Benny's World

Saturday, May 23, 2009

Why a Revamped Public Plan for National Health Care is Important

The Congress continues to struggle with PAC donations from insurance, pharmaceutical and the American Hospital Association --or whether or not to they tell them that our system is broken. Which do you think is winning?

Meantime, Progressive Tokyo penned at Docudharma a diary about how National Insurance works in Japan. My understanding is that it is similar in other parts of Asia, and I'm pretty certain it is the same for Germany and the Netherlands.

Every month a certain percentage is deducted from my pay check which includes both my National Health Care and my National Pension. This amount is matched by my employer. While I don`t wish to discuss my finances in detail, I can tell you every month they deduct roughly 40,000 yen (around $385 dollars) by comparison my wife who is a stay at home mom pays roughly 7000 yen (around $65) for her coverage. All children under 15 are covered for free. Once you are in the National Health Care system you are given a National Health card.

With this card you can go to ANY doctor, hospital, or clinic.

Now when you do need care you go to the provider of your choice and give them your card. After seeing the doctor and getting your treatment and/or prescription drugs you will have to pay a small co-pay. This is 30% of service cost 70% of which is paid by your National Health insurance.


Progressive Tokyo gave an illustration of what he considered affordable care:
Two days before Christmas 2 years ago I had developed a extremely sore throat and was worried so I decided to go to my local hospital in Chofu. When I arrived I had a severe fever and I could barely swallow. I walked into the hospital and was seen by a bi-lingual physician almost immediately (maybe a 5 minute wait after showing my National Health Care Card) who examined my throat, asked when it had began and took my temperature. He decided that a throat culture was necessary and it was sent to the lab.In the meantime he prescribed a painkiller and antibiotic and asked me to come back in 2 days. While the painkiller certainly helped my throat pain, it seemed that the antibiotic was having no effect. When I went back to the hospital they informed me that I had a severe case of Strep throat and I needed a much stronger antibiotic, which was prescribed immediately.

After 1 and 1/2 weeks of antibiotics I was healthy and able to enjoy the New Years celebration (unfortunately no alcohol)!

The total cost of this treatment including prescribed drugs and lab work?

Roughly 7000 yen ($65.00)

I would have said about a year ago, my treatment would have cost the same, except recently, my insurance now requires a deductible for prescriptions. Thus, I'm not clear that this more affordable than I have now, but here's the difference: he can go anytime to any doctor anywhere. I cannot do that. If it is after 8pm, I am charged $250 for an emergency room visit, or if it was more severe than a sore throat, I'm likely to still be shipped off to the emergency room. I haven't asked Progressive Tokyo if that was also the case and he seems to be offline at the moment.

I also like it that alternative medicine is covered under Progressive Tokyo's plan.

And don't forget the $385 monthly premium includes towards a pension plan. So roughly, he is paying for a pension and health care for that amount. This is a lot less than I pay for a pension and health insurance.

I did ask if PT (at the Daily Kos version of his diary) was unemployed, what would it cost, and he said $60-70 per month. That's the safety net involved, and one that many of us believe we need, but the problem then is that those who are homeless and no job, what happens to them? That's where Canada and Britain are superior.

Congress, it doesn't make sense for more insurance companies to regulate the care we get. What is more important to improve their inefficiencies and make care not just affordable but also based on performance. From the Center of American Progress (where Elizabeth Edwards is a senior fellow), here are the problems to be addressed:

How to modernize the health system to eliminate and reduce costs

Many of the problems in the U.S. health care system come from the antiquated way in which we deliver care. Most of what is done in medicine was developed in the past few decades, yet it is delivered in doctors’ offices that haven’t changed in decades and with payment systems designed 50 years ago. The result is flawed care: Many patients fail to receive adequate care, receive too much care, or receive care in the wrong way.

There are a number of areas where care is poor, ultimately leading to worse health and (often) higher costs, such as:

* Oversupply of well-reimbursed services. Most providers are still paid according to the number of services they perform rather than the quality of that care, which incentivizes doing too much.
* Failure of chronic care management. Primary and secondary prevention are not provided as routinely as they ought to be, or in settings that work for patients.
* Lack of performance data. Little is known about which treatments are best for particular patients and which providers are best at doing them.
* Insufficient competition in insurance. The insurance market for individuals and small firms often revolves around selecting healthy patients to insure rather than providing valuable care to the sick.
* Ineffective health system design. The wrong people often provide services (e.g., primary care doctors doing what nurses do better) or services are provided in the wrong way (e.g., surgery performed at hospitals with a very low volume of patients).
* Needless administrative complexity. Medical offices and insurance companies often have to hire extra administrative personnel to handle the complex paperwork that comes from dealing with multiple insurance companies and the uninsured.
* Inappropriate end of life care. Patient wishes about death are often overridden or unknown at the end of life.

I have to agree with these reforms as I believe my mother's care was not very good in the last two or three years of her life, and while I'm about to sound like a freeper, I was very disappointed in how the doctors handled her COPD care, and at the end, she died from it, with a bill of $187K. There were many hours no doctor saw her. She was given drugs that didn't help all of that much. In mid-March this year, she suffered a stroke and a heart attack within 24 hours, and it's because of neglect, to a certain extent. That's outrageous, and I think the hospital just racked up the charges towards the government (she was on Medicare), with poor assessment, and they had put a breathing apparatus on her when she succinctly did not want her life extended. I guess they wanted to keep her alive long enough for the family to get there, but when I got there, she was already in a semi-coma. I'd like to believe she heard me say good-bye, but I will never know, to be truthful. I also think I was misled that she was going to be better. My sister sensed that she would not, but what was she supposed to believe either?

So I think that the public plan needs to also exert leadership with quality care--to make these other private insurers compete successfully.

My mother probably should have been sent to hospice if there was not much they could do to save her. But no, hospice care was only covered 50%. Again, another freakin' insurance issue. Why wouldn't anyone be allowed to die with dignity and with comfort instead trying all kinds of ICU that wasn't necessary anymore? Again the difference between US and European care, in this instance.

Our President has said he would like to see a public option, but yet, after convening all of these special interest groups, it's not gotten anywhere how to hammer out a better plan. Paul Krugman had a few words to say about that yesterday:
But just three days later the hospital association insisted that it had not, in fact, promised what the president said it had promised — that it had made no commitment to the administration’s goal of reducing the rate at which health care costs are rising by 1.5 percentage points a year. And the head of the insurance lobby said that the idea was merely to “ramp up” savings, whatever that means.

Meanwhile, the insurance industry is busily lobbying Congress to block one crucial element of health care reform, the public option — that is, offering Americans the right to buy insurance directly from the government as well as from private insurance companies. And at least some insurers are gearing up for a major smear campaign.

On Monday, just a week after the White House photo-op, The Washington Post reported that Blue Cross Blue Shield of North Carolina was preparing to run a series of ads attacking the public option. The planning for this ad campaign must have begun quite some time ago.
Guess who said the same thing on September 17, 2007:



Looks like the same situation as Krugman described the ads from BCBSNC yesterday:

It’s a scary image that might make some sense if private health insurance — which these days comes primarily via HMOs — offered all of us free choice of doctors, with no wait for medical procedures. But my health plan isn’t like that. Is yours?

“We can do a lot better than a government-run health care system,” says a voice-over in one of the ads. To which the obvious response is, if that’s true, why don’t you? Why deny Americans the chance to reject government insurance if it’s really that bad?

For none of the reform proposals currently on the table would force people into a government-run insurance plan. At most they would offer Americans the choice of buying into such a plan.

And the goal of the insurers is to deny Americans that choice. They fear that many people would prefer a government plan to dealing with private insurance companies that, in the real world as opposed to the world of their ads, are more bureaucratic than any government agency, routinely deny clients their choice of doctor, and often refuse to pay for care.
And indeed, when I looked at Senate Finance plan, it tipped-toed around a public plan.

JRE once said that "joining them" instead of beating the system would not bring universal health care. And yep, I think we are still going to get screwed, with Obama saying that compromise was necessary, meaning not having it mandated and that if millions still get left out, we are still making "progress."

As Krugman said, it's up to our President to convince us otherwise. The special interests have already called his bluff.

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6 Comments:

  • Excellent column, Benny!

    Our system of healthcare is badly broken, and too many people are finding this out the hard way. Too many pay a fortune for insurance, and discover big holes in coverage and lack of quality care when it is too late. It is a disgrace for anyone in our country to receive poor medical care, and especially evil when children and the elderly suffer.

    I do not know who in Washington today might be brave enough to stand up to special interests and fight for a national health care plan as one choice open to everyone. Elizabeth Edwards is right when she says that just the possibility of a national plan option has brought swift promises of cost cutting from the private sector.

    Our country is blessed to have so many good healthcare professionals and medicine and equipment. We just need to find a way to take rampant greed, and wasteful inefficiencies, out of the picture so these are available to all of our people.

    Who will stand up for us? Who will lead on this issue with so many highly paid lobbyists working hard to kill any plan for national healthcare?

    By Blogger bettync, at 8:35 AM  

  • Thank you Benny - watching that vid made me a bit sad, knowing what might have been. We are going to get screwed, there shouldn't be any compromises to our Health Care ... wonder what members in Congress would do if their Health Plans were compromised?

    By Blogger waiting for hope, at 3:26 PM  

  • While it's not "sexy" and won't garner media attention, addressing the administrative complexity is an area that can be done quickly and with a major impact. The red tape of billing and insurance payments is so out of control that even the professionals who do the work every day frequently can't figure it out.

    I know people who have had bills excused because no one could straighten out the mess they had created. Likewise, I know people who have paid bills they shouldn't have because they had no idea what the bills were for or why payment had been denied.

    No one should have to worry about fighting with providers or insurance companies when they are ill. The nightmare bureaucracy also eats up a huge amount of money and resources that could be put to better use providing care.

    Actually, the providers and insurance companies could address it independently by coming up with standardization in some fees and billing systems. It's not rocket science but no one wants to even begin to make an effort.

    By Blogger indyvoter, at 3:26 PM  

  • Thanks Benny. I going to spread your message and John Edwards' video around the web.

    By Blogger Cherubim, at 3:29 PM  

  • thanks all who visited. Truly I believe the public option, in order to be competitive with the private options, will have to be more accountable for its care. Quality care should be the goal, not just access. But it seems like John and Elizabeth are the only ones who understand this, and neither one are in Congress or obviously, the WH.

    I don't think anyone who wasn't a big supporter of JRE/EE will understand that the vision was always more important than him and EE as people. EE is right that the work was good-- and the goals they had for making our country better was what motivated them to keep going, despite the indiscretion.

    By Blogger benny06, at 7:12 PM  

  • Very worthwhile posting, Benny. Have read that the Japanese very strictly regulate the level of profit made by private insurers. Also, the medical profession is not nearly as lucrative as here. Read three decades ago a book on how doctors at medical universities keep the supply of doctors in short supply to keep up industry salaries and the various evidence for that.

    By Blogger cybercitizen, at 11:14 PM  

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