Month: October 2009

A Good Idea Takes Shape

If you go back to the beginning of Rubinhealth.com you will see a little piece I wrote on what healthcare reform means to me — and how it would be possible to get something done.  It’s still on the site.  In this summary, I spoke about a limited public option.  My premise was to start it out slowly and give it some time to determine if it would work before it was expanded.  I said it should start it in a region with limited participation which would allow vested parties, including providers, insurers, the public, and yes the government to see what worked and did not work.  Guess what, this is close to what is happening now…

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It’s time to take a break

It’s time to stop talking about healthcare reform for this entry and my next blog. It’s not that healthcare reform is not important,  it is – and there will be plenty of time to talk about it in the future.  In my next blog I want to explain how doctors get paid and why it’s dangerous to say “they get paid too much” – but that’s a later topic… Read more

Open Enrollment, What to Expect

This is going to be quite an open enrollment season – many large corporations that provide healthcare insurance to their employees through self-insured plans are changing the model for providing benefits.  What many employees will see are higher co-pays, higher deductibles, higher co-insurance levels, and finally, severe penalties for seeing their physicians out-of network.  Forget about going to an out of network hospital or diagnostic imaging facility.  Those costs will be too high for most to afford.   As corporations struggle to make money in a bad economy, reducing healthcare costs has become an easy target.  Since the country does not yet appear ready to tackle rising costs, the easy solution is making the employees pay more for the same coverage…

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The Lobbyist -What a Joke

There have been many studies done about healthcare in other countries — what works and what does not – I wrote a blog about the Swiss system a few weeks back.  The common theme in all these other countries is not so much how they implemented healthcare reform, but rather that they did implement something… Read more

Anthem vs. America vs. A National Plan

Many of you may not have heard about the legal case in Maine.  Anthem BC/BS (a company owned by Wellpoint) raised their premiums for individual policy holders 18.5% this past year.  The problem is the Maine thought the increase was too much money and lowered them down to 11%.  Anthem built their increase on a 3% profit margin and money held back for reserves or unanticipated risks.  Maine built their legal case on the assumption the insurance executives are paid too much money.  Well, that’s not exactly what is in their legal filings but it’s what the Attorney General from Maine said on the news.  Then it was stated as a case for a national plan… Read more

Am I happy?

I have been asked by many if I am satisfied with the various components of the healthcare reform drafts that have been presented by the various committees in the House and Senate.  I think I have been fairly consistent in my beliefs that in reforming the current US healthcare system, to start out, less is more.  There is no change in my beliefs.  The problem now is figuring what constitutes less vs. more.  To do that, we need to see how the Senate and House will ultimately reconcile all their various bills into something the American public and all of the various and numerous interested parties accept (or try to accept).  Our previous failures in reforming the healthcare system date back longer than Bill Clinton and the early 1990s.  We have allowed our healthcare system to evolve into its current form over many decades.  As I have been saying all along, it is going to take many more years to unravel and rebuild the current system into something that works for many more Americans than what we have today.  Believe me, what we have today needs work.

The primary reason the bulk of my focus has been on the Baucus/Finance bill is because I believe the content is the most reasonable approach to starting to reform the system, i.e. less is more. Certainly there are problems with the bill for everyone.  But if you understand healthcare and take a truly objective view, this bill makes some sense.  It really does start slowly.  Let me highlight the big concepts:

  1. There is not government plan – a less expensive and less bureaucratic way to start;
  2. Eliminates preexisting conditions as a reason for an insurance company to deny you coverage – any reform must have this component;
  3. It creates an independent body to review whether various healthcare treatments are effective so we can fund programs that make sense and benefit the public (hopefully removing wasteful spending);
  4. Creates an exchange system so consumers can find polices that work — increasing consumer choice and competition (to lower prices);
  5. Creates a mandate so everyone pays into the system – spreads the risk and puts everyone on the hook for their healthcare (we all pay for it now anyway);
  6. Creates subsidies for those who can not afford insurance so they can buy insurance – clearly a must have in all bills; and,
  7. Taxes groups that can be taxed (insurance companies, pharma, device makers, etc) – we need to raise money – period (see some of my previous blogs on this topic).

This is a good and reasonable start.  There are clearly other provisions in the finance bill but I believe these are the big ones.   Each one of these is political and creates a series of complicated discussions.   There is never going to be an easy way to reform the system perfectly.   Nor is there any one way to do it correctly.  So we can squabble forever over who is right and who is wrong – what a total waste.  Or, we just start somewhere (here) and work it through.  With unemployment where it currently is in this country and healthcare expenditures rising for everyone, individuals, employers, and the government – we are out of time.  What we have in the Baucus/Finance committee plan is taking it slowly.  I cannot say that about the House Bills.  I have to hope the final bill to the President looks like what has been done in the Senate Finance Committee.  If not, we could be in trouble.  Real trouble.

We are NOT Switzerland

On the front page of the New York Times Thursday there was a great article on how the Swiss have managed to reform their healthcare system by providing coverage to all Swiss citizens, while lowering overall costs – all with no rationing of care.  Good for the Swiss.  I am not going to tell you how they did it because you can read the newspaper on your own by going to www.nytimes.com.  In all fairness, the Swiss have some good ideas.  But for that matter, so do the British, French, Germans, and countless other countries.  You know what, so does America.  The Baucus/Finance Committee bill, which was supposed to be crafted as bi-partisan and actually does have some republican and democrat ideas (it was drafted by republicans and democrats before the group of six fell apart), could actually transform the American healthcare system. This includes providing insurance to all Americans (or as many as possible to start), lowering costs (the bill has to be budget neutral), and make everyone responsible on some level for their healthcare (individual mandate).

Here is the problem; Congress is having a hard time finding compromise and agreeing on something that we can call a starting point in healthcare reform.  The Swiss did it with a government mandate, including restrictive price controls, higher cost sharing, and placing financial limits of physician practice and suppliers.  Also, no Candian style of rationing care in Switzerland.  But who cares.  What the Swiss did could never be done in this country.  Period.   If we did what the Swiss did, we would have a war with all impacted groups including doctors, hospitals, insurance/drug companies, congress, and many others.  We could potentially paralyze our healthcare delivery system.  We have a much more complicated and larger healthcare system than the Swiss (their population is less than 8M people). 

But don’t dispair.  We can do this – we can reform healthcare if we want to do it.  Keep reminding your representatives you want reform.  I had two callers on my show Thursday (Sirius/XM Doctor Radio), both hard working and both unable to get health insurance they could afford.  That is not acceptable anymore.  No insurance, pre-existing conditions, and they cannot get primary care. When they get sick, it’s going to costs us as a society even MORE money to take care of them in the hospital/have them collecting disability (which actually is what happens, they stop working and collect state aid when they get sick).  It really makes no sense to tell these two callers from yesterday to move to Switzerland.  They, like I do, love this country. 

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