New Year's Health Care Reform Roundup

Welcome to our first health care news roundup of 2008! Most of the health care news lately has been about the politics of reform. From mandates in Massachusetts to the floor of the California State Capitol there is no lack of news on the subject. With that in mind we would like to share a small sampling of health care in the media as we end the first week of the New Year.

Lets start in Iowa, the land of the caucus. CNN brings us text and video about Kathy Strangli, an Iowa voter who is dying of an incurable lung disease called lymphangioleiomyomatosis. She is devoting her final days to changing U.S. health care and has been grilling candidates on the subject across the state of Iowa to do it. So far she has confronted all but two presidential hopefuls on the subject and has attended more than 70 campaign events to do so.
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Next stop is California, a state that has held a high profile in the news as Governor Schwarzenegger and the state legislature have wrestled with implementing universal healthcare. Aliza Marcus over at Bloomberg takes a good hard look at Schwarzenegger's battle for health care reform and the lessons it holds for U.S. Presidential candidates.
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Then we turn our attention to the East Coast of the U.S. The Business Review brings us the scoop on New York Governor Eliot Spitzer's decree to his Health Commissioner and his Insurance Superintendent that they have until May 31 to concoct a plan for universal coverage in New York state.
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As we move along the coast we find the Boston Globe reporting on Vermont Governor Jim Douglas who is aiming his efforts at preventative medicine. To be specific he is attacking obesity, a major contributor to "more than 15 chronic conditions." The details will be released during his State of the State address next week, but the Globe article gives a basic overview of the plan (adding prevention specialists, allocation of grant money, among other features).
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Our last stop on this virtual tour is in New Hampshire, the next state to fall under the media microscope now that the Iowa caucuses are finished. As the various contenders for the White House prepare to converge on the state the International Association of Dental and Medical Disciplines (IADMD) has issued a press release calling on the candidates to get input from actual doctors when formulating their approaches to health care reform.

"Health care is such an important issue the candidates should be listening to the IADMD doctors that have the medical training to solve the crisis. I commend Hillary Clinton, John Edwards, Mitt Romney and Barack Obama for talking about health care. But their plans are not viable for many reasons, such as cost and their non-doctor approach," says Dr. Ryan.

Dr. John J. Ryan is the founder of the IADMD and a New Hampshire based family dentist.
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That's all for now, see you next week!

SOURCE: "Schwarzenegger's Health Battle Carries Warning for Candidates " 01/04/08
SOURCE: "Businesses warm to idea of universal health care" 01/04/08
SOURCE: "Governor wants to fight obesity with grants and specialists" 01/03/08
SOURCE: " Dying Iowa voter grills candidates on health care" 01/03/08
SOURCE: "Press Release: New Hampshire Doctors Group Challenges Presidential Candidates on Universal Health Care" 01/04/08

photo courtesy of Benimoto, used under this Creative Commons license

Meeting the Criteria: The American Health Care 'Non-System'

David E. Drake, doctor of osteopathy and clinical professor of psychiatry at Des Moines University, brought us a wonderful opinion piece in the Des Moines Register yesterday. One that highlights the vagaries of a health care system that our own Mr. Halvorson has called "badly flawed, perversely incented, inadequately coordinated, incredibly inconsistent, strategically unfocused, and too often dangerously dysfunctional." His article shares experiences and data he accrued during his attendance at the recent Physicians for a National Health Plan conference.

With some 1,500 private health-care plans with their own confusing array of deductibles, co-pays, and allowed payments, health-care delivery in the United States comes out of a business model that makes money by denying or greatly restricting services even to those who believe they are covered by private insurance.
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Conference speakers pointed out differences in administrative overhead between a system based on a revised Medicare, 2 percent to 3 percent, versus up to 15 percent for private companies, with an additional 15 percent for profits.

He also shares some of the input given by a foreign colleague at the conference, as a contrast with the system here in the United States.

One of the speakers was a Canadian psychiatrist who makes more money than many American psychiatrists, with overhead limited to one to two minutes per day of billing on his part, with all fees billed to one central payer, the government. Speakers were clear that this is not "socialized medicine," but a central payer with physicians still practicing on their own. Socialized medicine would be akin to the Veterans Affairs' system, where the hospital and physicians are employed and run by the government.

The Canadian psychiatrist pointed out that there are regional differences by province, but that he can see a patient as often as he would like, with no co-pays or deductibles. His malpractice is about a third of what I pay, and this tab is picked up by the province as negotiated by physicians and the area health plan. If he believes a person requires inpatient care, he can hospitalize the patient without the need for pre-certification. He and the patient decide how long the patient will stay in the hospital.

This insight into the Canadian way is most interesting, and far less "socialized," than the way it is oft times presented by our political class and the mass media. Perhaps there may be ideas in their approach that we could cherry pick while developing our own?

The good Doctor's points are important ones, and are thrown into sharp relief by the second half of his column, which describes the bureaucratic nightmares awaiting him at his practice once the event was over.

I returned from the conference to see my sole employee, my office manager, overwhelmed by returned claims from multiple insurance companies, denials and a barrage of phone calls to confirm insurance coverage and get approval for outpatient care.

A few days later, I needed to hospitalize a woman who was so overwhelmed with anxiety that she was not able to function - at work or at home. The hospital admission staff told me at the outset that her insurance company would probably deny payment for her stay - that "she didn't meet criteria."

Indeed, initially the first day was denied, only later to be approved, while her three other days were denied even after phone calls from the hospital social worker and me. I was told that since she was neither suicidal nor psychotic, the insurer would not pay for her hospital stay after the first day. The decision was neither about clinical necessity nor good judgment, but about reimbursement and "criteria."

Since 1970 we have increased our number of health care providers by 150 percent, but 2000 percent more administrators. (Yes that does say 2000, it is not a typo.) That statistic alone speaks volumes on the subject, reaffirming once more that what we need is Health Care Reform Now!


SOURCE: "Health 'Non-System' Needs True Reform, Not Band Aids" 12/01/07
photo courtesy of Ack Ook, used and remixed under this Creative Commons license

A Populist Prescription from Barack Obama

Health care is the subject on everybody's lips, especially those running for office. Members of both major political parties have laid out their platforms on this issue as they either campaign for office or prepare to do so, but there is dissent within each party as well. Barack Obama created quite a stir yesterday with his reaction to comments on Hillary Clinton's failed attempt at reform back in 1993. The Associated Press provides a relevant quote from his Sac City, Iowa, appearance:

"It was a closed process and not everybody understood what was taking place, so when the insurance companies and the drug companies started running those 'Harry and Louise' ads, nobody really knew what was what. That's why the American people have to be involved."

After Clinton's plan was proposed, special interest groups ran the commercials, featuring a fictional couple worrying about losing their ability to pick their own doctors and warning that the government would take control of the health care system. Support for the health care expansion evaporated and the effort was eventually dropped.

Obama said the lesson to be learned was to involve the American people in the effort. Without political support, no health care expansion can be approved, he said.

Obama then followed the announcement of his more populist approach with the statement that he would announce outlines of a health care reform package in his first 100 days as President. The details of this package would then be drafted by a bi-partisan commission. Alec McGillis at The Washington Post takes note of the tactical change this represents within the overall debate:

The remarks were a new twist on the health care debate that has played a dominant role so far in the Democratic race -- until now, most of the candidates have focused on the differences between their plans, not how they would go about actually getting reform enacted. The comments also represented a variation on a theme that Obama first introduced in an interview with The Washington Post last month -- that he would be in a better position to unite the country than would Clinton, given her polarizing reputation among many voters. And it is a rebuttal of sorts to the argument Clinton has been making on the trail in recent days -- that she, unlike Obama, has the experience to know how to work within the system to get things done. In Clinton's highest-profile bid for reform, Obama is reminding voters, the system won.

SOURCE: "Obama Vows Open Health Reform Process " 09/05/07
SOURCE: "Obama Draws Clinton Contrast" 09/05/07
photo courtesy of SEIU International on Flickr remixed and used under this Creative Commons license

Healthy Voices Across The Nation

From the halls and meeting rooms of Capitol Hill to the offices and press conferences of governors around the country, proposals and ideas for reforming our health care system are being announced and argued. A vast array of approaches and plans are being put forth as people on both sides of the partisan fence attempt to find an equitable and implementable solution to the current state of affairs.

Across the nation, citizens are being consulted on the subject as the politicians evaluate possible support for their various plans.

East Coast: In Vermont, the state Legislature's Health Care Reform Commission is consulting its constituency for input. According to the announcement in the Rutland Herald, some questions the Commission put forth in their open hearing were:

What do you believe the next steps should be in health care reform?

What specific suggestions do you have for expanding the state's new Catamount health insurance program for people without coverage?

In addition to expanding affordable coverage, which of the options being considered by the commission are most important to successful health care reform?

Midwest: In Iowa, the consultation with the voting public continues, as reported by The Journal. Their article focuses on Kay Ciha, a resident who has had constant issues with the Medicare system since her husband suffered an accident:

Ciha was one of about 20 county residents from all walks of life - seniors, businesspeople, physicians - that took part in a forum for the Legislative Commission on Affordable Health Care Plans for Small Businesses and Families, a bipartisan group of legislators working to provide a cost-effective health care to Iowans. Sen. Becky Schmitz and a representative for U.S. Congressman Dave Loebsack attended the meeting to hear the wish lists of people who were present.

West Coast: eMax Health reports, the findings of CaliforniaSpeaks, a 3,500 person statewide conversation that took place simultaneously across Sacramento, San Diego, Humboldt County, Fresno, Los Angeles, San Luis Obispo, Oakland and Riverside on August 11:

The eight sites were linked by satellite, so that participants could see and hear what other attendees said across the state. Skilled facilitators led face-to-face discussions at each location while ideas were recorded, considered and voted upon throughout the day with personal voting keypads. To ensure that attendees spanned all different ages, ethnicities, and socio-economic backgrounds, CaliforniaSpeaks used a random selection process to invite most of the participants to take part in the conversation.

While there is a diversity of opinions on the subject, concern over the issue seems nearly universal.

SOURCE: "Public Input Sought on Health Care Reform" 08/29/07
SOURCE: "Citizens Voice Concerns on Health Care" 08/30/07
SOURCE: "How Californians View Current Health Care Reform Proposals" 08/30/07
IMAGE SOURCE : public domain map