What's in the Healthcare Bill for You?

[PST]

TWW claims that John "missed the prejudice boat" simply because the research he cited was published by the American Public Health Association, which has these goals:

"The goals of both the online and the print versions of the Journal, published monthly by the American Public Health Association, are

• To publish the best scientific research in the field of public health
• To serve as a forum for diverse viewpoints on major public health issues and policies
• To promote diverse public health practice models
• To increase public and professional understanding of public health problems and their solutions through delivery channels relevant to different audiences and their needs
• To work in concert with the 3 main priorities of the American Public Health Association, namely
  • to develop universal coverage,
  • eliminate health disparities, and
  • rebuild the public health infrastructure.

(Formatting by me, text by them.)

The ones in red -- which as far as I'm concerned amount to wanting better health for everyone, not a bad goal -- apparently are so indicative of bias that they outweigh the goals of publishing the best scientific research, serving as a forum for diverse viewpoints, and the others.

I don't think you can just waive this study away with nothing but a claim of bias. This isn't the instant, disposable opinion of some newspaper pundit or talk-show jockey. It is careful, quantitative research by six doctors using medical case histories accumulated using interviews, physical examinations, and laboratory testing from 9,000 patients over a period of years. The paper can be read at http://pnhp.org/excessdeaths/health-ins ... adults.pdf. Like good scientific research, it is transparent. The authors have explained what they did and left themselves open for criticism of their methods. Like good scientists, they have included a whole section on what they see as the limitations of the study. Their conclusions are consistent with earlier research. If someone thinks that it is unworthy of our attention, they should read it and say why.

Does anyone really doubt the truth of these conclusions, though? Not the precise numbers, 45,000 excess adult deaths annually, but the general proposition that some people suffer unnecessarily or die because of lack of medical coverage. Christmas gives many of us a chance to visit with relatives we don't see very often. Am I the only person who sees a difference in the health of those who get regular medical care and those who don't? I see the have-nots skipping the routine tests and getting care only in emergencies. Now, someone may say, "that's not my problem, why should I taxes for to fix it?" but that doesn't mean there isn't a problem.

The lead author of the study, Dr. Andrew Wilper, has been quoted as saying:

The uninsured have a higher risk of death when compared to the privately insured, even after taking into account socioeconomics, health behaviors and baseline health. We doctors have many new ways to prevent deaths from hypertension, diabetes and heart disease — but only if patients can get into our offices and afford their medications.

That goes right to the heart of the problem. Several people in this thread, including some deeply opposed to the bill, have noted that no one is turned away from hospital emergency rooms. I don't want to be a broken record, but that is a crazy, wasteful way to handle hypertension, diabetes, and heart disease. We treat the uninsured when their feet have to be amputated or they suffer strokes, and we pay hugely to do so. I think that the worst example is kidney disease, most of which is due to hypertension and/or diabetes. According to MarketWatch, a business publication rather than a publication by doctors interested in improving public health (http://www.marketwatch.com/story/the-gr ... f-dialysis):

Dialysis treatment costs Medicare almost $72,000 per patient per year; total outlays for patients in kidney failure were $23 billion in 2006, 6.4% of Medicare's total budget. Overall chronic kidney disease and its complications account for over $49 billion, or about 25%, of all annual Medicare expenditures.

Again, just think about the people you know. The ones without health coverage are the ones who aren't getting their blood pressure or cholesterol or blood sugar checked, let alone treated. There are solid, pragmatic reasons to want universal coverage. Both the reduction of human suffering and the reduction of wasteful, too-late medical care demand it.

[So Well]

Maybe because graft and corruption in this country exceeds that of the other countries? Maybe because our politicians and government officials are cozier w/the financial industry and big business than those of other countries? Maybe because our once great country is fast going to hell in a handbasket?

Corruption is one of the most difficult things for a democratic society to deal with. Individual freedom must not be given up.

[DreamStalker]

Again, just think about the people you know. The ones without health coverage are the ones who aren't getting their blood pressure or cholesterol or blood sugar checked, let alone treated. There are solid, pragmatic reasons to want universal coverage. Both the reduction of human suffering and the reduction of wasteful, too-late medical care demand it.

I am thinking about the people I know and I have become acquainted with several Medicaid patients in the last six months. Now they have had all those things checked you mention and everyone of them is diabetic (Type 2) and has high cholesterol and about half of them have high blood pressure. They have been given sessions with a nutritionist and their doctors have told them to eat appropriately, exercise regulary, lose weight, and check their blood sugar throughout the day. How many of them do this? None. Not a single one. I still have the image of one of them, with a morbidly obese BMI, sitting relaxing at 3:00 p.m. eating candy. She told me, "My doctor told me not to eat candy because I have diabetes, but I do anyway."

You know from reading the forum that the longterm CPAP compliance rate (4 hours per night minimum) is less than 50%. You may also know that doctors' pet peeves are the patients that keep coming to them over and over for years for medication for their ills while disregarding their advise to improve their diet, exercise and lose weight.

Rob the pockets of responsible people and throw their hard-earned money at these people - that is not charity - it is a sin.

Yea, maybe you are right. They are just animals. Maybe they are better off put out of their misery and out of your hard-earned wallet?

Since you are without sin, maybe you should do the deed?

[no_more_headaches]

Again, just think about the people you know. The ones without health coverage are the ones who aren't getting their blood pressure or cholesterol or blood sugar checked, let alone treated. There are solid, pragmatic reasons to want universal coverage. Both the reduction of human suffering and the reduction of wasteful, too-late medical care demand it.

I am thinking about the people I know and I have become acquainted with several Medicaid patients in the last six months. Now they have had all those things checked you mention and everyone of them is diabetic (Type 2) and has high cholesterol and about half of them have high blood pressure. They have been given sessions with a nutritionist and their doctors have told them to eat appropriately, exercise regulary, lose weight, and check their blood sugar throughout the day. How many of them do this? None. Not a single one. I still have the image of one of them, with a morbidly obese BMI, sitting relaxing at 3:00 p.m. eating candy. She told me, "My doctor told me not to eat candy because I have diabetes, but I do anyway."

You know from reading the forum that the longterm CPAP compliance rate (4 hours per night minimum) is less than 50%. You may also know that doctors' pet peeves are the patients that keep coming to them over and over for years for medication for their ills while disregarding their advise to improve their diet, exercise and lose weight.

Rob the pockets of responsible people and throw their hard-earned money at these people - that is not charity - it is a sin.

And of course all our ills are self-induced. Cancer, all those skinny people with Diabetes, apnea.
Not that apnea happens to lead to hypertension, obesity, diabetes on a much greater scale. The best part is the strong correlation between ability to who take care of themselves and people who have access to insurance.

[So Well]

The bill before Congress will make things worse for poor people.

[sthnreb]

I have a brother in law in FL that gets $714 per month from Social Security and is on Medicaid. He survives on it whereas many people couldn't. He is 62 now. His wife died at age 49, about 5 years ago and she worked in a hospital. She died from cancer. She wouldn't go to the doctor herself and when she finally had a blood clot and went to emergency found out she had the uteran cancer. He had surgery last week for a hernia and was back in the hospital Friday with kidney bleeding. He gets food stamps or card too. He pays nothing now when he goes to the hospital. Does Obamacare mean he will get it cheaper? I know FL is one of the sweet heart states that votes were bought from. Just wondering how it could get less unless they pay him?

[DreamStalker]

Yea, maybe you are right. They are just animals. Maybe they are better off put out of their misery and out of your hard-earned wallet?

Since you are without sin, maybe you should do the deed?

That is not a thought that ever came into my mind, but it did come into your mind. Does it reveal more about what is in your heart than what is in mine?

In the short time I have been here, I would give you, DreamStalker, the trophy for always restating the "opposition's" opinion in extreme terms and vilifying him with a broad brush.

Well perhaps I misread your thoughts and should apologize. It just seemed to me that your point was ... if "these people" can't or aren't willing to take care of themselves, then responsible people should just let them die ... in order to keep your fat wallet ... which would of course not be a sin (the fat wallet that is).

If I am wrong about your point ... please correct.

BTW - I'm for all out governement takeover of healthcare "insurance" (like my Rooster friend) just so that "these people" have a chance to get some kind of care ... if that is in any way revealing of what is in my heart?

Thanks for the trophy too ... I put it away in my signature.

[Uncle_Bob]

Unlike most people i have had chance to live and work in a country with a socialized health care system, the NHS in England.
As a working professional I also had additional private insurance (through BUPA) provided as a employment benefit and for which i made a minimal monthly contribution.
Initially it seemed a bit odd having to pay for health insurance. Insurance is something I normally associate with a purchase to cover the cost of an unlikely event like early death or car wreck etc I do not know of any person that has not needed medical care. I used the NHS for routine doctors visits and Rx and all that kind of stuff. The private insurance kicked in whenever i needed a surgery or procedure for which i would have had to spend time on a long waiting list if I was to use the NHS system. To me it seemed like i was paying and using both systems. I never heard of any death panels, unlike the death panel i have now on my insurance, my one million per person maximum on the policy.

Historically the NHS system seemed to work for a while then it got in trouble. It became open to abuse, it catered to health tourists and bent over in the name of political correctness. Today it is possible to obtain cosmetic surgery on the NHS, just simply mention that fact that the appearance of the body part in question is causing you emotional distress, anxiety & depression and you can get a very costly cosmetic surgery at the tax payers expense
In order to gain more votes government would throw more and more money at it, creating more and more management levels to create more and more bureaucracy. It's in such state now that the government could throw millions at it and none of that would filter down to actual patient care.

I am not a socialist in general and despite my experiences I am still for some kind of health care program available to all. I'm not 100% familiar with the current bill and can not get my head around how to create the "perfect system" from what we have now. Even more worrying is the fact that although i understand the imperfections of the current health insurance based system I am afraid the current bill is being rushed through and has not been well thought out.

[PST]

I have a brother in law in FL that gets $714 per month from Social Security and is on Medicaid. He survives on it whereas many people couldn't. He is 62 now. His wife died at age 49, about 5 years ago and she worked in a hospital. She died from cancer. She wouldn't go to the doctor herself and when she finally had a blood clot and went to emergency found out she had the uteran cancer. He had surgery last week for a hernia and was back in the hospital Friday with kidney bleeding. He gets food stamps or card too. He pays nothing now when he goes to the hospital. Does Obamacare mean he will get it cheaper? I know FL is one of the sweet heart states that votes were bought from. Just wondering how it could get less unless they pay him?

Your brother-in-law, like others currently receiving Medicaid benefits, shouldn't see any changes. The main beneficiaries will be workers who don't get insurance through their employers. It will make individual policies more available, without exclusion for preexisting conditions, and subsidize their purchase on a sliding scale based on income.

That "sweetheart state" business is really not true for Florida, despite what Carl Rove and others have said. (I won't try to deny it for Nebraska, but I bet that doesn't make it to the final bill.) Florida Senator Bill Nelson sponsored an amendment to the bill several months ago (not as some sort of last minute deal) that prevents certain cutbacks in the Medicare Advantage program. Medicare Advantage is a Bush-era program whereby the government pays a premium to a private insurer to provide coverage instead of doing so directly. On average, the cost is 14 percent higher than the average cost of Medicare. The original bill was going to cut back on the excess. Sen. Nelson's amendment prevents such cutbacks for current Medicare Advantage members in areas with high costs. Since Florida has a lot of seniors and high costs, many Floridians will benefit from the amendment, but it is not limited to Florida.

[So Well]

That "sweetheart state" business is really not true for Florida, despite what Carl Rove and others have said.

Time will show that it is indeed true for Florida.

[PST]

I am not a socialist in general and despite my experiences I am still for some kind of health care program available to all. I'm not 100% familiar with the current bill and can not get my head around how to create the "perfect system" from what we have now. Even more worrying is the fact that although i understand the imperfections of the current health insurance based system I am afraid the current bill is being rushed through and has not been well thought out.

This is the effort of the better part of a year. Committees in both houses of Congress have been working on a healthcare reform bill since last spring. The first House version was reported out in July. According to an article I saw in Politico, the Senate debated the bill for 25 straight days, the longest debate on a bill since the declaration of war for WWI. Whatever faults this bill may have, they are not due to rushing it.

[DreamStalker]

Yea, maybe you are right. They are just animals. Maybe they are better off put out of their misery and out of your hard-earned wallet?

Since you are without sin, maybe you should do the deed?

That is not a thought that ever came into my mind, but it did come into your mind. Does it reveal more about what is in your heart than what is in mine?

In the short time I have been here, I would give you, DreamStalker, the trophy for always restating the "opposition's" opinion in extreme terms and vilifying him with a broad brush.

Well perhaps I misread your thoughts and should apologize. It just seemed to me that your point was ... if "these people" can't or aren't willing to take care of themselves, then responsible people should just let them die ... in order to keep your fat wallet ... which would of course not be a sin (the fat wallet that is).

If I am wrong about your point ... please correct.

BTW - I'm for all out governement takeover of healthcare "insurance" (like my Rooster friend) just so that "these people" have a chance to get some kind of care ... if that is in any way revealing of what is in my heart?

Thanks for the trophy too ... I put it away in my signature.

Sorry, I have read enough of your posts going way back to have some idea of what venom is in your heart. That you would even have the thought of "They are just animals. Maybe they are better off put out of their misery and out of your hard-earned wallet" is appalling to me, much lest to try to contribute it to someone else.

When I said, "I have become acquainted with several Medicaid patients in the last six months" it is because I began volunteer my time and money with an organization that allows me to work directly with welfare patients.

People that do the kind of welfare work I am doing are rarely pushovers. I assure you I have the strength of my convictions and your bullying tactics will serve you very poorly with me. I will learn a lot more about you from your posts. You will hear from me again and I won't be sending you smilie icons.

Well ... ... ...

Umm ok.

Does that mean I'll have to give back the trophy?

[PST]

Again, just think about the people you know. The ones without health coverage are the ones who aren't getting their blood pressure or cholesterol or blood sugar checked, let alone treated. There are solid, pragmatic reasons to want universal coverage. Both the reduction of human suffering and the reduction of wasteful, too-late medical care demand it.

I am thinking about the people I know and I have become acquainted with several Medicaid patients in the last six months. Now they have had all those things checked you mention and everyone of them is diabetic (Type 2) and has high cholesterol and about half of them have high blood pressure. They have been given sessions with a nutritionist and their doctors have told them to eat appropriately, exercise regulary, lose weight, and check their blood sugar throughout the day. How many of them do this? None. Not a single one. I still have the image of one of them, with a morbidly obese BMI, sitting relaxing at 3:00 p.m. eating candy. She told me, "My doctor told me not to eat candy because I have diabetes, but I do anyway."

You know from reading the forum that the longterm CPAP compliance rate (4 hours per night minimum) is less than 50%. You may also know that doctors' pet peeves are the patients that keep coming to them over and over for years for medication for their ills while disregarding their advice to improve their diet, exercise and lose weight.

Rob the pockets of responsible people and throw their hard-earned money at these people - that is not charity - it is a sin.

I understand the frustration we all feel about those people who don't take their doctors' advice to lose weight and exercise more, especially when we're one of those people. You have picked the highest hurdles though. Many preventive measures are easier to get compliance with than weight loss and exercise. I confess that I don't have to look any farther than the mirror to see someone who is a lot better at taking his Lipitor than shedding his excess pounds. I think in general you will find that people comply better with almost any treatment other than weight loss and exercise.

The question I was dealing with, though, is the accuracy of the study John Fisher cited. Does health insurance make a difference in mortality? The study controls for other variables like gender, age, race/ethnicity, poverty income ratio, education, unemployment, smoking, regular alcohol use, self-rated health, physician-rated health, and obesity, and still concluded that we get 45,000 extra deaths annually among the uninsured. I accept that it is a value judgment, not an empirical issue, whether it is right to spend taxpayers' money to help people who may not care of themselves. But when we make that judgment, we should take into account the evidence that lives would actually be saved. In addition, the relevant group is not those already getting Medicaid. They are a sunk cost, so to speak, in that they get benefits now and that is not going to change. They're not the ones this bill will affect. I dislike the condescending term, "working poor," but I don't know what other one to use. The plan pretty much leaves alone the Medicare recipients and those with jobs that provide good benefits. The main group to benefit will be the working poor. It provides a way for those who aren't indigent but don't have medical insurance to buy it. Some of them will be imperfect people like me who don't do everything they could to stay healthy, but I still think that this is a profoundly sensible thing to do. In addition, it should reduce the number of cases in which the public or charity must pick up the pieces after disaster results from a lack of ongoing care.

[frazzled-snoozer]

As I've watched the Healthcare debate unfold over the years I've been amazed at how stunningly our representatives avoid debating the real questions head-on. When Pres. Obama talked about having "transparency" in the discussions I knew that was laughable. This whole thing has been negotiated behind closed doors with deals being made on every front. I work for a medical billing service and we've been discussing the real issues for 20 years. But what we've seen with this "debate" is that none of the core issues has been addressed except pre-existing conditions. It started out simply that we wanted:
1. Easier access to affordable health coverage
2. Mechanisms to prevent people from losing their coverage
3. Encourage cost stability
4. Address the inevitable bankruptcy of Medicare and Medicaid
5. Detemine appropriate handling of illegal immigrants
On the two ends of the political spectrum all of these issues could be addressed. The big question that needed to be debated this whole time is do we go with a single-payer system or do we develop free-market solutions? All this "in between" stuff is a like patching a boat with masking tape. So, if the debate should've been between just two concepts, how would that debate have played out?
1. Single-payer coverage has been tried in many places and the flaws are now evident. It's simply because "socialization" inevitably erodes into unsustainable growth. It's human nature to try to get all you can out of the "system". Medicad and Medicare give us a slimpse into how costs grow. And choices will always be limited when "the whole" is paying for it. Also, the idea by some, that it's "free" disguises the true cost of the system.
2. A re-vamping of the insurance industry that encourages the most competition would be one where each individual purchases their own plan (not employer related at all). Companies would be allowed to trade across state lines. The government wouldn't demand any company cover something they don't want to cover because consumers' demands would create the competition needed to formulate desired plans. Tort reform would bring dr's malpractice insurance down thus bringing down medical costs. There are more ideas for Medicare, Medicaid and illegal immigrants but this is plenty wordy enough for now.

[PST]

Unlike frazzled-snoozer, I think the process has been quite transparent. Otto von Bismarck is supposed to have said, "To retain respect for sausages and laws, one must not watch them in the making." This time around, we got to watch. In the Senate, where the proponents needed every single last Democrat, due to unanimous Republican opposition, we watched the compromises unfold senator by senator. It wasn't pretty, but it sure was public.

Anyway, frazzled-snoozer says it comes down to either single payer or revamping the private system. Single payer just isn't in the cards. It hasn't been debated much because everyone knows it doesn't have the votes. So we are left with how to revamp. Frazzled-snoozer proposes in part:

A re-vamping of the insurance industry that encourages the most competition would be one where each individual purchases their own plan (not employer related at all). Companies would be allowed to trade across state lines. The government wouldn't demand any company cover something they don't want to cover because consumers' demands would create the competition needed to formulate desired plans.

I just don't understand how that can work. I represent insurance companies, and competition doesn't make them want to cover everyone. It makes them want to cover the good risks and let the other company cover the bad ones. A company that takes too many bad risks has to raise rates, and then all the good risks want to go elsewhere while the bad ones stay, a process called adverse selection. If the difference between good and bad were small, then insurers could adjust individual rates appropriately. But the differences are large, and sufficiently bad risks are just going to be left without coverage in an unregulated system.

Here is an example. Huntington's disease is an incurable neurodegenerative genetic disorder. If one parent has it, each child has a 50 percent chance of getting it. Symptoms usually emerge around age 40. There is no cure. People with the disease start with impeded coordination, but then dementia sets in, so eventually they need full time care. The disease is not fatal. Life expectancy is around 20 years after symptoms start. Thus, treatment is extended and expensive. Why would an insurance company in a competitive system want to insure someone with a 50 percent chance of contracting this disease, and if it accidentally insured someone with Huntington's, why would the company renew, year after year, when it was spending more than the person could possibly pay in premium. The problem isn't limited to extreme examples like this one. Because of the very long-term consequences of illness, competition just can't work the same way it would for a quick, yes-or-no risk like fire insurance. To make a system based on private insurance work, unfortunately, we will need a complicated regulatory framework, and that's what we're getting.