Wyden: Fix the economy by fixing health care
Kari Chisholm
Over at Real Clear Politics, they've published the full transcript of an interview with Senator Ron Wyden on health care reform. He addresses a number of areas, but the one that struck me was the part about how fixing health care is a way to fix the economy. In other words, we should not wait until the recession ends to fix the health care system.
RCP: Health care costs -- which accounted for less than 8 percent of America's economy in 1990 and less than 12 percent in 2000 -- now account for more 17 percent of GDP. This trend is the cause of great concern for many who regard health care spending as a potential nation-ruining issue. They fear that if we are spending more on health care, then we are by necessity investing less on infrastructure, energy and education - spending that contributes greatly to our economic prosperity.How important is it for the future of our economy to get health care spending under control?
Wyden: Fixing health care and fixing the economy are two sides of the same coin. The fact of the matter is that the reason the take home pay of the American worker never goes up is because health care is gobbling up everything in sight. In fact if you look at recent years, employer spending keeps going up and it seems like the fastest rising part of that is health care. So containing health costs is absolutely pivotal, and of course what Senator Bennett and I have been able to do is bring 13 other members of the U.S. Senate together for a bipartisan effort to contain those costs.
RCP: You recently said that "We're spending enough on health care. We're just not spending it in the right places." Where are some of the wrong places that we are spending health care money?
Wyden: One that comes to mind over the last few days is that the people in the individual insurance market are just getting creamed right now, especially with all the layoffs. When those people lose their coverage, they move into the individual market. So probably one of the first things for containing costs is making sure that individuals are in the position to have their funds pooled, so they can be part of a larger group which has more bargaining power in terms of what they get for their health care dollar.
The insurance market is broken. For example, it discriminates against people who are sick. Certainly fixing that so that insurers compete on the basis of price, benefit, and quality rather than cherry picking is an opportunity to control costs.
A third area, in terms of health marketplaces, is that most people don't have a choice. They don't have a choice of options even if they have employer coverage, and most of the time they don't have a choice of plans. So giving them a choice and the ability to benefit financially as a result of a careful selection of their insurance coverage would be a third area where we spend a lot but we don't spend it in the right places.
For the amount of money that the country is going to spend this year on health care, you can go out and hire a doctor for every seven families in the US and pay the doctor almost $230,000 a year to cover them. Whenever I bring it up with doctors, they say "Where do I go to get my seven families?"
Read the rest at RCP. Discuss.
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2:09 p.m.
Mar 19, '09
[Full disclosure: My firm built Senator Wyden's campaign website. I speak only for myself.]
Mar 19, '09
Having seen Gov. Dr. Kitzhaber speak and give his slide show on the health care system in this country, I'd love to see an explanation here about the ways Wyden's view and Kitzhaber's view can be combined and gotten more into the state and national dialogue.
I admire both Ron and Dr. John, and think they both have good ideas. But perhaps Kitzhaber's ideas are more transformative?
His "community of care" idea and Wyden's "for the amount of money we are spending on health care in this country, we could pay one doctor for each 7 families and the cost would be the same" idea don't seem that far apart.
3:13 p.m.
Mar 19, '09
Kitzhaber touches upon the "real" problem. Most politicians dance around the notion of personal responsibility. We must not only improve the health care system, but we must also improve health . . . as he would say.
A child with attention deficit disorder can be given pharmaceuticals (anti-psychotics) at a high cost, but we refuse to acknowledge the research that has shown how chemicals, such as the dyes in soda pop, have given rise to increased A.D.D. This is the real issue. We are polluting our bodies and the net effect is a cascade of negative health issues.
Yet why are the only solutions pointed at marketplace competition or money in general? Our commitment to healthy lifestyle choices will greatly reduce the burden our poor diets are placing on the health care system. Here's a great . In a similar segment, they quoted that 40-45% of breast and colon cancers could be altogether prevented.
We are timid about making the link between poor choices and poor health. But that is the real problem.
Mar 19, '09
In much of Europe midwives handle 75% of childbirths. In Oregon it is about 15% and less in the U.S. Also in Europe nurses overall account for about 60% of medical costs. Both of these factors may help us understand why our costs are as high as they are.
Mar 19, '09
Jenson, part of what Kitzhaber talked about is that "individual responsibility" alone is not the answer. A low income person without access to mass transit or a social network including someone with a car will find it difficult to eat fresh fruits and vegetables if they are not available near where they live.
A senior citizen living in an apt. alone may need help remembering to take medications, and may have health problems on a 100 degree day if the apt. cooling system fails. But Medicare, while it will pay for the ambulance to rushs that person to the hospital, and pay for stabilizing the patient's condition in the hospital, can't pay for an air conditioner for the apartment.
Programs like Even Start for small children and their families also fit into the Kitzhaber model, as I understand it.
Mar 19, '09
Wyden's plan is right in de-linking health coverage and employment. I am not clear on what he offers. More and more I think there is a simple solution, to contain costs and to offer universal health care, simply enhance Medicare and offer it to everyone, with the option for people to pay more for Medicare plus programs for more cadillac options. The single payer controls the costs, and all providers have to adjust to the cost containment system. The private insurance system now is broken beyond repair, and infinitely more tyrannical and inhumane than any single payer system.
Mar 19, '09
An example of our healthcare system today....I have an ear infection. I go to clinic and see a DOCTOR. Doc spend 30 seconds looking in my ears and says "You have an ear infection." Then he tries to prescribe $80 ear drops. The last time I had an ear infection, I was prescribed another type of drop that only cost $32. The difference b/t the two, $80 drops 2X daily, $32 drops 4X daily. I took the cheaper meds. Cost of office visit: $119
Can anyone explain why I was seen by a DOCTOR and why that illness should have cost me $199?
Mar 19, '09
One aspect of our current health care "system" that is often overlooked is the hidden places we pay for it:
A large percentage of our auto insurance is to cover health care costs.
A large part of our legal system is devoted to dealing with health care costs--many large law suits would be settled for much less if health care was essentially taken care of with a single-payer plan.
There's the circular loop of high health-care costs causing high malpractice insurance, which leads again to higher health-care costs. Again, a single-payer system would greatly reduce this, because a great deal of medical malpractice claims are for future health care costs.
Mar 19, '09
mp's comments remind me of my favorite memory of the Dutch health care system. Reimbursement is based on solving the problem, not on how you get there. There, you could have gone to an alternative therapist, got relief, and they would no doubt have charged the system less. The choice is up to the patient. It has the healthy effect of putting the different therapy delivery modalities into direct competition.
It's also a good example of how being liberal can be cheap.
Mar 19, '09
It has the healthy effect of putting the different therapy delivery modalities into direct competition.
That'll put the cat amongst the pigeons!
6:46 p.m.
Mar 19, '09
Having recently gone a few rounds with the medical system (4 CT scans, 3 ER visits, 3 hospitalizations, and one gruesome surgery in 3 months), I have a few observations about this.
The pricing models are all screwed up. The same CT scan that cost $1600 in Portland was over $6,000 at the ER in Florida. My insurance company paid it. Huh? Why in the world does it cost more in Florida? It was the same procedure using the same equipment.
The docs have to start thinking of costs. That's so key, and it rarely gets raised as an issue. If the doctors would prescribe the cheaper treatment, most times it would be fine, but they don't think about their patients' costs or system costs. We have made the doctor/patient relationship sacred, and everyone raises holy hell if the insurance company, health plan, state/federal plan doesn't want to pay for what the doc orders.
Even my (usually rapacious) insurance company left money on the table. Case in point: I needed IV antibiotics for a few more days prior to surgery. I had already been in the hospital for four days, and was feeling well enough to go home. I initiated the idea of doing the IV antibiotics at home myself and talked the doc into it. If United Healthcare would answer their phone on Saturday, I could have gotten out then and saved more. As it was, we had to wait until Monday to make sure it was authorized. Home health bill was $600, compared to about $5K it would have cost to be in the hospital for those days. The idea never occurred to the doc, and I had another doc tell me that she would never allow a patient to do such a thing. (I chose to change specialists.)
I use a primary care practice that I pay an annual fee of about $500 for. The fee is for all the office visits I don't use. When I have a problem, generally I just email my doc (or call if I'm in a hurry) and we deal with it without an office visit. However, most docs operate under the model where they don't get paid unless you spend time in their office. So, the incentive is to make everyone come in. mp97303 above could have diagnosed his/her own problem AND suggested the treatment. I do that all the time unless it's something big.
I was lucky. I had insurance, although we're about to have to go COBRA due to a layoff. Still, this little problem ran up a good $65K in charges. I was darn lucky to get out of it with $5K out of pocket. For many people, it would have been a complete disaster and led to bankruptcy. For people without insurance, they would have had to let it go to emergency surgery level, which carries both a high risk of death and a likelihood of much longer and more intense--like ICU-- hospital stays.
So, while the system largely worked for me, I saw a lot of opportunities for savings, a few inequities, and a lot of inefficiency and cluelessness about options.
7:58 p.m.
Mar 19, '09
So it sounds like the general conclusion is that we have a health care model that does not work. It needs to be turned upside down, shaken and then raised upright again.
Kind of like a snow globe.
People should look into supporting Dr. Kitzhaber. I hate to paraphrase anything the man says because he's 10x more eloquent than I am at conveying a highly needed message.
www.archimedesmovement.org
Mar 19, '09
Among the dirty secrets that no one is talking about are these: Any real "fix" of our health care system means it's going to have to turn into a non-profit system, running it as a profit business whether corporate or not, means there's little left for real care.
Doctors are going to lose their status of privilege and wealth in this society, and become regular health professionals like they are in other countries. Doctors are going to turn into health care workers who give services to people, and lose their status of CEOs managing a business enterprise.
Drug companies are going to lose their huge profits and protected status.
11:06 p.m.
Mar 19, '09
De-linking insurance from employment by ending the employer tax break is key, for two reasons:
1) It frees up a huge amount of money to be spent on covering individuals and the uninsured.
2) It would create a market for health insurance more like car insurance, where consumers shop for and buy their own insurance plans according to their own needs and preferences, rather than being forced whatever plan their employer offers.
Even if individuals are subsidized with vouchers or tax credits for health insurance plans, the economic incentive will rest with consumers to make more economically savvy choices. Doctors and insurance companies would focus more of their attention on taking care of and pleasing the patient, who would be their customer. Unlike the current system where the "customer" is really the insurance company or the government or the employer.
Mar 21, '09
This is the most realistic observation and intelligent statement I have ever heard from an Oregon Democrat! Three cheers for Ron Wyden!
Make that a simple clapping sesssion and a "Right on" !
It is apparent that Ron has grown out of the denial stage and wants to fix health care for our children.He understands that the current dogma on behalf of both republicans and democrats concerning health care is status quo big insurance.
Now that he has spoken the truth, will the AMA, insurance companies, AARP, and Seniors turn against him? How will he raise money for his next campaign when he is defying the machine?
Whats next will he state that drug companies cannot advertise on TV, so as not to brainwash our seniors into very very expensive designer drugs that our children will have to pay for at 10 dollars a pill.
His statements undermine the very foundation of his PAC donor list!
For the love of Pete!
This is a beginning of meaningful dialogue!
www.StephanAndrewBrodheadForOregon.com
Mar 21, '09
Please look at my simple platform here:
http://iraqeraveterangibill.com/Senior_Health_Care.html
Maybe Ron Wyden can look at it and make value adding imput? Or maybe his statements were an outburst of "political suicide on health care reform tourettes syndrome?"
www.StephanAndrewBrodheadforCongress.com
Mar 23, '09
Many of these kudos for Wyden's plan must have come from insurance company flacks. A not-for-profit health care system is the only real solution. Both the major parties are cowed by the insurance lobby and AARP is part of the problem, not the solution. Enough Wyden fawning.