By ANN McFEATTERS
At a recent town hall meeting, widely shown on cable TV, a nearly hysterical, sobbing woman was saying that her insurance company had denied home health care for her bedridden husband.
The congressman listened to her, promised that his staff would look into the matter and went on to say that the trouble with America today is government.
Americans in such situations have to turn to each other for help, he said, warning there is too much dependence on government.
Leaving aside the obvious fact that the congressman-who-hates-government is part of government -- and gets his paycheck from taxpayers, how many neighbors have the proper nursing skills and the time to help with rigorous daily care for someone who is not a relative?
A few days later a report by the National Conference on Citizenship reported that Americans have cut back on the amount of volunteering and civic works they do, largely attributable to the recession.
Their annual "civic health index," based on polling data from May, reports that 72 percent of Americans said they have "cut back on time engaged in civic participation, which includes time spent volunteering, participating in groups or performing other civic activities in their communities."
It also said 66 percent of Americans say they feel others are responding to the recession by "looking out for themselves."
The report quotes the conference's chairman, Michael Weiser, as saying, "The economic crisis has triggered civic foreclosure," although he added, "The good heart of Americans is still very evident, though, as they refocus on basic needs."
One way President Obama is proposing to pay for health-care insurance reform is to cut back on charitable deductions taxpayers now take. Taxpayers earning more than $250,000 a year now give about $81 billion annually to charity. By one estimate, that could drop by nearly $4 billion if the tax deduction decreases. Needless to say, the philanthropic community is concerned.
At the same time, many charities, hit hard by the economic downturn, had intended to rely more on volunteers.
But all this overlooks the fact that most health care for the elderly -- the biggest users of health care in America -- is provided by relatives, usually spouses and daughters. Very little is being done to help them, as witnessed by the panicked woman at the town meeting.
Despite the heated rhetoric, we are far, really far, from solving the health care mess in this country. The unwieldy, convoluted 1,017-page health insurance reform bill passed by the House (America's Affordable Health Choices Act of 2009 to "provide affordable, quality health care for all Americans and reduce the growth in health care spending") is full of inconsistencies, vague promises and loopholes.
As summer draws to a close, the Senate still has no version. (If Democrats push through a version with no Republican support or input, it will be disastrous. The country will rebel.)
And we still have no clear idea what President Obama wants or where his line in the sand is although health care is allegedly his top priority.
Health-care costs account for 15 percent of our entire Gross Domestic Product, a figure that the Congressional Budget Office predicts will be 49 percent by 2082 if nothing is done. And 47 million Americans remain uninsured, with thousands more losing insurance every day. Yet, despite Obama's latest deadline of September, a compromise plan has yet to emerge.
We begin September with no comprehensible package in hand, with anger and fear on all sides from the residue of riotous town meetings, with little leadership from the White House even as we hope for serious negotiations.
It would be nice if the sentiment over the death of Sen. Edward M, Kennedy would spur compromise and action, although that is unlikely.
This whole endeavor has been so badly handled by nearly everyone involved, it's heartbreaking. If nothing is done, millions more will lose their faith in government. If nothing is done, government then truly will be the problem, not the solution.
Showing posts with label Health care. Show all posts
Showing posts with label Health care. Show all posts
Saturday, August 29, 2009
Thursday, August 13, 2009
Health-care Reform;An Original And simple proposal
With over 300,000,000 people in America, it figures there must be someone who has the experience and skill set to reliably solve the health insurance and access problems besetting our country without throwing away the most excellent and caring medical system in the world.
Recently, when an old friend, a seasoned educator, and I, a seasoned physician, got together on a vacation in Colorado, he asked me if I had a simple solution for the medical insurance and access problems on the front pages of America's newspapers.
I told him "Yes, I do," but that it is so simple and inexpensive, without taxes or cuts in medical quality, that no one would believe me. It was he who insisted I put pen to paper because he felt there was an audience for a common sense solution to the health care ailments of America.
So here is the distillation of my 40 years' observation.
First, we should change the current 50 state patchwork of private insurance programs -- which cannot cross state borders -- to a national clearinghouse of private insurance choices that can compete across the whole country. Meanwhile, we should regulate the competing companies so that they must take all comers, regardless of pre-existing conditions.
Secondly, we should return health care insurance companies to the pre-1984 federal regulations that limited their fees to administration only (about 15% of medical dollars), without excessive profits going to their boards of directors, CEO's or shareholders. The provision of medical care is not the type of profession that can be treated as a simple commodity. The corporatization of health care was a bad idea, and it's getting worse. It has contributed tremendously to the crisis we're in now where hospitals and doctors feel squeezed -- forcing some of them to shut their doors or quit -- while insurance company profits soar.
Third, we need to make health insurance plans completely portable for individuals with life changes, in order for the insurance companies to compete on a flat playing field for the whole U.S. population. Ideally we should move away from employment-based health care. If employers do not have to pay the soaring costs of healthcare for their employees, they can raise their employees' salaries in a commensurate manner, and the employees, in turn, can choose which level of health care plan they want to purchase.
Of course, people who can afford it should be required to purchase health insurance, in the same way that we are required to purchase car insurance, but they would have the choice of which plan to purchase.
And last, the health care overhaul should include meaningful tort reform that caps frivolous malpractice suits. Such a policy has seen great success in California for 34 years.
With the four above changes, competition across the whole country should prompt health insurance companies to improve efficiency and cost-effectiveness (similar to what GEICO has done in the car insurance arena). Notice that the government has not had to spend significantly or nationalize health care to accomplish this. All that is needed is thoughtful insurance company regulation, and the mandatory participation of all citizens who can afford what will be competition-driven reduced premium costs.
But what about the indigent and illegal alien populations who still need access to good medical care? How do you take care of them without an extra tax burden on the working population? This is easy for me to envision because I did it for decades via the model of our USC/Los Angeles County Medical Center -- the busiest teaching hospital in the United States.
"County USC" handles hundreds of thousands of clinic visits by indigent and illegal alien patients every year, allowing for wonderful experience for our doctors-in-training under the guidance of a great faculty. Because our hospital has 2000 penetrating-wound (knife or gunshot) patients per year, the U.S. military rotates its trauma surgeons here for 6 months at a U.S. Naval sub-station, before deploying them to Iraq and Afghanistan.
Thus, the final no new-tax solution to the health care problem is to get all of the urban medical schools back to serving their local indigent populations, with a standing "open door" policy, and no dumping of those patients off to other private hospitals or clinics while still obtaining Federal Grants (such a dumping policy was recently disclosed to have taken place at the University of Chicago Medical School).
If the large urban medical schools remember that "school" is in their name, they will use the teaching environment to promote great care as we've done for over 100 years at County USC. Also, in carrying out this primary teaching function, the schools could be subsidized (as has been done for decades by Federal, state and county funds), but with the money going directly to the delivery of medical care, rather than the expansion of bricks and mortar.
Great American-style medical care can be provided cost-effectively in simple perk-free settings, as in the U.S. military hospitals, without requiring the private rooms and flat screen TV's for every patient that have contributed to bankrupting many hospitals.
Federal regulations and mandates of all U.S. medical schools to emulate the County USC model would address the load of indigent patients and give our medical schools back the patient experience they sorely need for continued training of our physicians.
This plan represents my simple solution to preserving all of the best aspects of choice and quality and access in the American medical system, without the need for new taxes at all. Nor does it require nationalizing under a government-run plan, which is guaranteed to increase bureaucracy as well as the delay of essential medical services, such as seeing a specialist, undergoing surgery, or obtaining cancer treatments.
And an added plus is that our medical schools can get back to their teaching mission as best exemplified by the County USC model, while providing great training for our future doctors
by Dr Paul Toffel
Recently, when an old friend, a seasoned educator, and I, a seasoned physician, got together on a vacation in Colorado, he asked me if I had a simple solution for the medical insurance and access problems on the front pages of America's newspapers.
I told him "Yes, I do," but that it is so simple and inexpensive, without taxes or cuts in medical quality, that no one would believe me. It was he who insisted I put pen to paper because he felt there was an audience for a common sense solution to the health care ailments of America.
So here is the distillation of my 40 years' observation.
First, we should change the current 50 state patchwork of private insurance programs -- which cannot cross state borders -- to a national clearinghouse of private insurance choices that can compete across the whole country. Meanwhile, we should regulate the competing companies so that they must take all comers, regardless of pre-existing conditions.
Secondly, we should return health care insurance companies to the pre-1984 federal regulations that limited their fees to administration only (about 15% of medical dollars), without excessive profits going to their boards of directors, CEO's or shareholders. The provision of medical care is not the type of profession that can be treated as a simple commodity. The corporatization of health care was a bad idea, and it's getting worse. It has contributed tremendously to the crisis we're in now where hospitals and doctors feel squeezed -- forcing some of them to shut their doors or quit -- while insurance company profits soar.
Third, we need to make health insurance plans completely portable for individuals with life changes, in order for the insurance companies to compete on a flat playing field for the whole U.S. population. Ideally we should move away from employment-based health care. If employers do not have to pay the soaring costs of healthcare for their employees, they can raise their employees' salaries in a commensurate manner, and the employees, in turn, can choose which level of health care plan they want to purchase.
Of course, people who can afford it should be required to purchase health insurance, in the same way that we are required to purchase car insurance, but they would have the choice of which plan to purchase.
And last, the health care overhaul should include meaningful tort reform that caps frivolous malpractice suits. Such a policy has seen great success in California for 34 years.
With the four above changes, competition across the whole country should prompt health insurance companies to improve efficiency and cost-effectiveness (similar to what GEICO has done in the car insurance arena). Notice that the government has not had to spend significantly or nationalize health care to accomplish this. All that is needed is thoughtful insurance company regulation, and the mandatory participation of all citizens who can afford what will be competition-driven reduced premium costs.
But what about the indigent and illegal alien populations who still need access to good medical care? How do you take care of them without an extra tax burden on the working population? This is easy for me to envision because I did it for decades via the model of our USC/Los Angeles County Medical Center -- the busiest teaching hospital in the United States.
"County USC" handles hundreds of thousands of clinic visits by indigent and illegal alien patients every year, allowing for wonderful experience for our doctors-in-training under the guidance of a great faculty. Because our hospital has 2000 penetrating-wound (knife or gunshot) patients per year, the U.S. military rotates its trauma surgeons here for 6 months at a U.S. Naval sub-station, before deploying them to Iraq and Afghanistan.
Thus, the final no new-tax solution to the health care problem is to get all of the urban medical schools back to serving their local indigent populations, with a standing "open door" policy, and no dumping of those patients off to other private hospitals or clinics while still obtaining Federal Grants (such a dumping policy was recently disclosed to have taken place at the University of Chicago Medical School).
If the large urban medical schools remember that "school" is in their name, they will use the teaching environment to promote great care as we've done for over 100 years at County USC. Also, in carrying out this primary teaching function, the schools could be subsidized (as has been done for decades by Federal, state and county funds), but with the money going directly to the delivery of medical care, rather than the expansion of bricks and mortar.
Great American-style medical care can be provided cost-effectively in simple perk-free settings, as in the U.S. military hospitals, without requiring the private rooms and flat screen TV's for every patient that have contributed to bankrupting many hospitals.
Federal regulations and mandates of all U.S. medical schools to emulate the County USC model would address the load of indigent patients and give our medical schools back the patient experience they sorely need for continued training of our physicians.
This plan represents my simple solution to preserving all of the best aspects of choice and quality and access in the American medical system, without the need for new taxes at all. Nor does it require nationalizing under a government-run plan, which is guaranteed to increase bureaucracy as well as the delay of essential medical services, such as seeing a specialist, undergoing surgery, or obtaining cancer treatments.
And an added plus is that our medical schools can get back to their teaching mission as best exemplified by the County USC model, while providing great training for our future doctors
by Dr Paul Toffel
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