Talk:Health Care

Helfrich Essay

Birthdays that end in zero seem to hold a special significance to us.

On my 40th birthday I went on a photographic safari to Africa. On my 50th I sang at my lifelong friend's funeral. Sandy had known she was dying for a long time. With each hospitalization for infection, amputation, heart attack and stroke, she knew it was just a matter of time. When she was told she needed dialysis she took control the only way she could. She requested hospice care. Within a few days we gathered for one last slumber party with our dear, funny friend as Sandy's life came to a premature end. Sandy didn't die because we don't have the finest medical professionals and pharmaceuticals available. She died because during many periods of her life she lacked health insurance. You cannot manage a chronic illness like diabetes in emergency room visits at each crisis. Even after she lost her right leg at age 42 it was a couple of years before she qualified for Social Security Disability and Medicare coverage. By then the damage to her organs was irreversible.

Isn't it time to admit that our market-driven, employer-based system of health care coverage is failing? It is estimated that 25-30 percent ($400 billion per year) of health care expenditures are wasted on the overhead costs of managing hundreds of different private and public health plans. Scott Ideson, president of Regence Blue Cross Blue Shield of Utah, recently stated that that company's administrative expenses were only 8 percent in 2004. But I would like to ask if that figure includes the cost of sales and marketing to the individual employers, TV and print advertising and political lobbyists. I know that 8 percent figure also does not include the cost incurred by physicians and health facilities to submit claims to hundreds of separate health care plans. Ask your family doctor how many clerical employees he or she has to employ to manage the nightmare of submitting claims. Private insurers don't compete by delivering care at a lower cost. They compete by creating a risk pool that turns away people with chronic illnesses and by refusing to pay claims. Do we really believe that 300,000 uninsured Utahns (45 million nationally) are unworthy of receiving consistent, medically necessary care? Medical costs are the leading cause of Utah bankruptcy filings and growth in medical costs in 2004 were four times the growth in wages.

More and more businesses are backing away from the promises they have made to employees and retirees. How many small businesses can absorb the $12,000 per family (average family of four), per year, cost of employer provided health insurance? It is costing General Motors $1,500 for each new car to provide health benefits to employees, dependents and retirees. Toyota is locating its seventh North American plant in Canada instead of the United States because the labor costs are cheaper. Lifesavers closed up its plant in Holland, Mich., and moved it to Canada where it could reduce labor costs by $4 an hour.

General Electric, Boeing, Lucent Technologies, IBM, Verizon, SBC Communications and Ford Motor are all struggling with sky-rocketing health benefit costs. Seventeen American steel manufacturers have now declared bankruptcy and terminated retiree health coverage. Can we set aside the argument about when life begins and instead ask ourselves why life has to prematurely end for some 18,000 uninsured Americans per year? If the United States had an infant mortality rate as good as Cuba's we would save an additional 2,212 American babies a year. Can any of us with insurance feel certain that we will have coverage should we develop a chronic illness, experience a job loss or change? Let's stop rearranging the deck chairs on the Titanic and explore a single-payer health plan that covers everyone. Would it displace thousands of people working in the health insurance industry? Absolutely! But wouldn't it be far better to retrain these people to deliver health care rather than to deny health claims? Encourage your congressmen and senators to reintroduce the "States' Right to Innovate in Health Care Act" (formerly H.R. 1033) which would allow an individual state to explore health care reform without jeopardizing existing federal dollar contributions.

Christine B. Helfrich chairs the Health Care Reform Caucus of the Utah Democratic Party. She is an employee of the University of Utah.

Single Payer

Christine, I think "Single Payer" is a great ideal, but far from reality. In the same sense having a "Hydrogen Economy" would solve many problems, but it won't happen overnight. What I am proposing with cooperatives is something that could eventually be unified into one system.

How would the cooperatives differ from existing insurance companies and HMOs, asside from being not-for-profit institutions? Dilvie 21:42, 14 September 2005 (MDT)

I think the mere fact that they're non-for-profit is a big distinction. One thing that healthcare providers consistently tell me is that the profit-motive does not serve the public in healthcare. In addition, public regulation and transparency of these coops would be essential. Pashdown

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Hi Pete I wish I could believe that non-profits organization/cooperatives could be the answer for health care coverage but the fact is they still have to compete with one another for patients/employers and for risk-pools which keep the sickest patients from participating.

Intermountain Health Care is non-profit but there are plenty of physicians, consumers and business people who don't think they play fair. Hospitals and physician providers now contract with the different health plans to accept a discounted fee. IHC takes the difference between the discounted fee and what they consider full price and they call it "charitable care" and take a write off. Patients who are uninsured are billed the full amount by IHC despite the fact the insured patients get the same care at the discounted rate.

Chris Helfrich State Democratic Health Care Reform Caucus

Putting the coops under the same rules as HSAs would cover the sickest patients. With a government guarantee, the coop would not have to reject coverage. In addition, the negotiated discounts that insurance companies receive would also be available to the coop. Essentially, the coop is nothing more than a HRA (Healthcare Reimbursement Account) that is shared between businesses and individuals that also has the privileges traditional insurance has.

The problem that "single-payer" insurance has is the change is monumental. With relatively stable, effective government systems like Social Security under attack, I think going "single-payer" is nothing more than wishful thinking at this point. There has to be a more dramatic political shift in Washington before it could ever gain traction. Coops present a private solution that can be a test-bed for larger. Pete Ashdown Thu Sep 15 23:01:44 MDT 2005

Drug Policy

Drug policy is one of my pet issues. This article in the Canadian National Post pretty well sums up my feelings:

The War On Drugs Cannot be Won - By James P. Gray

Based on my experience as a federal prosecutor with the United States Attorney's Office in Los Angeles, as a criminal defence attorney for the U.S. Navy JAG Corps, and as a trial judge in Orange County, Calif. since 1983, I've concluded that the U.S. government policy of drug prohibition has not only failed, but that it is hopeless.

The problem is not that our law enforcement officers aren't doing a good job. In truth is they have a dangerous and difficult task, and are doing better than we have a right to expect. They are no more to blame for the failure of drug prohibition than was Elliott Ness for the failure of alcohol prohibition. The problem, rather, is that our prohibitionist laws make the trafficking in illegal drugs so obscenely profitable that we will never exhaust the supply to criminals willing to take the risk of imprisonment in order to produce and sell them.

In fact, our present system is giving us the worst of all worlds. As a direct result of our policy of drug prohibition, crime, violence, corruption, taxes and -- in many cases -- even drug usage have increased, while the health and civil liberties of citizens have suffered. America's "prison-industrial complex" has gotten so fat and powerful from the money our governments have budgeted for the War on Drugs that it has become politically dangerous for elected officials to speak out against the current policy. Under these circumstances, it is up to ordinary people -- as citizens, taxpayers and voters -- to call a halt to these failed policies.

We should begin by asking the following questions:

- What is a "drug"? If the answer is that a drug is a "mind-altering, sometimes addictive substance," why are substances such as nicotine, alcohol and even caffeine not also addressed by the same policy?

- Why do we not make distinctions between drug use, drug misuse, drug abuse and drug addiction? I agree that marijuana, for example, can have harmful effects upon the user if taken to excess on a regular basis. But obviously, so can alcohol. I drink a glass of wine almost every night with dinner. Does that mean that I am in need of an alcohol treatment program?

- Why is it appropriate to send gifted actor Robert Downey Jr. to jail for his problems with cocaine, but send Betty Ford to treatment for her problems with alcohol? Aren't these really medical issues that should be addressed by medical professionals? Shouldn't we use the criminal justice system to address people's conduct, and leave the medical community and social mores to address what people put into their bodies?

- Given that there has never been a society in human history that has not embraced some form of mind-altering drug to use and abuse, should we not put our focus on harm reduction, rather than fighting human nature through prohibitionist mechanism?

- On a related note, why do our policies not take into account the problems caused by the War on Drugs itself? For example, I have never heard anyone say that it is a good thing to be a heroin addict. But if some people become heroin addicts, why should they also get AIDS from dirty needles? That is a separate problem that is caused by prohibiting the distribution and possession of hypodermic needles and syringes, as well as turning the drug-addicted people into criminals, thus pushing them farther away from medical facilities where they can get help. Moreover, why should the people of Colombia see their military, police, judiciary, safety and way of life corrupted by our drug money? The people of Colombia do not have a drug problem: No one is dying from coca plants. What they have is a devastating drug money problem.

History is instructive. Consider that when alcohol prohibition was repealed in the United States, homicides went down by 60% after only one year, and they continued to decline each year thereafter until the beginning of the Second World War. There is no question in my mind that we will experience similar results when we finally repeal drug prohibition.

In June of 1994, the RAND Corporation released a study that found we get seven times more value for our tax money by drug treatment programs than by the incarceration of drug addicts. So let's make drug treatment available upon demand, and get the non-problem users of drugs out of the criminal justice system. This will enable us to focus our scarce resources upon the problem users -- men and women who are driven by drugs to commit violent crimes.

Further, let's do what we can to take the profit motive out of the sale of drugs. Programs of decriminalization and medicalization are working effectively in countries like Holland and Switzerland. They can work in the United States and Canada as well.

Dilvie 12:42, 13 October 2005 (MDT)

Health Care Platform

Pete,

Your health care platform is logical, fair and could be accomplished without raising taxes because the money currently being spent on drug enforcement and 3rd party insurance is top-heavy with administrative expenses.

Good job! We just need to get the message out to Orrin Hatch's fans that his support of the pharmaceutical and insurance industry is at the expense of affordable health care and medicines for all Utahns.

Thanks for your hard work!

Christine Helfrich, Democratic Health Care Reform Caucus

Health care savings account

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An Honest Solution for Lowering Health Care Costs

(By Mark E. Towner, Former CEO, Advanced MD Software; Former CEO, Health Net Services of Washington and Alaska; and Current Public Interest Representative, Utah Health Data Committee)

After nearly a quarter of a century providing management consulting, hardware and software selection, and technical training services to the health care industry, I have come to the conclusion that the only solution to lowering healthcare costs in the United States is to introduce market forces that allow individuals to make their own decisions on how much or little healthcare they need.

The solution is a forward-funded combination Health Savings Account and a High deductible Insurance policy that would only kick in for hospitalization and catastrophic medical expenses. This also provides total portability of coverage between employers, and eliminates the need for COBRA.

The State of Utah, as well as every county government, municipal government, city government, or large employer could stop and even reduce health care costs for their employees, and save taxpayers millions of dollars. This solution also solves the current controversy over benefits for non married domestic partners. The Health Savings accounts and the catastrophic policies are owned and controlled directly by the employee. The employer would pay into an employee’s Health Savings Account $2500 in the first year, and then add $1500-$2500 for following years of employment. The Health Savings Account would be used to then pay in full at time of service or PIFATOS. The Employer would then pay for the employee’s catastrophic insurance plan, and allow the employee to purchase additional catastrophic coverage for family members or civil partners. Employees could also choose to pay directly for their prescription drugs from their savings account, or purchase a standalone Rx policy. The long term benefit for those employees who do not spend their Health Savings Account dollars, is that this money is convertible into a retirement plan upon reaching the age guidelines required. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year!

This is how the system works. Pay In Full At Time Of Service – is truly a “Cash-Based System.” A patient sees a doctor for a non-catastrophic reason – yearly check-up, a nagging flu, a twisted wrist, an aching stomach, etc. The doctor bills the patient after the visit. The patient pays in full with their Health Savings Check/ Debit Card. Because doctor charges are anywhere from 25 – 50% inflated due to administrative costs caused by billing the health insurance industry, you’ll be paying drastically reduced rates for your medical expenses. Providers are only too happy to discount their fees if it means getting paid immediately, and not having to bill and wait for an insurance payment. Annual deductibles and co-pays would be a thing of the past.

Now, ask yourself. How often do you go to the doctor? And when you do, how long does it take the doctor to treat what you have? The fact is, most healthy Americans don’t visit the doctor all that often for non-catastrophic reasons, and when they do, they don’t visit with the doctor for all that long and they don’t receive very elaborate treatment. So why are most healthy Americans paying huge sums of money to insure themselves against regular doctor visits that actually aren’t that expensive?

• In 2004, minimum health insurance for a family cost around $9000/year. Catastrophic health insurance cost around $3000/year. That’s $6000 in savings. By practicing PIFATOS, if you pay $1000 for all your doctor visits/year, you’ll be saving $5000 for the year! www.simplecare.com

I investigated HSA's for my own company. The problem lies in the ramp-up. How to convince an employee that they will not need immediate health care in the near future while they build their HSA is a difficult proposition. The catastrophic plans weren't all that cheap either.--pashdown 16:46, 28 November 2005 (MST)

I'm not sure how I feel about HSAs, but Paul Zane Pilzer brought up an interesting idea during his interview on January 6, 2006's Midday Metro on KCPW-AM/FM. He said that HSAs allow people to spend money on preventive measures, and this is in stark contrast to the current health care paradigm of only treating people when they are sick or injured. Pilzer asserts that the current paradigm is why health care costs are so high. Why don't we encourage health care companies to encourage their clients to proactively take steps to avoid illness and injury (or greater problems) by subsidizing fitness, nutritious eating, and other health promoting practices? If auto insurance companies give steep discounts to new parents to buy car seats for their infants and young children, why can't health insurance companies subsidize fitness endeavors (money to join a fitness club, take an aerobics class, buy running shoes or a bike, etc.), nutritious eating (nutrition education, healthy cookbooks, etc.), etc.? --Anhhung18901 11:34, 6 January 2006 (MST)

Mitt Romney plan

Interesting happenings in health coverage in Massachusetts: [http://www.time.com/time/columnist/klein/article/0,9565,1137628,00.html]

Prescription Drugs

(Moved from Social Security article) The Medicare Prescription drug plan is deliberately confusing to retired consumers, to be advantageous to the drug companies, and should be simplified eliminating the giveaways and "subsidies" to the pharmaceutical industry.

Does this deserve its own policy? Where is the line between R&D and excessive profit?--pashdown 12:22, 13 January 2006 (MST)

offshore medical care

Many expensive procedures are available at greatly reduced cost overseas--"medical tourism" promises to be an important source of income in countries like India, Jordan, etc. Should not health insurers be encouraged to pay for offshore care and to encourage their customers to use it? Is there much to be saved with such a policy?

Weighty problems

It is not that hard to tell that we Americans are getting fatter, and this fat brings health problems. The fact that our youth are getting fatter, too, is of great concern. We need to impart better lifestyle education to the youth of our country. Perhaps we could require students to focus on one sport a semester or a school-year to give an activity more time for a student to become attached to. My first season of running junior high school cross country got me hooked on running (I've been running 9 years now, and I'm still going). Of course, we want youth to be exposed to many physical activities, and that is why we could limit the length of time that a student is focused on one activity. Also, why don't we have room mothers come into the the classroom (okay, room mothers in elementary and other types of role models for higher grades) and cook with students? I would argue teaching cooking skills to kids can be fun and more beneficial than having a party. When someone knows how to cook, they have a better ability to control what they eat. One example of a program pushing for this, is the Food Network's Cook with Your Kids campaign. Granted, there is plenty of red tape when you cook in a public school, but everything has red tape these days...--Anhhung18901 23:52, 13 December 2005 (MST)

French system

This is not necessarily useful infromation for the campaign, but my understanding of the French system is that it is not "single payer" as such. Instead, they have a set of flat reimbursements per treatment which are targetted at some form of idealized cost of the treatment. The doctors then set their own prices as they like, and people may purchase insurance to go more expensive doctors, but the clever targeting of the reimbursements means that many people look for a cheaper doctor if theirs goes significantly above the reimbursement. This ends up reducing the cost of health care for everyone, even the people who go to more expensive doctors, without forcing any doctor to do anything.

Anyone have a citation or article on this?--pashdown 12:23, 13 January 2006 (MST)

Tort Reform

Mr. Ashdown should vigorously oppose so-called 'tort reform'. He should not accept that framing, but instead use 'commpensation caps' whenever the issue is raised. Compensation caps use in states to control rising costs have proven largely ineffective. What compensation caps certainly do accomplish is harming those injured the worst by medical mistakes and negligence. A new Harvard School of Public Health study indicates only a relatively small percentage of medical malpractice claims are unmeritorious. We should concerntrate public policy on the real problem and act to remove those unmeritorious claims from the legal system earlier. An expert review board in each state to certify cases as meritorious is one possible solution, as is national certification of med mal attorneys. In concert with those measures, more stringent financial ratio requirements for med mal insurers would help atabilize premium prices, preventing the market spikes that have compromised some physician's ability to practice.--Mbryan 17:58, 19 May 2006 (MDT)