The Top Five Controversies in Health Care Today
Published December 30, 2008 @ 08:01AM PT
The notion of comprehensive health care reform is not controversial anymore. Indeed, a December 2008 Washington Post/ABC News poll found that 77% of Americans, cutting across the ideological spectrum, felt that President Obama should tackle a major overhaul of the health care system, with a majority saying he should do so immediately after entering office.
But aside from a notion that our broken system needs fundamental change, there are significant differences of opinion as to when and how politics or policy should intervene.
1. Tackling Obesity
When we’re obese or overweight, we’re at increased risk for hypertension, type 2 diabetes, coronary disease, stroke, cartilage degeneration, respiratory problems and a host of other medical ailments, including some types of cancer. This explains both why the Center for Disease Control collects standardized data on obesity from state departments of health each year, and why those stats should make us nervous. In 1990, no state had a prevalence of obesity greater than or equal to 15% of the population. By 2007, thirty states had a prevalence greater than or equal to 25%, and three of those states had a prevalence greater than or equal to 30%.
We, as a nation, are gaining too much weight.
On the one hand, it should be no surprise that behavior and environment are major factors for this. In poorer areas and the inner city, fast food chains are ubiquitous and access to fresh vegetables is poor. A more sedentary lifestyle for children at home, at school and in child care, combined with the allure of sugary snack marketing has caused childhood obesity to more than double in the past 20 years.
But on the other, many Americans are overweight due to genetics, metabolism or socioeconomic conditions. How can government intervene with those who could easily combat the factors that cause them to be overweight without stigmatizing those who could not? How will the libertarian instincts of Americans respond to any attempt at regulation or taxation of hamburgers, potato chips and beer – even if it’s for their own good?
2. Compensation for Primary Care Physicians vs. Specialists
There’s a reason why increased investment in primary care and prevention is touted in any serious health care reform plan. But there’s also a primary care physician shortage already in this country, to the tune of 45,000 or so. If we were to enact universal coverage, that shortage would quickly turn into a crisis. Why aren’t doctors going into primary care as much as other specialties? There’s one factor we can’t ignore anymore: compare a pediatrician’s average salary ($175,000) to a cardiovascular surgeon’s ($558,719).
Certainly, some specialties often require far more training, worthy of additional compensation. But how do we make it more lucrative to be a primary care physician? Should the government more aggressively control compensation, as they do in Japan and Germany, to bring specialists and primary care physicians more into parity? Should we offer additional support to medical students and residents who intend to go into high-need primary care roles? Or should we recruit more nurse-practitioners who can take on many though not all of the functions of a primary care doctor?
Despite the potential for system-wide catastrophe, someone will be angry no matter which path we pursue.
3. Redefining Success in Health Care
One of the most enduring myths of the American health care system is that it’s the best in the world. Well, we do have the biggest machines, the latest drugs, the most experimental procedures, and spend the most money. Big Pharma regales us with tales about state-of-the-art drugs developed only in the U.S. Technology companies talk about how their medical device has helped revolutionize medicine. Heck, we have nearly twice as many MRI machines per 1 million people as any nation (except Japan). But at the end of the day, those factors are anecdotal at best, completely irrelevant at worst.
Sure, we’re somewhat better in some cancer treatments and smoking cessation. But those aren’t the metrics we should be using to define the best health care system in the world. Instead, we should be looking at life expectancy, preventable deaths, infant mortality – all areas in which the United States dramatically lags behind other nations. And that’s not even mentioning those in this country without access to affordable health care.
Health care isn’t Christmas morning. Yet some still define success by who has the best toys. It’s a fight that’s not going away.
4. Recognizing How Money Affects Medicine
When asked about a skill they’re familiar with, most people think they’re better than average – even though that’s mathematically improbable for all of them to be so. So too, most health care providers think they’re immune from being heavily influenced by the role of money in medicine. Health care workers and administrators are all too familiar with the hoops they have to jump through to provide quality health care for their patients in the face of insurance companies looking for a reason to deny their claims. But that’s just part of the problem.
Think about the effect on prescriptions of that 5-minute visit from the pharmaceutical rep who leaves behind pens and notepads emblazoned with a pharmaceutical company’s logo. Or how the constant need to see enough patients to be profitable alters the behavior of doctors. Or how the fear of medical malpractice lawsuits influences doctors and hospital administrators and yields the practice of wasteful “defensive medicine.”
Many would say these factors are overblown. Doctors would tell you that they’re intelligent enough to see through the sales tactics of the pharmaceutical companies. Progressives would tell you that only 0.9% of all malpractice suits end in a jury verdict for the plaintiff.
But when pharma is investing as much as ever in face-to-face marketing, and when an average interaction between a doctor and a patient means the doctor only waits 23 seconds before interrupting… well, we’ve got a lot of ‘splaining to do.
5. The Continued Role of Private Insurance
The fight for universal health care is beginning to resemble a wrestling free-for-all. In one corner, you have the insurance industry, which is willingly asking for increased government regulation, but thinks itself sufficient to insure all Americans, with no expanded or new public programs necessary.
In another, you have advocates for a single-payer system, for whom nothing less than the dismantlement of the for-profit insurance industry and the institution of a public “Medicare for All” system will suffice.
In still another, you have the supporters of the model espoused by Jacob Hacker, Barack Obama, Max Baucus, and Hillary Clinton, with a public system based on Medicare in direct competition with private insurance, which will either yield a more efficient private insurance industry, or a robust public plan that can ultimately evolve into a single-payer—or both.
In yet another, you have a new faction of conservative and progressive thinkers who think the problem lies with getting coverage from your employer, not whether the coverage is public or privately provided. Their solution calls for the dismantlement of employer-based health coverage, empowering consumers.
In still another, you have free market purists for whom any government intervention in the industry is tantamount to “socialized medicine” (most people aren’t clear on what that means, but man, it sounds scary!)
Nothing fractures consensus on the need for health care reform like the role of private insurance. A comprehensive solution will only involve one of the above approaches – and which one is truly anyone’s guess.
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Comments (11)
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Tim has been an online organizer and blogger on health care policy for the Obama for America campaign (during the primaries) and currently for the Committee of Interns and Residents/SEIU Healthcare, a labor union for intern and resident doctors. Views expressed here are Tim's, and don't represent the positions of CIR or SEIU.
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It is very disappointing to a supporter of a single payer system like myself to learn that the most influential people in the new government are planning to maintain the insurance industry. Well, there is quite a variety of roles for this industry in a single payer system. (Please read the 2004 WHO report, What are the equity, efficiency, cost containment and choice implications of private health-care funding in western Europe?) Obviously, insurance can cover items of healthcare which are beyond the basic benefits to which everyone is entitled. But beyond that is the possibility of covering some of the same basic benefits (tweie), but at a carefully regulated profit rate, as in Germany. Can we now do regulation? Eliminating advertising and teams to deny coverage will save citizens a lot of money; so will eliminating the multiplicity of insurance forms that most doctors have to contend with. The main problem in control of a system with significant duplicative private insurance is to guarantee that access will not be compromised. This problem of social justice has yet to be solved. But if we are looking at cost, it is clear that even the regulated overhead of private insurance is 2-4X as great as that of public sector coverage in each country. A country that has a serious economic problem, like the U.S., cannot afford private insurance any longer!
Posted by Paul Friedman on 01/14/2009 @ 08:38PM PT
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I am disabled for several years. An American who has worked and paid taxes since I was 14, I do not see any support for Medicare, the cost of which goes up every year, while its benefits for me and my doctors decline, and the "pharmacy coverage" has a great big hole in it that you wouldn't believe.
the President-elect's stimulus package includes, for Health care The proposal would spend $39 billion to subsidize health care insurance for the unemployed and provide coverage through Medicaid; $90 billion to help states with Medicaid; $20 billion to modernize health information technology systems; and $4 billion for preventative care.
Why do we need 90 BILLION for medicaid? Are we going to continue providing free healthcare for illegal aliens and continue to let them invade our country?
Medicare has a 3% overhead cost to administer. HMOs/PPOs get something like 33% overhead. Why aren't we outsourcing the HMOs and PPOs and let Medicare administer all healthcare. That 33% overhead can be poured into the coffers, and several new service plans can be defined based on cost. We need to do something about income tax, to unburden the poor, tax the illegals 50%, collect a declining FICA tax percentage from the rich ($250k/year is not RICH), such as a flat tax with teeth so that the poor are not burdened and the illegals do not benefit, we can fund health care and administer it with a working, efficient model.
Posted by Joanne Martino on 01/15/2009 @ 03:58PM PT
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Sorry to "hog" the posts:
Tackling obesity. I find "high fructose corn syrup" in almost every processed food. Who would expect that in a loaf of bread? This stuff makes the brain think it is still hungry: it is like an addictive drug to make people never realize they are "full".
Wheat is in almost everything. One of the higher percentage allergens that causes big bellies, why do I find wheat in potato bread, oat bread, rye bread, and so on?
The food industries need to be audited by nutritionists to determine alternatives for bad ingredients.
Packaging 100 calorie snacks is a horrible waste of packaging. So is bottled water that makes no claim of purity.
Posted by Joanne Martino on 01/15/2009 @ 04:05PM PT
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Someone Talk to this lady and listen to what she sais
if Gvernment thought like her, Americans would be healthier, our enviroment would be healthier, our choices would be greater, "One ounce of prevention is worth one pound of cure" some people might even get cured god forbid of diseases, political reasoning would not enter into the equation , Americans Health would.
Greater prevention equals less sick, less need of money infusions from Gov.
Expansion of approved treatment options, more healthy Americans. (Accupuncture, Chiropractic, etc..etc.. should be covered as they prevent chronic diseases and acualy cure afflictions, without surgery nor drugs they should be promoted not limited, these are just common sense adjustments.
Here go check out what American Health is really about, pretty much a Political ground battle and little to do with assuring our Health :
Rima E. Laibow, MD
Medical Director
Natural Solutions Foundation
www.HealthFreedomUSA.org
This is one who doesn't speack with a forked tongue and who knows how first avoid , then work to cure with treatments that are usualy less bad than the treatments.
Existing Laws and lobbyist pressures is what is determining our health care options and results, time to change the sistem and make health care , its main objective, if it benefits the american people's health , that should be the deciding factor and if others loose millions because of it , Tough . That's health CARE . everything else is BOLONY !
Posted by Jai Mati on 01/19/2009 @ 10:29AM PT
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While all of these are concerns when it comes to our healthcare, or a lack thereof, I see nothing here addressing Mental Health Services. I don't know about other counties, but here in Duval County, Mental Health Services, especially among low income families is virtuality impossible to access. The clients I see are often suffering from depresion, anger problems, substance abuse and a host of other mental health problems. These people can not see a psycharist if they don't have health insurance. Many of them don't have an income and without the counseling and medications they need, they cannot hold a job, or properly care for themselves or their children. Mental Health reform has to be included in any healthare plan that is formed.
Posted by Anna Matthews on 01/21/2009 @ 08:29PM PT
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I believe the biggest issue in healthcare that need to be resolved fairly quickly is: lack of adequate healthcare for the poor, the disabled, the elderly, and the uninsured or underinsured.I think whether it is a single-payer system or a regulated industry, what needs to be done asap are for all citizens and green card holders: 1) Change the laws so insurance companies cannot exclude pre-exisiting conditions (this is for people who need to change their insurance, such as if they become unemployed or they lose their insurance or have no insurance to start with), 2) Provide free or low-cost insurance based on a graduated percentage of income such that people under certain income levels (based on family size and cost of living in their areas) would pay nothing to get coverage for current on-going conditions and medications and lab tests, new serious illnesses, emergencies, etc. As their level of income increases above the lower limit, they would pay a percentage of the basic cost until some higher limit is reached, where they would pay the full basic amount (current programs like Medi-Cal in California have income limits that are WAY TOO LOW).
I really believe that people who have insurance through their employers and people who are wealthy can get good medical care. The biggest problem in this country is for people with no income, low income, unemployed, employed but working for companies that don't provide insurance, and the disabled and elderly. These people need access to quality healthcare immediately. I know many people who cannot work or pay their bills becasue they have serious illnesses and cannot affor to get proper treatment so they can get healthy enough to work. I believe that resolving the above issues ASAP would give us the biggest bang for the buck.
Posted by Jim Huether on 01/22/2009 @ 10:30AM PT
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Convert to a national single payer system. Remove the constraints on the system imposed by an unethical, irrational and inefficient insurance industry. Begin a real healthcare program by continued focus on prevention and early intervention. Increase accountability for bad outcomes with a rapid response team that uses health courts and a central reporting center, rather than the present cumbersome and ineffective medical malpractice system. Constant refinement of the delivery of healthcare can proceed in this way with multiple, immediate response feedback loops. Give caretakers and patients adequate time to review and correct past medical records as well as to discuss risk factors that need future intervention. Emphasize constant information reliability and use this for evidenced based medical interventions. Interface with law enforcement in a more rational way to truly provide public safety in the communities. Eliminate the war on drugs which has been a failure and has caused harm to individuals and communities while costing taxpayers billions. Change to a consumption tax system and leave regular income alone to pay for only health care and social security. Abolish the IRS and the incomprehensible tax code. This will save billions to be used for other areas that represent real value in the national economy.
The present healthcare system is in a state of catastrophic failure. Immediate, dramatic action must be taken...
Posted by shawna murray md on 01/26/2009 @ 10:16AM PT
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One thing we truly need is to have advocates for patients. I am going through a drama now. I had a biopsy of leg muscle on Dec. 4 2008. I am still waiting for final results (prelim results were sent to my doctors Dec. 14 but the electron microscopy has yet to be done). Medicare and myself have been billed.
I called the hospital where the labs were being done to complain about being billed prior to results and was told by "customer service" that they are only there to make payment arrangements. I asked to speak with a supervisor and was told I could talk to voice mail. Finally I asked for a patient advocate. She called the lab and was told the results had been faxed to my doctors on Dec. 14. I called the doctors back only to find that these results were only the preliminaries.
I have waited almost 8 weeks now to find out if I have muscular dystrophy. My doctors offices do not call me--I have to call them. Today, I was told to stop calling so often (I have called 3 times in 8 weeks) because they have "many other patients". When I stated there is no communication unless I initiate it, I was told "we have many other patients and cannot keep track of remembering to call the lab about one patient". When I asked what I should do (I am a total emotional wreck waiting to find out what is wrong with me) to get information, I was told I should wait and the doctor will call me when and if there is any information.
I asked the medical assistant to read to me what the report said about the pending work and found it said "the remaining specimin is being kept in formalin pending a possible electron microscopy". This means that the test I've been waiting on has not even been done yet. I asked if it had been ordered and the medical assistant said she didn't know. I asked her to ask the doctor and she told me she would but that I should not call her back but wait for her to call me and that it wouldn't be today---maybe next week (today is Monday).
The fact is that I do have the best doctors in town. I do not doubt their skill or talent but I find that I need an advocate to make sure things are getting done and that I get information at all. The hospital lab can't talk to me and my doctor's offic won't.
If we had universal care, I sincerely hope that patient advocates would be part of it to make sure that things are done, labs followed-up and have someone to help the patient to get things done that the doctors offices won't or can't do and to go between the doctor and patients to ensure communication of some kind.
In the meantime, I am calling Medicare to have them investigate why I am being billed prior to final results from the lab. Sounds like possible medicare fraud to me! A simple biopsy test should not be over $1,000.00 (my share is $60.00 which is still hard to handle on less than $1,000.00/month in Social Security benefits but who cares? Now Washington!)
Posted by Steve Cannon-Engl... on 01/26/2009 @ 04:26PM PT
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It seems to me that who administers our health care system should not be our highest priority. But I will go on record as one who does not feel the government should take over that responsibility.
As a survivor of Crohn's Disease for over 43 years, I have learned that toxic pharmaceuticals, pesticides, preservatives and other additives in our foods have caused more problems than any illness I have ever encountered. The greed and misuse of trust in our present health system has played a great part in causing illness and keeping the American people ill. Keeping us alive is one thing, but our quality of life is quite another.
Our first priority should be to realize the prepaganda in almost all phases of our society, which teaches us that our only proper health alternative is pharmaceuticals. The rising costs of these pharmaceuticals is prohibitive in many cases.
Very insidious tactics are being used to gradually take away our natural health supplements such as fish oil and nano silver. Scientific evidence shows their effectiveness without any toxic additives, i.e., a lack of omega-3 oils can cause depression in children.
Pharmaceutial companies are crafting prescription fish oil and prescription nano silver products so that they can sell a toxic product at much higher prices to insurance companies. The natural products should be considered by doctors and suggested to insurance companies by doctors. It would be in the insurance companies best interest to pay for them at a much lower cost rather than allow the pharmaceutical companies so much power.
Right now I consider the pharmaceutical companies to be more damaging than the cigarette companies were. What is the difference in what cigarette companies did and what pharmaceutical companies are doing? It seems they have taken over the medical schools and the FDA. This is where we need to start.
We also need to consider our great problem with food additives that are toxic. How many toxins are tested on rats at one time? If you read the labels, you will note we eat 20 to 30 additives in a meal, many of which are toxic chemicals. Do researchers combine 20 to 30 toxins to test how much damage is done to a rat? The only cure for Cancer may be to quit consuming so many toxins. Let's try that on our children and see how healthy they become.
Beverly Dearing, M.S., LPC
Posted by Beverly Dearing on 01/29/2009 @ 10:54AM PT
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What do most Americans know about Acupuncture? Did you know Acupuncture has been determined by the WHO and NIH to BE EFFECTIVE in treating Addicitons, Allergies, Arthrits, Constipation,Depression, Diabetes, Fibromyalgia, Infertility, Hypertension, Neuralgias, Sciatica, Tendonitis, TMJ, etc.
The Amazing thing is that this form of treatment is so POWERFULLY effective, YET COST EFFECIENT and WITHOUT NEGATIVE SIDE-EFFECTS, but has had very little acceptance into the main stream of medical practice. This is an area that needs to be looked into, because it holds the promise of an improved quality of life fro so many at very little expenditure.
Many surgical preocedures and pharmaceuticals that are costly and have negative impacts on the overall health of human beings are regularly being utilized at great costs to the American public not only in monetary expenditures , but also in exacting a toll on the individual's well-being. I am an acupuncturist who has only been practicing for a few years, and already I have seen numerous clients improve who had tried acupuncture as a last resort, or who had been to a medical doctor and was told there was nothing more the profession had to offer them to treat their condition. If we do anything we need to bring to light this ancient form of healing and give it a proper place in the arena of health- care industry.
Posted by Maryanne Smith on 02/02/2009 @ 08:28AM PT
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if we're talking about change (i mean real reform) all health insurance companies must be abolished and pharmaceutical companies must be strictly regulated like a public utility. it's not that these corporations are inherently evil, but the ways the laws are set up they will continue to behave in evil ways.
obama (just like hillary did) is trying to keep health insurance companies at the table which is why they’ll fail. the United States National Health Insurance Act which had 93 cosponsors last time it was submitted to the house of representatives is our best bet right now.
hopefully a democratic president wouldn't try to veto a bill pushed by democratic congress.
a few links about the bill...
http://en.wikipedia.org/wiki/United_States_National_Health_Insurance_Act
http://www.govtrack.us/congress/bill.xpd?bill=h110-676&tab=summary
http://www.pnhp.org/publications/executive_summary_of_the_united_states_national_health_insurance_act_hr676.php
list of all cosponsors...
http://thomas.loc.gov/cgi-bin/bdquery/z?d110:HR00676:@@@P
email your congressperson and urge them to become a cosponsor.
some fun facts...
the united states is the only first world nation without universal healthcare.
the united states is ranked #37 as a health system by the world health organization.
Posted by joey jojo on 02/08/2009 @ 08:28PM PT
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