Tales from the Trail

The miracle of Obamacare

July 24, 2009

President Barack Obama is pretty smart, but can he really achieve the impossible?

Extend healthcare coverage to 47 million uninsured people without rationing coverage to the rest of the country, while at the same time actually reducing healthcare inflation.

Finance the whole thing without hurting the middle class or pushing up the budget deficit. Achieve one of the biggest reforms in American history, something that so famously eluded his Democratic predecessor Bill Clinton — and get it all done without any pain.

Millionaires might have to pay more tax, and insurers might be kept “honest” by a government-run insurance option, but what’s surprising about this debate is that more people aren’t squealing. OBAMA/

When he was asked this week what the American people might have to sacrifice to get all this through, Obama had what might seem an unlikely answer.

“They’re going to have to give up paying for things that don’t make them healthier,” he said.

Reuters correspondent Steve Holland wrote an analysis  about the master salesman’s struggle to sell this particular reform to the American people.

Kevin Sack in The New York Times wrote a piece which nailed the public’s reaction pretty well too.

Is painless healthcare reform really possible? Or is someone somewhere not telling us something?

The beauty of Obama’s strategy so far is that he has kept everyone “inside the tent.” By keeping his own cards close to his chest, he has kept everyone else in the game. But is it time for Obama to show a little more of his hand?

Click here for more Reuters political coverage

Photo credit: Reuters/Jason Reed (Obama listens to five-year-old boy at healthcare meeting in Cleveland)

Comments
4 comments so far | RSS Comments RSS

Why isn’t anyone inquiring about: WHY our health insurance costs have gone up?? Does anyone realize that health insurance goes up BECAUSE health care costs have gone up? We are putting the cart before the horse. We should be addressing the rising cost of health care first. If we get the health care costs under control, our health insurance costs adjust accordingly. Just like most other industries, health insurance is a very competitve market. If Wellpoint ( health insurance giant ) gets lower claim costs from the health care providers, their best interest is to then lower the costs of premiums. I.E. to gain MORE market share from their competitors such as, ( UnitedHealthCare ) and guess what, other health insurance companies MUST follow suit to stay in business. Insurance companies can’t loose all their business to another carrier. Bottom line, we must pay attention to the rising cost of health care FIRST. Someone on capital hill should pay attention to the actual root of the problem, overpriced health care costs. Besides, does anyone realize that the top 5 pharmacutical companies pay OVER 5 Billion a year to advertise their drugs! Who pays for those t.v ads?? We do, in our health insurance premiums!

Posted by Knalker | Report as abusive
 

You hit the nail on the head! Until this is the central theme of health care reform – there will be no reform. At least not sustainable long term cost effective reform.

This is the key element Mr. Obama has failed to grasps. We all know about the denied claims, but they are NOT the central issue. But, it paints a populus picture he likes to shine in. It also plays to the ignorance of the general population on this topic.

Posted by EB | Report as abusive
 

Let me assure you that the quality of health care available in this country is second to none. I find it insulting that politicians refer to their meddling as “Health Care Reform,” as though our training or expertise were not adequate to meet their standards. No one is turned away from emergency rooms in my home state of New Jersey if they require emergency care, regardless of their insurance or ability to pay. The technology, pharmaceuticals, and skilled health care providers available to every person is unmatched anywhere in the world.
A large part of the reason our mortality figures are not the highest in the world stems from the fact that we are a heterogeneous and free society. If you choose, for example, to eat yourself into morbid obesity, the medical field can — and does — aggressively treat the secondary diseases such as heart disease, hypertension, diabetes, and joint destruction that result from that obesity with the latest and often most expensive treatments available. Not only do these treatments cost significant amounts of money, but the result is that patients survive far longer with these chronic secondary diseases than they could in the past, driving up the cost of health care.
However, despite the best care for these secondary diseases, they still take a toll on the body, so people manage to die younger than they otherwise might. This is NOT a result of a lack of health insurance, nor is it a result of a lack of quality care. It is simply a result of the personal freedom we all possess in this country, even when our choices are self-destructive.
Perhaps other cultures pressure individuals to conform to standards, thus yielding a healthier underlying population. Perhaps other cultures favor home-cooked meals over fast foods. Perhaps there are other factors of which I am ignorant that make a few other countries capable of longer life spans than the average in the US. In any event, personal freedom is at least part of the cause for the discrepancy, but sacrificing personal freedom for this reason would be a fate worse than premature demise from self-inflicted disease.
Infant mortality is another statistic often quoted as being better in countries spending less on health care. Again, from my personal experience, I can attest to the horrors of infants being brought into city emergency rooms here in the US because their parents chose to neglect them to the point that they were in mortal danger. The story often involves drug addicted parents who take their government handout checks intended to provide food for their infants and instead sell them on the streets to buy drugs. Fortunately, this is not a daily problem in most hospitals, but there is no question that such behavior skews the infant mortality statistics against our country.
Drug abuse and child neglect are repugnant, but in the absence of a roving gestapo, they are unlikely to disappear overnight. Well-intentioned government assistance and housing have failed to stop this kind of behavior. Infants and children subject to such abuse who are discovered and brought into the health care system receive unsurpassed care. However, the laws often require that they are returned to their parents, only to face another round of this Russian Roulette. Surely, no amount of health care finance reform will break this cycle, as again, these problems stem from a culture of anonymity and a lack of morals and ethics.
Politicians contend that proper preventative care can decrease the prevalence of self-inflicted disease, and many studies suggest that there is clearly a correlation between physician recommendations and changes in behavior favoring a healthier lifestyle. However the majority of patients never make the effort to improve their health, and physician contact is probably no more effective than a well-designed public service campaign by the Surgeon General. After all, how many people actually do not know that smoking causes disease or that obesity leads to health problems? Surely it makes more sense and is far less expensive to initiate an aggressive public service campaign championing healthy lifestyles and choices before dismantling the finest health care system in existence!
Insurance companies, like any company, must make a profit. Generally, their profits should be kept in check by vigorous competition. The anti-competitive laws that prevent interstate health insurance sales stifle this needed competition, creating localized monopolies for individual carriers. These monopolies foster inefficiencies and lower return on health care premium investments. True reform would allow consumers to shop across state lines for policies that best met their needs while insurance companies competed aggressively with one another to provide the greatest value for their insured.
Lastly, the shameful absence of any effort to rein in the indirect costs that the tort law system adds to the price of health care suggests clearly that the goals of the reform zealots have little to do with controlling unnecessary costs in the system.
No health care financing reform bill can be taken seriously if it does not address tort law, fund aggressive public relations campaigns to encourage healthier lifestyles, and allow free market competition to maximize choice and minimize inefficiencies in the system.

 

I quit practicing medicine in 2003 at the age of 43. Like most doctors, I went into medicine with a lot of idealism. The first half of my medical career was in the Army (they paid for my medical education). The second half was in private practice.

In the Army system, a single payer system, I was free to focus my attention on patient care, as were my colleagues. Conversations between doctors revolved around the latest medical research on how to best care for our patients. I never thought about how much money a particular treatment option for a patient would earn for me – I was paid a salary and it was the same no matter what treatment options I chose. I never had to deal with getting an insurance company to pay me for my medical services after I had already given them. I never had to argue with an insurance company after they denied my treatment plan for a patient as “medically unnecessary.”

In private practice I was horrified to see how money was the driving force behind everything doctors did (do). Doctors talked with each other about opening their own specialty clinics to capture fees that had previously gone to hospitals. Over the years the discussions at medical conferences began to devote less time to the science behind new innovations and more time to teaching doctors how to make money with the new innovations.

Worst of all, I saw patients routinely suffer from unnecessary, expensive, and often harmful treatment interventions that were clearly chosen because they earned the most money for the doctor and the hospital.

I even had the bizarre experience of having an insurance company try to convince me to pursue a series of invasive surgical procedures in a particular patient instead of the much less expensive exercise program I had recommended because the series of surgical procedures was in their algorithm for treating the diagnostic code I had assigned the patient and exercise wasn’t.

And, I haven’t even mentioned the problem that since I graduated from medical school in 1985 there has been a huge shift in who finances medical research. It used to be government and universities with an interest in advancing medical knowledge. Today most medical research is financed and directed by pharmaceutical companies and their main objective is getting research data that can be used to market their products – whether the products are really useful or not.

I am speaking from an entire career’s worth of experience. There is no place for “free market ideas” in medicine – not if you want your doctor to actually take care of you.

Posted by monteladnermd | Report as abusive
 

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