Thursday, July 23, 2009

Choose Optimism

The fight for health care reform on the federal level is getting tough. The gloves are off. Republicans have talked about "breaking" President Obama, and "killing" reform. Democrats are split, with fiscally conservative Democrats working to scale back reform efforts, undermining efforts to get Bills out of the five Congressional committees with jurisdiction over the issue before the August recess. The timing is critical because, during the August recess, reform will lose momentum, and the monied interests -- insurance companies, pharmaceutical companies, employer groups -- will step up their practice of running attack ads, scaring the public, who will express their fears to members of Congress, who may start to feel that the public really doesn't want reform.

But the public really does want reform. And there is enough consensus on several important issues that it would be a shame to lose it. There seems to be agreement on elimination of pre-existing condition exclusions and limitations; elimination of lifetime caps; the need for some cap on out-of-pocket costs; the need for some subsidies for the middle-class and/or small business. If we got just this, it would be better than nothing -- but not good enough to cause us to celebrate.

The President's press conference last evening was not as effective as he needed it to be. He's a great speaker, but far more energizing when speaking to a crowd of regular folk than when talking to the press. The public -- not reporters -- need that "Yes We Can" kind of speech that reminds us why we felt so incredibly optimistic on January 20, 2009 as we watched President Obama take the oath of office.

And the truth is that we absolutely can. Plenty of other countries do it at an acceptable cost, providing good care. You hear horror stories about Canada and the UK, but not about France, Germany, the Netherlands. Since a lot of Americans want to keep their private health insurance, we can't enact a single payer plan here -- at least not now, not yet. So we won't have the most efficient government-run health care.

But instead, we ought to have at least a public option that keeps insurers from raising premiums without concern for competition or affordability. Yesterday, the Commonwealth Fund issued a report that found that a public option would save us $200 billion dollars over 10 years. DO NOT LET YOURSELF BE FOOLED -- a public option SAVES money by keeping private insurers at competitive rates, and by covering the uninsured for the least possible cost, reducing the amount of money the federal government ends up giving hospitals to cover the cost of emergency room (and other) care for the uninsured. The insurance industry is running ads trying to scare us about "government run" health care. That's NOT what we're talking about. All we're advocating is a CHOICE of a public plan that would compete with the private plans. How else do you think we are going to get the private insurers to reduce premiums so that insurance is affordable for all? Unless you can answer that question, you ought to favor a private option.

All of the hand-wringing about how we're going to pay for health care reform is a red herring. A public option SAVES money. Reducing payments to overpriced Medicare Advantage plans -- private insurers who run Medicare for more money than it costs the federal government to run the same program -- will SAVE money.

And yes, it's time to reign in some of our doctors. The last time I saw my gastroenterologist in New York, she spent $3600 of my and my insurance company's money on needless tests, repeating every blood test and stool culture I'd had done only 10 days earlier. One visit, $3600. That's outrageous. When she complained to me about her fear that health care reform would make things worse, I thought to myself that her perspective is colored by her apparent belief that unnecessary procedures are entirely justifiable!!! This waste has to stop, so to the extent that there may be mechanisms in place to stop this, that's a good thing.

That's not the same thing as allowing insurance companies to continue to deny coverage of anything they want to based on the assumption that roughly 94% of people will not appeal a coverage denial. There should be a presumption in favor of the treating physician, and insurance companies should have to pay a fee or tax for every insurance appeal they lose -- and patients should get a bonus for appeals they win. That provides a disincentive to insurers to deny coverage without really good reasons, and it also provides an incentive to patients to learn to prepare insurance appeals, which really isn't all that difficult. This is an important piece of the puzzle that should be included in reform, but it has not been discussed at all.

I probably could ruminate on this all day. There's so much to say, so much that can and should be done. But more than anything else, I'm just afraid that we will sit here and watch the opportunity slip through our fingers like sand.

And that's why it's SO important that you contact your members of Congress and tell them that you want reform and you want it now. To find your Senators, go here. To find your Representative, go here. Don't let yourself be spooked by television ads paid for by the health insurance industry. Stand up and demand health care reform now. If you don't make the effort, we can't win. It's a phone call. Do it now. Jennifer


  1. Hey Jennifer, hope everything is going well. Someone said in the bill, there is a part where if you do not take innoculations or other procedures, they will call the State in so you are forced to--I'm also thinking blood transfusions? Do you know anything about this?

    I've heard bad stories about all the countries mentioned above because they rate you on your worth--if you have x amount of pre-existing, they may choose not to treat you.

    They took Repliva off the formulary (iron) so it's not covered. It's only 33$ a month. It's a lot less expensive than a blood transfusion ;-).


  2. Rabbit, this is a good example of the scare tactics people are using. I've read the drafts and there's no forced behavior. There are incentives to preventive care, but no requirements. Nobody would ever require you to have a blood transfusion -- that's insane. Remember that private insurance like you have now will still exist, and if you want to stay with it, you can.

    You're wrong about France, Germany, Netherlands. I have two friends who lived in the Netherlands until they just moved to Canada. They both have inflammatory bowel disease. They both got good, timely medical care in the Netherlands.

    It's awful that all this mis-information is going around. It makes people afraid of reform. None of this is true. Jennifer

  3. Netherlands still has for-profit health insurance too. The German system is quite good--spends basically half as much in GDP terms as we do and gets the same results.

  4. Also there is absolutely no way the government could compel someone to take vaccinations. The First Amendment prohibits that through the Freedom of Religion clause.