Thursday, October 29, 2009

John Stossel Speaks at Healthcare Town Hall

I am not as well educated in healthcare policy or politics as Dr Wes, Dr Val, KevinMD, Movin’ Meat, or Dr Sid Schwab.  I keep reading and listening, trying to understand and decide where I stand.  I seem to be more of a centrist (I think).

I was not able to attend any of the previous town hall meetings held in Little Rock on healthcare, but was able to attend the one today.  It was sponsored by the Americans for Prosperity.   The headline speaker was John Stossel.  I am happy to note it was a civil discourse though that may be due to most of them leaning the same way.

I didn’t come away any clearer than before. 

I do tend to agree with Stossel that “when insurance is paying” (and not the individual) “it changes behavior.”  We aren’t as engaged in the decision making when someone else is paying.  However, it is very difficult to get straight answers or even estimates when it comes to healthcare.  It’s easy to say what an x-ray might cost.  It is difficult to estimate all the drugs, surgeries, care someone might need who has been involved in a major accident.  WSJ Health Blog provides links to sites that can help with cost questions.

I don’t tend to agree with Americans for Prosperity when it comes to pre-existing conditions.  I know it messes with “free market” values that I and others feel insurance companies should NOT be allowed to deny coverage due to pre-existing conditions.  A couple of extreme examples were in the news recently regarding babies – one denied because of overweight, the other due to underweight.  It’s one thing to argue that I as an adult can control my weight, exercise, and not smoke, but it’s another to deny someone like Kerry insurance coverage as an adult due to being diagnosed with Type I diabetes as a 6 yr.

There are too many regulations in medicine for a true free market.  I do worry about adding more. 

There were a few good questions asked, but not so good answers.  Here’s one which many of us have been asking – What in the healthcare reform is addressing the projected shortage of doctors?   Will there be access to care even if there is insurance coverage?  No good answers given.  None.

Movin’ Meat has a good post up today, House Health Care Reform Bill released.  Here’s a portion of it.  Be sure you read the entire post.

The bullet point summary:

  • As widely reported, the "Robust" public option is dead; long live the "Weak" public option!  Enough House moderates - citing fiscal conservatism - rejected the cheaper option which would have paid providers at Medicare + 5%, and the bill as released would require the public option to negotiate fee schedules with providers like any other insurance company. IMHO, this is better policy even though it costs more, but hypocritical Blue Dogs get under my skin.
  • 96% of legal American residents covered.
  • The bill is Deficit Neutral and actually reduces the deficit by $100 Billion over ten years.
  • Total expenditures are in the region of $900 Billion.
  • Slows the rate of growth of Medicare from 6.6% to 5.3% annually.
  • Expands Medicaid to 150% of federal poverty level (and I didn't find the citation but I read the Feds were going to pay 75% of the costs of the expansion).
  • Financed though savings in Medicare Advantage, taxes on families earning >$1 million, individuals earning more than $500,000, taxes on the insurance industry and medical device makers.
  • The Insurance industry's anti-trust exemption is revoked.
  • Curiously, it allows states to make "insurance compacts" which will allow insurers to market policies across state lines -- a long-time conservative goal.
  • Closes Medicare Part D donut hole
  • All the typical insurance regulations, Insurance Exchanges, etc, with a strong employer mandate (8% of payroll for large companies).

Something mentioned at the town hall which troubles me:  “Nevada is the only state which will not have to match Medicaid funds.”  In my humble opinion, no state should gain at the detriment of another. 

Benjamin Spillman of the  Las Vegas Review-Journal writes this

The changes would provide more health care help for Nevadans without dipping into the state's budget at least temporarily.

Under changes made by the Senate Finance Committee, Nevada would be one of four states to be reimbursed 100 percent by the federal government over five years for the cost of increasing the number of people eligible for Medicaid.

After five years, the federal government would pay 82.3 percent of the cost to provide care to the newly eligible people. Nevada would pay 17.7 percent, said sources who worked on the legislation.

"I promised the people of Nevada that I wouldn't support any health insurance reform proposal that wasn't good for our state, and I meant it," Reid said in a statement.

Dr Wes tweeted this link earlier today.  Read it.

doctorwes

Politico: Must-read supporting documents for new House #hc bill http://tinyurl.com/ygqog89 #healthcare

1 comment:

elizabeth said...

I just stumbled upon your blog while searching panniculectomy. The quilting aspect of your blog is a complete delight! I would like to comment on the aspect of the "free market" when applied to health care. We do not have a free market here in the US. That would imply that there is choice and that the consumer is able to make informed rational decisions. When my son had his first asthma attack on a Saturday I had to take him to an ER. (Actually, we took him to the children's hospital urgent care clinic, they treated him for several hours, he did not get better...they needed to close...he was transported by ambulance, with flat screen tv....he was not seen for several more hours...when he finally got the steriod he was fine)The nebulizer was billed as $200, my portion $40. I have since seen the same nebulizer for $25 from several internet retailers. I did not have "options" to choose from. My family doctor's office is closed on Saturday. I was not given an option to "rent" a nebulizer while I shopped for a better deal. I did not have a no frills/no flat screen tv option.I was too crazy with worry to make a calm decision. I'm pretty sure the whole incident would have been less costly if it happened in Canada or western Europe. Maybe researching and purchasing a panniculectomy can been seen as an exercise in free market dynamics, but for most health care decisions it is not. Anyway, I love your blog.