The Obama Plan - Healthcare

[WhiskeyGirl]

Lowering Costs by Increasing Competition in the Insurance and Drug Markets: The insurance business today is dominated by a small group of large companies that has been gobbling up their rivals. There have been over 400 health care mergers in the last 10 years, and just two companies dominate a full third of the national market. These changes were supposed to make the industry more efficient, but instead premiums have skyrocketed by over 87 percent.

Barack Obama will prevent companies from abusing their monopoly power through unjustified price increases. His plan will force insurers to pay out a reasonable share of their premiums for patient care instead of keeping exorbitant amounts for profits and administration. His new National Health Exchange will help increase competition by insurers.

http://www.barackobama.com/issues/healthcare/


What kind of research is document statements based on?  Feelings that the insurance company is ripping people off, or statistics?  How many American's have private policies?  How many are covered or not covered by something else?

There are fewer and fewer companies that offer health insurance to private individuals.  Search the web and see what is available, never mind the medical history.  Many companies that offer insurance to their employees have a form of "self-insurance" and pay for every claim out of the corporate pocket. 

Death Spiral or Euthanasia?
The Demise of Generous Group Health Insurance Coverage
http://rider.wharton.upenn.edu/~prc/PRC/WP/BWP2004-2.pdf

Medicare, Medicaid, insurance companies, and Obama's plan for America - Who is controlling costs? 

Where does the money come from to pay claims?  Deep government pockets?  (the country is broke and in debt, raise taxes?)  Private employers?  (many employers are already struggling and pass along increases to employees, or offer less generous plans)  The individual?  (many individuals do not have the benefit of negotiated rates with hospitals and doctors) 

How many average people can affort care and treatment for a heart attack without some kind of help?  Maybe its time to start outsourcing the care of Americans to Thailand and other places that offer bargain treatment? 

Taxpayer?  The cost of medical care under existing government programs  continues to rise.  Why?  Is the government making money on the taxpayers?  Maybe the government has some pork in these programs they can cut?

[WhiskeyGirl]

Here is what I see when I look at the broken healthcare system in the U.S. ~

There are newer, bigger, and more expensive hospitals popping up all over.  At one time, hospitals were run by communities, religious organizations, doctors, and others. A rural family might pay the doctor with a chicken.   Hospitals were not big business.  Maybe not so fancy, but they did care for the public.

The Obama site suggests that insurance companies control the healthcare dollar, make excess profits, and inefficient.  Why not look at healthcare providers too?  Who decides what a fair profit for hospital systems or provider's is?

In my simple world here are the dollars and sense ~

I had inpatient surgery last year.  The hospital billed the insurance company (from memory) almost $20,000 for a few days stay.  The insurance determined that about $6,000 was due based on their contract with the hospital.  What happened to the $14,000? 

When I saw that bill and went into shock, all I could think was "Thank God I have insurance.  Thank God I have to pay the deductible.  Thank God my employer is successful and generous enough to provide medical insurance for employees."

The doctor was around $8,000 before insurance, $2,500 after the insurance adjustment.  There were also bills from the anesthesiologist, lab, and some misc.

What if I didn't have insurance?  If I were uninsured, that $20,000 plus the others would have been a tremendous burden.  What if I didn't have money for the deposit?  Why wouldn't the uninsured get the benefit of the discount? 

What about that $14,000...is that pure profit?   Would the hospital go broke if they didn't get that $14,000 from every such billing?

~~~~~~~~~~~~~~~

If my dog went to the vet for a similar surgery it would be less than $500, everything included.  Very common surgery.

My vet has a very basic facility.  There is no health club, no cafeteria, it's older, no marble, granite or natural stone, just tiles.  Simple and effective.

The difference in my humble mind ~ my vet has to ask me to dig deep into my pocket and come up with the money.  The vet takes credit cards and cash, and has a simple payment plan available.

For humans, hospitals, doctors, and other providers, don't ask the insured patient for money.  They bill the government (taxpayers) or private insurance (patient/employer). 

If you have no insurance, they may send you home with pills, you lose your home, maybe you leave the hospital with nothing, or are discouraged because you don't have medical card and deposit to bring along with you.  In some countries with socialized medicine, there are waiting lists, and it may take months or years to get into the hospital.

Why does a similar surgery cost over $30,000 for a human, and less than $500 for a dog?

Imagine how many people could be treated using existing healthcare dollars,
if my surgery had cost just $500?

What is a fair profit for healthcare providers?

$20 bandage in the hospital, $2/box for bandages at Walmart.

The $20 bandage is paid by taxpayers, employers, and the uninsured. 

The $2/box of bandages is what I would buy at Walmart.

The above reflects my real life healthcare adventures and opinions 

[WhiskeyGirl]

Drugs

Does the fountain of youth exist anywhere?  Is there a potion / snake oil that will fix everything?  Why does the search for good health through drugs cost so much money?

Lower prescription drug costs. The second-fastest growing type of health expenses is prescription drugs. Pharmaceutical companies are selling the exact same drugs in Europe and Canada but charging Americans more than double the price. Obama will allow Americans to buy their medicines from other developed countries if the drugs are safe and prices are lower outside the U.S. Obama will also repeal the ban that prevents the government from negotiating with drug companies, which could result in savings as high as $30 billion. Finally, Obama will work to increase the use of generic drugs in Medicare, Medicaid, and FEHBP and prohibit big name drug companies from keeping generics out of markets.

http://www.barackobama.com/issues/healthcare/

Why do American's pay more than others?  Why are American's so special?

Why shouldn't American's expect the same favorable pricing from drug companies that these companies offer other countries?

What is easier for the patient?  Paying less at the local pharmacy?  Or, having to find a pharmacy out of the country, mail/fax/communicate the prescription and wait for the prescription to be delivered? 

What if the drugs get lost in the mail?  Time and money are precious for many people.  Has anyone who promotes these policies ever tried to get a replacement prescription from a foreign country?  Maybe from a mail-order pharmacy in the U.S.?

Why shouldn't everyone PAY THE SAME FAIR PRICE for drugs?

It would be my opinion, that drug companies and healthcare systems have little if any competition...almost a monopoly.  What is there incentive to control costs that are passed along to the government healthcare programs, taxpayers, insurance, and the uninsured?

What is a fair profit for drug companies?

Should everyone chip in for profit?  Or, just Americans?

[WhiskeyGirl]

Here is the McCain plan.

http://www.johnmccain.com/Informing/Issues/19ba2f1c-c03f-4ac2-8cd5-5cf2edb527cf.htm

The McCain plan does not seem to address the issues of controlling costs at the provider or drug company level.  imho  What is a fair profit for providers and drug companies?

The State of Hawaii has had some very different ideas when it comes to healthcare. 

Hawaii has been a trendsetter in healthcare since the 1960s. In fact, statistically it's the healthiest state in the United States, boasting longer lives and fewer instances of serious disease per capita than any other state.

The state's hospitals, long-term care facilities and physicians represent virtually all medical and surgical specialties and sub-specialties in modern medicine.

http://www.hawaiipacifichealth.org/

http://hhic.org/home_play.asp

http://ssl.honoluluadvertiser.com/livinginparadise/2007/healthcare

There are some problems -

http://www.hah.org/000131d/hah.nsf/7aa1d4a91e4587a20a2565e1007b6ddb/52d93d9329e431f90a2568830001d19e?OpenDocument

A PERFECT STORM

THE FORCES SHAPING
HAWAII'S APPROACHING
HEALTHCARE CRISIS

In Hawaii, we’re fortunate to have quality healthcare accessible when and where we need it.

But that could be changing.

For years, the operating costs of hospitals, nursing homes, and hospices have risen steadily, while Federal and State reimbursements for the services they perform have declined. Until solutions are found, our hospitals and others are facing a financial crisis that will leave them unable to provide the range of services and level of quality we expect and deserve.

http://www.hah.org/000131d/hah.nsf/77b5f1893da336240a2569300003058a/3ce7b86041657e090a257108007a0704/$FILE/Storm.pdf

[Kermit]

There is something like 70 million American's uninsured and millions whose healthcare exceeds their ability to pay or co-pay.

Something has to change.

[Tylergal]

There is something like 70 million American's uninsured and millions whose healthcare exceeds their ability to pay or co-pay.

Something has to change.

That is an absolutely untrue and something being promoted by the peddlers of socialized medicine.  Several family members and I are in the business, and that is false, false, false.  There are approximately 40,000,000 uninsured, many of whom are illegal.  This number fluctuates somewhat from time to time, but even the uninsured are treated at the finest hospitals in the country, much better than any of us could aspire to. 

[Tylergal]

Here is Obama explaining his healthcare.
www.fighttheears.com

[WhiskeyGirl]

The number I see is 40 million and a lot of state initiatives.

Project aims to change US healthcare 

The US is one of the richest countries in the world - but on basic measures of health, like life expectancy, it lags behind many poorer countries.

As the state of Massachusetts pioneers a new scheme to increase state involvement and get everyone insured, the BBC's Jill McGivering asks whether it could be a model for the rest of the country.

"We send bills to probably about 25 different payers," he said.

"Every one of them has a different set of rules. If you printed out our regulations around billing for radiology studies, it would be a pile of paper seven inches thick."

'Crazy' system

That sort of waste disturbs those who see chronic imbalance in the US system.

Americans spend more than twice as much per person on health as the British. Yet more than 40 million Americans - about 10% of the population - are completely uninsured.

http://news.bbc.co.uk/2/hi/americas/7484028.stm

Vermont -

In less than a year, he reported, the state has enrolledone-sixth of uninsured Vermonters — a number officials estimated in 2006 atabout 63,600  — in state-sponsoredhealth care programs. Enrollments come in the wake of more than 35 specificinitiatives recommended by the Vermont Commission on Health Care Reform anddesigned to contain costs, increase access and improve the quality of healthcare for state residents.

http://www.addisonindependent.com/node/1406

Pennsylvania -

Need care, not cards
 
Tuesday, July 1, 2008 11:50 AM EDT
 
To the editor:

Pennsylvania lawmakers are in the process of reviewing two competing health care proposals. Governor Ed Rendell’s $1.4 billion proposal is designed to essentially provide nothing more than insurance cards for 207,000 currently uninsured Pennsylvanians. A newly introduced Senate proposal, HealthNET PA, would cost the state $100 million and would provide actual care to 507,000 currently uninsured residents.

The keystone of the HealthNET PA plan is a $50 million investment in community health clinics. These clinics, one of which I started, provide vital care such as scheduled physician appointments, specialty appointments (including gynecological, optometry, gastroenterology, orthopedics, mental health and podiatry), labs, X-rays, Ct- Scans, MRIs, medications and much more. At a fraction of the cost of health insurance, these health clinics provide real care to real people.

http://www.dailyamerican.com/articles/2008/07/02/opinion/letters_to_editor/letter725.txt

[WhiskeyGirl]

Something to watch ~

Senior Advisers to Obama and McCain Will Illuminate the Presidential Candidates' Healthcare Proposals, in Their Only Scheduled Joint Appearance

NEWARK, N.J.--(BUSINESS WIRE)--Jul 1, 2008 - In their only scheduled joint appearance of the presidential campaign, the senior healthcare advisers to Sens. Barack Obama and John McCain will illuminate the candidates' healthcare proposals and address questions about the future of the American healthcare system at a symposium hosted by Rutgers Business School on Tuesday, July 15.

Gail Wilensky, Ph.D., senior fellow for Project HOPE, adviser to Sen. McCain's campaign, and contributor to the McCain Healthcare Plan, will represent McCain; and David Cutler, Ph.D., Otto Eckstein Professor of Applied Economics at Harvard University, adviser to Sen. Obama's campaign, and contributor to the Obama Healthcare Plan, will represent Obama.

The program, American Healthcare 2008 and Beyond, is coordinated by the Blanche and Irwin Lerner Center for Pharmaceutical Management Studies at Rutgers Business School, in partnership with the HealthCare Institute of New Jersey. It will be presented from 10:00 a.m. to 2:00 p.m. at IDT's Washington Square Conference Center (520 Broad Street, Newark, NJ).

Advance registration is required. Admission, including parking and meals, is $500 (discounted to $400 for Rutgers alumni; employees of sponsoring companies Bristol-Myers Squibb, Eisai, Johnson & Johnson, Merck, Novartis, Roche, Schering-Plough, and their subsidiaries; and members of the HealthCare Institute of New Jersey and BioNJ).

To register, visit www.business.rutgers.edu/lerner, email icastillo@business.rutgers.edu or call 973-353-1016.

Says Mahmud Hassan, Ph.D., director of the Lerner Center and a Rutgers Business School professor, "With over 40 million Americans uninsured, and given the hyper-cost inflation of healthcare services, the presidential healthcare plan is a primary issue that will affect Americans for years to come. This is a unique and exciting opportunity to examine, in an academic atmosphere, proposals to address these far-reaching issues."

http://www.pharmalive.com/News/index.cfm?articleid=553509&categoryid=63

(Maybe it will be broadcast somewhere )

[Tylergal]

Be careful what you wish for in socialized medicine.  It will only be there if it is there and there is no guarantee you will get medical treatment.  Just check into the Canadian and British systems, which are falling apart and they are looking into our system as a model for their bankrupt system which cannot treat minor emergencies and then ask yourself why so many foreigners come to America to get their healthcare.  It is better you investigate than take any candidate's say-so for what he/she is going to do to us.  It's be careful what you wish for you.

[Kermit]

There is something like 70 million American's uninsured and millions whose healthcare exceeds their ability to pay or co-pay.

Something has to change.

That is an absolutely untrue and something being promoted by the peddlers of socialized medicine.  Several family members and I are in the business, and that is false, false, false.  There are approximately 40,000,000 uninsured, many of whom are illegal.  This number fluctuates somewhat from time to time, but even the uninsured are treated at the finest hospitals in the country, much better than any of us could aspire to. 

Unfortunately it IS TRUE

70% of the uninsured are in families with at least one full-time worker. 10% have at least one part-time worker. The rest are retired or unemployed.
http://www.macsmind.com/wordpress/2008/06/25/who-are-the-47-million-uninsureds/
10.2 million are noncitizens. About 80% of them are legal residents, but many have low-income jobs and can’t afford or don’t have access to insurance.
9.2 million have household incomes of $75,000 or higher. Some are healthy and don’t want coverage. Others can’t get it because of preexisting conditions



10 million children age 18 and under are uninsured.
http://www.amsa.org/cph/CHIPfact.cfm


http://www.cdc.gov/Features/Uninsured/
14.8% of American's uninsured

http://aspe.hhs.gov/health/reports/05/uninsured-cps/index.htm
16% of American's uninsured

NATIONAL ISSUE FOR UNINSURED AND HOSPITALS CLOSING DUE TO NON PAYMENT
National Problem

How many hospitals across the country are close to closing due to the non-payment of bills and the failure to collect for services rendered? There are more than just the two in the Chicago area. It’s a national issue.
http://www.midwestbusiness.com/news/viewnews.asp?newsletterID=19255

Pennsylvania agency could shut down due to uninsured fight
http://www.pennlive.com/midstate/index.ssf/2008/07/pennsylvania_agency_could_shut.html


http://www.pbs.org/newshour/bb/health/april97/poor_4-2.html

http://www.usatoday.com/money/industries/health/2004-09-29-nonprofit-salaries_x.htm

[WhiskeyGirl]

From the Obama web site -

http://www.barackobama.com/issues/healthcare/#coverage-for-all

Obama's Plan to Cover Uninsured Americans:

Comprehensive benefits. The benefit package will be similar to that offered through Federal Employees Health Benefits Program (FEHBP), the plan members of Congress have. The plan will cover all essential medical services, including preventive, maternity and mental health care.

Why not just expand FEHBP? 

From my reading, Obama's plan will keep Medicare, Medicaid, FEHBP, a program similar to FEHBP (but not FEHBP), private insurance (government regulated for pricing and benefits), and other programs.

Why not one program for everyone?  Why not the Congressional plan for everyone?  If there is a national standard, why not just one payer?

It seems like this is expanding on the patchwork of care that exists today.  Adding another layer of bureaucracy and cost.  jmho

Where are the numbers?  Actuarial projections? 

Where is the cost control for providers?  Suppliers to hospitals?  Drug companies?

[WhiskeyGirl]

No one want's to pay for the sick, including the government ~

Battle erupts over Medicare coverage of dialysis 

By Jeffrey Young 
Posted: 10/05/07 07:08 PM [ET] 
A cadre of large corporations is waging a lobbying campaign against changes to Medicare coverage of kidney dialysis they say would cost them billions.

Lawmakers are seeking to reduce Medicare spending on dialysis treatments by $1.2 billion over 10 years by adding a year to the amount of time that employers have to pay for the dialysis services received by their Medicare-eligible workers.

The companies, operating under the umbrella of the Corporate Health Care Coalition, object to being asked to foot the bill for Congress’s attempts to find savings in Medicare to help offset new spending on other priorities, such as preventing a scheduled 10 percent cut in Medicare fees for physicians.

They contend the cost to them would far exceed $1.2 billion because private health plans pay higher rates than Medicare to dialysis providers. According to the corporations, their additional costs would be more than $2 billion and would drive up insurance premiums for everyone on their rolls.

“These estimated Medicare ‘savings’ are really a pure cost shift from the federal government to employer group health plans, adding costs at a time when employer plans are already struggling with health costs,” Verizon’s vice president of federal government relations, Andrew Meckleburg, wrote on Sept. 17 to the chairmen and ranking members of the House Ways and Means and Senate Finance committees and their respective health subcommittees.

According to these companies, Medicare spends an average of about $67,000 to treat a dialysis patient for a year, compared to nearly $180,000 for employers’ health plans.

Opposing the large employers on this issue is the for-profit kidney dialysis center industry, which is dominated by the chains DaVita and Fresenius Medical Care. The industry is represented in Washington by an 11-member trade association, the Kidney Care Council.

“We support an extension of [Medicare Secondary Payor],” council President Rob Forman said.

Forman acknowledged that private insurers pay higher rates than Medicare’s but said this fact reflected underpayments by the government rather than overpayments by the private sector.

http://thehill.com/the-executive/battle-erupts-over-medicare-coverage-of-dialysis-2007-10-05.html

Lawmakers have warned that Medicare's current payment policy encourages doctors to overprescribe the drug to receive more government reimbursement. The Baucus bill would change that by lumping the costs of the drug into payments for all other dialysis-related services.

Dialysis center operators like Fresenius Medical Care AG and El Segundo, Calif.-based Davita Inc. would cut down on their use of Epogen to increase profits, Citigroup analyst Paul Heldman wrote in a note Monday. While the new payment system wouldn't take effect until 2011, Heldman states it could reduce Epogen usage by 20 percent, lowering Thousand Oaks, Calif.-based Amgen's earnings per share to $5.16 from $5.88.

http://money.cnn.com/news/newsfeeds/articles/apwire/e949c57250da5129b9c9b24d94899277.htm

What is a fair profit for a company when there are few competitors? 

Will there be a provision to tax 'windfall' profits by hospitals, medical providers, and their suppliers?

Who is looking out for the pockets of the American taxpayer?

[nonesuche]

Actually I think drug costs have risen far more rapidly than overall facility and staff healthcare costs. The pharmas represent one of the largest lobby entities within the US in Washington, they are also why we don't have more cures for cancer for all of the latest cutting edge possible vaccines and cures are being developed off our shores in places like Australia, Britain, and even France. The pharmas make a lotta money off cancer drugs, as a result they have been very effective in squashing research efforts for cures in the US.

If you have never had a friend who was a pharma salesperson then that's an education too, lots of insights there and I have a friend who was once married to a VP of Sales for one of our largest pharmas in the US. Trust me, at times the pharma's pushing of drugs is only wrapped in a prettier package than the drug pushers on the street.

You can also buy mail order drugs from Canada far cheaper than in the US, further proof that the pharmas have had a real hand in creating some of these issues.

WhiskeyGirl, I don't want socialized medicine, sorry but I do not, but I also don't think either of these candidates will sponsor it either. Kermit, in response to your postings why do you think our Senate and Congress don't pull this issue to the forefront and get it resolved? I'm just interested in your thoughts on why not.