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.

Jim Hightower Channels John Edwards (sorta)

This video is priceless.

It's always impressive to see a politician take an unbending stand on principle, so I salute George W for going against popular opinion by vetoing the SCHIP bill, which would have extended health coverage to some six million uninsured children in our country.

Bush said that what irked him about this children's health proposal is the principle of providing government-financed, coverage which he derided as "federalized" medicine. George, you see, is a die hard privatization ideologue, and he insists that people should get their health care from the free market, not the government. The vast majority of his Republican colleagues in Congress agreed, voting to uphold his veto of the children's bill.

This news prompted Alan, one of our stalwart [listeners] [readers] in Fort Collins, Colorado, to suggest a national campaign in support of this principled stand that the Republicans in Washington have taken. Since Bush and his GOP allies don't believe in federalized medicine, Alan says it is our duty to free them of the burden of having their own health coverage paid for by us taxpayers! As a matter of principle, we must take away their government health plans and let them buy their own in the free market.

This idea offers two pluses: one, taxpayers will no longer have to pay benefits to politicians who are ideologically opposed to them, and, two, the money saved can be redirected to the millions of American children without health coverage.

Edwards has said that in the first 6 months of his first term if Congress did not pass a UHC bill, he would invoke the 27th amendment and that no one in Congress, the WH, or the Executive Building would have those privileges.

Maybe JRE could take a tip from Alan and Jim in the way of rephrasing this concept, such as "if Congress doesn't pass a UHC the first 6 months in office, they should resign their health care privileges or else I will take them away from them."

That would get the attention of the crossovers.

Elizabeth Edwards Talks about Health Care, Subject She Understands

From the WCF Courier this evening:

Elizabeth Edwards said one of the first things her husband will do if elected president is bring his universal health care proposal before Congress.

"Also on the first-day agenda is using that honeymoon period to get health care in front of Congress, so we can get universal health care passed immediately," she said.

That's exactly what Sharon Mott of Waterloo, 63, wanted to hear. She will be uninsured for another two years until she becomes eligible for Medicaid.

"I hope nothing happens before then," she said.

Many in the crowd of about 50 showed up with health care on their minds. Godert VanDerHart of Waterloo, 83, said he learned of the convoluted health care system when his wife, who has since died, suffered a stroke five years ago. It's now a top issue for him.

"He's the strongest on the health care issue," he said. "There's always been talk (of reform), but I'd like to see some action."

Under John Edwards' plan, which would require all Americans to purchase health insurance, employers must either cover employees or help finance their coverage. It would also create tax credits to make plans more affordable, and expand Medicaid and the State Children's Health Insurance Program.

When he unveiled his proposal, John Edwards said the program would be paid for with taxes, arguing the benefit of universal health care outweighs the cost. He has said the $90 billion to $120 billion annual cost could be paid for by eliminating President Bush's tax cuts on households earning more than $200,000 and by collecting unpaid capital gains taxes.

Elizabeth Edwards also sharply criticized the Medicare Part D prescription drug plan. She said if it weren't for her and her sister, her parents would vastly overpay for prescription drugs because they can't make decisions independently for health reasons.

"It's entirely too complex and too punitive. If my parents are stymied by this stuff, and they are, each month they delay (in choosing a plan) would cost them more money, and not more money just on the front end, more money for the rest of their lives."

I saw John Edwards vote on the Medicare D bill. It was a horrible bill, giveaways to drug companies who already receive plenty of R & D funding from us. I'm glad JRE said no.

JRE Buzz: Healthcare Plan on DVD Sent to Iowans

From Aaron Myers this evening on JRE blog:

Greetings from Chapel Hill HQ. During a staff meeting yesterday, our crew watched a DVD that the campaign is mailing to Iowa caucus-goers. Families around Iowa will be seeing the video this week -- and you can watch it online here. The video describes John Edwards' plan for true universal health care.

Our new DVD will arrive in 70,000 mailboxes bundled with details of the Edwards health care plan. It's a great package -- showing a real plan to guarantee health care to every American. (Right now, 47 million Americans have no health insurance at all -- 265,000 of them in Iowa alone.)

Unfortunately, we can't mail a DVD to all of you. We can certainly put the video on YouTube. Have a look.

We know that many of you are curious to see what happens here at HQ. I'll do my best to snap photos more often. And we'll introduce more of the staff (and our great local volunteers). Stay tuned on the blog. And thanks for the energy you put into the campaign.

My reaction to the YT?

My investment in this campaign is worth every penny of this video on YT and DVD. I hope Jackie and others in Iowa will invite others they meet tomorrow and Saturday to tell them to open this mail package, review the video, and really see this candidate with an open mind with a plan for one of the top 3 concerns they have.

The first of it almost sounded like a negative ad because of the music, but when the contrast came JRE explicating his plan for action on the problem, it clicked with me and kept me focused.

However, what resonated was the end, and I confess I got teary-eyed, is the man who remarked,

He keeps talking about the right and the truth, and uh while we haven't heard that in quite awhile.

And I think he would be the one that everyone could say, 'Hey, that's my President' and really mean it, and be proud of it."

Sounds like an Iowan and the rest of us. Iowa ground booters, get out there in this better weather to help get his message out.

JRE in Iowa tomorrow and Sat.

Different way to get message out as nearly 80% of Iowans have DVD players. I bet only a small fraction read the net. I wonder how this will work in light of teevee ads, and how the teevee stations will cover his town halls?

Stay tuned as there will be more buzz l8tr..

Edwards Holds Health Care Town Hall in Iowa

This video (about 5 min long) lays out Edwards' plan for health care.



To read more about the plan, click here.

He's likely to be asked about it today at the AFSCME forum in Carson City today. It will be live on C-SPAN. Edwards is fourth to be interviewed.