Wednesday, July 22, 2009

Healthcare, Healthcare, Healthcare

Unless you’ve been living under a rock, you’ve probably noticed that, of late, a huge percentage of the political discussion (whether in Congress or the media) has focused on healthcare. That’s a good thing. Sorta. The problem is that, when most of us are truly honest with ourselves, the issues are so complex that most of us have nothing more than a superficial understanding of the real issues or the implications of the competing policy ideas. Add to this the fact that so many of the “experts” that we hear talking about healthcare have their own agenda, sometimes disclosed, oftentimes not. And of course the role of politics cannot be discounted (and query whether most of the members of Congress truly understand the issues either, beyond the talking points from their respective parties and lobbyists spending vast sums of money to secure their votes). Unfortunately, due to the complexity of the issues, the healthcare debate has been ripe for politicians to distort facts and mischaracterize ideas, sometimes due to a lack of understanding, but sometimes with true intent to deceive or mislead.

Thus, as we continue to the listen to the ongoing debate, there are few things that we, as voters and, more importantly, as the individual recipients of actual healthcare, must keep in mind.

  1. The “talking head” being interviewed on the evening news (or any other program) may be an “expert” but chances are that the person has an agenda, whether as an employee or “consultant” for an interested company or organization or as a lobbyist. We should demand that news outlets (and entertainment channels like FOX News) be more candid and forthcoming with any relationships that a featured expert has with an interested company (or whether the person lobbies on behalf of an interested party). Moreover, when we hear that expert voice an opinion, we must consider whether that opinion is being offered for the benefit of one side or the other. Thus, when an expert says, “Policy X will mean Y,” stop to consider whether Y would be good or bad for those with whom the expert may be involved. And consider whether the news (or FOX) are being balanced in the presentation of expert opinions. If not, ask yourself why.
  2. When you hear your member of Congress talking about healthcare, ask yourself whether that member of Congress actually understands the issues or is just parroting party-line talking points. And then ask yourself whether the opinions being voiced by that member of Congress will be of benefit to you or whether someone else stands to be the primary beneficiary. And, when you hear a member of Congress tell you what a particular bill says, don’t take their word for it; instead, take some time, go find the bill, and try to read it yourself. Or at least take the time to see if others have done a fact check on the claim. A few days ago a member of Congress gave a speech saying that page X of the House healthcare plan said that in 5 years, private plans would be eliminated (or something to that effect; the particulars aren’t important for this discussion). Simply reading the designated page revealed no such provision; yet many people will probably believe the “fact” set forth in her speech. We should also demand that our representatives cease using truly harmful rhetoric in their debates. A Georgia Congressman declared earlier this month that adoption of the House healthcare plan would “kill” Americans. How is that kind of rhetoric constructive to the debate? Finally, don’t forget that members of Congress presently participate in a government run health plan that is, by all accounts, excellent.
  3. Remember the influence of lobbyists. How much money have drug companies spent lobbying on the healthcare issue? And why have they spent that money? Obviously, the drug companies have a vested interest in shaping any healthcare reform in a way that will be financially beneficial to them; why else spend the money (and let’s don’t forget that many drug companies aren’t even American companies…). How much money have insurance companies spent lobbying? How about medical groups or trial lawyers? Compare your answers to those questions with the following: How much money have you spent lobbying? How much time have you spent talking to your elected representatives? Doesn’t seem quite equitable, does it?
  4. Insurance companies make money from the premiums that people pay. They lose money by paying hospitals and physicians to provide care to the people who paid the premiums. In other words, the more medical care we get, the less insurance companies earn. So, next time you hear a representative of an insurance company suggest that insurance companies are “working for consumers” or are on the “consumers’ side” recognize this falsehood for what it is. Moreover, if insurance companies are really so good at protecting consumers and offers such good products and services, why are they concerned with a government-sponsored plan?

I don’t know what healthcare reform should look like. But here are a few ideas:

  1. Every American should be able to access high quality, reasonably affordable, basic healthcare. During one of the Presidential debates a question was posed to Sen. Obama and Sen. McCain, asking whether healthcare was a right or a privilege. In a modern, technologically advanced nation like ours, one that strives to be the exemplar for the world, I agree with Sen. Obama’s answer that healthcare should be viewed as a right. And using the emergency room is not an acceptable substitute for quality, basic healthcare.
  2. Patients and their doctors should make healthcare decisions, not insurance companies. This issue is important to my family. My wife, as you may know from previous posts, has a rare illness that is treated by just a handful of doctors in the country. Many doctors, let alone insurers, have never heard of her illness. In fact, those time that we’ve were forced to seek treatment at the emergency room (before we knew what her illness was), the treatment given turned out to be wrong because, while the illness presented in a particular way, unless the doctor understood what the illness really was, the standard approach to treat the particular symptoms did not really help (it would make a good episode for House). So her doctor (who, until recently practiced at the University of Michigan and is now moving to Harvard) prescribed a course of medication that has largely kept her illness in check. But he has instructed her, when her symptoms do trigger, to take an extra dose of her medicine. The problem is that frequently, as the end of the month approaches, she doesn’t have enough medicine left and our insurance company refuses to pay for any extra medication because that would exceed their formulary guidelines, even though they don’t have any real understanding of her illness. The doctor isn’t some quack and the drugs are not hyper-expensive or experimental. Yet the insurance company is trying to dictate the medical care or drug treatment that my wife should receive notwithstanding: (a) the doctor’s prescription and (b) the fact that the drug treatment works. I and others like me should not have to fight with insurance companies when they disagree with the diagnosis or prescription of the treating physician.
  3. People should be able to choose their doctor.
  4. People who like their current health insurance should not be forced to terminate their coverage.
  5. Insurance companies should not be able to refuse coverage based on a pre-existing condition. One of the reasons that my wife and I haven’t found alternate coverage is that no insurer will cover her now that we know about her illness. Her only option besides keeping our current coverage would be to enroll in the state “high risk” pool.
  6. Even though I’m a lawyer, I do support limits on malpractice claims. Too many malpractice actions are without real merit and too many doctors seem to practice defensive medicine to avoid malpractice actions. That said, doctors should be competent in the services they perform and, if they aren’t, they should be held liable.
  7. Healthcare coverage should pay for reasonable preventative, wellness, and pre-natal care. If we work to make ourselves healthier in the first place (not exactly one of my great strengths), it will benefit our society in the long run, financially and otherwise.
  8. Every child should be entitled to the best quality healthcare. The health of a child should not suffer because the parent is poor or made bad decisions or is an illegal immigrant or for any other reason. We need to recognize that children are the future and we need to do what we can, as a society, to ensure (insure?) their health.

Well, I could probably go on and on about my thoughts for healthcare reform. I’ve listed a number of things that I think should be done, but, as I said from the outset, I don’t know how to get there. I do know that we, as taxpayers and consumers of healthcare need to demand more from our elected representatives as they debate the issue: more clarity, more intellectual honesty, and less political grandstanding.

One final thought. In our representative democracy, it is people who vote. Our nation was founded by “We the People” and we often talk about “government of the people, by the people, and for the people”. And it is people who need healthcare. Insurance companies don’t get cancer, drug companies don’t get diabetes, and hospitals don’t get the flu. People do. When we think about healthcare in America, we need to keep forefront in our minds, that what we are talking about is the health of people; the “health” of insurance companies, drug companies, hospitals, or others may be considered, but not at the expense of the health of the American people.

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