MRIs should be viewable by all treatment professionals at each visit as needed.
Money is available to help doctors and providers better able to share medical records and this sharing is in evidence locally. The goal is to have records digitized within five years but progress is slowed by costs and complexity.
7. Litigation should balance the needs of those hurt by bad practice with the need for affordability. Jackpot verdicts and forum shopping can drive malpractice premiums and health care costs. Bad doctors should pay but not disproportionately to the wrong done.
This goal is unmet. The costs of litigation have been exaggerated for political purposes as the total medical malpractice burden is a small part of overall costs. Reform is still needed.
8. The emergency room should be the last choice for treatment, not the first. Undocumented workers, uninsured citizens and people without other access to care choose the most expensive, least efficient form of care delivery because they have no choice. These costs are shifted to workers and companies who are on the books and those of us who have insurance.
Expanding insurance coverage to an additional 35 million Americans will help cut down the issue of ER care as a first or only response. Furthermore, the justice in seeing almost everyone have access to care is laudable in and of itself.
The calls for repeal of the health care legislation are likely to flounder on the shoals of truth. The new plan is far from perfect, but I do not think Americans will want to return to a system that allows insurance companies to exclude those of us who have pre-existing conditions or drop coverage for the seriously ill and exclude those of lesser income.
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