Where We Stand on Getting HealthCare Reform

Houston Medical ComplexUp until quite recently, healthcare has been one of the issues I've known the least about.  Aside from paying way more money than seemed to make sense for coverage and having a couple of sisters with some significant healthcare issues, I haven't had much reason to pay attention.  However, it's my nature to want to understand what's going on in our national conversations.  So, I bring you what I think of as the intelligent layperson's guide to beginning to understand this important issue that is right here, right now.   It is looking like we are going to get a healthcare bill this year.  The big question now is how different it will be from the broken system we have now.  I'm hopeful AND and watchful.  I also make the occasional phone call to weigh in with one of our Congressfolks.  As much as this issue is important in itself, it also is beginning to feel like a turning point in our democracy.  We are making our voices heard and it is making a difference.  The public option is on the table in a way it was not just a few months ago - because we forced it to be on the table.  Well, with some help from our newly elected President of course.

The Basics

I'm in a women's Political Book Group and we read about healthcare a couple months ago.  For that topic, we decided to read one or more of three books and then share our findings.  Overwhelmingly, the book, "Overtreated: Why Too Much Medicine is Making Us Sicker and Poorer" by Shannon Brownlee, was the favorite.  

The author, who has written extensively about medicine, contends that while we're looking to provide insurance coverage for all our citizens, we need also to understand that the current system is overtreating some patients, notably those who are willing and able to pay for a wide range of tests and procedures and surgeries than they don't need but that are immensely profitable for the physicians and facilities that provide them.  At the same time, our healthcare system is so overwhelmed that it fails to provide the simplest, most straightforward care that is more of what most of us basically need.  

The implications, which she then proceeds to delineate, are staggering.  It is rare that a book like this is a page-turner.  This is a page-turner.  She contends, and provides research that says, that between one-fifth and one-third of the money we spend on healthcare is unnecessary.  Her figure is seven hundred billion dollars.  $700,000,000,000.  A year.  That's for heart surgeries and hysterectomies and tonsillectomies and CAT scans and such that would not have to be done if we relied more on primary care physicians who had the time to talk with and listen to their patients and did not send them to high-cost specialists after a five-minute consultation. 

She attributes this overtreating to several things - greed, sometimes, but also a need for hospital systems to bring in money to offset the care they provide, mostly through costly emergency room services, to people without insurance.  She also talks with researchers about the enormous disparities between different hospital systems as to the types of discretionary care they provide.  It's startling to her and to us that there is so little standardization about when to take out tonsils or ovaries, for example, or how aggressive to be with mild heart symptoms.  Physicians in each system just assume that what they do is the standard, when research conducted across hospital systems or across regions says otherwise.  The need for more science in the health care system comes up over and over again. 

I would guess that the red flag that the healthcare change resistors are waving about "rationing healthcare" is code for letting the existing system continue to operate as is without oversight or competition, providing more and more profit for a bludgeoning healthcare system.   

One of the women in the Book Club sent around an article that discussed this same topic.  The article, "The Cost Conundrum: What a Texas town can teach us about health care" is in the June edition of the New Yorker.  It was written by a doctor, Atul Gawande, about the high cost of care in McAllen, Texas.  The article received quite a bit of press and was reputed to have been mandatory reading at the White House.  If you want just a sip of the argument on differences in healthcare between healthcare systems, take a read of his very well-written piece.  

Obama's Three Principles for a Healthcare Bill

President Obama tells us that he has three principles that must be adhered to in whatever bill passes Congress.  They are:

  • The rising costs of healthcare must be brought down
  • Americans must have the freedom to keep whatever doctor or insurance plan they currently have now or would like to have
  • All Americans must have quality, affordable healthcare
Seems relatively simple, straightforward and essentially right.  However, as we all know, those who have tried to implement anything resembling universal healthcare have been thwarted by the powerful lobbying on behalf of the people who make a lot of money off the current system.  

And on the Other Side

The powerful lobbying has not changed.  The WAPO had a sobering article a week ago about the huge number of former Congressional staffers who are now working for the insurance companies.  And these are not just Republicans, folks.  Several former high-level staffers for Max Baucus, conservative Democratic Senator from Montana and the Chair of the Senate Finance Committee, are now working as lobbyists.  As Ezra Klein of the WAPO says in his blog,

One of the secrets about lobbying in Washington is that money doesn't buy access. It buys people who already have access. And that makes it much more insidious.

Labor walking for Healthcare ReformCitizens Rise Up

The difference now is that we seem to have a populace that is engaged in this complex issue.  This is new.  It's one thing for Americans to get engaged in relatively simple issues, like the unfortunate Terri Shiavo incident or President Clinton's sexual escapades.  But it's very rare in my history of paying attention, that the public is willing to get down with complex issues.  And man, this one is complex. 

However, Labor has gotten involved and has been educating and activating their folks for a while.  Healthcare professionals have been extraordinarily involved and have been a very important voice for folks to hear.  Foremost have been the California Nurses Association and the Physicians National Health Program.  Bill Moyers has persistently had the best people on his show, including folks from the aforementioned healthcare profesional groups and, most recently, Wendell Potter, former Director of Public Relations for CIGNA.  And, Dr. Dean is on the case as well.

Another new force, progressive bloggers and activists, has been very effective as well in reaching our Congressfolk.  Darcy Burner has moved on to become Executive Director of a new organization, the American Progressive Caucus Policy Foundation, which has done an admirable job of organizing the herd of progressive "cats" in Congress.  A group of foremost national progressive bloggers are keeping readers abreast of the latest moves by Congress and the precise times and Congressfolk in need of calls on any given day.  It's pretty impressive.  Here's the latest for today with links to up-to-date lists of Representatives committed, leaning and wavering.  If you have 10 minutes, you can know that the calls you make are precisely the right ones for maximum impact.

It makes a difference.  Chad Lupkes, writing at the Washington State Democratic Chairs website, discusses the changes that Senator Cantwell has made, likely as a result of the many calls she received from her constituents, me included.

I will be the first to admit that my knowledge on this subject is limited to what I've been reading and watching over the last couple months.  So, please feel free to add your thoughts and reading suggestions.  Also, talk with your friends.  Have this conversation.  This, along with Climate Change, are hugely important bills that Congress is actually likely to pass.  Let's make sure they are the best we can get at this time.  Besides, having this conversation nationally and being a part of this citizen lobbying is helping us exercise our democracy muscles.

Costs and a Cartoon

P.S. Apparently, contradictory to what you may have been hearing, the Congressional Budget Office (CBO) is reporting that the House's proposed bill will either be revenue neutral or will actually save us quite a bit of money. 

And we'll end with a cartoon that sums up the problem.

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This page contains a single entry by Lynn Allen published on July 19, 2009 2:45 PM.

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