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Is National Health Care Dead on Arrival?Dr. Roger Kahn, Bob Haiducek of Medicare For All, and Robert Martin Discuss the Pros, Cons, Myths & Realities of Health Care Reform
Dear Editor, The Review;
First, people with common sense know there is something fishy about the rushed way this is coming about. Something this massive: a sweeping change in health care access, ought to be done with some deliberation and not just voted out by legislators who have not talked to their constituents--and have not read or discussed the bill! Reworking about 20% of our economy is pretty scary when you only get dribs and drabs about who and what is involved. Something that costs over (another) trillion dollars ought to expand coverage. Yet the focus seems to be on ways to ration it. This plan limits care at the time it’s most needed, in order to expand it to times when it’s not. What sense does that make? What are some of the specifics of the Obama, Pelosi and Reid plan? Here is the link to the 1018 page document: http://docs.house.gov/edlabor/AAHCA-BillText-071409.pdf And here are my concerns. There is cost cutting involved to balance the expanded access proposed. The cost cutting is achieved by rationing and denying healthcare, especially to seniors and the sick. This is implemented through “The National Health Care Board”, which will “approve or reject treatment for patients based on the cost per treatment divided by the number of years the patient will benefit from the treatment.” This means that our seniors and sick patients will be denied treatment. This is not surprising. Seniors and the sick in Canada and Britain, two counties who’s health care Obama admires, are routinely denied treatment. When I was in Detroit, people used to regularly flee Canada across the Ambassador Bridge and through the Windsor Tunnel to get standard treatments like heart surgery that were restricted, delayed or just not available in Canada. For example, the nurse daughter of an unstable patient hospitalized in Toronto told me they sent him home for 6 months to “get his blood pressure under control”. We NEVER do that to patients here. Assuming they survive the 6 months we would have to evaluate them all over again prior to doing their surgery. The only savings I see in this is in death… a non-covered “benefit”. What about new treatments to save lives? In the last 20 years we have revolutionized cardiac care and now can reverse heart attacks, treat cholesterol and fix blockages without surgery (angioplasty and stents). And as for other areas, we can now cure many cancers that were untreatable just a few years ago (lymphomas and leukemias for example). Will we still have hope for more medical breakthroughs? The Obama, Pelosi and Reid plan creates the “Federal Coordinating Council For Comparative Effectiveness Research”. Its purpose is “to slow the development of new medications and technologies in order to reduce costs.” Well, Jerry Lewis’s hopes for a cure for muscular dystrophy just “slowed down” along with treatment for sickle cell anemia and cystic fibrosis. Those illnesses are considered bad odds. Under Obamacare, the “odds” will be the determining factor as to whether you are treated, or shuffled into “end of life counseling.” Am I being harsh here? Section 1233 is devoted to” Advanced Care Planning.” After you turn 65 you have to go to a mandatory counseling program designed to discuss and prepare for ending life. This occurs every five years unless you have a chronic illness. Then it has to be done yearly. Topics will include “how to decline hydration, nutrition, and how to initiate hospice care.” Well, how about doctors who say, “I did take the Hippocratic Oath, no matter what the bureaucrats say, the patient comes first? The plan outlines oversight of doctors and hospitals by the “National Coordinator for Health Information and Technology” who “will monitor treatments being delivered to make sure doctors and hospitals strictly follow government guidelines that are deemed appropriate.” And, of course, “doctors and hospitals not adhering to guidelines will face penalties.” I am told, “penalties include six figure fines and imprisonment.” So consider the lady I treated from Australia who had a heart attack here. They have national health care in Australia and her embassy wanted me to send this woman directly home from the intensive care unit so they could care for her there. I refused, telling her embassy, “You are a whole country. Can’t you take care of this poor suffering woman?” So I sent her to USA heart surgery and as she left the hospital she thanked me saying, “If you had sent me home they would have just let me die.” I received Christmas cards from her for 10 years—10 Christmases she would not have celebrated if left to government health care. So under ObamaCare I suppose the odds are that putting patients first will get me fined big time and jailed. Hmmm. Doing the right thing is sometimes costly. I got my positive TB test giving mouth-to-mouth resuscitation to a man with TB. I suppose I can do hospital follow-ups during visitation time at the Freeland Prison. Then, there is section (102) titled “Protecting the Choice to Keep Current Coverage” which makes it illegal to keep your private insurance if you lose your job, retire, or have an insurance change. By the way I can’t find anywhere in the document a section on strategies to prevent disease, or on fighting to extend the life on an elderly patient. It is a big bill. Maybe I missed it. There is a section that exempts congress from Obamacare, however. It is not enough to just criticize the Obama plan. What do we doctors think might improve access, preserve quality and cut costs? Defensive medicine increases the cost of medicine about 30% according to any doctor or nurse you ask (personal injury lawyers say it is only 3%). If we go to a gross negligence standard for lawsuits (like the rest of the world) we could save enough there alone to increase access for millions of people. Why do we need a whole new bureaucracy to deliver health care? We ought to look at using what we have: the Medicaid system, which has many great ideas and is dedicated to access. Many of those ideas, like managed care, ought to be implemented across the country. State by state economies of scale will save money but don’t eliminate comparability or invention like one big federal program will. We ought to have health care coaches for the sick, especially those with mental illness, as they are the most costly to care for and have a very guarded prognosis. If the feds have to do something across the country, do that. We ought to develop preventive care; put health clinics in rural and urban America (especially school based clinics) and we ought to expand our medical schools and the availability of PAs and nurse practitioners. Medicaid payments ought to be competitive at least with Medicare so we stop losing practitioners in rural and urban depressed areas. I don’t think you ought to browbeat sick people about the end of life. Make advanced directives portable, transferable, legal, registered and accessible across our country and people will voluntarily tell you what they want to do when they are terminally ill. However we change medicine in our country we need to be inclusive and caring. We need to keep our empathy for the sick as we reform our health care. And we all need to be part of the decision. After all this is about our lives for each and every one of us. The approach of American doctors is to beat the odds, to save as many patients as possible. The approach of federal bureaucrats will be to play the odds and save as much money as possible. Excluding our people from healthcare is not an improvement. That is also not the American way.
Roger Kahn, MD.
FACC. FACP.
Dear Editor;
I agree that health care reform should be carefully designed and should “expand coverage”. However, all of us should automatically be covered and never receive a major medical bill. That is not what the Congress is preparing, even though their report very clearly indicated in 1991 that this would be an option. Most Americans have never heard of the best option: non-profit health insurance, such as the best version of that, which is single-payer. All of us (100%) could have all medically necessary care for our entire lives, while paying much less and realizing huge savings for our families and businesses. It’s an improved Medicare for All, no longer privatized. It involves the least government and no use of health insurance companies for medically necessary care. Simplicity and efficiency allows for the complete access and complete coverage. Why don’t Americans know? Some are trying, but we need more help, especially since another round of expensive media propaganda is underway, sponsored by health insurance and pharmaceutical companies, to control our opinions. Following are my specific responses regarding Dr. Kahn’s input, followed by additional information: It’s great to hear that Doctor Kahn spoke with patients who are “very frightened” about the Congress’ plans. People should be. However, keep in mind that there is no “Obama health plan.” There is no “Obamacare.” Obama is not helping us get to single-payer. On March 5 President Obama announced that he’s leaving health care reform legislation up to the U.S. Congress. Obama provides only a few guiding principles. Four health care resolutions are in the U.S. Congress. Among these, Dr. Kahn references House Resolution 3200. It’s most up-to-date copy is here: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.txt.pdf Members of the U.S. Congress know that their plan will leave over 15 million un-insured. Dr. Kahn provides some quotes he indicates are from the proposed legislation, including “The National Health Care Board… ‘will approve or reject treatment for patients based on the cost per treatment divided by the number of years the patient will benefit …’ Unfortunately, neither this quote nor any pieces of it are found in the resolution. For example, I cannot find the phrase “National Health Care Board” … nor the words “approve or reject treatment”. We already have rationing with health care, which is based on making profits and how much one can pay. The uninsured and under-insured are hurt the most, having tearjerker experiences. The numbers of patients who “regularly flee Canada” are tiny compared to the amount of excellent care provided to Canadian citizens and to Americans who are working and living there. Canadian health care is fine. My wife and I and our two young sons lived there. Canadians and Americans confirm that it’s fine. See “Real Life Stories” (1). Yes, we will have medical breakthroughs. We will maintain our use of advances from all over the world, including the examples of Canada, England, France, Sweden and the U.S. Research and development will continue. Yes, Dr. Kahn is being harsh when he writes about “end of life counseling” and his reference to "slow the development of new medications and technologies in order to reduce costs." The former has been debunked as an unsubstantiated scare tactic. The latter is so ridiculous it does not deserve a reply. Counseling “designed to discuss and prepare for ending life”? This is a gross misrepresentation that stimulates fear, not understanding. There is no such coordinator in the resolution by the title Dr. Kahn communicated. There is no mention of either “not adhering to guidelines”, nor any mention of “monitor treatments”. I am glad the Australian lady was treated well in the United States. Isaac, an American who lived in Australia for two years, gave a glowing report last year of the “care … of the highest quality” that he received (perforated eardrum) and his mother-in-law received (cancer). See “Real Life Stories”(1). What matters are not individual stories, but the overall performance. Australia, France and Japan are the top three performers in minimizing deaths due to preventable diseases. The U.S. is 19th out of 19 countries. See “Real People” (1). All physicians, especially the family physicians, will enjoy “Putting patients first” when we have single-payer. Costs will be dramatically reduced; helping increase the physicians’ net income. Physician time for patients will increase. Result: better health care and better physician job satisfaction. Section 102 makes no reference to what Dr. Kahn wrote. A way to help prevent disease is to allow people to get to the doctor. Americans can’t afford it. They fear the resulting health care will be too expensive. It is not in the scope of this resolution to cover specific strategies of disease prevention and ways to extend the life. There is no section that exempts Congress. Malpractice premiums for physicians will drop dramatically with single-payer. Health care will be provided automatically from pre-natal till the end of life. Patients can sue for an injury, but not for health care for the rest of their life. Do we need a “whole new bureaucracy”? No. Single-payer will eliminate most government bureaucracy, all of the for-profit bureaucracy, and most or all of the supporting bureaucracy! See “Bureaucracy” (1) Other ideas to improve health care? Let’s try them. First we need to act on the highest priority: get single-payer, one public agency, separate from the government. We need to find those tens of millions who have no health insurance. And we need to find those who have experienced hardships due to the U.S. barbaric way to pay for health care. We need to tell them that there is a much better way and ask them to help get that better way. Single-payer is both inclusive and caring. Improved Medicare for All; no longer privatized. Read about it at “Benefits”(1). Help get it with only 10-15 minutes of effort each month. ; Following is additional information: Congressional regulations on health insurance companies would not only increase taxes, but also cause health insurance premiums to sky-rocket, as already demonstrated in the state of New York. In the second poorest county of New York (Allegany) a family can get insurance that costs between $36,000 and $57,000 per year, not including the deductibles, the co-pays and the coinsurance for major medical bills. The U.S. Congress is preparing to implement mandated health insurance. That means dictated, forced payment to for-profit health insurance companies. People in Massachusetts have been negatively impacted by their three years of mandated health insurance. They call it the Gestapo state. Pay or pay a fine. Don’t pay the fine and be guilty of tax evasion and face a possible prison sentence. See “Two Choices” (1). It is time for hope. What have other free-market countries done over the years? They implemented non-profit health insurance. Their people are experiencing the benefits, while our average health performance declines. The rest of this article is a partial list regarding what we could have. • No premiums to health insurance companies and a higher Medicare tax will net to provide a huge savings. See “Costs and Savings”(1). - Higher household incomes and higher business incomes are results of the lower cost. • No major medical bills or the fear of getting one. ;- Never again have the many kinds of hardships that can result from a major medical bill. • Always have access. All ages. All medically necessary care. Choices? We’ll have choices! Lifestyle choices: which job, which employer, which profession, timing of retirement or a leave of absence or going to part-time for a while to care for a relative. Not choices of health insurance companies. Summary: caring, not profits. We need to overcome that immense media propaganda, mentioned at the start, with the overwhelming force of citizens not just educated, but also communicating to each of our U.S. Representatives. What we do want is hopefully clear. We, the people, need to tell the U.S. Congress, such as Representatives Camp, Kildee and Stupak. Please select “Sign Up” (1). (1) The referenced website is http://www.medicareforall.org.
Respectfully,
PRESCRIPTION FOR DISASTER: FOLLOW THE PIRATES Aren’t drug companies kleptomaniacs given the prices they charge and the subsidies they get from our tax dollars? And HMOs are certainly suffering from attention deficit disorder -- they keep on denying people the health care they already paid for. It’s important to ask, why do we apply pathological categories to human beings but not to these institutions? - Ralph Nader
by Robert E. Martin There is plenty of noise and mis-information circulating once again in the debate over national health care, only this time our country cannot afford to blow it. But all signs indicate Congress will predictably cave into special interests from the insurance & drug industry as they have in the past. As journalist Matt Tabbi notes in the Sept. 3rd edition of Rolling Stone, “The system doesn’t work for anyone. It cheats patients and leaves them to die, denies insurance to 47 million Americans, forces hospitals to spend billions haggling over claims, and systematically bleeds doctors with the specter of catastrophic litigation.” Even as a vehicle for delivering bonuses to insurance company fat cats it’s a failure because the generation they spent denying preventive care to patients now witnesses their profits sapped by millions of customers who enter the system only when they are sick. Detractors of national health care claim it will result in ‘rationing’; but they forget that rationing already exists every time a claims adjustor denies a patient for care due to a pre-existing condition. I agree with Mr. Haiducek, every single developed country outside the United States uses The Single Payer System because it allows doctors & hospitals to bill and be reimbursed by a single government entity. In the real world, nothing except a single-payer system makes any sense. There are currently 1,300 private insurers in this country, forcing doctors to fill out different forms and follow different reimbursement procedures for each one. Consequently, nearly a third of all health care costs in America are associated with wasteful administration. Fully $350 billion a year could be saved on paperwork alone if the U.S. went to a single-payer system – more than enough to pay for the whole enchilada – if legislators possessed the cajones to stand up and say so. Every major player in the current health care debate knows this and has admitted it at one time or another, including Obama, Waxman, and Pelosi, however they all have abandoned it. Of course, Obama received $2,727,970 from the health insurance industry; and there isn’t a legislator in Congress that isn’t in on the take. Leading advocates of single payer, including doctors from the Physicians for National Health Program, have pushed for Single Payer; yet when you have 4 times the number of health insurance & drug company lobbyists in Washington than there are representatives, once again the will and voice of the people, whom approve by wide margins curtailing the profit gouging going on in the insurance industry, are left out in the woods – or on the sickbed, as the case may be. Our highly fragmented approach to health care allows hundreds of insurance companies to take anywhere from 16 to 40% of premium dollars off the top for profit, administration, and multi-million dollar CEO salaries. As Gerald Shiener, a doctor at Wayne State University School of Medicine notes, “It’s time we realize that for-profit health insurance companies only degrade medical care in the name of profit. This system has bankrupted our hospitals, undermined medical education, and deprived the public of the care it paid for.” According to Marcia Angell, senior lecturer in social medicine at Harvard Medical School (and former editor of the Journal of the American Medical Association): Private insurers regularly skim off the top 10-25% of premiums for administrative costs, marketing, and profits. The remainder is passed along a gauntlet of satellite businesses – insurance brokers, disease-management and utilization-review companies, lawyers, consultants, billing agencies, information management firms, and so on. Their function is often to limit services in one way or another. They, too, take a cut, including enough for their own administrative costs, marketing, and profits. Indeed, as much as half the health-care dollar never reaches doctors and hospitals -- who themselves face high overhead costs in dealing with multiple insurers. During the first term of his Administration, President Clinton recognized this travesty. That is why a cornerstone of his Catastrophic Health Care Reform Plan contained a provision to eliminate the multitude of insurance carriers that drive health care costs skyward and replace it with one federally regulated carrier that would process claims and eliminate these outrageous costs. However, the Republican controlled Congress back then scuttled the plan, shouting claims of ‘socialism’ without recognizing the fact that the ‘corporate socialism’ they had created was tearing the country apart at the seams. In 1996, analyst Don DeMoro estimated the stock wealth of HMO executives ($6.9 billion), the combined five-year profits of 12 select managed care companies ($8.8 billion) and the approximate amount of health care merger and acquisition activity from 1992 to 1996 ($134 billion). Again, the combined amount would provide comprehensive health insurance for 130 million Americans, over half the population currently insured. A 1999 study of 1,568 CEOs in 31 industries found that HMO executives topped the list in compensation, trailed by CEOs of drug manufacturers and biotech companies. Gauging by what has gone on this summer, apparently little has changed, except with rising premiums, an ever-increasing number of Americans are falling into the abyss.
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Dr.
Kahn and I, via these two perspectives presented within the pages of The
Review, have inputs about the expected law that neither one of us
want. Included below are what over half of Americans want and
need. For a different set of reasons, neither of us wants what the
U.S. Congress is preparing for health care reform.