More Truth-Telling

Sarah Palin says health care reform will result in death panels who will decide when to stop providing care to the elderly. In fact, the House draft legislation includes a provision inserted BY A REPUBLICAN (according to President Obama) that says that if a doctor spends time counseling you on end of life care -- whether it's time for hospice, whether you have a living will, what your intentions are -- the doctor can be reimbursed by Medicare. That's all -- it lets a doctor be paid to do something she's not paid to do today. No death panels. No euthanasia. Just the counseling you already want and get, but with payment to your doctor.

Health care will be rationed. If you think this isn't already happening, you're a very lucky person because you aren't one of the millions who've had services, treatments, or medications denied by an insurance company. Are you really happier with insurers rationing care than you are with a panel of doctors and scientists studying various treatments to see if the expensive ones really work better? Frankly, yes, I would guess that coverage will be denied of some things -- no different than today.

Today in New Hampshire, though, the President took the question of rationing in a different direction. He said we may not need to cut costs by eliminating expensive treatments if we are more efficient about what we're spending now. For example, did you know that private insurance companies are paid billions of dollars to administer Medicare at a cost that greatly exceeds the cost of the government providing the same care under traditional Medicare? Medicare Advantage Plans are private insurers administering Medicare. The government also administers Medicare. But we pay Medicare Advantage Plans more. The President said he'd rather subsidize people who can't afford insurance than subsidize insurance companies. I'm with him.

The President did make a small error today, though (with all due respect to the President). A gentleman asked him why his Medicaid program wouldn't let him stay on Lipitor until he had tried other drugs first. The President assumed he'd been forced to try a generic before being allowed to stay on the brand name. Instead, this man was talking about what's called step therapy -- I had one case in which the patient was on a proton pump inhibitor called Protonix. His insurance company had negotiated discounts with the manufacturer of other proton pump inhibitors like Prilosec, Prevacid, and Nexium. So every year, they were making him try the other drugs to save a little money because they couldn't get a discount on Protonix. I had to document the fact that the man had done this dance three years in a row, with the same outcome, so his insurer would let him have his Protonix long-term. The President said that, since generics are fine for most people, he didn't really have a problem with them making this man try the generic first, as long as they were willing to give him back his Lipitor if the generic didn't work as well. But what the man was really talking about was being forced to take an entirely different drug. To be perfectly honest with you, I expect that insurers in the post-reform world will still do these same sorts of things -- but NOT because the government has anything to say or do with it.

So those are today's truths. I'll keep on telling these truths as long as I have to. We need health insurance reform now. The people who are against it are either invested financially or they're misinformed and scared. I can't stop the corruption, but maybe I can get you some good information.

Indeed, if you have questions, post them as comments and I'll gladly research and find the answers for you. Jennifer