Sunday, October 11, 2009

How to Make Health Reform Work

It is still uncertain what we will get from the Congress and Senate for Health Care Reform this year but I see some major problems with the bill as it is currently being discussed. They say something is better than nothing but I am not so sure. Politics, partisanship, big money and industry influence are all playing a role that is not good for the American public.

Here are the problems with the current legislation that must be fixed if we are to win:
  • It still leaves 25 million Americans uninsured. 100% coverage is a must and if other countries can do it, so can we.
  • Insurers are allowed to charge older customers 5X more than younger. If you are in your 50s you may pay $10,000/year. Is that affordable for anyone?
  • Insurers can maintain any profit margin they want. $6.5 billion in "insurance fees" (to help make it financially palatable) will be passed on to consumers in higher rates.
  • There are no cost controls on what insurers can charge.
  • There are no restrictions on denial of care.
  • There is no challenge on monopolies (In some areas there are only 1 or 2 insurers).
  • There are no controls on drug prices and no government leverage to negotiate rates.
  • There is no definition of covered benefits.
  • Most of the reforms don't even start until 2013!
  • Medicare rates are below inflation and there is a 25% Medicare cut in physician fees.
  • There is nothing to benefit primary care and nothing about coordinated care.
  • There is no change in the flawed Medicare Sustainable Growth Rate (SGR) formula which is totally unworkable with cuts every year that get "reversed" by congress after physicians and AARP go wild.
  • There is no public option.
  • There is no liability reform.
So what do we have? The plan is a corporate welfare boon for Insurance companies (instant customers, high prices) and big Pharma (instant customers, high prices). Most of the pieces that would benefit the public are delayed for 4 years. There is nothing to control rising costs and, in fact, costs will skyrocket without changes in how we pay doctors and hospitals. It continues to pay for "more" care, rather than coordinated care. It continues to pay for getting sick rather than staying well.

EverythingHealth supports true Health Care Reform. We deserve a better bill.


KM said...

I or someone I'm related to has experienced so many of these points you are making, that is so true it makes me angry that nothing is going to be done for any of us as insured patients as far as any improvements.

Anonymous said...

I agree KM!!!
Fixing the existing holes is going to cause BIGGer Problems!!

Raymond Bouchayer said...

Well said Dr. Toni . We must have a pubic plan , period .How do we pay for it ? the same way those shifty Politicians have done it with paying for wars that were not necessary , bailing out Wall Street, the Banks and the car Industries ... Those Politicians had no trouble finding the money for those things , so now lets get something for us the "tax payer's"and cut the BS about kissing up to the Insurance and Pharma CO. And for thee love of God lets educate the ignorants that listen to all the scare tactics used by those companies.

Raymond Bouchayer said...

Every Politician that have been taking money from the Insurance and Pharmaceutical companies should go to jail ......they have taken "Bribes " and that is illegal for a regular citizen why should it be different for them ?. To fund their re-elections ? no thanks. We need and want Politicians that are dedicated to the best for us and to never take money to sway the votes .

life insurance Canada said...

Well, theme insurance in our country is always a reason for many disagreements. I have read an interesting statistics, ans so that single person earning $26,500 pay $2,300 for health insurance, but if his income rises to $32,400, his premium rises to $3,700. This yields an implicit marginal rate rate of 24 percent.
Good to know, isn't it?

Anonymous said...

Toni, I disagree. Remember, Medicare was only supposed to cost 9 billion dollars when first proposed in 1965. In 2007, medicare cost $440 billion dollars. It's unfunded liability for the next 75 years was $34 TRILLION in 2007. A FAR FAR cry from the 9 billion originally proposed.

I'm a physician that also studies economics very closely. You cannot have a viable "government" program because there is no incentive to make a true profit. If there is no incentive to make a profit, then there is no fiscal responsibility. Of course only the government can get away with this because they have a printing press, aka federal reserve. Welcome: inflation.

Ronald Reagan said it best: "If you don't stop Medicare, you will be telling your children and your children's children what it was once like in America when men were free."

Our country is 11 TRILLION dollars in debt. The budget DEFICIT has tripled since Obama took office. This conversation is not about wars and other unnecessary expenditures (i'm opposed to those too). This is about spending at a break-neck speed that we simply cannot afford at this time. It's about adding a public option that will destroy the lives of our children. 1 trillion dollars over 10 years? Really? If you believe that, then you are as gullible as those who thought that 9 billion dollars for Medicare was an over-estimate back in 1965.

Toni Brayer MD said...

Anon 7:11: The government should not make a "true profit" on health care and even in a capitalistic society we have institutions that are for the public good that are not wall street profit driven (schools, fire dept, utilities,post office). Yes, you can go outside the system and buy Fed Ex or private school. Health care should be the same.

Health spending is a problem for all modern countries so there is no doubt that we need better and more efficient ways of delivering health care. The Medicare bank is already broken. That does not mean public support of health care should be abandoned. It means we need to really start looking at our payment system, our cost shifting, our lack of primary care, our legal system and start implementing fixes all along the way. It is not popular because "my" fix is your "shareholders profit".

TR Reid just compared US Health care with the other world nations. We don't need to become "socialized' but we do need to make incremental changes.

Abandoning Medicare and creating 153,843,360 more uninsured is not the answer.

KM said...

I agree with Dr.Brayer having been to Europe last year and having to use their medical services, I don't see why the US can't use one of their examples to model health care reform for our citizens. I have a friend who lives in France and friends in Holland and they get good medical care and everyone is covered. In Holland it is required for everyone like car issuance is heres for all citizens no matter what there income is, if they are retired or unemployed as well as if there are preexisting medical conditions.

I'm also reading TR Reid's book that explains the comparison very well.

Steven Reidbord MD said...

$9 billion in 1965 is worth more than $59 billion in 2007, according to CPI Inflation Calculator. Thus, Medicare expenses expanded by a factor of about 7.5 over 42 years in constant dollars, or about 6% annually.

However, the main point is exactly as Dr B says. Basic health care should be part of the public fabric of society, just like basic education and postal delivery, and just like it is in virtually all other developed Western countries.

Kim said...

You have given nice information and I like it.I like that list of problems.Thank you very much for sharing this with us.


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