The 2010 Reforms in the House Healthcare Reform Bill

Here is a first look at the House Health Insurance reform bill that would initiate these changes in 2010! It is truly worthy of our support.

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House leadership has released this fact sheet on the key elements of the House healthcare reform bill that will begin in 2010.

House leadership has released this fact sheet on the key elements of the House healthcare reform bill that will begin in 2010 [pdf].

Among the most important of these front-loaded provision are the creation of the high risk pool, extension of COBRA benefits (which should also include some sort of subsidy program, since COBRA rates are often unaffordable, though select groups do receive assistance under the Recovery Act), upping the age that people can be covered by their parents' plans, and the increased funding for Community Health Centers are all very good starts for 2010. The most key for staunching the bleeding in our system, if you will, are the high risk pool and the Community Health Center funding. More of the uninsured will be able to get insurance through the pool and the CHCs, which are absolutely critical to providing care for the uninsured, will at least see some increased ability to do so.

A handful of the reforms will immediately address issues for Medicare beneficiaries, all solid reforms that should also provide some political help in 2010--seniors vote.

Here's the full list of what will start happening in 2010 under the bill.

1. BEGINS TO CLOSE THE MEDICARE PART D DONUT HOLE — Reduces the donut hole by $500 and institutes a 50% discount on brand-name drugs, effective January 1, 2010.

1. IMMEDIATE HELP FOR THE UNINSURED UNTIL EXCHANGE IS AVAILABLE (INTERIM HIGH-RISK POOL) — Creates a temporary insurance program until the Exchange is available for individuals who have been uninsured for several months or have been denied a policy because of pre-existing conditions.

1. BANS LIFETIME LIMITS ON COVERAGE—Prohibits health insurance companies from placing lifetime caps on coverage.

1. ENDS RESCISSIONS—Prohibits insurers from nullifying or rescinding a patient’s policy when they file a claim for benefits, except in the case of fraud.

1. EXTENDS COVERAGE FOR YOUNG PEOPLE UP TO 27TH BIRTHDAY THROUGH PARENTS’ INSURANCE— Requires health plans to allow young people through age 26 to remain on their parents’ insurance policy, at the parents’ choice.

1. ELIMINATES COST-SHARING FOR PREVENTIVE SERVICES IN MEDICARE—Eliminates co-payments for preventive services and exempts preventive services from deductibles under the Medicare program.

1. IMPROVES HELP FOR LOW-INCOME MEDICARE BENEFICIARIES—Improves the low-income protection programs in Medicare to assure more individuals are able to access this vital help.

1. PROVIDES NEW CONSUMER PROTECTIONS IN MEDICARE ADVANTAGE— Prohibits Medicare Advantage plans from charging enrollees higher cost-sharing for services in their private plan than what is charged in traditional Medicare.

1. IMMEDIATE SUNSHINE ON PRICE GOUGING—Discourages excessive price increases by insurance companies through review and disclosure of insurance rate increases.

1. CONTINUITY FOR DISPLACED WORKERS—Allows Americans to keep their COBRA coverage until the Exchange is in place and they can access affordable coverage.

1. CREATES NEW, VOLUNTARY, PUBLIC LONG-TERM CARE INSURANCE PROGRAM—Creates a long-term care insurance program to be financed by voluntary payroll deductions to provide benefits to adults who become functionally disabled.

1. HELP FOR EARLY RETIREES—Creates a $10 billon fund to finance a temporary reinsurance program to help offset the costs of expensive health claims for employers that provide health benefits for retirees age 55-64.

1. COMMUNITY HEALTH CENTERS—Increases funding for Community Health Centers to allow for a doubling of the number of patients seen by the centers over the next 5 years.

1. INCREASING NUMBER OF PRIMARY CARE DOCTORS — Provides new investment in training programs to increase the number of primary care doctors, nurses, and public health professionals.

via The 2010 Reforms in the House Healthcare Reform Bill | PEEK | AlterNet.

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Health Care Public Option: Did money talk?

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The so-called "public option" component of health care reform died today when the Senate Finance Committee's Health Care Subdivision essentially the entire committee rejected an attempt to include it in legislation the panel is considering. Other bills circulating at the Capitol still have "public option," but Sen. Max Baucus removed it from his bill under pressure from Republicans, who considered it Socialist. The number of Democrats refusing to support the idea pretty much sinks it.The vote was 15-to-8, with Democrats Baucus, Sen. Tom Carper, Sen. Kent Conrad, Sen. Blanche Lincoln, and Sen. Bill Nelson joining all of the committee's Republicans with "no" votes.Most of the Democrats voting against the bill, were among the biggest Democratic recipients of health care cash in campaign fundraising. Coincidence? Who can say? The campaign finance system is such that one can only speculate what role it plays when legislation is considered that affects the campaign contributors. So you have to decide.

via Did money talk? | News Cut | Minnesota Public Radio.

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Study links 45,000 U.S. deaths to lack of insurance

It's hard to believe that this country can tolerate this scale of problem without taking action. 45000 died each year due to lack of healthcare. Healthcare debt figures into most every bankruptcy. The time for action is now!

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Nearly 45,000 people die in the United States each year -- one every 12 minutes -- in large part because they lack health insurance and can not get good care, Harvard Medical School researchers found in an analysis released on Thursday.

"We're losing more Americans every day because of inaction ... than drunk driving and homicide combined," Dr. David Himmelstein, a co-author of the study and an associate professor of medicine at Harvard, said in an interview with Reuters.

Overall, researchers said American adults age 64 and younger who lack health insurance have a 40 percent higher risk of death than those who have coverage.

[..]

The Harvard study, funded by a federal research grant, was published in the online edition of the American Journal of Public Health. It was released by Physicians for a National Health Program, which favors government-backed or "single-payer" health insurance.



An similar study in 1993 found those without insurance had a 25 percent greater risk of death, according to the Harvard group. The Institute of Medicine later used that data in its 2002 estimate showing about 18,000 people a year died because they lacked coverage.



Part of the increased risk now is due to the growing ranks of the uninsured, Himmelstein said. Roughly 46.3 million people in the United States lacked coverage in 2008, the U.S. Census Bureau reported last week, up from 45.7 million in 2007.



Another factor is that there are fewer places for the uninsured to get good care. Public hospitals and clinics are shuttering or scaling back across the country in cities like New Orleans, Detroit and others, he said.



Study co-author Dr. Steffie Woolhandler said the findings show that without proper care, uninsured people are more likely to die from complications associated with preventable diseases such as diabetes and heart disease.

via Study links 45,000 U.S. deaths to lack of insurance | U.S. | Reuters.

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Franken Tap Dances So Fast Tea Party Can't Start!

YouTube - Franken Tap Dances So Fast Tea Party Can't Start!

[youtube=http://www.youtube.com/v/SCNs7Zpqo98&hl=en&fs=1&]

The Return of the Welfare Queen and Open Class Warfare

Michael Steele invoked class warfare in his fear mongering attempt to turn seniors against the working poor who can't afford health care by claiming the seniors will lose Medicare benefits if health care goes to the uninsured. This guy is as dishonest as anyone in the Republican Party.

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The healthcare reform debate took a rather remarkable turn last week when the Washington Post published an Op-Ed piece by Republican National Committee chairman Michael Steele telling retirees that his party would fight any effort to modify the benefits they derived from the government-run Medicare program in order to offer similar benefits to others. The Op-Ed was immediately supplemented by an item on the RNC Web page trumpeting a "Seniors' Health Care Bill of Rights," similarly pledging the GOP to a to-the-death defense of Medicare benefits and procedures, allegedly under dire threat from universal health coverage.Steele's gambit mainly got attention because it was laughably in conflict with nearly a half century of Republican attacks on Medicare, and because he adopted every ludicrous made-up claim about the impact of this or that health reform bill on Medicare. In a disastrous NPR interview later in the week, the GOP chieftain had a predictably difficult time explaining why the GOP wanted to "protect" Medicare because it was so bad a program that it couldn't withstand any "raids."

[..]This should be familiar to any political observer over the age of 30 as a new version of the old "welfare wedge": the emotionally powerful conservative argument that Democrats want to use Big Government to take away the good things of life from people who have earned them and give them to people who haven't.

[..]What's most interesting, and dangerous, about the new "welfare wedge" is that it's not about poor people who don't work for a living. After all, most very poor families often already have health insurance (depending on where they live) via Medicaid, and those who don't work these days generally don't have the option of working. The target of "welfare" shouters seems to be the working poor, or middle-class minority families who are struggling to stay in the middle class.

via The return of the welfare queen | Salon.

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The Plan for White Slavery?

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Racism has a hidden face within all of us. Anyone who is different beyond our imaginings is suspect. By placing people in the "other" category, we distance ourselves and make them the enemy. To the Right Wing Nuts, Obama has become the thief.

The Plan for White Slavery | The LA Progressive.

In his bestseller, Blink, Malcolm Gladwell noted that people make powerful associations with appearances and make “snap decisions” based on “thin slices” of experience. One of the many studies he cited required the subjects to assign positive or negative words to images of white or black people. To their surprise, the subjects, including himself, associated positive words with pictures of white people and negative words with photos of black people.

Thus after a history of repeated othering of African Americans in the US, it is not unusual for the picture of the black thief climbing through the windows of our homes to evolve into the imaginings of a black man in the White House stealing our healthcare and hard fought freedoms. As educator and writer Tim Wise, shrewdly observed “the longstanding association in white minds between social program spending and racial redistribution has been long established, by scholars such as Martin Gilens, Kenneth Neubeck, Noel Cazenave, and Jill Quadagno, among others.” What is reparations in the mind of the Right?—another form of stealing. Tim further notes, bestselling writer and conservative commentator Glen Beck, as well as shock talk-show hosts Sean Hannity and Rush Limbaugh, have linked health care reform and every piece of Obama’s legislative program with reparations. “His (Obama’s) goal is to create a new America. A new model. A model to settle old racial scores..,” decries Glen Beck.

Leaders from the healthcare corporate industry and the Right have been tapping into this programming. Observing the town hall rage and media coverage, historian and journalist Rick Perlstein reminds us that throughout history “the crazy tree blooms in every moment of liberal ascendancy, and where elites exploit the crazy for their own narrow interests.” Rick goes on to cite various examples such as Vice President Nixon claiming he found hidden in the White House “a blueprint for socializing America” or the various absurdities from the Right that the 1964 Civil Rights Act would “enslave” whites and that the Soviet Union served as an incubator for the “civil rights movement.” He concludes, “Good thing our leaders weren’t so cowardly in 1964, or we would never have passed a civil rights bill—because of complaints over the provisions in it that would enslave whites.”

However, the escapees of the Goldwater asylum are not the only ones prone to their programming being activated. Each one of us has it in them. Remember, during the struggle for desegregation of the lunch counters and outlawing racial housing covenants, a number of opponents used free market arguments of the “right to refuse service.” As Ronald Reagan once said as he successfully campaigned to be governor of California, “If an individual wants to discriminate against Negroes or others in selling or renting his house, he has the right to do so.” Reagan, who publicly opposed the 1964 Civil Rights Act and the 1965 Voting Rights Act, still overwhelmingly won as president despite launching his campaign with a speech on state rights at the site of three slain civil rights activists. I am not saying all those who disdain any governmental involvement in healthcare want to push people of color to the back of the bus, but in the current healthcare debate, they have de facto shoved those without healthcare to the side to fend for themselves.

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Who's behind the attacks on a health care overhaul?

Those behind the fight against health care are profiteers. Do you want to pay more for health care just to keep money in these guys pockets?

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Much of the money and strategy behind the so-called grassroots groups organizing opposition to the Democrats' health care plans comes from conservative political consultants, professional organizers and millionaires, some of whom hold financial stakes in the outcome.If President Barack Obama and Congress extend health insurance coverage to millions of uninsured Americans, raise taxes on the wealthy to pay for it, and limit insurers' discretion on who they cover and what they charge, that could pinch these opponents.Most of them say they oppose big government in principle. Despite Obama's assurances to the contrary, many of them insist that the Democrats' legislation is but the first step toward creation of a single-payer system, where the federal government hires the doctors, approves treatments, sets the rules and imperils profit.These opposition groups appear to have spent at least $10 million so far on ads attacking the Democrats' plans. Still, supporters of a health care overhaul have outspent opponents by more than 2-to-1 so far, according to Evan Tracey of the Campaign Media Analysis Group, which tracks ad spending. Supporters include drug makers angling for their own protections, unions, the American Medical Association and AARP, the seniors' lobby. Supporters announced this week that they intend to spend $150 million promoting an overhaul.

more at: Who's behind the attacks on a health care overhaul? | McClatchy.

The Truth about Healthcare

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Lots of common sense here. Seems a bit uncommon these days of right wing propaganda filling our media sources. Here is the truth.

David Axelrod
Senior Adviser to the President

We launched www.WhiteHouse.gov/realitycheck this week to knock down the rumors and lies that are floating around the internet. You can find the information below, and much more, there. For example, we've just added a video of Nancy-Ann DeParle from our Health Reform Office tackling a viral email head on. Check it out:



8 ways reform provides security and stability to those with or without coverage

1. Ends Discrimination for Pre-Existing Conditions: Insurance companies will be prohibited from refusing you coverage because of your medical history.


2. Ends Exorbitant Out-of-Pocket Expenses, Deductibles or Co-Pays: Insurance companies will have to abide by yearly caps on how much they can charge for out-of-pocket expenses.


3. Ends Cost-Sharing for Preventive Care: Insurance companies must fully cover, without charge, regular checkups and tests that help you prevent illness, such as mammograms or eye and foot exams for diabetics.


4. Ends Dropping of Coverage for Seriously Ill: Insurance companies will be prohibited from dropping or watering down insurance coverage for those who become seriously ill.


5. Ends Gender Discrimination: Insurance companies will be prohibited from charging you more because of your gender.


6. Ends Annual or Lifetime Caps on Coverage: Insurance companies will be prevented from placing annual or lifetime caps on the coverage you receive.


7. Extends Coverage for Young Adults: Children would continue to be eligible for family coverage through the age of 26.


8. Guarantees Insurance Renewal: Insurance companies will be required to renew any policy as long as the policyholder pays their premium in full. Insurance companies won't be allowed to refuse renewal because someone became sick.

Learn more and get details: http://www.WhiteHouse.gov/health-insurance-consumer-protections/

8 common myths about health insurance reform

1. Reform will stop "rationing" - not increase it: It’s a myth that reform will mean a "government takeover" of health care or lead to "rationing." To the contrary, reform will forbid many forms of rationing that are currently being used by insurance companies.


2. We can’t afford reform: It's the status quo we can't afford. It’s a myth that reform will bust the budget. To the contrary, the President has identified ways to pay for the vast majority of the up-front costs by cutting waste, fraud, and abuse within existing government health programs; ending big subsidies to insurance companies; and increasing efficiency with such steps as coordinating care and streamlining paperwork. In the long term, reform can help bring down costs that will otherwise lead to a fiscal crisis.


3. Reform would encourage "euthanasia": It does not. It’s a malicious myth that reform would encourage or even require euthanasia for seniors. For seniors who want to consult with their family and physicians about end-of life decisions, reform will help to cover these voluntary, private consultations for those who want help with these personal and difficult family decisions.


4. Vets' health care is safe and sound: It’s a myth that health insurance reform will affect veterans' access to the care they get now. To the contrary, the President's budget significantly expands coverage under the VA, extending care to 500,000 more veterans who were previously excluded. The VA Healthcare system will continue to be available for all eligible veterans.


5. Reform will benefit small business - not burden it: It’s a myth that health insurance reform will hurt small businesses. To the contrary, reform will ease the burdens on small businesses, provide tax credits to help them pay for employee coverage and help level the playing field with big firms who pay much less to cover their employees on average.


6. Your Medicare is safe, and stronger with reform: It’s myth that Health Insurance Reform would be financed by cutting Medicare benefits. To the contrary, reform will improve the long-term financial health of Medicare, ensure better coordination, eliminate waste and unnecessary subsidies to insurance companies, and help to close the Medicare "doughnut" hole to make prescription drugs more affordable for seniors.


7. You can keep your own insurance: It’s myth that reform will force you out of your current insurance plan or force you to change doctors. To the contrary, reform will expand your choices, not eliminate them.


8. No, government will not do anything with your bank account: It is an absurd myth that government will be in charge of your bank accounts.  Health insurance reform will simplify administration, making it easier and more convenient for you to pay bills in a method that you choose.  Just like paying a phone bill or a utility bill, you can pay by traditional check, or by a direct electronic payment. And forms will be standardized so they will be easier to understand. The choice is up to you – and the same rules of privacy will apply as they do for all other electronic payments that people make.

Learn more and get details:
http://www.WhiteHouse.gov/realitycheck
http://www.WhiteHouse.gov/realitycheck/faq

8 Reasons We Need Health Insurance Reform Now

1. Coverage Denied to Millions: A recent national survey estimated that 12.6 million non-elderly adults – 36 percent of those who tried to purchase health insurance directly from an insurance company in the individual insurance market – were in fact discriminated against because of a pre-existing condition in the previous three years or dropped from coverage when they became seriously ill. Learn more: http://www.healthreform.gov/reports/denied_coverage/index.html


2. Less Care for More Costs: With each passing year, Americans are paying more for health care coverage. Employer-sponsored health insurance premiums have nearly doubled since 2000, a rate three times faster than wages. In 2008, the average premium for a family plan purchased through an employer was $12,680, nearly the annual earnings of a full-time minimum wage job.  Americans pay more than ever for health insurance, but get less coverage. Learn more: http://www.healthreform.gov/reports/hiddencosts/index.html


3. Roadblocks to Care for Women: Women’s reproductive health requires more regular contact with health care providers, including yearly pap smears, mammograms, and obstetric care. Women are also more likely to report fair or poor health than men (9.5% versus 9.0%). While rates of chronic conditions such as diabetes and high blood pressure are similar to men, women are twice as likely to suffer from headaches and are more likely to experience joint, back or neck pain. These chronic conditions often require regular and frequent treatment and follow-up care. Learn more: http://www.healthreform.gov/reports/women/index.html


4. Hard Times in the Heartland: Throughout rural America, there are nearly 50 million people who face challenges in accessing health care. The past several decades have consistently shown higher rates of poverty, mortality, uninsurance, and limited access to a primary health care provider in rural areas. With the recent economic downturn, there is potential for an increase in many of the health disparities and access concerns that are already elevated in rural communities. Learn more: http://www.healthreform.gov/reports/hardtimes


5. Small Businesses Struggle to Provide Health Coverage: Nearly one-third of the uninsured – 13 million people – are employees of firms with less than 100 workers. From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. Much of this decline stems from small business. The percentage of small businesses offering coverage dropped from 68% to 59%, while large firms held stable at 99%. About a third of such workers in firms with fewer than 50 employees obtain insurance through a spouse. Learn more: http://www.healthreform.gov/reports/helpbottomline


6. The Tragedies are Personal: Half of all personal bankruptcies are at least partly the result of medical expenses. The typical elderly couple may have to save nearly $300,000 to pay for health costs not covered by Medicare alone. Learn more: http://www.healthreform.gov/reports/inaction


7. Diminishing Access to Care: From 2000 to 2007, the proportion of non-elderly Americans covered by employer-based health insurance fell from 66% to 61%. An estimated 87 million people - one in every three Americans under the age of 65 - were uninsured at some point in 2007 and 2008. More than 80% of the uninsured are in working families. Learn more: http://www.healthreform.gov/reports/inaction/diminishing/index.html


8. The Trends are Troubling: Without reform, health care costs will continue to skyrocket unabated, putting unbearable strain on families, businesses, and state and federal government budgets. Perhaps the most visible sign of the need for health care reform is the 46 million Americans currently without health insurance - projections suggest that this number will rise to about 72 million in 2040 in the absence of reform. Learn more: http://www.WhiteHouse.gov/assets/documents/CEA_Health_Care_Report.pdf

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Talking Points for Healthcare Reform

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1. When you need life-saving care, private insurance companies only profit by denying you and letting you die. If you have payed your premiums on time all your life, you're as likely to be dropped by your private insurance company when you need life-saving care as you are to get treated. A public option gives you a lifeline.

2. Private insurance companies are spending over $1M a day to kill the public option by inventing phony citizen groups, and trying to scare the elderly about euthanasia and pro-lifers with abortion; they know the only way to kill reform is to get people of good conscience fighting, while they laugh all the way to the bank. They don't think very highly of our intelligence.

3. We pay more than any other country to be 24th in life expectancy: while the average Canadian family spends less than $2000 a year on health care with no waiting periods, the average American family spends $29,000 a year, waiting for private insurance companies to approve every procedure.

4. 14,000 Americans lose their health insurance every day; 46M are uninsured.

5. 18,000 Americans DIE each year due to lack of health care: THAT'S 50 A DAY.

6. Two-thirds of American personal bankruptcies are related to health care costs.

7. Businesses - particularly small businesses - cannot afford to provide health insurance for their employees under the current employer based private insurance system, and will be forced to either drop their coverage or go out of business unless a public option is passed.

8. One-sixth of all our government spending is on health care, twice as much as any other country spends out of its budget. Our nation pays $2.5 trillion for care costing $912 billion .

9. Every independent estimate says the public option will save us money, from saving 150 billion dollars (CBO) to saving 265 billion dollars (Commonwealth). The Congressional Budget Office estimates the current bill in the House would leave a 6 billion dollar surplus.

10. So - if you'd rather spend more taxpayer money, bankrupt businesses, AND pay $29,000 a year for your family's private insurance coverage in exchange for a policy that can be dumped the second you actually need it, then the current system is great for you. If you'd rather spend less, wait less, have less of a chance of dying, and want to remove the corporate bureaucrat from between you and your doctor, then a public option is the way to go. Right now, even if you're lucky enough not to be dropped by your provider when you need urgent medical care, your private insurance company can overrule your doctor's advice for life-saving treatment and only offer to cover something cheaper; a public option would remove that middleman and leave these decisions where they belong, between the patient and doctor.

via Daily Kos: State of the Nation.

How can the richest people in the world allow millions to be homeless and without health care. Fifty American's die every day!

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Liberal Dems Say No to Deal on Health Care Reform

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It's about time someone stood up for the little guy.
Mother Jones

This could be a big deal. Fifty-seven liberal House Democrats sent a letter on Thursday to House Speaker Nancy Pelosi and Representative Henry Waxman, the chair of the House energy and commerce committee, saying they cannot vote for the deal Waxman cut with the Blue Dog Dems, citing the compromise's weak public option provision. It's a short note, but a possible big monkey wrench. Without these votes, the Democrats are far short of a majority.
The letter:

We write to voice our opposition to the negotiated health care reform agreement under consideration in the Energy and Commerce Committee.
We regard the agreement reached by Chairman Waxman and several Blue Dog members of the Committee as fundamentally unacceptable. This agreement is not a step forward toward a good health care bill, but a large step backwards. Any bill that does not provide, at a minimum, for a public option with reimbursement rates based on Medicare rates - not negotiated rates - is
unacceptable. It would ensure higher costs for the public plan, and would do nothing to achieve the goal of "keeping insurance companies honest," and their rates down.
To offset the increased costs incurred by adopting the provisions advocated by the Blue Dog members of the Committee, the agreement would reduce subsidies to low-and middle-income families, requiring them to pay a larger portion oftheir income for insurance premiums, and would impose an unfunded mandate on the states to pay for what were to have been Federal costs.
In short, this agreement will result in the public, both as insurance purchasers and as taxpayers, paying ever higher rates to insurance companies.
We simply cannot vote for such a proposal.

Back to you, Waxman.

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How Dennis Kucinich May Save the Health Reform Battle

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AlterNet

On Friday, an amendment he authored was added to the House bill that allows states to create their own single-payer systems instead of adopting the federally-run exchange system. The original bill allowed states only to enact their own exchange system -- it was a nod to federalism -- with the proviso that if a state (think a deep red one in the South) refused to adopt the plan, the feds could step in and set it up.
The Kucinich amendment is really key. If it were to survive the legislative sausage-making and be enacted into law, the we might expect a progressive state to take advantage of the opportunity and enact a single-payer system in the coming years. And, if those of us who have been pushing such an arrangement are correct, the result will be greater access and better outcomes at a lower price tag for that state's residents.
And then we can move from an often ill-informed argument over the Canadian or British systems to a debate in which we can hold up a model in which millions of real Americans see very tangible benefits from an actual single-payer system in action.

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Healthy examples: Plenty of countries get healthcare right

- The Boston Globe

That was Arizona Senator Jon Kyl, speaking last month about healthcare reform. But it could have been virtually any other Republican, not to mention any number of sympathetic interest groups, because that's the party line for many who oppose healthcare reform. If President Obama and his supporters get their way, this argument goes, healthcare in America will start to look like healthcare overseas. Yes, maybe everybody will have insurance. But people will have to wait in long lines. And when they are done waiting in line, the care won't be very good.
Typically the people making these arguments are basing their analysis on one of two countries, Canada and England, where such descriptions hold at least some truth. Although the people in both countries receive pretty good healthcare - their citizens do better than Americans in many important respects - they are also subjected to longer waits for specialty care and tighter limits on some advanced treatments.
But no serious politician is talking about recreating either the British or the Canadian system here. The British have truly "socialized medicine," in which the government directly employs most doctors. The Canadians have one of the world's most centralized "single-payer" systems, in which the government insures everybody directly and private insurance has virtually no role. A better understanding for how universal healthcare might work in America would come from other countries - countries whose insurance architecture and medical cultures more closely resemble the framework we'd likely create here.
Last year, I had the opportunity to spend time researching two of these countries: France and the Netherlands. Neither country gets the attention that Canada and England do. That might be because English isn't their language. Or it might be because they don't fit the negative stereotypes of life in countries where government is more directly involved in medical care.
Over the course of a month, I spoke to just about everybody I could find who might know something about these healthcare systems: Elected officials, industry leaders, scholars - plus, of course, doctors and patients. And sure enough, I heard some complaints. Dutch doctors, for example, thought they had too much paperwork. French public health experts thought patients with chronic disease weren't getting the kind of sustained, coordinated medical care that they needed.
But in the course of a few dozen lengthy interviews, not once did I encounter an interview subject who wanted to trade places with an American. And it was easy enough to see why. People in these countries were getting precisely what most Americans say they want: Timely, quality care. Physicians felt free to practice medicine the way they wanted; companies got to concentrate on their lines of business, rather than develop expertise in managing health benefits. But, in contrast with the US, everybody had insurance. The papers weren't filled with stories of people going bankrupt or skipping medical care because they couldn't afford to pay their bills. And they did all this while paying substantially less, overall, than we do.
The Dutch and the French organize their healthcare differently. In the Netherlands, people buy health insurance from competing private carriers; in France, people get basic insurance from nonprofit sickness funds that effectively operate as extensions of the state, then have the option to purchase supplemental insurance on their own. (It's as if everybody is enrolled in Medicare.) But in both countries virtually all people have insurance that covers virtually all legitimate medical services. In both countries, the government is heavily involved in regulating prices and setting national budgets. And, in both countries, people pay for health insurance through a combination of private payments and what are, by American standards, substantial taxes.
You could be forgiven for assuming, as Kyl and his allies suggest, that so much government control leads to Soviet-style rationing, with people waiting in long lines and clawing their way through mind-numbing bureaucracies every time they have a sore throat. But, in general, both the Dutch and French appear to have easy access to basic medical care - easier access, in fact, than is the American norm.
In both the Netherlands and France, most people have long-standing relationships with their primary care doctors. And when they need to see these doctors, they do so without delay or hassle. In a 2008 survey of adults with chronic disease conducted by the Commonwealth Fund - a foundation which financed my own research abroad - 60 percent of Dutch patients and 42 percent of French patients could get same-day appointments. The figure in the US was just 26 percent.
The contrast with after-hours care is even more striking. If you live in either Amsterdam or Paris, and get sick after your family physician has gone home, a phone call will typically get you an immediate medical consultation - or even, if necessary, a house call. And if you need the sort of attention available only at a formal medical facility, you can get that, too - without the long waits typical in US emergency rooms.
This is particularly true in the Netherlands, thanks to a nationwide network of urgent care centers the government and medical societies have put in place. Not only do these centers provide easily accessible care for people who use them; they leave hospital emergency rooms free to concentrate on the truly serious cases. Tellingly, a Dutch physician I met complained to me that waiting times in her emergency room had been getting "too long" lately. "Too long," she went on to tell me, meant two or three hours. When I told her about documented cases of people waiting a day, or even days, for treatment in some American emergency rooms, she thought I was joking. (In a 2007 Commonwealth Fund survey, just 9 percent of Dutch patients reported waiting more than two hours for care in an ER, compared to 31 percent of Americans.)
Dutch and French patients do wait longer than Americans for specialty care; around a quarter of respondents to the Commonwealth Fund survey reported waiting more than two months to see a specialist, compared to virtually no Americans. But Dutch and French patients were far less likely to avoid seeing a specialist altogether - or forgoing other sorts of medical care - because they couldn't afford it. And there's precious little evidence that the waits for specialty care led to less effective care.
On the contrary, the data suggests that while American healthcare is particularly good at treating some diseases, it's not as good at treating others. (In some studies, the US did pretty well on cardiovascular care, not so well on diabetes, for example.) Overall, the US actually fares poorly on measures like "potential years of lives lost" - statistics compiled by specialists in an effort to measure how well healthcare systems perform. In a 2003 ranking of 20 advanced countries, the US finished 16th when it came to "mortality amenable to healthcare," another statistic that strives to capture the impact of a health system. The Dutch were 11th and the French were fifth. These statistics are necessarily crude; diet, culture, and many other factors inevitably affect the results. But, taken together, they make it awfully hard to argue that care in these countries is somehow inferior. If anything, the opposite would seem to be true.
Critics of health reform frequently point to cancer as proof that American healthcare really is superior. And, it's true, the US has, overall, the world's highest five-year survival rate for cancer. But that's partly a product of the unparalleled amount of government-funded research in the US - something healthcare reform would not diminish. Besides, it's not as if the gap is as large or meaningful as reform critics frequently suggest. France (like a few other European countries) has survival rates that are generally close and, for some cancers, higher. Much of the remaining difference reflects differences in treatment patterns that have nothing to do with insurance arrangements and everything to do with idiosyncratic medical cultures. This is particularly true of prostate cancer, where a staggeringly high survival rate in the US seems to be largely a product of aggressive US treatment - treatment that physicians in other countries, and increasingly many specialists here, consider unnecessary and sometimes harmful.
None of this is to say that either the Dutch or French systems are perfect. Far from it. In both countries, healthcare costs are rising faster than either the public - or the country's business interests - would like. And each country has undertaken reforms in an effort to address these problems. The French have started to introduce some of the managed care techniques familiar to Americans, like charging patients extra if they see specialists without a referral, while developing more evidence-based treatment guidelines in the hope that it will reduce the use of unnecessary but expensive treatments. The Dutch overhauled their insurance arrangements a few years ago, to introduce more market competition and reward healthcare providers - that is, doctors and hospitals - who get good results.
But cost is the one area in which France and the Netherlands are a lot like Canada and England: They all devote significantly less of their economy to healthcare than we do. The French spend around 11 percent of their gross domestic product on healthcare, the Dutch around 10. In the US, we spend around 16 percent. And, unlike in the US, the burden for paying this is distributed across society - to both individuals and businesses - in an even, predictable way.
Of course, reforming health insurance in the US isn't going to turn this country into France or the Netherlands overnight, any more than it would turn the US into Britain and Canada. The truth is that the changes now under consideration in Washington are relatively modest, by international standards. But insofar as countries abroad give us an idea of what could happen, eventually, if we change our health insurance arrangements, the experience of people in Amsterdam and Paris surely matters as much as - if not more than - those in Montreal and London. In those countries, government intervention has created a health system in which people seem to have the best of all worlds: convenience, quality, and affordability. There's no reason to think the same thing couldn't happen here.
Jonathan Cohn is a senior editor of The New Republic, where he writes a blog called "The Treatment." He is also the author of "Sick: The Untold Story of America's Health Care Crisis - and the People Who Pay the Price (HarperCollins, 2007).
© Copyright 2009 The New York Times Company

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Healthy examples: Plenty of countries get healthcare right - The Boston Globe

Plenty of countries get healthcare right.

"I DON'T WANT America to begin rationing care to their citizens in the way these other countries do."
That was Arizona Senator Jon Kyl, speaking last month about healthcare reform. But it could have been virtually any other Republican, not to mention any number of sympathetic interest groups, because that's the party line for many who oppose healthcare reform. If President Obama and his supporters get their way, this argument goes, healthcare in America will start to look like healthcare overseas. Yes, maybe everybody will have insurance. But people will have to wait in long lines. And when they are done waiting in line, the care won't be very good.
Typically the people making these arguments are basing their analysis on one of two countries, Canada and England, where such descriptions hold at least some truth. Although the people in both countries receive pretty good healthcare - their citizens do better than Americans in many important respects - they are also subjected to longer waits for specialty care and tighter limits on some advanced treatments.
But no serious politician is talking about recreating either the British or the Canadian system here. The British have truly "socialized medicine," in which the government directly employs most doctors. The Canadians have one of the world's most centralized "single-payer" systems, in which the government insures everybody directly and private insurance has virtually no role. A better understanding for how universal healthcare might work in America would come from other countries - countries whose insurance architecture and medical cultures more closely resemble the framework we'd likely create here.
Last year, I had the opportunity to spend time researching two of these countries: France and the Netherlands. Neither country gets the attention that Canada and England do. That might be because English isn't their language. Or it might be because they don't fit the negative stereotypes of life in countries where government is more directly involved in medical care.
Over the course of a month, I spoke to just about everybody I could find who might know something about these healthcare systems: Elected officials, industry leaders, scholars - plus, of course, doctors and patients. And sure enough, I heard some complaints. Dutch doctors, for example, thought they had too much paperwork. French public health experts thought patients with chronic disease weren't getting the kind of sustained, coordinated medical care that they needed.
But in the course of a few dozen lengthy interviews, not once did I encounter an interview subject who wanted to trade places with an American. And it was easy enough to see why. People in these countries were getting precisely what most Americans say they want: Timely, quality care. Physicians felt free to practice medicine the way they wanted; companies got to concentrate on their lines of business, rather than develop expertise in managing health benefits. But, in contrast with the US, everybody had insurance. The papers weren't filled with stories of people going bankrupt or skipping medical care because they couldn't afford to pay their bills. And they did all this while paying substantially less, overall, than we do.
The Dutch and the French organize their healthcare differently. In the Netherlands, people buy health insurance from competing private carriers; in France, people get basic insurance from nonprofit sickness funds that effectively operate as extensions of the state, then have the option to purchase supplemental insurance on their own. (It's as if everybody is enrolled in Medicare.) But in both countries virtually all people have insurance that covers virtually all legitimate medical services. In both countries, the government is heavily involved in regulating prices and setting national budgets. And, in both countries, people pay for health insurance through a combination of private payments and what are, by American standards, substantial taxes.
You could be forgiven for assuming, as Kyl and his allies suggest, that so much government control leads to Soviet-style rationing, with people waiting in long lines and clawing their way through mind-numbing bureaucracies every time they have a sore throat. But, in general, both the Dutch and French appear to have easy access to basic medical care - easier access, in fact, than is the American norm.
In both the Netherlands and France, most people have long-standing relationships with their primary care doctors. And when they need to see these doctors, they do so without delay or hassle. In a 2008 survey of adults with chronic disease conducted by the Commonwealth Fund - a foundation which financed my own research abroad - 60 percent of Dutch patients and 42 percent of French patients could get same-day appointments. The figure in the US was just 26 percent.
The contrast with after-hours care is even more striking. If you live in either Amsterdam or Paris, and get sick after your family physician has gone home, a phone call will typically get you an immediate medical consultation - or even, if necessary, a house call. And if you need the sort of attention available only at a formal medical facility, you can get that, too - without the long waits typical in US emergency rooms.
This is particularly true in the Netherlands, thanks to a nationwide network of urgent care centers the government and medical societies have put in place. Not only do these centers provide easily accessible care for people who use them; they leave hospital emergency rooms free to concentrate on the truly serious cases. Tellingly, a Dutch physician I met complained to me that waiting times in her emergency room had been getting "too long" lately. "Too long," she went on to tell me, meant two or three hours. When I told her about documented cases of people waiting a day, or even days, for treatment in some American emergency rooms, she thought I was joking. (In a 2007 Commonwealth Fund survey, just 9 percent of Dutch patients reported waiting more than two hours for care in an ER, compared to 31 percent of Americans.)
Dutch and French patients do wait longer than Americans for specialty care; around a quarter of respondents to the Commonwealth Fund survey reported waiting more than two months to see a specialist, compared to virtually no Americans. But Dutch and French patients were far less likely to avoid seeing a specialist altogether - or forgoing other sorts of medical care - because they couldn't afford it. And there's precious little evidence that the waits for specialty care led to less effective care.
On the contrary, the data suggests that while American healthcare is particularly good at treating some diseases, it's not as good at treating others. (In some studies, the US did pretty well on cardiovascular care, not so well on diabetes, for example.) Overall, the US actually fares poorly on measures like "potential years of lives lost" - statistics compiled by specialists in an effort to measure how well healthcare systems perform. In a 2003 ranking of 20 advanced countries, the US finished 16th when it came to "mortality amenable to healthcare," another statistic that strives to capture the impact of a health system. The Dutch were 11th and the French were fifth. These statistics are necessarily crude; diet, culture, and many other factors inevitably affect the results. But, taken together, they make it awfully hard to argue that care in these countries is somehow inferior. If anything, the opposite would seem to be true.
Critics of health reform frequently point to cancer as proof that American healthcare really is superior. And, it's true, the US has, overall, the world's highest five-year survival rate for cancer. But that's partly a product of the unparalleled amount of government-funded research in the US - something healthcare reform would not diminish. Besides, it's not as if the gap is as large or meaningful as reform critics frequently suggest. France (like a few other European countries) has survival rates that are generally close and, for some cancers, higher. Much of the remaining difference reflects differences in treatment patterns that have nothing to do with insurance arrangements and everything to do with idiosyncratic medical cultures. This is particularly true of prostate cancer, where a staggeringly high survival rate in the US seems to be largely a product of aggressive US treatment - treatment that physicians in other countries, and increasingly many specialists here, consider unnecessary and sometimes harmful.
None of this is to say that either the Dutch or French systems are perfect. Far from it. In both countries, healthcare costs are rising faster than either the public - or the country's business interests - would like. And each country has undertaken reforms in an effort to address these problems. The French have started to introduce some of the managed care techniques familiar to Americans, like charging patients extra if they see specialists without a referral, while developing more evidence-based treatment guidelines in the hope that it will reduce the use of unnecessary but expensive treatments. The Dutch overhauled their insurance arrangements a few years ago, to introduce more market competition and reward healthcare providers - that is, doctors and hospitals - who get good results.
But cost is the one area in which France and the Netherlands are a lot like Canada and England: They all devote significantly less of their economy to healthcare than we do. The French spend around 11 percent of their gross domestic product on healthcare, the Dutch around 10. In the US, we spend around 16 percent. And, unlike in the US, the burden for paying this is distributed across society - to both individuals and businesses - in an even, predictable way.
Of course, reforming health insurance in the US isn't going to turn this country into France or the Netherlands overnight, any more than it would turn the US into Britain and Canada. The truth is that the changes now under consideration in Washington are relatively modest, by international standards. But insofar as countries abroad give us an idea of what could happen, eventually, if we change our health insurance arrangements, the experience of people in Amsterdam and Paris surely matters as much as - if not more than - those in Montreal and London. In those countries, government intervention has created a health system in which people seem to have the best of all worlds: convenience, quality, and affordability. There's no reason to think the same thing couldn't happen here.
Jonathan Cohn is a senior editor of The New Republic, where he writes a blog called "The Treatment." He is also the author of "Sick: The Untold Story of America's Health Care Crisis - and the People Who Pay the Price (HarperCollins, 2007).
© Copyright 2009 The New York Times Company

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Why The Healthcare Industry Doesn't Want Electronic Medical Records

Techdirt

...from the it-would-reveal-the-business-model dept


I've been really confused by the whole push for "electronic healthcare records" as some sort of big step for improving our healthcare system. It's such a minor part of what's needed that it seems to be looking at curing a cough when someone has terminal cancer. The cough isn't the issue. Also, it's never been quite clear why hospitals didn't move to electronic healthcare records in the first place. Lots of other businesses with tons of paper records long ago realized that moving to electronic records and making things more efficient wasn't just a fantastic way to make money, but a way to expand their own market. The switch from paper stock certificates to electronic ones didn't just save printing costs -- it enabled the stock market to change in a massive way (perhaps too much, many will note).
Andy Kessler, who's been thinking an awful lot about these issues (and whose book The End of Medicine hasn't received nearly the attention it deserves) has an interesting article discussing why the industry has resisted the move to e-healthcare records. While it would save some money, he notes, it would also expose the entire scam of the healthcare system: which is that they make a ton of money from inefficiencies baked into the system, which are totally hidden from view. It's a massive boondoggle for the industry, and e-healthcare records would actually make it easier for people to understand that the healthcare system profits from people being sick and not from having them be well.
The incentives are totally screwed up for everyone.
Healthcare providers make more money the sicker you are. Pharmaceutical companies make easy money with gov't monopolies limiting the ability to spread useful drugs. The actual costs are nearly totally hidden from most consumers, so they don't make smart choices at all. There's a lot of built in artificial scarcities in the system, and opening up the flow of information changes that.
Of course, in the grand scheme of things, this is dumb. Focusing on preventative care and actually keeping people healthy would actually provide a massive economic benefit not just to the healthcare industry, but to the economy as a whole. More healthy people contributing to production, output and consumption can do quite a lot for the economy. The numbers on some studies are staggering (we're talking trillions of dollars). If the incentives could be aligned such that people paid for staying healthy, rather than having illness treated, then there's a ton of money to be made without resorting to the old inefficient mess that is today's healthcare system.
But rather than tackle any of that, we get attempts to fix the cough in the terminally ill patient -- and the patient likes the morphine drip so much that he'll do anything to avoid getting healthy. It's time to fix the healthcare system. And while I don't necessarily believe that a small step like electronic medical records is all that meaningful, if Kessler is right and it actually drives some awareness to the underlying mess, perhaps it's at least a good start.

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