Tuesday, August 11, 2009

A 'common sense' debate about health care reform

The shouting and name-calling that have marked the "debate" over health care reform in other parts of the country has largely been absent in Manatee County, probably because U.S. Rep. Vern Buchanan opposes what President Barack Obama and the Democratic congressional leadership have proposed. So there has been no need for conservative opponents to flood his town hall meetings or other gatherings to try to shout-down Buchanan or those who favor a massive overhaul of the nation's health care system.

In fact, some who disagree with Buchanan on what exactly must be done, agree with him that the system needs an injection of "common sense."

Of course, one politician's "common sense" can be another politician's nonsense.

In a recent column published in the Bradenton Herald
, this is how Buchanan defined his "common sense" approach to health care reform:

There is no question that we need to reform a health care system that now consumes 16 percent of our national economic output. We need to make health care more affordable and accessible under a system that emphasizes preventative treatments and early detection.

Congress should take steps to make sure that health insurers cannot callously deny care to people with pre-existing conditions, like diabetes, heart disease or cancer. And we need to make coverage more portable so people can keep their insurance when they leave or change jobs.

Reducing frivolous lawsuits also would lower the overall cost of care and allow doctors to practice preventive medicine instead of defensive medicine. We should also create association health plans that allow small businesses to purchase group health plans, which will make coverage more affordable by spreading risk and increasing negotiating power. Finally, we should target waste, fraud and abuse rampant in the current system.

But what we cannot do is jeopardize the sacred relationship between patient and doctor by putting health care decisions in the hands of Washington bureaucrats. Any reform that results in delayed or denied treatment under a government-run system is a step backward, not forward.

In response to Buchanan's piece, Jan Schneider, who four times has run for the congressional seat now held by Buchanan, has co-written an op-ed in which she agrees with many of Buchanan's conclusions about American health care. But she concludes by offering her own "common sense" solution, one much more radical than the congressman's:
(W)e are convinced that the best solution is ultimately through a single-payer health insurance program covering all United States citizens and legal residents. Although the payer would be the federal government or a government-created entity, this is not “socialized medicine.” Doctors and hospitals would not work for or be owned by the government (except as already so with DOD and VA healthcare). Nor need there be a one-size-fits-all approach. As with Medicare supplements, individuals and businesses should have options to purchase additional coverage.

But beyond advocating for a particular, long-term approach, there is a more crucial point here. President Barack Obama has taken an exceedingly far-sighted, compassionate and brave position in promoting reform of the seriously ailing and outdated U.S. healthcare system. Those of us who support the initiative must assist by making our views known -- rather than allowing the debate to be framed by obstructionists, detractors and nay-sayers.
You can read all of Schneider's column below.



Common Sense and Health Care: A Differing Perspective
By Jan Schenider and Thomas E. Coler

“Do no harm” is a start, and we agree with most of the other guidelines professed by Representative Vern Buchanan (R-D13) in his article on “Apply common sense to health care reform.” Nevertheless, with the United States healthcare system in critical need of reform, our Congressman has offered no practical guidance.

The United States is the only wealthy, industrialized nation without a national health insurance or health care system. Our federal government, however, already directly provides health insurance for 28% of the population, including senior citizens, disabled, federal employees, military families and veterans, children, and the low-income. This is done through Medicare, Medicaid, the Federal Employees Health Benefits Program, TRICARE, Veterans Administration health care (CHAMPVA) and the State Children’s Health Insurance Program (SCHIP).

Unfortunately, about 46 million Americans have no health insurance. In addition, hundreds of thousands of people with insurance are bankrupted by an accident or illness. Providers too are suffering, since it is becoming increasingly untenable to comply with the federal mandate requiring of access to emergency services regardless of ability to pay.

Overall, about 60% of our health care is currently financed by public money, including federal and state taxes, property taxes and tax subsidies. About 20% is financed individually through health insurance premiums, out-of-pocket payments (such as deductibles and co-pays) and payments for care for the uninsured. Private employers pay only 21%.

At about 16% of gross domestic product, the United States spends roughly 70% more on health care than other developed countries. We also spend much more on a per capita basis (at around $7,300 annually). Still, the United States consistently receives low ratings on quality and efficiency of care, access, safety, and equity. We have lower life expectancies, higher deaths per thousand individuals, higher infant mortality rates, and so forth.

There are also collateral consequences of the current system. For example, our troubled automakers build in as much as $1,500 per vehicle in employee and retiree health insurance. With the rest of the industrialized world benefiting from national plans, this creates significant trade disadvantages.

With medical costs escalating, health insurance company profits have been growing even faster. This is so even though the administrative expenses in the private sector are considerably greater than for public programs. Company costs run in the range of 14 to 22% percent for most private employer-sponsored health insurance and more for individually-purchased plans. By contrast, Medicare administrative overhead runs about 3 percent of general expenses (6 to 8% factoring in support from other government agencies).

Against this background, the overall goal must be to make quality health care more affordable, accessible and economical. We agree with Congressman Buchanan that Congress must protect working families and small businesses – and avoid sacrificing the needs and interests of senior citizens. Those suffering from pre-existing conditions like diabetes, heart disease or cancer should not be excluded from health insurance –- nor treatment for Alzheimer’s and other forms of dementia precluded. Portability when people change jobs or move is likewise important. Similarly, the paired imperatives of modernizing health records by rendering them in electronic form while protecting patient privacy may improve both patient care and economy of delivery. We even concur with Mr. Buchanan on the desirability of reducing frivolous lawsuits (although probably disagreeing on what constitutes “frivolous”). And certainly, there should be increased emphasis on preventive and follow-up care.

Nevertheless, we are convinced that the best solution is ultimately through a single-payer health insurance program covering all United States citizens and legal residents. Although the payer would be the federal government or a government-created entity, this is not “socialized medicine.” Doctors and hospitals would not work for or be owned by the government (except as already so with DOD and VA healthcare). Nor need there be a one-size-fits-all approach. As with Medicare supplements, individuals and businesses should have options to purchase additional coverage.

But beyond advocating for a particular, long-term approach, there is a more crucial point here. President Barack Obama has taken an exceedingly far-sighted, compassionate and brave position in promoting reform of the seriously ailing and outdated U.S. healthcare system. Those of us who support the initiative must assist by making our views known -- rather than allowing the debate to be framed by obstructionists, detractors and nay-sayers.

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