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9/2/2009
Docs weigh in
How many health forums/listening sessions/rallies have you attended? One of the crowd last night referred to this being her sixth in the last 3 weeks. Geeesh. (She was good, and she was informed.) The forum co-sponsored by the Green Bay Area Chamber of Commerce and the Brown County Medical Society brought out a different set of experts – a panel of docs and hospital executives. Refreshing, but as you’d guess, any solutions proposed were doctor-centric. Way too doc-centric.
Of course, there were admonitions to the full house of hundreds in Green Bay’s Mayer Theatre to please be respectful. (They were.) One questioner, a local veterinarian I’ve gotten to know and regard highly, commented that the respect granted the panel was in relationship to the depth and sincerity of their responses. She’s been to several of the recent Kagen sessions, and defending what some have labeled as disrespect shown the congressman, knows of what she speaks. Good for her.
(Rep. Kagen was invited, but was “unavailable.” An aide from his Green Bay office did attend.)
Health insurance
Yes, make health insurance portable.
Yes, remove pre-existing conditions.
In order to do the above, must be incentives from the government to mandate coverage.
Bureaucracy
I appreciated the insights here: Yes, we need regulations. It’s the government’s role to regulate, to officiate the game. It is however, not the government’s role to play the game.
We heard tales and tales of the paperwork and hours upon hours of unproductive time spent in bureaucratic nightmares. Oh my. HIPAA is important. Health insurance claims adjudication is important. But they’re absolutely strangling the system.
One example: Electronic medical records. The three hospital systems represented are moving forward rapidly with EMRs, but still, the systems can’t talk to each other. The reason? It’s not incompatible software, but rather the government refuses to allow the use of a common identification number (as we use in banking and as the government uses for social security/medicare) because of privacy concerns. To balance privacy concerns with excessive costs and waste is critical.
Medical liability
This was the big one. “Probably the simplest piece for Congress to fix and so far they’ve not touched it.” Finally, we were told, tort reform (those vastly varying pain and suffering rewards) is becoming part of the discussion. $150 billion in annual savings a real possibility.
Transparency and Competition
The docs repeatedly spoke of the need for increased competition and transparency in the insurance industry. Not a mention was made of transparency and competition for providers, including those docs and hospitals represented on the auspicious panel. Very disconcerting. Absolutely no mention (until pushed by an audience member) of the critical importance of each of us shopping for our own health care. A physician/CEO on the panel: “In 17 years of practicing I first heard this question just a few weeks ago: ‘Is there anything you can do to keep down the cost of this surgery?’” Absolutely unbelievable.
Third party pay. The huge, huge elephant in the room that must change. Nary a mention by this esteemed panel of the physician’s role in transparency and the consumer’s role in all of this. Make the insurers compete and get their prices out there and on the table. But make it easy to get pricing for a doc’s product? That’s another story. (Just ask Dr. Kagen if his family’s allergy clinics make prices available. They don’t.)
One of the audience members, a nurse practitioner, suggested filling the void of coming physician shortages with the use of more physician assistants and nurse practitioners. Makes complete sense to me. One of the docs on the panel responded that yes, that’s a great idea, but it must be remembered that at the end of the day, “those medical professionals still need the supervision of a physician.” Our obviously experienced audience member reminded the physician/CEO that in Wisconsin, M.D. supervision of a nurse practitioner isn’t a requirement. Again I say, good for her.
All in all, informative. These docs need a seat at the table. Good for them for clamoring for that seat. “We’re scientists; we practice evidence-based medicine. It’s time for Congress to start practicing evidence-based legislation.” Good.
(Here's WisPolitics' writeup of last night's event.)
Jo Egelhoff, FoxPolitics.net
COMMENTS
It is apparent that the US medical system requires changes. I was told in a recent meeting with a very knowledgeable US Congressman,1st District, Paul Ryan, as many as 21 new Federal agencies are to be created under the new House Healthcare bill.
What a terrible contrasting vision he spoke illustrated will happen unless the physicians and healthcare providers stand up and bring these common sense changes into the discussion.
The Healthcare bills currently being pushed and slammed through congress will change American society forever unless we, the citizens remain active, calling and writing our leadership constantly and consistently.
Richard Parins (Wed Sep 02 07:35:26 2009)
It should also be apparent to you that Paul Ryan received his share of the $46 million in campaign contributions from the insurance industry.
21 new federal agancies? I can believe it. Major beaucracy costs go into the $1.5 trillion HR3200. It is a terrible bill and should be trashed or vetoed.
A better bill is HR676 Medicare-for-all that would pay for health care through our national infrastructure (yea, "taxes") and spend the $400 billion savings in industry waste on health care instead, extending health care to 100% of our people and making our corporations more competitive.
Before you jump all over this as "socialized medicine," please review the sites below:
http://SinglePayer.info
http://moneyedpoliticians.net/medicare-for-all/
Jack Lohman (Wed Sep 02 08:02:50 2009)
Ok Jack. You keep pushing. Enough. You can't continue to advocate for Medicare For All until you solve the huge cost problems in the system. You cannot continue to turn a blind eye to them and you can't keep blaming others about the nation's health care ills. Enough. When you have good ideas as to how we Americans must be individually responsible to understand exactly what our specific health care visits and procedures cost - and then to make good personal decisions based on that financial information and the associated medical data, your arguments simply cannot be taken seriously. Say what you will. It's enough.
Jo (Wed Sep 02 08:26:05 2009)
Jo, you (obviously) have excellent coverage, at least at the moment. But if left alone health care costs are expected to reach 40% of GDP by 2030 (or so). At what point does it end? Either you or your husband (or both) are comfortably insured through your employer. Currently, at least. These small-business workers thought they had insurance too, until their employer (or insurer) terminated their plan.
But it seems that you want to transmit to your readers without true debate from the other side. I've never seen you critical of a right-winger no matter how often they agree with your views. But when logical argument comes along, you pull in the reigns. Now that is real transparency!
But to your point, you continually promote "individual responsibility" and for people to "understand exactly what our specific health care visits and procedures cost." Well that's just fine. Please tell me if you will judge the cost of the procedure for your child based on price or whether the provider uses a 64-slice or a 24-slice scanner? Oh, you didn't know to ask that question? Most people don't. But if they should then ask for "price?" They should always seek out the lowest bidder?
Give me a break. And that's just a very minute part of a very massive equation.
In the terms of an economist, health care is considered "inelastic." You can't live without it and you don't want to see your children suffer. Yea, Lasik and cosmetic surgeries are "elastic," as are TV sets and widgets and washers and dryers. Competition works well in those areas. But not in real health care.
Yes, I've written extensively about how to fix the system, like re-instituting the Certificate of Need, eliminating the for-profit status of hospitals, eliminating the fee-for-service method of physician payment, tort reform, and much more. But right wingers won't have any of it. They think "'pay as you go" solves it all.
Now, if you don't want to talk about that and want to just continue your false claims unabated, let me know and I'll stay away. If you want an open debate about it, let's discuss it.
Jack Lohman (Wed Sep 02 09:42:52 2009)
I think I would like that debate. I appreciate both of your perspectives.
david (Wed Sep 02 10:06:32 2009)
I think Doc Assef hit the nail on the head last night. "I do the work on you and he (insurance and/or the employer) pays for it." Until we figure out who pays what for whom, NO ONE will ever know -or care - about costs, and how to control it.
And Jack...please, get off it. Government is only going to screw it up because they want to "protect" the small business workers by controlling everything from diagnosis through delivery and, MAYBE, the payment. You left wingers think we're too stupid to figure it out ourselves...and you want to protect us. LEAVE ME EFFEN ALONE, Jack!
Michael Bina (Wed Sep 02 10:08:14 2009)
Michael, I would be totally happy to provide a permanent opt out for you right-wingers, so when when you lost your job or insurance or retired without quite making it, or your child or grandchild was diagnosed diabetes at three (as was mine), or you needed a transplant or heart bypass, that we could just flip you the finger and let you (or your kid) die on the vine.
But we aren't that way and I doubt you are either. At some point in time at least some of you are going to need public help, even if you didn't pay into the system. And we're going to give it to you, or to your kid. That's what people with values and compassion do.
Jack Lohman (Wed Sep 02 10:24:17 2009)
JACK: You would "be happy to provide a permanent opt out for me"?? Sounds like you're threating me, Jack! Actually, it sounds exacly like The Obama Plan: just "off" the bastards who are sick - or are not born yet - or dare to disagree! Great Ideas all, Jack
Michael Bina (Wed Sep 02 13:31:23 2009)
Jack, why when someone is out of work, is the government the place you think they must turn to? We turn to friends and family and neighbors. We pay COBRA. And Jack, for those who can't afford health insurance, and don't have the luxury of COBRA or affording COBRA, tax credits are a solution that allow a health insurance subsidy for low income families. But subsidy or no, Americans must be able to make their own choices in a truly competitive market. Now, yes, reforms must be made in the insurance industry, primarily centered around transparency and competitiveness. State regulations that have added mandate after mandate after mandate must be trimmed to reduce the cost of insuring for basic medical care and catastrophic insurance of some kind. Your fantasy that everyone must fall into the arms of the government is seriously misplaced.
Jo (Wed Sep 02 13:46:35 2009)
Michael, this is NOT my decision, but if it were I'd give the "bastards," as you call them, exactly what they want; an opportunity to opt out. Forever, not just until they want to opt back in after everybody else has paid for the system. Or is that what you want?
It's funny that one of those who wants to "do their own thing" would actually object to someone supporting that they get their wish. It seems you just can't be satisfied. So that's "threatening???"
But then again, I can understand that if (if my memory serves me correctly) you are actually in the health care insurance business, then any form of obstructionism is useful to your cause. And so that my position and interests are not misunderstood you can see my complete disclosure HERE. I have zero financial interest in this.
Jack Lohman (Wed Sep 02 13:55:46 2009)
Jo, the last thing in the world we should be doing is subsidizing the insurance industry, and that's exactly what you accomplish when you mandate insurance and/or subsidize the poor so they can afford a policy. It drains 31% of our health care costs already, with 85% of the private market, and now you want to add the other 15%?
That's not the way I'd try to cut costs.
Tax credits? To someone who probably is not paying much (if anything) in taxes? Doesn't that add to an already bloated bureaucracy? We don't need "reforms" in the insurance industry; it needs to be eliminated totally. It is a make-work middleman. Cause them to cut costs to be competitive and they will cut patient care. They will NOT cut profits or salaries. Period. The patient will pay.
We'll probably never agree that health care is not and cannot be a competitive product, so I'll not waste your time on that argument. Keep looking for that lowest price.
And you are opposed to state mandates but not mandates for insurance? Well, okay.
But I will give you that transparency is needed, on quality rather than price. But that's going to involve a database of patient diseases, and both the left and right will object.
Jack Lohman (Wed Sep 02 14:24:33 2009)
First of all Jack, your 31% number is wrong. It's just plain wrong. Secondly, what's the margin in a jar of peanut butter? 1%? 5%? That's competition Jack. Competition. Being able to compare one policy with the next, individuals actually taking responsibility for purchasing their own insurance. Imagine that. Perhaps health insurance companies being able to sell nationwide, just as Skippy does. Imagine. Personal responsibility and transparency of contents and cost. Go ahead Jack, fall back on the government all you want. I for one, prefer the responsibility of self-reliance as much as possible, liberty and freedom.
Jo (Wed Sep 02 14:44:44 2009)
Well, Jo, whatever you say. But this from the New England Journal of Medicine, for whatever that's worth:
"Results: In 1999, health administration costs totaled at least $294.3 billion in the United States, or $1,059 per capita, as compared with $307 per capita in Canada. After exclusions, administration accounted for <b>31.0 percent of health care expenditures</b> in the United States and 16.7 percent of health care expenditures in Canada. Canada’s national health insurance program had overhead of 1.3 percent; the overhead among Canada’s private insurers was higher than that in the United States (13.2 percent vs. 11.7 percent). Providers’ administrative costs were far lower in Canada.
Between 1969 and 1999, the share of the U.S. health care labor force accounted for by administrative workers grew from 18.2 percent to 27.3 percent. In Canada, it grew from 16.0 percent in 1971 to 19.1 percent in 1996. (Both nations’ figures exclude insurance-industry personnel.)"
Source: http://www.pnhp.org/publications/nejmadmin.pdf
And please, we are not buying peanut butter. But you take your family members to the lowest bidder if you like. To you that may represent personal responsibility; to me it doesn't.
Jack Lohman (Wed Sep 02 15:06:49 2009)
My personal preference, Skippy peanut butter, is not the lowest cost peanut butter on the shelf my dear friend. In my mind, it's the best quality and best value. My mind. Not the government's mind. My choice. Able to be informed via a transparent and competitive market. And you fight for the government to make that choice. Do you buy your peanut butter, your auto, your home from the government Jack?
Jo (Wed Sep 02 16:33:15 2009)
For peanut butter I buy on the basis of taste. But I am not privy to the behind-the-scenes process of growing the peanuts or the testing of its safety. I do not buy based on price nor quality, but I trust the government to regulate the safety.
But nonetheless, there is no mechanism to test for medical quality, and I therefore suggest the national patient database in the link above. I also do not buy medical services on the basis of price. I know some of us do; I'm not one of them because I know - with 40 years in the industry - that price means nothing.
Jack Lohman (Wed Sep 02 16:52:44 2009)
Absolutely there are metrics to measure quality in health care. Dr. John Toussaint here in Appleton has been a leading proponent of such measuring for over a decade. And Jack, you need as well, to learn about the trail-blazing work of the Wisconsin Collaborative for Health Quality. Yes, there is much to be done; but certainly a great deal of work is started.
I'm not an expert in how or what must be measured to gauge quality and value in health insurance, but I'm sure there are folks out there that are much more informed than I in that area. Lots more experts than your friends in the government Jack.
Yes, the government is a very helpful partner when it comes to standards and regulating. But not in choosing my health insurance and my health care - and certainly not in providing my health insurance and my health care. Jack, your reliance on your beloved government might be coloring your judgment. My gosh - you don't trust yourself to make informed choices, but you trust the government to do it for you? I continue to be incredulous.
Jo (Wed Sep 02 17:04:15 2009)
Yea, there is already a highly respected system for tracking quality. It's called VistA, and it's open source and free for the asking. It was developed by ... drum roll please ... the US Government VA Medical system. Hospital's will not use it because they favor their own in-house secure system that they do not have to share with competitive hospitals. It would easily allow doctors to move the data to a hospital better equipped for a particular patient.
So much for competition.
And if I gave you the impression that I don't trust myself to make informed choices, you got it wrong. When I am properly informed I can make a qualified decision. And as a Medicare patient I've never had the government make a decision for me.
But you hold your head high and barge forward. You have more trust in CEOs than I do.
Jack Lohman (Wed Sep 02 17:20:52 2009)
9:00 AM Kathleen Dunn - 09/03D
After making headlines from his interview with Bill Moyers, Wendell
Potter, joins Kathleen Dunn, after nine, to discuss health care
reform and the insurance industry. Guest: Wendell Potter, Senior
Fellow on Health Care, Center for Media and Democracy.
www.prwatch.org. Potter worked for CIGNA, a major health insurance
corporation for fifteen years holding a variety of positions, serving
most recently as head of corporate communications and as the
company's chief corporate spokesman.
Jack Lohman (Wed Sep 02 20:38:34 2009)
Poll: Fifty-six to 60 percent of people in government-run Medicare rate it a 9 or 10 on a 10-point scale. In contrast, only 40 percent of those enrolled in private insurance rank their plans that high.
Jack Lohman (Thu Sep 03 04:50:05 2009)
Anyone heard about the $342 billion bailout of Medicare? Thought not. The media doesn't want you to know.
emily matthews (Sat Sep 05 16:59:55 2009)
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