got reform?

Thanks to Jim Buie and Ron M. for getting me in gear here: 

Having so much faith in personal health care insurance is false security, especially when the insurance industry continues to narrow their gate of accessibility and drive up the cost of health care in general. Health insurance companies don’t absorb any losses they incur when payouts exceed premiums, deductibles, etc. They pass the cost of [your] care on to doctors, clinics, hospitals, etc. and to the whole body of subscribers and members. They increase premiums making it less and less accessible to others, they dictate how much they’ll pay for services (which is usually a fraction of the actual cost), and they burden Medicare along with the ones who most need the benefits it provides. 

Having insurance or Medicare doesn’t absolve one from caring about the American health care system. I know my care cost more than I pay in for premiums, co-pays, etc. And I know that the cost of my care doesn’t just evaporate into thin air. It’s passed on and on through economic levels. Someone (you) is picking up the tab. While I feel neither “good” or “bad” about the economic consequences of the care administered to me personally, it is the bigger picture that challenges my perspective of the American health care system and its components.

Over the decades, the science of health care has advanced a lot faster than the economic forces that support it. There’s no way that the 60’s model of health insurance and medicare can support contemporary medical science. For example, if you’d had a heart attack in 1965, there would have been no heart bypass, stints, angioplasty, etc and your health insurance would not have had to payout like it would have if your heart attack had happened in 2000.

There have been plenty of adjustments in the insurance industry over the years; however, those collective adjustments in cost and policy are inadequate in contemporary health care. They cannot support the advances in medical technology, pharmaceuticals, advanced [life-saving] treatments and other procedures that maintain quality of life, etc.

What if continued stem cell R&D proves a cure for cancer resulting in a treatment that is obviously very costly? Could the insurance industry alone meet that challenge without an absolute crash? Progressive thinking would have to let go of that antiquated design of health insurance because the real value of scientific and medical advances in society is its social impact–not its economic consequences.

The question becomes one of delivery: Is it possible for one to get progressive care under a “system” designed to pay for leeches, roots, and blood-letting? While that question might sound absurd, the point is that medical science and health insurance are not in the same century. Medical science could freeze right where it is and, still, it would take decades for the insurance industry to catch up.

Political forces are another factor in the delivery of an American health care system, especially this election year. I don’t expect a drastic stopping/starting point in health care reform; however, I’m voting for the candidate who is firm on health care reform and who has the ability to to spark the difficult and lengthy reform process. I’m looking for a candidate who realizes the potential of what medical science can provide and the economy can support. I’ll support the candidate who has the vision that all the possibilities serve every American citizen–not just the ones who can pay for it.

Although I’m perfectly safe and sound in my own little health care world, I’m still for reform, and sooner better than later.

The following comes entirely from NYU’s Clincial Correlations Blog at http://www.clinicalcorrelations.org/  -and –  http://www.clinicalcorrelations.org/?cat=19 : 

John McCain (R)
This plan is similar to other Republicans’ in proposing a system of health care tax credits. In particular, a tax credit of up to $5,000 would allow families to buy health insurance, including plans from across state lines. McCain also proposes the same changes that other candidates have: insurance portability, tort reform, IT investment, and reform of Medicare reimbursement to focus on “diagnosis, prevention, and care coordination.” One point has particular relevance for our VA hospital: veterans should have “freedom to choose to carry their VA dollars to a provider that gives them the timely care at high quality and in the best location.”

The financing of his tax credits is not discussed on his web site, though the NY Times reports that “employers would no longer be allowed to deduct health care costs from their taxes under his plan.”

Hillary Clinton (D)
Clinton would require every individual to choose an insurance plan. Anyone could keep their current insurance if they were satisfied with it. Two other choices would be available: a menu of private options offering the same benefits that members of Congress receive, the other a Medicare-style public plan. Tax credits would be offered to working families to make it easier for them to afford insurance.

How would this be paid for? The details aren’t spelled out, and this is where the complications come in. (See the detailed analysis of Clinton’s plan at the blog Health Care Policy and Marketplace Review.) In particular, the Clinton plan predicts that “most savings [will] come through lowering spending due to quality and modernization.” As Robert Laszewski of the Health Care Policy blog says, this could be Clinton’s most dangerous assumption. If quality and modernization cannot ensure savings by themselves, if providers and payers cannot agree on cost-limiting measures, if more taxes on the higher brackets (i.e. the rich) will not be enough to balance the books (as Clinton assumes), what will happen to the Clinton plan?

Alongside Clinton’s individual mandate for health insurance, there are requirements for other participants in the system. Insurance companies “will end discrimination” and “ensure high value,” while “drug companies will offer fair prices”; providers will work collaboratively to deliver high-quality, affordable care; “large employers” will be expected to provide health insurance or contribute to the cost of coverage (small employers will receive a tax credit to offer coverage, or start doing so).

What “fair prices,” “high quality,” and “large employers” are supposed to mean has been a source of debate even before the first Clinton health plan. How will affordable coverage be mandated when some estimates place the cost of family health coverage at $12,000 per year? If twenty-five employees is the cutoff definition for “large business” (as the Clinton campaign has indicated), what would smaller businesses be required to provide?

Barack Obama (D)
Like Hillary Clinton’s plan, as well as those of many other Democratic candidates, Obama’s “Plan for a Healthy America” proposes universal coverage, made possible through a number of proposals. Individuals and small businesses would be able to “buy affordable health care similar to that available to federal employees” or choose from a newly created federal insurance program. A proposed National Health Insurance Exchange would allow anyone to enroll in participating private plans. Medicaid and CHIP would be expanded and employers would be obligated to finance at least part of their employees’ health coverage. The plan would make illegal discrimination by insurance companies on the basis of pre-existing conditions.

Proposed financing of his plan includes increased efficiency from investment in information technology, better management of chronic diseases, and promotion of preventive medicine. Obama is also in favor of repealing the ban on direct negotiation by the Medicare drug plan (Part D) and proposes decreased payments to private Medicare plans (which on average charge 12% more than government-run Medicare). In addition, a proposed national reinsurance plan for catastrophic coverage would decrease premiums by having government shoulder the cost of the longest and most expensive hospital stays, for example in the ICU. No dollar figures are given in his proposal.