The use of the euphemism “public option” has added to the confusion in the health care reform debate. Let us call it what it is; plan to cover the millions of uninsured and underinsured.
I include the large numbers of Medicaid recipients among the under insured. Because of poor reimbursement there are major swaths of the country, suburban and rural areas, where primary physicians do not accept Medicaid and an even a larger number who limit the number of these patients in their practices. These numbers are even higher among subspecialists and the problem of inability to get necessary subspecialist help has reached epidemic proportions.
Many others who have private insurance are partially covered because of the rampant abuse of the pre-existing clause by insurance companies. Still others because of job losses are on the way to join the ranks of the under insured and uninsured.
AT ITS VERY ESSENCE UNIVERSAL HEALTH CARE IS AN ETHICAL QUESTION. Do we as a society believe that health care is a basic human right that all of inhabitants of the US should have or do we consider it a luxury. Are we in line with the 12th century Muslim scholar al-Ghazali who asserted that “Profession of medicine is a duty on the society that some of its members can carry in lieu of the whole.” Or do we agree with John Mackey, CEO of Whole Foods who basically said “health care is a commodity that only the rich deserve.”
Americans are compassionate group of people with an admirable history of caring for their neighbors and regardless of party affiliation would support the idea that basic health care it is a right not a privilege. They have seen too many horror stories of friends and family whose lives have fallen apart because of a serious or chronic illness. Most would agree that there should be basic, including catastrophic, coverage for all.
Let us also be honest that we cannot cover millions of new individuals and fund Medicaid and Medicare properly without spending money. Reform, including malpractice reform, may save substantial amounts but not enough for the new expenses. They would have to come from either new taxes, or redistribution of funds in the budget or both.
But if as a nation we agree with the basic goal of leaving no citizen behind in health care coverage then we can discuss the best option or options that are available to accomplish it. We would only be joining the Brits and Canadian and many others who already do so.
The choices include the government run insurance company, the “public option”, but who would want a new bureaucracy; look at all the bureaucracies we already have, look at the post office. Insurance companies could be mandated to offer a simple, economical basic plan for all comers. This would provide for catastrophic coverage, hospitalizations and routine preventive care. The premiums for this frill free plan may be subsidized. Another option, which the administration is already considering, would be to change the Medicare into a hybrid plan where some who qualify might buy into. Medicare has been around and its administrators have done a decent job administering healthcare compared to the private insurance companies; without question they like the private insurers need better oversight.
But the administration has to be honest and up front and President Obama should follow his own advice that we should speak in public what we say in private and stop using euphemisms that only confuse; that is the best antidote to the smear of socialism that the reform is being subjected to. What makes a nation great is not its wealth and might but its ideals and compassion; I believe we live in a great nation
Javeed Akhter, a physician practicing in the Chicago area, is a free lance writer.
Wednesday, September 30, 2009
Ten Myths about health care reform debate.
Just as truth is the first casualty of war, in the debate on health care reform facts have become increasingly shrouded in the fog of partisan debate. Here is an attempt to separate ten myths from facts.
Myth #1. US has the best medical system in the world.
For those few who have the Cadillac Insurance plans this is indeed true. US physicians are very well trained, Hospitals are equipped with star wars technology, the procedures and medical and surgical protocols used here are followed by the rest of the world. But if health criteria like life expectancy, infant and child mortality and cost effective care are used as parameters US is lower than most developed countries. No Canadian or Brit would like to migrate to the US for better health care.
There are also huge rich/poor, rural/urban and inner city/suburb divides. In the Chicago area this North/South divide is both figuratively and literally true. There are North side Hospitals in Chicago that are so well appointed they rival five star Hotels and others in the South side of the city that look like they are in a poor country in a different continent. No system that leaves millions of its citizens unprotected can be called a good system
Myth #2. Folks who have private insurance love it and want to keep it.
That may have been true a few years ago but is no longer accurate. There is very little of the old hassle free commercial insurance left. The avarice of the insurance companies has resulted in a diabolically complex system that is currently in place with multiple and confusing plans like PPO, HMO, conventional commercial and POS tailored differently for individual physicians and PHOs. Co pays keep getting higher, there are in network and out of network options to consider (your favorite physician may be out of network and therefore out of reach) and pre authorization even for PPO insurance is common place. The “pre existing condition” clause and loss of coverage when individuals move to a different job are other examples of egregious Insurance behavior that the health care reform proposals may successfully eliminate.
Current insurance plans may accurately be described as schemes to increase corporate profit and less to do with providing health care. Patients and care givers alike spent hours trying to deal with the complexities of the system. Many physician practices have one or more associates devoting their time simply dealing with paper work generated by many and confusing rules. For hospitals this administrative load is exponentially greater. Patients have to jump through hoops of fire to get the insurance companies to pay up. There is a great need for simplifying the plans, making them uniform and putting in place oversight and tight controls. Reform proposals do not address this issue simplifying rules and reducing paper work.
Myth #3. There is a lot of fat in Medicare and Medicaid, which with reform will result in major savings.
Medicaid is poorly managed and highly underfunded. The reimbursement is so low that large numbers of primary care physicians do not accept Public Aid patients. The numbers of specialists who decline Public Aid recipients is even higher and has reached crisis proportions.
Medicare is riven with incompetence and graft and in theory can be reformed; no one has reformed it in years. The reimbursement to pharmaceutical firms for medications can be easily fixed with significant dollar savings. Similarly the payment to hospitals can be structured to provide mare cost effective care.
It would be better to take the administration of Medicaid and Medicare out of the hands of government bureaucrats and give to an independent agency with strong oversight.
Myth #4. Malpractice reform is not needed as it is a necessary protection for patients and does not affect the cost of care.
The current malpractice system is corrosive, penalizes the caregivers directly and the patients indirectly as it adds immense cost to the health care system. A popular medical website, visited by physicians to learn current management of illnesses, includes a section dealing with the medico-legal angle of the illness. It is common to hear in discussions among physicians phrases like “It is not indicated medically but for medico-legal reasons it would be prudent to run the test.” A direct effect of the current malpractice system is to force physicians to practice defensive medicine with its attendant cost.
People tend to forget that doctors are humans too and a malpractice suit not only threatens their livelihood and savings but causes serious emotional stress. Many experienced physicians have retired early or moved from sates like Illinois to states like Indiana that have instituted reasonable malpractice reform that we can learn from and improve upon.
Physicians are not suggesting getting rid of malpractice claims but making them fair and balanced. Malpractice reform would result in reduction in the practice of defensive medicine and excessive testing with large cost savings. Physicians need to be more transparent and police their own better. In a global sense tort reform is about restoring trust between patient and physician. Health care reform ignores this issue.
Myth #5. Americans are unwilling to pay extra for extending coverage to their uninsured fellow citizens.
Americans who are compassionate as a group have an admirable history of caring for their neighbors and regardless of party affiliation would support the idea that basic health care it is a right not a privilege. Although the 12th century Muslim scholar al-Ghazali is not well known, they would agree with his assertion that ““Profession of medicine is a duty on the society that some of its members can carry in lieu of the whole.” They have seen too many horror stories of friends and family whose lives have fallen apart because of a serious or chronic illness. Most would also agree that there should be a safety net of catastrophic coverage for all.
Myth #6. AMA’s support implies physicians are lined up behind the plan.
Most physicians are not. AMA is apprehensive of the changes as they appear to be poorly thought out. They are supportive of the plan because they do not appear to look like they are hindering reform.
Myth #7. The “public option” is popular with many.
Most actually do not understand the logic behind the public option. They do not see much difference between the public option and other government run plans like Medicare and Medicaid and are afraid it might turn into another boondoggle. Physicians and Hospitals worry that it might be another way of driving down their reimbursements.
Myth #8. The plan will cost a trillion dollars over 10 years.
The history of health care insurance cost predictions tell us that it will end up costing a lot more.
Myth #9. Physicians and Hospitals should be evaluated and reimbursed based on outcomes.
Physicians would argue evaluating performance on practicing Evidence Based Medicine and not outcomes alone is a better option. The outcomes depend on many and complex variables and would be difficult to use as the only way of judging good care. Caregivers who take on patients with higher acuity and complexity may have lower outcomes. Consequently physicians and hospitals may start screening for patients with lesser acuity.
Myth #10. President Obama is attempting health care reform.
What is being attempted started out as health care reform but may now be described as a health insurance reform. A true health care reform would be holistic and attempt to change and not just insurance but attitudes toward health, like obesity, lack of physical exercise, self afflicted addictions like nicotine, drugs and alcohol and end of life issues. It would mean changing the health care attitudes of the care receiver as well as the care giver. The challenges of delivering health care to the inner city and rural areas depends not merely on availability of insurance but access to care, transportation, making primary care available, educating the families and patients on the importance of preventive care and doing outreach at home when necessary.
It is a change in attitudes that is critical to health care reform.
Javeed Akhter, a physician practicing in the Chicago area, is a free lance writer.
Myth #1. US has the best medical system in the world.
For those few who have the Cadillac Insurance plans this is indeed true. US physicians are very well trained, Hospitals are equipped with star wars technology, the procedures and medical and surgical protocols used here are followed by the rest of the world. But if health criteria like life expectancy, infant and child mortality and cost effective care are used as parameters US is lower than most developed countries. No Canadian or Brit would like to migrate to the US for better health care.
There are also huge rich/poor, rural/urban and inner city/suburb divides. In the Chicago area this North/South divide is both figuratively and literally true. There are North side Hospitals in Chicago that are so well appointed they rival five star Hotels and others in the South side of the city that look like they are in a poor country in a different continent. No system that leaves millions of its citizens unprotected can be called a good system
Myth #2. Folks who have private insurance love it and want to keep it.
That may have been true a few years ago but is no longer accurate. There is very little of the old hassle free commercial insurance left. The avarice of the insurance companies has resulted in a diabolically complex system that is currently in place with multiple and confusing plans like PPO, HMO, conventional commercial and POS tailored differently for individual physicians and PHOs. Co pays keep getting higher, there are in network and out of network options to consider (your favorite physician may be out of network and therefore out of reach) and pre authorization even for PPO insurance is common place. The “pre existing condition” clause and loss of coverage when individuals move to a different job are other examples of egregious Insurance behavior that the health care reform proposals may successfully eliminate.
Current insurance plans may accurately be described as schemes to increase corporate profit and less to do with providing health care. Patients and care givers alike spent hours trying to deal with the complexities of the system. Many physician practices have one or more associates devoting their time simply dealing with paper work generated by many and confusing rules. For hospitals this administrative load is exponentially greater. Patients have to jump through hoops of fire to get the insurance companies to pay up. There is a great need for simplifying the plans, making them uniform and putting in place oversight and tight controls. Reform proposals do not address this issue simplifying rules and reducing paper work.
Myth #3. There is a lot of fat in Medicare and Medicaid, which with reform will result in major savings.
Medicaid is poorly managed and highly underfunded. The reimbursement is so low that large numbers of primary care physicians do not accept Public Aid patients. The numbers of specialists who decline Public Aid recipients is even higher and has reached crisis proportions.
Medicare is riven with incompetence and graft and in theory can be reformed; no one has reformed it in years. The reimbursement to pharmaceutical firms for medications can be easily fixed with significant dollar savings. Similarly the payment to hospitals can be structured to provide mare cost effective care.
It would be better to take the administration of Medicaid and Medicare out of the hands of government bureaucrats and give to an independent agency with strong oversight.
Myth #4. Malpractice reform is not needed as it is a necessary protection for patients and does not affect the cost of care.
The current malpractice system is corrosive, penalizes the caregivers directly and the patients indirectly as it adds immense cost to the health care system. A popular medical website, visited by physicians to learn current management of illnesses, includes a section dealing with the medico-legal angle of the illness. It is common to hear in discussions among physicians phrases like “It is not indicated medically but for medico-legal reasons it would be prudent to run the test.” A direct effect of the current malpractice system is to force physicians to practice defensive medicine with its attendant cost.
People tend to forget that doctors are humans too and a malpractice suit not only threatens their livelihood and savings but causes serious emotional stress. Many experienced physicians have retired early or moved from sates like Illinois to states like Indiana that have instituted reasonable malpractice reform that we can learn from and improve upon.
Physicians are not suggesting getting rid of malpractice claims but making them fair and balanced. Malpractice reform would result in reduction in the practice of defensive medicine and excessive testing with large cost savings. Physicians need to be more transparent and police their own better. In a global sense tort reform is about restoring trust between patient and physician. Health care reform ignores this issue.
Myth #5. Americans are unwilling to pay extra for extending coverage to their uninsured fellow citizens.
Americans who are compassionate as a group have an admirable history of caring for their neighbors and regardless of party affiliation would support the idea that basic health care it is a right not a privilege. Although the 12th century Muslim scholar al-Ghazali is not well known, they would agree with his assertion that ““Profession of medicine is a duty on the society that some of its members can carry in lieu of the whole.” They have seen too many horror stories of friends and family whose lives have fallen apart because of a serious or chronic illness. Most would also agree that there should be a safety net of catastrophic coverage for all.
Myth #6. AMA’s support implies physicians are lined up behind the plan.
Most physicians are not. AMA is apprehensive of the changes as they appear to be poorly thought out. They are supportive of the plan because they do not appear to look like they are hindering reform.
Myth #7. The “public option” is popular with many.
Most actually do not understand the logic behind the public option. They do not see much difference between the public option and other government run plans like Medicare and Medicaid and are afraid it might turn into another boondoggle. Physicians and Hospitals worry that it might be another way of driving down their reimbursements.
Myth #8. The plan will cost a trillion dollars over 10 years.
The history of health care insurance cost predictions tell us that it will end up costing a lot more.
Myth #9. Physicians and Hospitals should be evaluated and reimbursed based on outcomes.
Physicians would argue evaluating performance on practicing Evidence Based Medicine and not outcomes alone is a better option. The outcomes depend on many and complex variables and would be difficult to use as the only way of judging good care. Caregivers who take on patients with higher acuity and complexity may have lower outcomes. Consequently physicians and hospitals may start screening for patients with lesser acuity.
Myth #10. President Obama is attempting health care reform.
What is being attempted started out as health care reform but may now be described as a health insurance reform. A true health care reform would be holistic and attempt to change and not just insurance but attitudes toward health, like obesity, lack of physical exercise, self afflicted addictions like nicotine, drugs and alcohol and end of life issues. It would mean changing the health care attitudes of the care receiver as well as the care giver. The challenges of delivering health care to the inner city and rural areas depends not merely on availability of insurance but access to care, transportation, making primary care available, educating the families and patients on the importance of preventive care and doing outreach at home when necessary.
It is a change in attitudes that is critical to health care reform.
Javeed Akhter, a physician practicing in the Chicago area, is a free lance writer.
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