Congress, Obama, Must Do Healthcare Reform Right
My husband and I are baby boomers [Editor's Note, "Learning From the Best," August 2009]. While we recognize the need for some kind of healthcare for those who have none, what is being proposed to pay for it, along with the very real possibility that we may not be in charge of decisions regarding our healthcare, frightens us. We have healthcare provided to state retirees (Michigan) and pay a portion of the premium. We do not understand why the government is proposing an entirely new healthcare system when there are already two government sponsored programs in place (with administrators, field personnel to process, and eligibility criteria)—Medicaid and Medicare. Why can't this new program be tied into the Medicaid program? Those who do not qualify for the traditional/existing Medicaid program and qualify for this "new" program could participate through an arm of the Medicaid program created for uninsured citizens. The states would not bear the burden of any costs associated with the new program. We live in a border community with a sister city in Ontario, Canada. Their citizens come across the river to obtain healthcare because it can take months or even years to obtain a hip replacement or even cancer treatment. We do not want a system where we travel to a Third World country to have a hip or knee replaced—or heart surgery.
Patricia M. Shimmens, Sault Ste. Marie, MI
As the chief medical officer at Meritain Health, I have the unique opportunity to spend much time with America's workforce as I work to help employers truly understand their respective drivers of healthcare cost. What is of utmost importance is the poor health of Americans and the increased need for health services. This increase is what is driving cost along with technology, pharmaceuticals, etc. With improved health, the need for all these services, pharmaceuticals, and technology will be reduced. The proposed measures that I see will not improve quality or reduce cost. To reduce reimbursements to hospitals will force closure of some hospitals that communities desperately need. To reduce physician reimbursements at a time when 50 percent of primary care physicians are contemplating leaving the profession doesn't seem to address the problem. To adequately address the problem in a way that won't compromise the issues is to reduce the utilization of health resources. You do that not by rationing care but by focusing on improved health. Then factor in some degree of accountability. None of this is being proposed. I work with people now who have insurance, and they often don't use their prevention benefit until a health crisis occurs and of course then it is too late.
Larry Luter, M.D., Lutz, FL
There are no easy solutions to our healthcare problem. I would hope that we will preserve the system as it is for those who have good care and just concentrate on those who don't. Subsidizing the insurance costs of those who cannot afford to buy health insurance is undoubtedly something that will have to be done. That said, it would require significant co-pay so the system will not be overrun by those who go to the doctor for trivial illnesses. If a co-pay is not required, the system will self-implode from overuse. There are not enough doctors, hospitals, etc., to handle the demand if unrestricted access to healthcare is allowed. If the trivial use of the system is not controlled, rationing will inevitably result.
Jim Gaumer, Chico, CA
The onus on Medicare spending lies squarely in the hands of the providers. Since its inception, Medicare has been a cash cow for physicians and hospitals. To put the burden of Medicare costs on the elderly is unfair; like most of us, seniors erroneously put their trust in their doctors to do the right thing. Remember, Medicare isn't free. Healthcare costs incurred by Medicare recipients are a tremendous burden as evidenced by the fact that one in five seniors skip important doctor's appointments and medications because of these costs. The Kaiser Family Foundation reported that Medicare beneficiaries spent as much as 15.5 percent of their income on insurance premiums and healthcare services in 2003! If we truly want to reform healthcare we must weed out the doctors who are more interested in revenue streams from those who promised to help heal. A payment system based on value rather than fee for service would help accomplish this.
Jeff Kreisberg, Ph.D., Coppell, TX
Our country has been dragging its feet in caring for its citizens. This is a disgrace. Every other industrialized nation has single payer health coverage for its citizens. It is past time that Americans "grow up" (and this applies especially to the stubborn Congress members who resist every opportunity to do the right thing for the people). Insurance companies have a stranglehold on them because they are indebted for campaign contributions. I have followed this carefully and a large majority of Americans want single payer, as opposed to letting insurance companies continue to call the shots on people's health.
Bev Switzenberg Waters, Sacramento, CA
If President Obama wants to change the way the country gets its healthcare considering cost, effectiveness, and fairness, then he and all members of Congress should be participants in any plan that is adopted for the rest of us. What is good for us should be good enough for them. Then, and only then, will it be fair to all concerned.
Harold Monroe, Stockton, CA
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Reader Comments
medicaid and medicare part A and B
My mother was awarded 300.00 extra dollars as a result of my father's death, when this happened, she immediately cut off of SSI, in turn the railroad retirement board became involved in the medicare and medicaid/ they said that because she received this big sum of money, she is now not eligible for assistance, and they retirement retirement is now sending her letters saying that she owes a certain amount of money, can they do this? out of the blue? someone please tell me what to do. By the way, my mother is 93 years old ! !
'Fundamental' change
The 'innovative' idea of a 'pay for value / outcome' pack came after the CBO had previously pointed out this health care reform wouldn't work without 'fundamental' change in the out of date system. It is said that as much as 30 percent of all health-care spending in the U.S. -some $700 billion a year- may be wasted on tests and treatments that do not improve the health of the recipients, and this 700 billion dollars a year can cover a lot of uninsured people.
The expected Benefits of this 'innovative idea' are as follows ;
1. Meet the objective of revenue-neutral.
Supporters of the agreement say it could save the Medicare System more than $100 billion a year and 'improve'
care, that means more than $1trillian over next decade, and virtually needs no other resources including tax on the
wealthiest. Supposedly even the 'conservative' number of such savings might be able to meet the objective of
revenue-neutral.
2. Quality and affordability.
If you are a physician, and your pay is dependant upon your patient's outcome, you will most likely strive to
prescribe the best medicine earlier in the process, let alone skipping the wasteful, unnecessary treatments.
3. No intervention in decision-making.
The innovative idea of 'a pay for outcome' will more likely prompt team approach and decision, as at Myo clinic.
Under the 'pay for outcome' pack, for good reason, best practices as 'recommendations' would simply help them
make a better decision, and the government won't still have to meddle in the final, actual decision-making
process as a non-expert.
4. Speed up the introduction of IT SYSTEM.
The pay for 'Outcome' pack is most likely to expedite the introduction of Health Care IT SYSTEM.
The synergy effect of the combined Health Care IT & a pay for 'outcome' system may allow the clinicians to
'correctly' diagnose and effectively treat a patient earlier in the process so that it can measurably scale back the
crushing lawsuits and deter the excuse for unnecessary cares to make fortunes.
5. Accelerate the progress in medical science, in return, it saves more cash.
6. Settle the regional disparity.
7. Reduce the emergency room visits & save immense costs.
Public health insurance plans such as Medicare and Medicaid paid for more than 40 percent of U.S. emergency
room visits in 2006, according to government figures released recently. Many experts say reducing these hospital
visits would be an important way to lower the enormous, and growing, expense of U.S. health care.
I share the opinion that unlike the insurer-friendly senate plan by 'some' members, only a strong public option will be capable of getting the premium inflation under control and saving the U.S in turbulence.
To my knowledge, a dual system tends to deliver better results than a pure single payer system. Supposedly, to be or not to be might be up to the innovations like a pay for value program, otherwise, the forthcoming start-ups may fill the void with competitive deals. The competition based on 'fair' market value would be a beauty of true capitalism, not monopoly, an objective for anti-trust.
Thank You !
Team approach and decision
The innovative idea of 'a pay for outcome' will most likely prompt team approach and decision, as at Myo clinic, and the result is a greater likelihood of correctly diagnosing and effectively treating a patient earlier in the process.
Studies have documented that nearly one half of physician care in the United States is not based on best practices and that at least 98,000 Americans die of a 'medical error' each year.
Under the 'pay for outcome' pack, supposedly best practices as 'recommendations' would simply help them make a better decision, and the government won't still have to meddle in the final, actual decision-making process as a non-expert.
Thank You !
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