Category: Health Care

Health Care By Barack Obama

Nothing New Here

President Obama is an outstanding speaker.  Tonight’s health care presentation to Congress was no exception.  The reaction of both political parties was predictable.

The president wisely did not draw any lines that could not be crossed.  He did throw a few bones to the Republicans in the hopes of winning the support of some moderates in that party.   The outstanding of those was tort reform.

The often repeated goals of a revised health care system is

  1. lower costs
  2. cover all Americans
  3. drive quality
  4. and be paid for (without impacting the federal budget)

Unfortunately the number one goal was mostly ignored with the exception of the president’s contention that insurance companies are making added profits in the Medicare system.  He did not say Medicare Advantage programs but that is most likely the target of his comment.

There was no discussion about actually lowering costs of health care.  There was no discussion about improving the quality of care.   Mr. Obama’s focus was on ensuring that no one would be denied health care and that everyone has affordable health care by setting maximum out of pocket payments.

Unless moderate Democrats and Republicans reach a compromised plan there will be no changes in our health care system.  Today my bet is on “business as usual.”

Isn’t Health Care Rationed Now?

A sixty year old gentleman, who works for a pest control company, comes to my home every other month to spray around the outside of the house to reduce the invasions of bugs.  He was hospitalized from June 30 to July 4.  He had a blood infection in one leg.  The doctor wanted him to stay in the hospital another week.  He wanted to go home and enjoy some vacation time.  The doctor relented and he went home.  He went back to work a week later and although the leg is sore he is recovering.

He was hospitalized for four nights.  His medical insurance is denying him coverage for two nights.  The insurance company contends that two nights care was sufficient time for his recovery.

Is this a case of rationing health care?

Going Postal on Health Care

I almost forgot that Tom Purcell is supposed to be writing humorous columns. Today’s piece was definitely was not one of those. It is a very serious column that has at least one significant flaw. Healthcare insurance has been in the hands of private enterprise since insurance was invented. The postal service was included in our Constitution. Fed Ex is a recent development. So why hasn’t private enterprise done a better job? Could the answer be greed? The United States is the only industrialized nation in the world that does not provide its citizens with universal health care. That isn’t funny.

Bill George’s column in BusinessWeek does a very good job of highlighting some areas that need attention now. Mr. George is correct in saying that “Obama has surrendered policy to politics.” His proposal for health-care reform is worthwhile considering. Trying to get our senators and congressmen to listen to our ideas is nearly impossible. Many of those representatives are receiving donations from health industry companies for their re-election. It’s unlikely they will be listening to the voting public.

Update on Health Insurance Company Profits

This information was obtained from Yahoo’s financial reports site (http://finance.yahoo.com).  This is Operating Income.  You could argue that their income per share is low.  I would argue that the job they fulfill in our society requires that their profits remain even lower given their purpose.    

Quarter ending   6-30-09: Aetna $2.475 billion
  Coventry Health Care $619 million
  CIGNA $378 million
  Humana $1.073 billion
  UnitedHealth $859 million
  WellPoint (Blue Cross/Blue Shield) $3.592 billion

A Real Need for Health Care in America

There really is a need for no cost or low cost medical care in the United States.  Remote Area Medical (RAM), an organization that provides health care in third world countries came to Los Angeles, California.  Stan Brock, the founder of this organization was named “person of the week” on ABC World News.

About 1,500 (revised to 6,000) people were provided with dental, optical and other care.  Hundreds are being turned away.  One man interviewed on local television drove 80 miles for dental care.  He is employed and does have medical coverage from his employer.  He has no dental coverage and the cost of a root canal and bridge of $5,000 was more than he could afford.  The local newspaper had an item asking for more volunteer doctors.

NPR and the Los Angeles Times both had articles on the event.  It’s obvious America does have a health care problem.

Obama Wants to Limit Health Care

Seniors and the poor are the president’s targets.  In his July 22, 2009 press conference the transcript reads, “And it’s about the fact that the biggest driving force behind our federal deficit is the skyrocketing cost of Medicare and Medicaid.”  Today CNN quotes the President saying, “…must get control of Medicaid/Medicare spending.”  The problem is Mr. Obama never talks about the ways to control costs.  Will there be limits on the payments to doctors and hospitals, limits on payments for drugs, or limits on payments to insurance companies?  Ignoring the discussion on cost control, I believe, is intentional.

Once again it’s the rich and powerful versus the rest of us.  Insurance companies, large medical care businesses, and pharmaceutical companies are permitted to charge what ever they want.  There are no incentives to lower the costs.  The middle class senior relies on Medicare for health insurance.  The poor and disabled rely on Medicaid.  If it’s the middle class and poor versus the rich and powerful it doesn’t take a terribly smart person to realize who will win that confrontation.

In California the poorest among us have been impacted most by the budget cuts.  Medicaid and in home health care services were cut in the face of a rising budget deficit.  The influential and high ranking members of government were not significantly impacted. 

“If only the elderly would die without making a fuss the Medicare system will be able to handle its costs.  Why must you old people be so uncooperative?”  They won’t say the words exactly like that but everything points to those thoughts.  Of course the president denies this idea.  Unless he proposes other cost savings ideas this can be the only conclusion that can be reached.  This is disgusting.

We Need Health Care Reform

There is no health care crisis in the United States.  85% of all Americans have health care insurance.  No one is turned away from a hospital.  Most areas offer no cost medical care to low income families.  Even Kern County California, a small town and farming area, provides similar services.

President Obama is in the wrong fight.  His focus should be solely on lowering the cost of health care.  That is an issue facing everyone in America.  Health care for every American is a wonderful idea but the time has not come to make this a reality.  Lower costs will probably help to add more families to the insured rolls. 

President George W. Bush tried to revise Social Security and he failed.  The reason that these changes fail is that the public basically likes and is comfortable with the existing systems.  There is no obvious reason to change either of these programs.  It’s the American idea, “if it ain’t broke, don’t fix it (spoken) also if it’s not broke, don’t fix it.”

I skim read H.R. 3200 ‘‘America’s Affordable Health Choices Act of 2009.’’  This is not a law.  It is a proposed law or bill.  Why didn’t I read every single word?  There was too much legal jargon that only a lawyer could understand and he would have to be familiar with U.S. Code (USC).  That is the codification of the general and permanent laws of the United States.  This proposed law is 1,017 pages long.  References to advance care planning and advance directives in the bill only aid those opposing a new health plan.  Most people already know about medical power of attorney and advanced health directives.  Including help in preparing those documents in the proposed law only supports the fear that the government will try to reduce health care costs by encouraging the elderly to sign documents that will deny them medical care.

Medicare recipients are rightfully concerned about the loss of Medicare benefits.  There is too much language in this bill about changes to existing Medicare plans.  This is an alert to seniors and the AARP that savings in a new national health plan will come at a cost to seniors.  After all it is senior citizens that do receive the most health care services.  The AARP has not endorsed this plan or any plan.

 The Administration is correct in identifying serious flaws in our health care system.  Those flaws should be addressed.  Throwing out the entire system because there are a few problems is the wrong approach.  After all, most parts of health care do operate fairly well.  Cost of medical care is the number one issue according to the president.  That is the challenge that should be addressed.  I am sure there are other issues but here is my list.   Mr. President just address these issues:

  1. All medical facilities must implement on line medical records.  The benefit is the sharing of information between doctors and easy access by the doctor of a patient’s history.  Kaiser Permanente Southern California has that program in place.  The two doctor office caring for my mother still uses had written records as does my dentist.
  2. Insurance companies must be prohibited from denying health care coverage based on a patient’s medical history.  There should be no criteria for premiums.  Everyone should be pay the same rate based upon geographic area.
  3. Eliminate lifetime caps on the amount of coverage set by insurance companies.
  4. Regulations must deny insurance companies the right to cancel insurance.
  5. Insurance companies must be allowed to sell their plans in any state thus increasing competition.
  6. Generics drug manufacturers should have the right to produce copies of brand name drugs after five years rather than the current rule of no limits on Biotech drugs and standard limits on other drugs of 17 years.
  7. Develop improved Medicaid programs for those not covered by existing plans due to their cost.  The plans must be limited to those currently eligible for Medicaid.
  8. Impose excess profits tax on all health care providers (i.e. insurance companies, pharmaceutical companies, hospital associations, health care provider associations, etc.).
  9. Tax breaks for individuals similar to businesses who have no employer provided insurance.
  10. Portability and of coverage and reduced costs of coverage for those who have lost their employment.
  11. Tort reform that will reduce the cost of a doctor’s business insurance.

Just these improvements will lower the cost of medical care for everyone.  These are enhancements that both Democrats and Republicans will be willing to support.

We Need A Real Health Plan

Kathleen Sebelius, secretary of Health and Human Services, was not prepared for her appearance on Meet the Press yesterday.  David Gregory ate her alive.  David used the interview techniques that proved so valuable to his predecessor, Tim Russert.  He simply used her own words in questioning the administration’s plan for health care.

 

President Obama’s objectives were repeated by Mrs. Sebelius in an NPR interview.  She did not disavow those goals. 

 

  1. lower costs
  2. cover all Americans
  3. drive quality
  4. and be paid for (without impacting the federal budget)

She was unable to explain where there are any consequential savings in the Obama health plan.  Then she went on to admit that coverage for all Americans isn’t a priority but it is one “of the goals.”  As to quality of care she admits there will be limits but argued, fairly well, that limits exist now in currently available insurance plans.  Finally Mrs. Sebelius told viewers that the president has not taken a position on taxing the wealthy to pay for the federally sponsored plan.  He has not offered any ideas on how to pay for his plan.

 

All in all, the secretary’s appearance gave me no assurance that any part of this plan has been well researched.  I agree with those that say health care should be available to everyone just like police and fire department services.  The problem is that 85% of the population has health insurance through their employers.  The second problem is the current cost is too high.

 

If all of the above goals are equally important congress will have to devise an alternate plan.  Mrs. Sebelius confirmed that the cost of health care has reached 16% of GDP.  That should be enough of a motivator to make this happen.

The United States Does Not Provide the Best Medical Care

When I grew up in the United States I was taught that this country is the greatest in the world. Furthermore the rest of the world was far behind the United States in every way from technology to literacy to whatever.  I soon understood that the teachers were either misinformed or were intentionally misinforming the students.  You see up until the age of nine my family visited their home town, Winnipeg, Manitoba, Canada every summer.  That city looked like most cities in the United States (i.e. street cars, tall buildings, telephones, radio, etc.).

The teacher in my 4th and 5th grade classes told us that Winnipeg still had farmers bring in their crops in horse drawn wagons.  I tried, in vain, to correct this ridiculous image.  I realized that the students were probably being given incorrect information about many other things.  It was my first understanding that teachers were not infallible.  When my own mother became a teacher, as I entered college, I knew my earlier suspicions had been confirmed.

Now I find that another “fact” about the United States is called into question.  Conservative talk radio show hosts keep telling us that we have the best health care in the world.  The Central Intelligence Agency (CIA) of the United States government has a web site that provides mortality table for every country in the world.  Our country is in 50th place out of a total of 224.  Macau is in first place and Japan is in 3rd.  Canada is in 8th place.  Isn’t Canada the country most criticized for its “socialized” medicine?  Oh yes, that’s the country that still uses horse drawn wagons to bring their crops into the towns to sell at markets.

Oh, wait minute those CIA figures are all estimates.  President Obama has probably influenced the results of that survey.  The problem is that every other web site places the United States well below Canada and below many other countries in 36th to 50th place.

The reality is that 45 million Americans are not covered by any health plan.  Arguments that no one is turned away from an emergency room, does not mean they are covered by a plan.  No plan means that you only go to the doctor when it is an emergency.  The consequence is the individual pays the full fee for every visit and those visits are more likely than not to an ER.   

Have you gone to an ER when you are covered by a plan?  My daughter had chest pains that lasted for half a day.  She thought she was having a heart attack.  She has Blue Cross medical insurance.  It’s a plan that requires her to pay 100% of the first $3,500 of annual medical fees.  Her cost for that visit was over $1,100.00.  If you do not have any insurance plan the ER will charge you an even higher rate and payment is due immediately.

Do I support abandoning our employer provided insurance system? NO!  The objective is to provide coverage for every American.  That probably means some type of Medicaid system.  How will that be accomplished without destroying the employer based system?  That’s the trillion dollar question.

Long Term Care Insurance

If you are very rich you can afford to hire a care giver or live in an assisted living facility or nursing home.  If you are not rich your family will have to struggle with the reality of giving you care.

 

I enrolled in a Personal Finance class at my local community college (Pierce College, Woodland Hills, CA).  The description said, “learn the basics of investment strategies, The new Medicare RX plan, Long Term Care Insurance, financial planning, the law, as well as techniques to minimize taxes, and how to create an income in retirement.”  It turned out that two of the six classes I attended were sales pitches.  The other four provided very little in the way of new information or ideas.

 

One session was presented by a man who claimed to be a financial adviser.  His real purpose was to enroll class members with his firm that manages your savings.  The cost is just 1% of the value of your investments per year.  He would not consider anyone with less than $250K as a client.  So that is a mere $2,500 per year for the least eligible client.

 

Another session, my last, was a series of scare tactics to enroll with the presenter for long term care insurance.  This presentation was made by a woman who wore dark sun glasses during the entire presentation.  I felt like I was at one of those presentations at a local restaurant that includes a free lunch.  She cautioned the class to disregard Consumers Reports evaluations of this insurance.  After questioning her about the soundness of the insurance companies offering these policies, and being asked to be quiet by the class instructor, I left the room.  Reaching my house I, of course, immediately went to the Consumers Reports website.

 

Here is what I found on the CR website.

Sales pitches and their catches

To sell you on long-term-care insurance, agents may play fast and loose with the facts. These pitches are drawn from an insurance-industry publication and interviews with agents.

The pitch: You need to buy long-term-care insurance when you are young. More than 40 percent of people who need long-term care are under age 65.

The catch: Only 159,000 of the 238 million people under age 65, or less than 1 percent, receive nursing-home care.

The pitch: There is nearly a 50 percent chance that a person will require 24-hour care in a skilled-nursing facility.

The catch: One percent of those ages 65 to 74 live in a nursing home, 4 percent of 75- to 84-year-olds, and 19 percent of those age 85 and older.

The pitch: If you are over age 65, you don’t need inflation protection.

The catch: According to the most recently published figures, the average age of admission to a nursing home is 83, and costs are expected to rise more than 5 percent a year. At age 65, you face 18 more years of inflation.

The pitch: You’ll get into a better nursing home if you have insurance.

The catch: While some nursing homes may prefer to take residents who do not have to rely on Medicaid, there is no guarantee that those homes provide better care. To check on any nursing facility you are considering, visit the ConsumersUnionCenter for Consumer Health Choices Web site at www.consumersunion.org/health/nursing-rpt603.htm.