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.
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.
Commander in Chief Obama Speaks at Naval Academy Graduation
Kind of cool, I think. Inspiring to the graduates there. Perhaps they had expected John McCain, but instead, they get the new commander.
Here's some text from President Obama's speech, courtesy of the WH blog:
After an era when so many institutions and individuals acted with such greed and recklessness, it's no wonder that our military remains the most trusted institution in our nation. And in a world when so many forces and voices seek to divide us, it inspires us that this class came together and succeeded together, from every state and every corner of the world. By building an institution that's more diverse than ever -- more women, more Hispanics, more African Americans -- the Naval Academy has reaffirmed a fundamental American truth: that out of many, we are one.
We see these values in every one of these sailors and Marines, including those who have already served their country -- the dozens among you with prior enlisted service.
It's the perseverance of Elvin Vasquez, a Marine supply chief in Iraq -- who finally got into the Naval Academy on his third try -- who never gave up trying because he says, "there's just something about being a Marine."
It's the example of Carlos Carbello -- -- who left the tough streets of L.A. to serve on a destroyer in the Pacific and who has used his time here to mentor others, because he's the oldest midshipman -- the old man -- at the age of 26.
It's the patriotism of Sade Holder -- who came to America as a child from Trinidad, enlisted in the Navy and then earned the titles she values most: "U.S. citizen" and "Navy Midshipman" and today, "Ensign."
And it's the reverence for tradition shown by James P. Heg -- a communications -- a communications maintenance Marine in Iraq who today is joined by the man who first urged him to sign up, his grandfather, returning six decades after he was a midshipman, a submariner from World War II, 89-year-old Captain James E. Heg.
Honor. Courage. Commitment. These are the values that have defined your years in the Yard and that you'll need in the years ahead as you join the fleet, and as you join and lead the Marines, as you confront the ever-changing threats of an ever-changing world.
Congrats to the Navy officers and our new defenders. I wonder if JRE had been president if he would been asked first by one of the academies to be the speaker at Annapolis, as Elizabeth's dad was a naval pilot.
After being on Tweety's show last night, Elizabeth Edwards went over to the Willard Hotel to address the National Press Club. About 300 attended this sold-out event.
According to the NPC web site, Elizabeth read from chapter one of Resilience about her father and his determination to live and walk again.
Not certain what questions were asked, but she also spoke about "motherhood, about how she always chose family first over her career as an attorney, about her breast cancer and how she is best using her time in the face of a terminal diagnosis."
Diane Rehm may be the exception to any suggestions to EE that I have offered on this blog about women interviewers; Diane Rehm is solid, asking questions about areas others have covered, but less so in a pointed way. Interview: http://wamu.org/audio/dr/09/05/r2090521-26155.asx
It's clear that EE is comfortable with her, and I'm glad. Elizabeth shines on her own, but she can speak the truth with Diane.
Thanks, Diane, you seem to get it about marriage and personal tribulations.
Please listen to the interview: it's worth the time.
Update: here's the video clip of the interview with Chris Matthews. Matthews had a very different take; more about JRE as a political candidate.
Good luck trashing another woman in terminal cancer, chick. Get over it, otherwise. That person would do anything to get the sordid details, but not respect Elizabeth's openness otherwise. Bet that person wishes life and stories plopped her direction, but...guess what, it's not all about that correspondent, as much as she is trying to make it to be about her.
The women interviewers (barring last weekend on Today Weekend) have been the worst about Elizabeth's opinions. They have attacked her mercilessly because I think they are po'd at themselves about similar situations, but take it out on EE.
It's no wonder why I have more male friends than women, but I do have some special women friends from meeting JRE and EE. And always will.
The View will interview EE tomorrow. Unfortunately, I'm concerned they will be like Oprah, too interested in the affair, rather than Elizabeth's gifts that she's brought to the table in her book. But surely, they could be no worse than Oprah.