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Health Care Discussion in New Smyrna Beach

By ObamaBob NSB - Jan 16th, 2009 at 3:38 pm EST

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There was an excellent Health Care Discussion held in New Smyrna Beach on January 30th, 2008 that was activly attended and produced an exceptional report detailing the difficulties and opportunities for health care policy in our country.

The event was hosted by Pat Wilson and the report was written and edited by Diana Barden, Trudy Duffy, Donatella Young, and Mary Lou Schropp.

The full text of the summary report is below:

Notes from Health Care Community DiscussionHosted by Pat Wilson on January 30, 2008New Smyrna Beach, FL Highlights and representative comments Participants overwhelmingly perceived the biggest problem to be the lack of universal coverage through a single payer system. Health insurance policy and profit motives were cited repeatedly as responsible for out of control costs and personal tragedy. § Eliminate for-profit health insurance that has no incentive to help people prevent or treat illness.§ Eliminate for-profit insurers as sources of most coverage by having national health for all as in England and France.§ Expand existing federal health care programs to include all citizens.§ We need more information on how to control the rate of increase in costs for health services. Why should these costs be so much higher in the US than in other industrialized countries? Getting employers out of the picture was generally viewed as desirable.§ Employers should not provide most coverage. This is better done by government (even with its current inadequacies)§ Stop employer based coverage. Expand Medicare to cover everyone. Participants were clearly in favor of attention being given to health through nutrition, life style choices and preventive care. § Use tax dollars to launch media campaign of healthy lifestyles to lower cost of health problems from poor lifestyles.§ Make educational info about health and nutrition available through early childhood education programs and make it mandatory.§ Bring back mandatory physical education. Question 1: From your own experience, what do you perceive is the biggest problem in health care? The discussion on the cost of health insurance and health care itself raised several issues including:

The power and influence of insurance companies to dictate procedures and prescriptions, often in contention with medical advice. In addition, some felt that insurance companies were gaining too much influence over the practice of medicine by widespread, glossy advertising more expensive pharmaceuticals that have no generic equivalent. The cost of insurance company administrations, which one participant pegged at 30%, was also discussed as a problem.
The cost of malpractice insurance, not only for physicians, but also for other health care professionals such as private duty nurses and pharmacists, primarily due to the litigious culture.
The practice of “defensive medicine” to defend against lawsuits.
The lack of portability in health insurance so that people who leave their jobs have to start over with a new insurance company, sometimes with pre-existing conditions not covered.
The lack of coverage for health care that prevents more serious problems
The lack of access to care, including specialists, especially for people covered by Medicaid.
The lack of a true safety net for the truly indigent and the underinsured which is placing a crushing burden on the community hospitals that must provide care.

With regard to this last point, there was discussion that for many people (and at the recent suggestion of President Bush), the emergency room is the fall-back provider and, in effect, the primary care provider for the indigent. This is the most expensive care available. The indigent and non-insured have little affordable access to physicians to take care of minor problems before they become major issues. Taxpayers end up paying for care in the most expensive setting because there is no provision to care for the indigent and uninsured in a less expensive setting. Question 2: How do you choose a doctor or hospital? What are your sources of information? How should public policy promote quality health care providers? The consensus was that basic information on education, Board certification and hospital privileges could be found on websites hosted by insurance carriers or by the State of Florida. However, to determine if a specific doctor is a caring practitioner, people rely on word-of-mouth or trial-and error. Most attendees felt more transparency regarding provider history would be useful and a rating system similar to the one established for nursing homes. Also more peer review and/or ratings from the AMA made available to individuals as well as government provided educational tools to be able to use information effectively. The bigger problem was that people often are required to change providers when they change insurance companies. People dependent upon employer-paid health insurance have no control over the choice of insurance carriers and some employers change carriers frequently, if they can get a cheaper contract. This can disrupt the continuity of care for some employees. Maintaining the quality of health care is, in part, the job of hospitals which have risk management committees, peer review processes and quality assurance committees. Selecting a provider that has hospital privileges is one way of ensuring that some organization has vetted the provider. If a person selects a physician who does not have hospital privileges, it is incumbent upon them to do their own credentials checking. Question 3: Have you or your family members ever experienced difficulty paying medical bills? What do you think policy makers can do to address this problem? Many attendees had personal experience or knowledge of such difficulty, whether due to an aging parent or uninsured family member where either the cost of care or access to costly care is impossible to manage. Again the overall remedy was seen as a single payer system covering everyone which might, due to increased participants, bring down health care costs overall. Members of the group decided that any experiences they wanted to share would be emailed to the discussion organizers. Questions 4 & 5: In addition to employer-based coverage, would you like the option to purchase a private plan through and insurance-exchange or a public plan like Medicare? Do you know how much you or your employer pays for health insurance? What should an employer’s role be in a reformed health care system? Discussion for these two questions ran together. Attendees overwhelmingly noted the need of portability and standardization. One segment of the group would prefer that insurance was not based with employers at all. Issues with employer-based insurance included the lack of portability, the high cost of COBRA to continue employer-based insurance when you leave a job, the lack of uniformity among insurance policies offered by different employers, and the fact that many employers do not provide insurance or that many people work one or more part-time jobs and are not eligible for benefits. If health insurance continues to be offered through employers, members of the group felt that the federal government should offer more assistance to small businesses to provide benefits and that some benefits must be available for people who work part-time. In addition, the point was made that business and government must work together to ensure that all employers offer a package of necessary benefits, rather than offering stripped down, bare bones policies that leave employees expectedly vulnerable financially. If employers are involved in a reformed health care system, members of the groups suggested several federal mandates should be part of any insurance package, primarily requirements for preventative and wellness programs and for coverage for pre-existing conditions. It was discussed that mandates need to be national because state mandates create too much variance in health insurance programs and could impact people who move across state lines. Tax incentives for employers was also suggested. Because many of the participants are already on Medicare, they are familiar with the need to purchase supplemental policies to cover things not covered by Medicare and to pay co-insurance and deductibles. The consensus was that this is not good policy, especially with regard to the new Part D for prescriptions. Many felt Medicare was “broken, too big, too complex”.The preference was for inclusive insurance without the need for add-ons. Question 6: Below are examples of the types of preventative services Americans should receive. Have you gotten the prevention you should have? If not, how can public policy help? There was some overlap with the discussion on an earlier question. Preventative care must be mandated, the group felt, because the coverage for this type of care is spotty. One participant asserted that employer wellness programs are effective where they exist because they tend to lower health care costs. However, another participant noted that some employer wellness plans have a punitive element in that if wellness goals (weight loss, smoking cessation, blood pressure reduction) are not met, the cost of the insurance may be higher. One suggestion that alternative medicine, such as massages and chiropractic services, be included in a national health plan was countered with the opinion that the cost would be prohibitive and that covering the indigent and uninsured has to take precedence. Attendees felt access to additional mandatory screenings and alternative therapies should be offered and that dental care should be part of included services Question 7: How can public policy promote healthier lifestyles? The discussion of healthier lifestyles and personal responsibility also entered other discussion points. There was discussion on federal involvement in developing more education on diet, specifically. However, it was noted, that fresh and healthy foods need to be made as available and as inexpensive as fast foods and junk foods. If cash-strapped mothers can satisfy their children’s hunger with readily available hotdogs and chips, they may not take the time and spend the extra money to offer more expensive fresh fruits and vegetables. There was some discussion on offering financial incentives for medical students to focus on family medicine rather than more lucrative specialties so that there are more primary care physicians who can take the time to educate patients on healthy lifestyles. In addition, more college programs to educate nurses are needed to counter the nursing shortage and to fill the ranks of retiring nurses. One participant was enthusiastic about an electronic medical record that monitored his exercise and calorie intake to help him maintain control of his diabetes. This kind of feedback, he felt, was invaluable in helping him control his own health. He felt that providing patients with the tools to monitor and control their own heath would be very beneficial. One participant noted that there is a “Medikids” bill under consideration in Congress that would, in effect, be Medicare for kids. Parents could opt out, if they have other insurance, but the default would be government insurance, which would help children get a healthy start in life. It was suggested that children with broad-based health insurance would have a better chance of adopting a healthy lifestyle that would continue into their adulthood.

One participant note the need for mandatory physical education and also suggested using media campaigns to increase public awareness of healthy lifestyle issues.

Annexes ANNEX 1 The non-insured have little affordable access to physicians to take care of minor problems before they become major issues. Mary Lou Schropp provided this story illustrating how timely access to antibiotics would have saved thousands of dollars spent in hospital/emergency room care as well as a simple and rapid recovery to the patient.There are too many people – both children and adults -- in this county who are uninsured and they have no access to care, except in emergency. Whatever the concerns about a government-run national health care system limiting choices for patients and rationing access to care, it could not be worse than the current system that leaves millions of people with NO choice and rations care on the basis of ability to pay. It concerns a friend of my son. While she was at my house, I noticed that she was not feeling well and I asked her about it. It was apparent to me that she was suffering from a urinary tract infection (any woman who has had this problem knows the symptoms!) and I told her to ask her mother to take her to the doctor. However, her parents did not have health insurance for their children. The mother treated this teenage girl with ibuprofen and cranberry juice – which, of course, provided little relief. Within the week, the girl was in so much pain, she could hardly walk and her parents took her to the ER. There she was found to be dehydrated (she had stopped drinking so she would not need to urinate) and in need of antibiotics. She was hooked up to IVs and kept overnight and then sent home with a prescription for antibiotics and was just fine. The irony is that for lack of a $4 prescription, this girl ended up with a large hospital bill that was eventually covered, I assume, by the taxpayers and/or the hospital, since the family is low income (but has too much income to qualify for Medicaid). The girl did get care – but only after the situation had gotten out of control and become very expensive. With access to a physician or nurse-practitioner who could write a script for a simple antibiotic, she would have been saved a great deal of pain and the taxpayers would have saved a lot of money. This in essence, is why our current system makes no sense. And this is the type of problem, I think, that a reformed health care system needs to address first. ANNEX 2 Brooke Alexander provided this statement from a term paper she wrote on health care. $34.5 billion dollars per year are spent on uncompensated care costs, which includes fund for free care, discounted care, and "bad debt" that is written off by the provider if the uninsured person cannot pay. This 34.5 billion is paid by the taxpayers for this purpose alone...The Institute of Medicine estimates that the cost of universal coverage would amount to $34 - $69 billion per year, while the annual cost of diminished health and shorter life spans of Americans without insurance is $65 - 103 billion (this cost is paid through the taxpayers and in a loss of producitivity to the economy). By implementing universal health care, the United States would actually be saving billions per year due to more productivity in the economy because of the better health of the workers.
ANNEX 3 A HEALTH PLAN FOR AMERICA: AN "ATLANTIS INITIATIVES" APPROACHSummary of Proposals No citizen left without medical help. How? Everyone gets a One-Click Help Medical Card, (electronically furnished with all medical info). The OCH provides free treatment for all conditions deemed of public concern, including: § current hospital emergency services-checkups and medical advice§ preventative vaccines§ infectious diseases, including STDs§ addictions: alcohol, drugs, obesity (first year)§ injuries whether physical or mental. arising out of accidents,§ patients suffering from industrial pollution (costs provided by special pollution taxes on polluting industries.§ patients who have accepted a rigorous health regime, in respect of diet, exercise, check ups, etc and taken normal safety precautions as using seat belts, motorcycle helmets, etc as appropriate.§ The OCH may charge patients accordingly for medical care who have not accepted such conditions. Individuals paying for other conditions: § Cooperative health plans, eg Samaritan Ministries (tax relief available)§ Current private insurance plans, supervised by special courts, for alternative, special high cost or immediate treatments (as UK’s BUPA.) Health Care and Poverty:We should adopt the Mexican OPPORTUNITIES program, for cooperating communities featuring welfare payments to mothers who keep their children in school, bring their families to health checkups and education classes. Health Care and BusinessBusiness payments to workers should be gradually phased out and replaced by increased payroll taxes, ensuring an even playing field between businesses, home and abroad. Health EducationDoctors should hand out pamphlets generally descriptive of the patient’s problems, including recommendations as any diet or lifestyle modifications as well as reference to validated alternative treatments. All medications should be delivered to the patient with the kind of informative packaging of eg. Wyeth Pharmaceuticals Protonix, with easily understood illustrated descriptions of the causes, symptoms, and workings of the condition, and the way the drug acts to deal with the problem, with reference to possible side effects, along with dietary and other recommendations. It also included an 800 number and website address for further information. Websites, such as WebMD and TV channels, such as Discovery’s Health Channel, should be incorporated into a generally available network of health information. Public HealthOnce governments have accepted responsibility for general health, both ethics and economics require a greatly stepped up effort to reduce industrial pollution, ecological deterioration and similar hazards. Sales taxes should be adjusted flexibly to cover the damage the manufacture of any given product inflicts on public health and welfare. NPR and PBS should be encouraged to open up separate channels to provide continuous beautiful and soothing classical music, perhaps drawing on such resources as Montreal’s "La Plus Belle Musique du Monde." This would provide an immediate antidote for stress relief. Atlantis Philosophy in Education, as applied to Health Care.The Atlantis Educational Initiative started as an attempt to raise educational standards and lower costs by treating students with much greater respect, but concomitantly with greatly increased responsibility for their learning. The intensive tutorial methods on which Atlantis is based date back to 15th century Oxford, and have been developed in pilot projects at UC Berkeley and McGill since the 1960s. The same philosophy applied to health care would offer the patient a much higher level and greater availability of treatment, in return for a greatly increased patient responsibility for his or her own health. Moreover, should the Atlantis Initiative be widely adopted, the potential savings in education would presumably take pressure off healthcare budgets. On another level, the Atlantis Outreach Tutorials would be very easily adopted to provide additional support to such various areas as patient care and actual medical research. More on the Atlantis Educational Initiatives can be found on its website,HTTP://WWW.ATLANTISEDUCATIONALINITIATIVES.ORG or on paulpiehler.com. Paul Piehlerpaulpiehler.com

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