Friday, December 5, 2008

Senator Daschle To Lead Health Care Reform

President-elect Barack Obama, along with his newly appointed Heath and Human Services (HHS) Secretary, Senator Tom Daschle, have announced they will overhaul the US health care system. Daschle is talking about Obama’s promise to expand insurance coverage, improve quality and reduce cost as a prime goal for his new administration.

Daschle spoke Friday in Denver and assured the audience that despite the economic crisis, President-elect Obama plans to focus on health as a top priority. Mr. Daschle believes the economic health of the United States is directly related to our ability to reform our health care system.

The Obama transition team has posted a website,, and they are soliciting comments from consumers and experts across the nation. The site has posted videos that describe how Senator Daschle, the leader of the Health Policy Team, plans to tackle health care. They are inviting Americans to post their stories, experiences and ideas and their first goal is to “listen” and get input into the problem.

Senator Daschle promises an open and transparent process, but details of what might be coming were scant. As head of the HHS, Mr. Daschle will have responsibility for 11 agencies, including the National Institutes of Health, the Centers for Medicare and Medicaid Services, the Food and Drug Administration and The Centers for Disease Control and Prevention.

The pundits and naysayers are already active on the blogs and opinion pages in saying health reform is impossible and will lead the United States into further economic ruin. They cannot get past the fact that “Health Care Reform” does not equate to “Government Run Healthcare”. Every developed Nation has lower costs and better quality outcomes than the United States and they all utilize private insurance along with universal coverage for all citizens. The private sector should be a part of the health care puzzle but strong regulations are needed to ensure affordability and elimination of unfair underwriting and cherry picking.

Unregulated capitalism leads to greed and corruption. We have seen that in the banking industry and it is prevalent in the health industry too. Our incentives are designed to reward unnecessary care, waste, duplication and unproven technology. We have no policy for preventive care, primary care and end of life care and the patient is often far removed from the actual costs involved in health spending.

Expanding Medicare is not the solution to our problems. Medicare also rewards waste, duplication, unnecessary care with payment policies that say, “More is better” and “get all you can because it is free.” Medicare is overregulated, driving up the cost of care by providers. The insurance industry is under regulated, which allows obscene profits, denials of care and leaves millions of Americans unable to afford insurance coverage at all.

President Obama and Senator Daschle would be wise to pay attention to every detail of health care and rebuild from the bottom up. This will include revamping medical education, Medicare and Medicaid payment reform, taking on the pharmaceutical and insurance lobby, addressing the shortage of primary care and designing systems that shore up health care professionals and taking on malpractice reform and tort laws. They will be facing powerful interests that are against change and have a huge stake in keeping their profitable system going as long as possible.

No one said it would be easy. We’ve talked about the problem long enough and now it is time to do the hard work that will require more than lip service. The solutions will require Obama and his team to stay on track and provide the leadership for a long and hard struggle for change.


Peter said...

"Unregulated capitalism leads to greed and corruption. We have seen that in the banking industry and it is prevalent in the health industry too. Our incentives are designed to reward unnecessary care, waste, duplication and unproven technology. We have no policy for preventive care, primary care and end of life care and the patient is often far removed from the actual costs involved in health spending."

With banking, the government passed the Community Reinvestment Act which forced banks to lend money to risky borrowers, which precipitated sub-prime mortgages and the housing bubble. With healthcare, the government by way of Medicare, incentivized procedures and specialists while deincentivizing preventive and primary care, which precipitated a massive shortage of primary care physicians and a situation where only 2% of medical students plan on going into it. The government has already put our economy into recession with its banking regulations. What do they want to do with healthcare, besides more havoc than they already have?

I fail to see how more government involvement through the efforts of Daschle and Obama will reverse the disasters that the government has already caused through its prior involvement. Doing the same thing and expecting different results is madness.

Toni Brayer MD said...

Peter: Perhaps we are expecting different things from "government". We always get into trouble when legislation is linked to special interest groups and powerful monied interests. Doing the same thing means bailing out the banks, hedge funds and automakers and leaving the same foxes to disrupt the henhouse again. Do you remember the Savings and Loan crisis? Same players 2 decades later.

Doing the same thing means expanding Medicare to all but changing none of the underlying problems that have bankrupted Medicare and decimated preventive medicine. Should we let the free market prevail and drive our uninsured rate to 40 million? 50 million? The free market does not want to take care of you if you have a chronic condition unless you can pay. Where do we stop and say this is no way to live?

I agree the havoc is multifactoral and government has played a huge role in creating our current problems. I have a utopian idea of how good government should work to allow the free market to thrive but to also ensure a safety net and fairness to all.

No government is anarchy. Too much government is China, 1965. Can't we find a happy medium?

Anonymous said...

Hi Toni,
I just discovered your blog through Happy Hospitalist. I really like it. But my complaint about various docs complaining about the system is that the major fixes are to change lifestyle and pollution and the only way to really do this effectively is through market forces.

I feel frustrated because few people are focused on the behavior which causes the medical costs and a concept of actually charging those people who intentionally cause medical costs from their voluntary behavior to pay for those costs.

New England Health Care Institute (NEHI) has done a wonderful study that demonstrates the following costs. The way to fix health care is to first fix lifestyle choices that incur health care costs and fix environmental problems that cause health care costs. Coal powered electric power plants and SUV cars cause pollution that incur health care costs. They ought to be charged a fee that goes directly into the health care system.
Cigarette smoking incurs health care costs and tobacco crops ought to be charged a fee to pay for the health care costs incurred by smoking that goes into the health care system and also pays for anti-smoking advertisements. High Fructose Corn Syrup (HFCS) and other simple sugars incur health care costs and these inputs need to be charged a fee to compensate for the added health care costs incurred by using these simple sugars. A standard 20 oz vending machine bottle of HFCS Coke has 220 cals which consumed on a daily basis amounts to about 20 lbs of fat per year.
Using market forces to charge pollution, smoking, HFCS & equivalents their full costs will automatically shift people into healthier habits. Increased costs contributes to teens never starting and adults quitting cigarettes. If HFCS Coke cost 50% more than diet Coke then people will probably consume more diet Coke and less HFCS Coke. Coal powered power plants will be induced to clean up their polluted output and so on.

Access to Care 10% Genetics 20% Environment 20% Behavior 50% (tobacco use, poor diet and physical inactivity, alcohol consumption, highway accidents, firearms incidents, sexual behavior, illicit drug use)

National Health Expenditures:
Access to Care 88% Other 5% Healthy Behaviors 7%

Their executive summary is well worth reading:

David MD

Anonymous said...

The link in the previous comment got truncated:

David MD

Viveca said...

We don't have to do everything at once which is what our government always wants to do and does badly.

We need to take on "and malpractice reform and tort laws."

Until that revenue scheme is put to rest the rest doesn't matter.

Do you think our politicians, most of which are attorneys, could put us first for a change?


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