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Let's Talk Health-Care Reform

For a health blog, we haven't talked much here about health-care reform. It's a huge, divisive and emotional issue -- in other words, perfect blog fodder.

It's clear that health-care costs are out of control and threatening to undermine the entire economy. It's heartbreaking to hear about people losing their livelihoods -- or their lives -- for lack of adequate insurance coverage. On the other hand, many find it unsettling to think of the government's taking over the whole health-care system or even large chunks of it.

Of course, we're already partway there: According to the Associated Press, "Most Americans may not realize it, but government already pays nearly half of the nation's health care tab. Government programs cover seniors, poor families, and many children." Yet still too many people are outside the system, receiving little or no health care.

But what's the best solution? The American Medical Association has embraced the broad outlines of the Obama administration's approach. Read the AMA's letter of support and see what you think.

We're not likely to devise a perfect solution in this forum. But I'd like to hear what you're thinking about health-care reform, changes you think would benefit you and your family -- and the country as a whole.

By Jennifer LaRue Huget  |  April 17, 2009; 7:00 AM ET
Categories:  General Health , Health Policy  
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Comments

Well, unfortunately, there's no easy answer because, fundamentally, the cost of health care continues to rise at, what would be in the long-term, an unsustainable rate. Republicans will bemoan the idea of government stepping into the health care system, but we've been doing the whole "private" health care for the past 50 years and the situation will only get worse.

Democrats will claim that greater government involvement in health care/insurance will bring down costs. They are correct that there will be some one-time savings, but the RATE at which health care costs go up will be unchanged, meaning that it will still be unsustainable in the long run.

So, then, the real question is why health care costs go up so much every year (on average). Some will claim it is lawsuits (typically, Repubs), whereas others (typically, Dems) will blame drug manufacturers. While there is some truth to each side's claims, these costs are relatively small pieces of the puzzle.

Fundamentally, what drives the increase in health care costs is a basic law of economics, which is the law of diminishing returns. As we expend resources to achieve certain returns, the amount of those returns decreases for the same amount of devoted resources. Therefore, to consistently achieve the same returns, we have to increase the amount of resources devoted to health care. The problem is that the law of diminishing returns is an exponential curve, in which the rate of change exceeds inflation. i.e. it's unsustainable in the long run.

So that means that, in the future, when currently incurable diseases become treatable/curable, we will have to decide whether the cost of doing so is worth it.

At the moment, we have decided that we will seek out and pay for every possible treatment/cure regardless of the cost. Thus, the unsustainable rate of health care cost increases.

There's no simple solution, but plenty of people on here will claim there's one.

Posted by: rlalumiere | April 17, 2009 9:56 AM | Report abuse

This is not completely solvable by any means, but is best served thru decentralized systems in competition.

Posted by: balataf | April 18, 2009 2:00 AM | Report abuse

There seems considerable reason to think the spiraling healthcare costs arise from competing insurance corporations' marketing costs, dividends, and executive salaries/bonuses; single-payer universal health coverage would solve these. Your commenter rlalumiere is right that some costs rise with improvements in treatments; however, his/her "in the future, when currently incurable diseases become treatable/ curable, we will have to decide whether the cost of doing so is worth it" avoids two crucial points: (1) many societies do feel such costs are "worth it" enough to devote their resources to medical care rather than to wars and "defense" industries; (2)that cost will certainly seem "worth it" when it's your daughter's or father's, even if not your own, life at stake. We see arguments like rlalumiere's put forth by some members of the Obama administration, I'm sad to say, when they misinterpret the Eliot Fisher/Dartmouth Health Atlas reports to say that patients do as well with "less intensive treatment" (fewer tests, doctor visits, rehospitalizations) as with more intensive treatment. The primary Dartmouth Health Atlas report cohort were patients whose records were studied for their last two years of life, and therefore obviously the report can show no difference in outcome between levels of treatment, since by hypothesis all patients died in two years. As for quality, if anyone troubles to look at the report, he/she will notice that the "high-intensity" hospitals in the data are (with some exceptions) the ones people seek to go to, the "low-intensity" ones those people dread as snakepits. Yet it is by "trimming" "unnecessary" tests etc. covered by Medicare/Medicaid to the "average" treatment intensity that the administration's current proposal would, in part, help pay for expanding coverage to the uninsured. In other words, the current administration proposal, in trying to avoid the controversy of single-payer coverage, can only meet its budget by de facto rationing of healthcare for the old, disabled, and very poor; this is a compromise that fails because it fails to stop the cost hemorrhage that is the insurance industry but instead merely shifts the cost/health burden from one part of the citizenry (the working uninsured) to another(the poor, old, disabled). Mr. Obama was elected to stand for the rights of the people; only a single-payer plan can do that.

Posted by: friedman1 | April 18, 2009 2:09 AM | Report abuse

Health care reform ideally should be comprehensive, but this is unlikely to occur.
Either this country is basically too conservative or special interest groups are strong enough to prevent a civilized, single payer, universal health care system as there is in every or nearly every other developed nation.

The most viable ways to reduce or limit the likely significant increases in health care costs are in the areas of preventative care and help most people become more healthy. This should include ensuring everyone has at least reasonable dental care and setting up a system of carrots and sticks for people to avoid becoming obese.

There should also be tort reform to limit most legal settlements, thereby reducing malpractice insurance costs for health care personnel and facilities. Obama and most Democrats are unlikely to take this route though, politics and special interest groups will probably thwart any such reforms.

Obama needs to take stronger leadership in telling Congress what he will not accept in any health care bill. He strongly criticized as a candidate Senator Clinton's individual mandate and Senator McCain's idea to tax employer paid health insurance benefits. Obama rightly contended either of these policies, if enacted, would create significant financial burdens for many people. Allowing either or both of these bad ideas in a health care "reform" bill would be unfair to millions of people and demonstrate Obama is just another politician, making promises to be elected, then discarding some of them, after taking office.

Posted by: Aprogressiveindependent | April 18, 2009 2:15 AM | Report abuse

Expanding the Medicare system to the whole population is the quickest way to enact a new health care system for "all" Americans. While it may appear expensive to do that, built-in controls, which Medicare has, can control run-away costs.
Since this is a "blog", I wil leave it at that, hoping that this starts a debate between those who know the present Medicare system well, as well as those who oppose it on the grounds that it is "governmentally controlled". My contention, supported by virtually every industrialized counttry in the world, is that our government has now had extensive experience with the system for almost a half century, and it is generally quite popular with those who benefit from it- and most doctors, admittedly begrudgingly, also go along with its basic raison d'etre.

Posted by: brucedouglas | April 18, 2009 3:31 AM | Report abuse

Single payer national health insurance, often called "Medicare for All" but it's proponents, is the only equitable, realistic, and cost controlling alternative for comprehensive health care reform. It is long overdue. The rest of the civilized world, latest of which includes Taiwan, have instituted national health insurance systems, to the great benefit of their populations. Morally and ethically it is our only way to achieve universal health care, in an economically sustainable fashion. Only single payer allows people their complete freedom of choice of doctor and facility, and to maintain their relationship with their family physician, which is the main, and only, condition that has proven to eliminate disparities in minority outcomes in health care. Being able to maintain a "medical home"is the most important factor in the best management of health for everyone, and making the most efficient use of our resources. Few of the means of cost reduction claimed by the Obama administration, including preventive care and electronic medical records have proven to save any money at all - adding preventive care typically increases costs, not reduce them, and electronic medical records can increase a variety of medical errors and be very costly to install and maintain, while adding great risk to medical privacy, especially if our current system of private insurances, eager to deny coverage to the sick, is maintained. Only single payer, by eliminating as much as 80% of the administrative complexity and paperwork burden imposed by thousands of different insurance policies now in existence.

Single payer, combined with federally subsidized medical education and tort reform to reduce the practice of defensive medicine, will contain costs as much as is wise and in the most tolerable fashion.

We must find the political will to stand up and bring the only adequate and sustainable system into existence here, and tackle the most difficult questions of what we as a society are willing to invest in health care, knowing full well that our own lives are at stake, and those of our loved ones. Our politicians will back away from that responsibility forever, unless we hold their feet to the fire. It appears to be in their long term self interest to leave denial of care to the bogeyman private insurance industry, instead of rising to the occasion and beginning the truly adult conversations that need to occur to make a humane system of health care delivery in the US a reality. Other countries have done it, surely we can muster the maturity.

Posted by: Firstresponder | April 18, 2009 6:08 AM | Report abuse

Health care for all is possible, Germany's had worked for 125 years, research German health care.Health care and Pharmaceuticals is huge business in the USA with lots of big executives getting filthy rich. Because of the fact that those running the insurance companies and pharmacy corporations don't want it the most ,should tell you just how lucrative it really is. Think of all the politicians who get kickbacks or took jobs with from big pharmaceuticals after helping them push something through the senate and house. Remember when they shut down buying prescriptions outside the country? The reason "Foreign drugs aren't safe" Being a Vietnam Veteran, since when did my country start caring about your safety?? Almost 59,000 names on the Vietnam wall if you need proof. I've paid into the Fed, State, Local, and Social Security Tax systems for 43 years and shortly before I retired from the company I worked at most of my life they decided to cancel all retiree insurance. My wife of 39 years and I should not even have to think about this nonsense, GET NATIONAL HEALTH CARE FOR ALL, I'M TIRED OF ALL THE EXTREMLY WEAK EXCUSES!!

Posted by: marine196971 | April 18, 2009 7:22 AM | Report abuse

Thanks for all these insightful, smart comments; you folks have clearly given these matters some thought.

I've heard horror stories from countries such as Great Britain in which patients can't get access to certain medications -- I'm thinking particularly of multiple sclerosis drugs -- because they're deemed too expensive to be on the government's formulary. Anybody out there have any first-hand experience with this?

Posted by: Jennifer LaRue Huget | April 18, 2009 7:53 AM | Report abuse

I too believe that everyone should have access to health care. But I disagree that healthcare should be "free." This already drives too many people to be over-treated. Adoption of the current Medicare/Medicaid programs is not the way to go. Neither program is adequately funded. Anyone in health care will tell you that both programs are heavily subsidized by the commercial market. In addition, neither program is effective in driving healthy outcomes. They are over-regulated and fail to recognize/encourage common sense treatments or deal with our most threatening medical condition, obesity. Should we NOT move to a single payor system, the qualifying age for Medicare (and Social Security) should be moved to 75-- and should increase each year. While we certainly have a social responsibility to help the infirm, I don't believe we can or should provide this entitlement to the perfectly healthy. Finally, I am a healthy babyboomer. My generation and those who come after us need to recognize that the world has changed. We can no longer feel "entitled" to retire at 65. Get over it and get on with it.

Posted by: kathomas2 | April 18, 2009 9:34 AM | Report abuse

GOGO not GOCO nor COCO
For adoption of a Public Option.

Dear President Obama,

Really, there’s no more money
To pay for Insurance Companies
To manage the best health care for
For 50 million squeezed in somewhere
Between Medicaid and Medicare
who just have enough to buy in,
but not enough to pay more corporate welfare.
No one’s asking you about a hand-out
Or subsidy like shameless failed Companies
Who won’t compete on a level playing field.
They don’t have and never had to
in all 50 of our unregulated states.

That’s their problem, unless you say
to get agreement from those both Houses
Who have already spent three decades
Of taxes we have yet to pay
And are going back for the rest.

I end this poem to leave both the best and rest
To your imagination of what this shaking nation
Will due if you continue to allow them to
trade our health care needs like a commodity,
hook our wallets and our credit cards,
let insurance companies into our homes
like DSL, cable , and cell phones.

We know GOCO and COCO
Are more than we can afford
And won’t work for 50 million
(And never could before).
You know you don’t have the money.
You know we have the right to choose
If you don’t abandon us
We won’t abandon you.

Notes on “Public Option” models for 50 million uninsured:
GOGO is government-owned, government-operated (most-affordable)
GOCO is government-owned, contractor-operated (20- 25% more offering less)
COCO is contractor-owned, contractor-operated (unaffordable)without high deductibles, or goverment-paid reinsurance
thats just more corporate welfare.

Posted by: lesholcomb | April 18, 2009 9:46 AM | Report abuse

TWO TIER HEALTHCARE:

1) Public system, subsidized by government, with subsidized universal electronic medical records based on the VA's system.

2) Private system where anything goes.

Model: Singapore Healthcare system

Posted by: perspectoff | April 18, 2009 10:19 AM | Report abuse

The comments have been thoughtful and thought-provoking. My thoughts without justification or facts.

It is morally right for all people in the US to have adequate access to health care.

A significant savings per capita could be realized with a single-payer (government operated) plan. OK, it may be a one-time savings but at least the starting point for future increases would be lower. (This plan would not replace personal choice of providers.)

The absolute cost will probably continue to increase as the number of people covered increases and new treatments are invented.

Allowing people to make informed decisions about end-of-life treatment could result in lower costs during the most medically expensive part of life.

We need a better method of financing medical school so that doctors don't start practice with huge debts.

just some thoughts from a senior citizen in Washington State.

Posted by: 2salmon | April 18, 2009 10:19 AM | Report abuse

For the Record, both the article writer and the bloggers ASSUME far too much. Seniors do NOT all have access to HEALTH Care especially now with that drug program in force. And if they tried to join they would be PENALIZED like criminals.

Next the 'industry' wants mandates to enforce and criminalize citizens who still PREFER to EAT, rather than enrich insurance execs a.k.a CEO's.
There is much more in the sands of this problem, and far too much of it belongs in the hands of congress... a congress that has made it plain they are there for the money for themselves, and to heck with the nations citizens who cannot PAY them for their needs too. Via the infamous LOBBY of politics. That is my opinion in a nut shell.
Thanks
stella

Posted by: watkins_stella | April 18, 2009 10:57 AM | Report abuse

Dear 2salmon,
Your are right about single-payer but my the following poem addresses the frustration with the way the Administration has dismissed that. It reduced me to marching around with a sign-- which was a long-time coming. I don't think the whole poem will fit but you'll get the gist.


Health Care Reform Lament #1

PRESIDENT OBAMA,
THE NUMBERS ONLY WORK FOR YOU AND ME
WITH SINGLE PAYER HEALTH CARE
AND NO CORPORATE SUBSIDIES
FOR INSURANCE COMPANIES
LET’S GET REAL,
LEVEL THE PLAYING FIELD!

After a five-hour drive
I held my hand made sign outside
The Health Reform Summit in Burlington
Three hundred miles away
on St Patrick’s Day 2009.
Then every few minutes
I’d flip it to the other side:

PRESIDENT OBAMA,
IF YOU’RE STILL ABLE
GET “MAX” TO PUT
SINGLE PAYER BACK
ON THE TABLE.
LET’S GET REAL.
LEVEL THE PLAYING FIELD!

150 protesters from several states,
who had done this before
had signs, unlike mine, neatly printed
“Medicare for All” and “Health Care for All”,
right-hand written.

Why had I who skipped protests of the 60s
started in 2009 to speak my mind with signs?
You promised all sides could to speak in an open process,
but that didn’t happen, so I had to do my best to protest.

Max Baucus said repeatedly,
single payer advocates would be
unable not sit at his table
since all Insurance Companies
agreed that financially
we would create a condition
of “unfair competition”.
But when he assured us once again
that our “solution” will be “uniquely American”
I felt a chill blow over the Hill.
Heard that before.
Been there.
Done That.
That means more Corporate Welfare.
We can’t afford to go there
anymore.

If I were a farmer, I would ride my tractor in protest.
If you asked me what I grow I’d say: corn, soybeans, arugula or hay.
But I’m not a farmer. I’m just a guy who worked decades
in cost-plus munitions programs,
de-institutionalization in a few states,
stabilizing public hospitals, clinic, and academic medical centers,
in communities with hospital cost-reduction experiments,
designing health plans with admin expense below 10%,
making ways to remove or reduce the need for public subsidies.
That’s my arugula, corn, hay and soybeans.

Many others just like me, have waited patiently
yet none of us is able to sit at Max’s table.
In the past we were asked.
Still welcomed on the Hill
as “Safety-Net” advocates,
to meet in Congress and Exec OB
in former Health Reform forums.
But now there’s a change.
I respect that you
must do what you need to.
All I can do that’s left
is my best to protest
holding signs higher each time.
They’ll all start with “President Obama”
but next time I’ll find a right-hander
to write in better letters than mine.


Posted by: lesholcomb | April 18, 2009 11:15 AM | Report abuse

I think socialized healthcare works best in countries that are Undeveloped. I lived in Brasil, and they have both socialized and private. Private healthcare was far, FAR better than the government hostpitals and clinics. Better doctors who cared, and you got what you paid for. If my life was on the line, I would prefer paying years of debt off than risking the scary treatment at the social one. Private healthcare is out of reach for those living in huts, so socialized was best for them, only because its better than nothing. Sadly for them, their doctors are overloaded, underqualified, and past feeling. They wait for a weeks to get treatment, which it isn't uncommon for many to get worse or die from misdiagnosis and poor treatment.
I think most proponents for such healthcare in the US are driven by rational, but mostly ideological means of provided healthcare for all. Of course it sounds beautiful, but socialized healthcare systems are worth it in the USA. Most will argue that most developed nations have such systems, but have you lived in these nations? Its cheaper, even though they pay for it in taxes, but they hate the HEALTHCARE. The United States has the best medical care that money can buy, but the downside is that a minority can buy it, so the goverment has to cover their costs.
In Canada you lose nearly all of your coverage after 65, (when its most needed). In England you cannot get second opinions, (a principle we are taught to value). 1 in 8 Pateints in England waited over 1 year to get any sort of treatment!!! 10% of patients in 2006 reported recieving erroneous treatments. We have shortage as it is of skilled medical proffesionals (among the highest paid industry) how many will spend 12 years and 300,000 dollars in loans to become doctors if they make a teachers salary? We dont need to hypothosize, just look at England and France.
-Lots of patients, no doctors and nurses.
-Monthes to get care, which is quick and low qualitiy care,
-Dont like it? Can't get a second opinion, sorry.
-Spend Billions in taxes for a lowsy inefficient system that cant be maintained.

Posted by: jordan8 | April 18, 2009 11:21 AM | Report abuse

I read the comment by "aggressive independent" regarding the need for tort reform in any health care legislation. I agree with him that there will be no reform because Obama and the Democrats receive generous campaign contributions from the trial lawyers. Tort refrom, although needed, will never happen. Everything in Washington is reduced to politics and all about staying in power. So, when Obama talks about reform, it will not be true reform. The goal is to take over more of the economy and health care is huge. The masses won't care because they won't pay for anything. We need to look carefully at what is proposed and then follow where the lobbyist money goes. Neither party will be honest with us on this one. That's why we need to replace our leaders with those who have not been tainted with campaign money.

Posted by: saelij | April 18, 2009 11:33 AM | Report abuse

The two steps to national health care are (1) make private health insurance illegal, and (2) make the VA a national system,while requiring Congress (the Senators and Reps themselves) to use it exclusively. It works well. Its administrative costs are low. It just needs adequate funding. The money which now goes into the obscene health insurance system would pay for what a national health system needs. Canada is another model, on which a nationalized U.S. health care system should be based. Go to www.pnhp.org for a really good program explication.

Posted by: mypost26 | April 18, 2009 12:07 PM | Report abuse

POOR: Uninsured with no money in America and you will receive ER treatment although you have no money.

MIDDLE CLASS: Uninsured with a savings or an income and you will be expected to pay. THIS IS THE MAIN ISSUE. An unexpected health problem for an uninsured person can break a person's bank or put them in debt that will take years to pay off. Stressful to think about.

Conclusion: In America, it is the MIDDLE (and upper middle) CLASS, not the poor, that should be most concerned about the health care situation.

There needs to be an affordable USA option for the MIDDLE CLASS. A 100-$150 per person per month premium seems reasonable. Even some of those defined as poor could pay this.

Due to the large number of people that would be paying into the plan and the reduction in MARKETING COSTS it could even end up being profitable which would save TAXPAYER DOLLARS.

Posted by: HalBowman | April 18, 2009 12:08 PM | Report abuse

Dear HalBowman,

Why is it that there are the "poor" or "low-income" and then "the middle class". Do middle-income people have more "class" or just more toys and plama TVs.

We don't have the best health care in the world -- just a lot of high cost technology, wasteful health corporations both on the delivery and insurance sides.

Among all the other "developed countries" we are "high-cost" and "low-class" when it comes to health care outcomes.

Every other day there's an article in the paper saying that we're 37 out of 39 in this, and at best 19th out of 37th in that among 39 developed countries. Why is it that our brains can't retain that. Perhaps it's that we assume that those world statistics aren't true and just like our advertising lies that we're so used to.

I have worked in health care for almost 40 years. Up until the 90's I used to call much of what I saw here in our health care "industry" to be "third world". After that I couldn't use that term any more since there was something additional missing that had been there before, and it was insulting to the Third World to call what we have now "third world".

I can't figure out what it is beyond the usual greed, incompetence, fraud, or arrogance.

In terms of labeling, I prefer to be called a US "citizen"-- it has a nice ring and a kind of dignity. Lower, upper, or middle doesn't do much for me.

Thanks for your thoughts, they were helpful.

Posted by: lesholcomb | April 18, 2009 2:11 PM | Report abuse

Dear President Obama,
We need Healthcare Reform. The Republicans want to provide tax credits. That wont Work!!!, The Democrats want a socialistic program that will will make to cost impossible for the goverment. That wont work!!! So what to we do? You Can't please everybody, but you have to do something. I can't afford health care for my family, it cost to much. I don't qualify for wellfare I make to much. So what do I do. We need a reasonable cost program that can take care of the MIDDLE CLASS. Like Jesus said, "The poor will always be with you." But they are already covered. Its people like me THAT ARE IN BIG TROUBLE!!! Please Help!!! Thank You.

Posted by: johngerena | April 18, 2009 3:04 PM | Report abuse

Good comments, all. One thing I think those against health care expansion don't realize is that we're already paying for others' insurance, in one form or another. Every car we buy, the purchases we make (well, maybe not at Wal-Mart...) has the high cost of insurance added in. I work for a municipal government, yet have been kept at less than full-time status so I don't have to be paid benefits (happens all the time here.) Ironically, I am paying the health insurance costs of those who are denying me my same benefits. As an older adult I cannot get insurance at any cost--I've been shut out of the system. The free market has to look out for its own bottom line and statistically I'm not a good risk, although fit and healthy.

Posted by: gbs4 | April 18, 2009 3:11 PM | Report abuse

its misleading is it health care reform or government run health care its not the same thing

Posted by: getsix1 | April 18, 2009 3:23 PM | Report abuse

so far Ive never seen one thing the federal government ran worked well and did not wast loads of money can any of you list a government program that had a balanced budget worked DOD ssi medicare madicade VA our schools or roads does how about regulating or not regulating banks they seem to be great at that if they do get into the health care i dont think id trust my pet dog to there care

Posted by: getsix1 | April 18, 2009 3:32 PM | Report abuse

cheep is just that it does not mean better

Posted by: getsix1 | April 18, 2009 3:35 PM | Report abuse

I just read a very interesting article on the AARP web site. The article explains how Geisinger Health System in Pennsylvania is cutting costs and providing better patient care. So there is hope, there are solutions out there.

Posted by: email1 | April 18, 2009 3:46 PM | Report abuse

If you would like to help pressure Congress to pass single payer health care please join our voting bloc at:
http://www.votingbloc.org/Health_Bloc.php

Posted by: letsgobuffalo | April 18, 2009 4:13 PM | Report abuse

Health Care ia very complex. United States of ours is a wonderful country, a largest industrial rich country of the world ! Alas, we have large population (30-40+ million people) who cannot afford "health care insured" so called uninsured. They utitize emergency room for emergency health care needs. We spend more per capita dollars than any other country in the world to get on near bottom of the list of providing "quality health care for all" This indeed is very sad and disturbing. Solutions are not easy either, as long as our politicians have different health care for themselves and their families and do not really address the problems in all honesty. Towards end of life and multiple complex medical problems providing care, expense associated with these, becomes very emotional and ethical delima, with diminishing returns for common good. Like many western european industrialized countries (these are countries with small populations) have experienced, we all have finite resources and we have to spend them wisely. We cannot as a society, provide everything to everybody as far as health care is concerned, and our politicians have to candidly understand and explain this to their constituents. Our social obligations for common good should be that we can provide all the care necessary which is meaningful, but certainly at some point ethics should play a part in deciding when enough is enough. I know, some would say this as rationing, but if provide a public/private partenership with government paying for general all care (it does it now for almost 50% of population anyway), additional voluntary personal paid insurance coverage for "everything care", then we may be able to hopefully pay for all uninsured population and still remain competetive in the world as far as our manufacturing goes. I have spoken to my friends in canada and uk and they are not terribly unhappy with their health care. (One example: we have approx. 1 cardiologist for a population of approx. 10,000 population, in UK and Canada, there is 1 cardiologist for 90,000 population, and longevity for heart disease is similar in all these three countries ! - how would one explain this ? - granted there are some differences is quality of life, expectation and patient poplulation - but I will submit, that there are not that-that much of a difference ! ).

Posted by: kenya11 | April 18, 2009 5:07 PM | Report abuse

Is anyone in the news or editorial departments of the Washington Post willing to answer or pursue this question:

Should the solution to America's moral and economic health care crisis be based on a model in which elected officials and public employees and voters and taxpayers have EQUAL ACCESS to the SAME LEVEL of health care or continue our current MULTITIERED health insurance CLASS system?

We CANNOT craft legislation without having this public debate and then deciding (voting?) on which path to take. If it should come to a national referendum how do you think the majority of Americans would vote?

Richard Ellmyer
Portland, Oregon

Posted by: ellmyer | April 18, 2009 5:41 PM | Report abuse

Lots of fallacy and misinformation here! It will be difficult to keep it simple. First, the US government has a track record of fiscal irresponsibility; hence, a government run healthcare system would be hugely expensive and inefficient.
Secondly, "healthcare" does not mean "healthy." You don't spend increasing amounts of money on an increasingly unhealthy population. Consider this, if everyone lost 10-15 lbs, quit smoking, and stopped drinking in excess, we would have a much more manageable problem.
Being healthy does not mean access to physicians.
Next problem, there are not enough primary care physicians (nor will there be anytime soon), for you to see. So, people go to Urgent Care and ERs for treatment. Currently, approximately 1/2 of all those in these waiting rooms are Medicaid. Many of those are there with very minor (non life threatening) illnesses. With the slated expansion of Medicaid, this should rise to about two thirds (and wait times will dramatically rise). So, who is going to see you?
So be healthy and adopt healthy habits and you won't have a problem. Good health is rarely found in doctor's office!

Posted by: SWDoc | April 18, 2009 9:13 PM | Report abuse

I agree with the comments of the American Medical association, but they left out an important point. We have to ask why we pay so much and get so little for our health care dollar. The answer is our medical research to "improve health care" is being funded or strongly influenced by big business. The major goal of big business is not the health of the patient but profit for the stock holders. Example: The original, purely government funded study, on risk factors for heart disease found that a low HDL cholesterol was a much stronger risk factor for heart disease than a high LDL. Since drug companies had drugs to lower LDL (statins) but only off-patent drugs to raise HDL (niacin}, heavy funding for research on lowering LDL and marketing to patients to believe LDL was the most important risk has dominated the field of heart disease prevention. Little government research money has been spent on how to effectively raise HDL by medications. And little public information is sent out to the public from the government on how to raise HDL by diet, exercise and weight loss. Government should fund more programs in disease prevention that cannot be influenced by big business.

Posted by: rgtroxler | April 18, 2009 10:56 PM | Report abuse

Of all the countries with a better system than the US (about 37 of them) only the UK is government top to bottom and it is not the best, though far better than the US.

All that are better (and less expensive) than the UK are single payer so there is controls on costs, and the competition is for quality rather than price (that is fixed).

As a result everyone chooses their doctor from any doctor, not just the ones on a restricted list. Likewise all other choices are universal as well.

By not allowing a two tier system those in power must make care good for everyone if they are to have good care as well.

If you have a Government and private system (like Brazil) the legs will be cut from the Government system as the powerful will not care safe in their cocoon of a system just for them as the rest have nightmare results.

Posted by: FreeDemm | April 19, 2009 2:10 AM | Report abuse

I am impressed with the thoughfullness of these comments and would add my thoughts to the dialogue:
A recent headline told us that a proposal under review by the Obama administration would reduce insurance costs by 30%, basically by extending Medicare to all citizens. The underlying fallacy of this analysis is that Medicare patients appear to receive less expensive care than private insurance patients because Medicare reimbursement rates are too low to pay for the services provided to Medicare patients. The rates are set by HHS accountants and the shortfall between these payments to health care providers and real world costs are shifted by the health care providers to private insurance patients in the form of ever increased premiums. If everyone is in the Medicare system ther is no more golden goose to pick up the difference and the 30% "savings" cannot be realized.
While I believe in individual freedom and accountability, it is time to dramatically reduce our consumption of tobacco products. Sharply increasing education, shoking age and taxation are all necessary.
While I enjoy my cocktails, the same should be considered for alcohol.

Posted by: karrie2 | April 19, 2009 12:58 PM | Report abuse

1st of all we can not move forward with a national healthcare plan until medicare and medicaid programs are fixed.

Currently, we pay 25% more for healthcare in the USA BECAUSE OF THE CODING REQUIRMENTS OF MEDICAID/MEDICARE AND that they do not pay hospitals or doctors enough money for services rendered.

Currently there are 17,000 medicare/medicaid codes that healthcare providers must use to receive payment for services.

Everytime a doctor sees a patient for a specific reason, the doctor must code the sevice differently. Doctors, hospitals are spending 25-30% of their cost and time trying to just code properly. Forget about paitent care.
Additionally because medicaid/medical under pays doctors and hospitals now, everyone else has 9% added to their bill to cover these costs.

If you have insurance, your premium is 9% higher to cover underpayment by the gov't and 25% higher due to coding.

Now here's the best part. Because Doctors and hospitals have been complaining about medicaid/medicare coding and running out of codes if someone is seen for a long term item - like a diabetes sore that will not heal for example, the gov't has SOLVED the problem. They are going to ICD-10 (look this up) which will now have 155,000 codes for doctors and hospitals to use and cost over $30 billion to implement.

The system was too complicated to begin with!!!!!!

THIS MUST BE FIXED BEFORE WE EVEN ATTEMPT NATIONAL HEALTHCARE!!!!

DEMAND YOUR CONGRESS MEMBERS CHANGE THE CURRENT SYSTEM, ELIMINATE THE 25%-30% WASTE OF CODING AND 9% UPCHARGE OF MEDICAID/MEDICARE.

OUR GOV'T IS THE PROBLEM NOW. They clearly are not the solution.

Posted by: debmries | April 19, 2009 2:19 PM | Report abuse

The ONLY reason for the spiralling cost of health care is government involvement in paying for it. The government decides how much doctors get paid (and doctors lobby VERY EFFECTIVELY to increase these rates), the insurance companies are pretty much forced to use the medicare reimbursement schedule the government sets, and costs go up year after year.

Communism is what destroys economies, not capitalism. In America, the government funded part of health care is communist. THIS is why costs are soaring.

Get the government out of health care and costs will come under control.

No reform involving more government involvement can do anything but drive costs higher.

Posted by: andycutler | April 19, 2009 3:03 PM | Report abuse

Nancy DeParle's statement Wednesday that Obama's health care "reform" will consist of a universal gatekeepered managed care plan with limited access to specialty care for at least 100 million Americans with chronic health problems is the kiss of death for "reform." Beltway people can do whatever they want but the rest of America will reject it. And rightly so. Is Obama still smoking?

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then they ridicule you,
then they fight you, then you win." --
Mahatma Gandhi

Posted by: asnet | April 19, 2009 4:47 PM | Report abuse

Can someone tell me why my Mom had to die? She was between insurance companies and had a lump in her breast...they waited 6 friggin' months to operate. We thought she might be OK, but then it came back 3 years later. I'm so angry

Posted by: charlesmurphy85 | April 19, 2009 6:08 PM | Report abuse

Health Care should not only be free if not universal, for this the State has an obligation laws that demand the right to health of citizens, and must fulfill.
Thank you
Herbal Remedies

Posted by: HerbalRemedies | April 20, 2009 6:22 PM | Report abuse

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