Healthcare: Sorting Fact from Fiction

House legislation on health reform is a win-some-lose-some proposition for those over 65. Especially, as outlined in The New York Times yesterday, when it comes to Medicare drug benefits.

Medicare beneficiaries would often have to pay higher premiums for prescription drug coverage, but many would see their total drug spending decline, so they would save money as a result of health legislation moving through the House, the Congressional Budget Office said in a recent report.

Premiums for drug coverage would rise an average of 5 percent in 2011, beyond the level expected under current law, and the increase would grow to 20 percent in 2019, the budget office said.

“However,” it said, “beneficiaries’ spending on prescription drugs apart from those premiums would fall, on average, as would their overall prescription drug spending (including both premiums and cost-sharing).”

The Congressional Budget Office report set off an immediate battle between Republicans and Democrats, each side eager to convince seniors — those vocal voters — that the other was representing the devil incarnate. Republicans swear the House bill will threaten Medicare beneficiaries in order to cover the uninsured, Democrats say the bill will help them by eliminating a gap in Medicare drug coverage.

On this particular segment of the impossibly complex bill, maybe seniors would do well to listen to their own purported champion:

Nancy LeaMond, an executive vice president of AARP, the lobby for older Americans, welcomed the report as evidence that “health care reform will lower drug spending.”

“Opponents of reform may use today’s projections to try to stall reform,” Ms. LeaMond said, “but we hope they will look at all the facts before jumping to a false conclusion.”

And there, some would suggest, is the problem. The facts have been virtually obscured by misstatements, misrepresentations and outright lies. Death panels? A lie that served its scary purpose. Rationing? It’s already here, folks; it’s done by insurance companies that deny coverage in sometimes arbitrary ways. Socialized medicine? Hello? Does anyone over 65 remember those screams before Medicare was signed into law in ’65? When half the population over 65 had no insurance coverage at all?

Set aside the fact that providing healthcare for all is simply the right thing to do. Millions of American seniors (whether you begin that definition at 65, 60 or — to their horror as it sometimes happens — 55) were motivated to support President Obama by not only their hearts but also their brains. If those brains can be called into play to sort fact from fear-mongering, we may yet get the health reform common decency requires of this otherwise civilized nation.

Health Bill Would Cut Drug Spending for Many on Medicare, Budget Office Says – NYTimes.com

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More on Health Care: Where the Costs Are

A few interesting factoids were dropped into the health reform debate by New York Times writer Amanda Cox Tuesday:

In 2006, health care expenses among half the United States population totaled less than $800 per individual, according to the federal Agency for Healthcare Research and Quality.

For openers, that seems entirely reasonable. Would that we could actually care for the citizenry at $800 a pop. Keep reading.

But the expenditures were not uniformly distributed throughout the overall population. Spending was far higher among the elderly, the obese and people who identified themselves as unhealthy. Median spending in those groups totaled $2,300 per individual. Although these patients represent just one-third of the population, they accounted for almost 60 percent of health care spending.

I hate to stomp this nearly dead — oops, bad metaphor — horse even further into its grave, but a lot of us, given the chance to talk to our doctors about aggressive, invasive, often futile end-of-life treatments that are going to make our ends horrific might choose to go home and spend our remaining time with palliative care, at peace. A nifty way to cut that $2,300 back down to $800. But Senator Grassley and others think we should now allow those conversations.

The truth may be too obscured by the cleverly promoted lies, but the issue is about choice. Compassion. Comfort. Peace. Sanity. If anyone could get this truth across to seniors, that one critical segment of reform might still survive. And personally, I’d like to have the option of saving the rest of you taxpayers my $1,500.

via Making Sense of the Health Care Debate – Prescriptions Blog – NYTimes.com.

Insuring the Uninsured: A No-Brainer

I’ll call her Joan. She is 61 years old, working in real estate and living comfortably in an upscale rental apartment thanks partly to rent control. She has a small 401k and a small, steady income from shared family ownership in a stable investment property. But the real estate business, you may have heard, hasn’t been wonderful lately. Joan lives frugally, gives of her time and resources to community nonprofits and is highly respected in business and social groups. She has no health insurance.

“I would if I could,” she told me some time ago. “But it’s either buy insurance or buy dinner. I’m fond of eating.” Twice in the past year Joan has had to have medical treatment; once for a nasty wound in a bike accident, once for an infection that required an overnight hospital stay. She went to the only place available, the understaffed emergency room of a crowded public hospital. Who picked up the tab? You and I. I am happy to do so, for Joan and everyone else who winds up in these predicaments. But come on, it’s not exactly cost-effective.

Expanding coverage to those currently uninsured is only one segment of this moving-target health reform; I hope it doesn’t get lost the way other key elements seem to be straying from the scene. People like Joan would be the first to purchase insurance through any reasonably-priced plan. Unfortunately, I don’t see many insurance companies eager to offer such a thing, and I don’t know where many of the currently uninsured will go if the public option comes off the table.  There were some 47 million uninsured at the latest count. Add to those the swiftly-rising numbers of independent contractors and freelancers of all sorts.

Getting non-emergency care out of the nation’s emergency rooms seems an enlightened thing to do… if we could just have a little more light and less heat in the discussion.

Fitness & Health Reform: Stay Flexible

Flexiblility is the new necessity. Political flexibility if one is to make the loop from truth to Sarah-Palin fiction, emotional flexibility if you’re following the market from day to day, mental flexibility just to stay sane with it all.

So maybe we’d better look at the physical. If you can just acquire and maintain a little physical flexibility you’re on the way to fitness, health and inner peace. At least, that’s what the yoga people tell me. Plus a lot of gym people, personal-trainer people and public park people. It is these last whom I tend to believe. I failed yoga (tried and just flat-out failed; I was too itchy for sunlight and speedier movement) and can’t afford a personal trainer. But parks! What a gift to the flexibility and fitness of the world and may we please not be closing them.

In our nearby urban park there is a par course. An array of exercise stations installed usually several hundred feet apart along an outdoor trail, the par course is the Everyman/Everywoman route to flexibility, especially for Boomers and Beyonders. It features a number of stretching posts (each station comes with illustrated instructions about what to do and how many times to do it) plus a variety of sturdily-equipped stations for things like chin-ups and sit-ups and other ups. I am addicted to the par course.

For the first five decades, fitness and flexibility aren’t all that hard to come by. Thereafter, one needs encouragement in this obesogenic (my new favorite word) society in which we live. Par courses are all about encouragement. You can’t manage to hand-walk more than halfway on the parallel bars? Last week you couldn’t get past one-third! Or you’re near despair at the chin-up station, and the hunky twenty-something at the adjacent bar applauds as you master a tiny new fraction of an inch.

By the time the final health reform bill is hammered out the issue of preventive medicine may be hopelessly lost in the shuffle. “Takes too long to produce results.” “Isn’t really worth the cost or the effort.” I don’t buy any of those arguments. Until we tackle the need for lifestyle changes like quitting smoking, losing weight and getting fit we’ll just keep pouring money down the drain of preventable illness. E-mail your senator. Write your representative.

Meanwhile, I recommend staying flexible.

Tracking Down a Rumor

Rumors come, and don’t seem to go. Jim Rutenberg and Jackie Calmes of the New York Times have weighed in again today with a few facts… just in case anyone is interested in facts:

The stubborn yet false rumor that President Obama’s health care proposals would create government-sponsored “death panels” to decide which patients were worthy of living seemed to arise from nowhere in recent weeks.

Advanced even this week by Republican stalwarts including the party’s last vice-presidential nominee, Sarah Palin, and Charles E. Grassley, the veteran Iowa senator, the nature of the assertion nonetheless seemed reminiscent of the modern-day viral Internet campaigns that dogged Mr. Obama last year, falsely calling him a Muslim and questioning his nationality.

Rutenberg and Calmes point out that the doggedly persistent rumor “was not born of anonymous e-mailers, partisan bloggers or stealthy cyberconspiracy theorists.

Rather, it has a far more mainstream provenance, openly emanating months ago from many of the same pundits and conservative media outlets that were central in defeating President Bill Clinton’s health care proposals 16 years ago, including the editorial board of The Washington Times, the American Spectator magazine and Betsy McCaughey, whose 1994 health care critique made her a star of the conservative movement (and ultimately, New York’s lieutenant governor).

This is the core of what all reasonable people know:

There is nothing in any of the legislative proposals that would call for the creation of death panels or any other governmental body that would cut off care for the critically ill as a cost-cutting measure.

But as T/S Contributor Andy Geiger points out, the real issue in health reform is that people are suffering because they don’t have health coverage. Opponents to any reform at all have found a handy way to create this smokescreen by keeping everyone riled up with an utterly false rumor.

I’ve spent much of my adult life working for better end-of-life care, including being forever on a soapbox urging everyone, not just seniors, to consider their end-of-life options, have conversations, create advance directives and then get on with living. I strongly, fully support the good provision in the health care bills that may indeed now get cut.

But we need not to lose this forest for a tree. Rational people have got to continue fighting for a decent system, a decent bill.

False ‘Death Panel’ Rumor Has Some Familiar Roots – NYTimes.com.

End-of-Life Care is Losing to Lies

Here is some of the current worst news on health reform:

The Senate Finance Committee’s health care plan will not include provisions dealing with end-of-life care, now one of the more controversial topics in the health care debate, the committee’s top Republican said on Wednesday.

Senator Charles E. Grassley of Iowa said in a statement that the committee “dropped end-of-life provisions from consideration entirely because of the way they could be misinterpreted and implemented incorrectly.”

If anyone knows misinterpretation, it’s Senator Grassley. He’s the originator of such enlightened parting phrases as the one he tossed out at an Iowa meeting Wednesday, about not wanting a health plan “that will pull the plug on grandma.” There is, of course, no grain of truth in that phrase, but its repetition does exactly what Sen. Grassley and his ilk wish: whip the opposition to any real reform into an emotional, unthinking frenzy. And they are winning the war against reason one battle at a time.

A Senate Finance Committee aide confirmed that the panel was not discussing end-of-life measures, adding that they were “never a major focus” of the committee’s negotiations.

House committees have passed legislation that would provide Medicare coverage for optional counseling sessions on end-of-life services.

But as people like Senator Grassley, and former N.Y. Lt. Governor Betsy McCaughey who sought fame and perhaps fortune by starting this whole flap, keep the country inflamed with misinformation the chances of decent legislation rising from these ashes grow dim.

The hopeless optimists of the land continue to believe that calls and letters and e-mails of sanity will convince our legislators that the country will rally around a decent bill… but Mr. Grassley and Ms. McCaughey are making optimism difficult.

via Senate Bill Will Not Address End-of-Life Care – Prescriptions Blog – NYTimes.com.

Health Care that Works: Integrated Medicine

President Obama speaks at a Portsmouth, NH event on August 11 (Darren McCollester/Getty)
President Obama speaks at a Portsmouth, NH event on August 11 (Darren McCollester/Getty)

Last night’s NewsHour included a segment that gives me hope: a clip of President Obama citing integrated medical systems that are actually working, followed by an excellent in-depth piece on the Billings MT clinic that proves the point. Billings is only one of such examples.

How do they work? By getting everybody under one roof and coordinating patient care. By letting different specialties work together, rather than sending a patient from one to another to another. By compensating doctors with salaries. This last is a sticking point: if you own a piece of the MRI business, for example, you might just be inclined to order more MRIs. Or you’re tied to the work-harder-get-richer principle. But more and more doctors seem interested in having a life, in not being on call 24 hours a day, in earning good money (integrated system compensations compare well with private practices) while focusing on patient care — without over-prescribing and over-ordering to guard against getting sued.

Why does this make such good sense? Because most patients (not all) sing its praises. Because integrated care saves money by keeping people healthier, reducing unnecessary procedures, keeping people out of hospitals… the list goes on.

My oncologist retired a year after a 2006 breast cancer episode. I went to meet my new choice on the 8th floor of Kaiser Medical Center in March, 2008. She looked at lab tests (2nd floor), spotted anemia, said I shouldn’t be anemic, ordered colonoscopy/endoscopy. G.I. doc (2nd floor) found celiac disease in June, connected me to nutritionist (across the street) and to endocrinologist (6th floor) who helped me design diet plus vitamins etc so I’m healthy again. Physical therapist (4th floor) discussed fitness plans. All of these specialists, my surgeon (2nd floor) and my primary care doc (4th floor) are friends. All respond to frequent e-mails within 24 hours, saving multiple calls and appointments. All post test results, etc on my personal web page. Thus, over a 3-year period: one overnight hospitalization for mastectomy, one out-patient procedure, a reasonable number of appointments, healthy patient.

Not everybody loves Kaiser, or the other clinics being studied. But it’s a model that works.

Straight Talk Q&A on Health Reform

One of the best fact-checks re health reform I’ve seen lately was just sent out by Ricardo Alonso-Zalvidar for the Associated Press:

Former Republican vice presidential candidate Sarah Palin says the health care overhaul bill would set up a “death panel.” Federal bureaucrats would play God, ruling on whether ailing seniors are worth enough to society to deserve life-sustaining medical care. Palin and other critics are wrong.

Nothing in the legislation would carry out such a bleak vision. The provision that has caused the uproar would instead authorize Medicare to pay doctors for counseling patients about end-of-life care, if the patient wishes. Here are some questions and answers on the controversy:

Q: Does the health care bill promote “mercy killing,” or euthanasia?

A: No.

Q: Then what’s all the fuss about?

And here’s where it all started:

A: A provision in the House bill written by Rep. Earl Blumenauer, D-Ore., would allow Medicare to pay doctors for voluntary counseling sessions that address end-of-life issues. The conversations between doctor and patient would include living wills, making a close relative or a trusted friend your health care proxy, learning about hospice as an option for the terminally ill and information about pain medications for people suffering chronic discomfort.

The sessions would be covered every five years, more frequently if someone is gravely ill.

Alonso-Zaldivar covers all the basics in this brief, to-the-point article. My personal favorite opinion is also in there. It’s a comment made by Monsignor Charles Fahey, 76, a Catholic priest currently chairman of the board of the National Council on Aging:

“What I have said is that if I cannot say another prayer, if I cannot give or get another hug, and if I cannot have another martini – then let me go.”

Maybe we should put that martini provision in the bill.

via Health care overhaul bill Q&A.

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