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calendar   Friday - July 24, 2009

Can the US President save the patient?

Always interesting (almost) to read the comments and questions and see how foreign journalists are covering the USA.

So many of you at BMEWS have commented on health care and recently Wardmom (love that lady) really opened up on the subject, that I don’t have anything to add. So I’ll leave it to you ppl.

I find this to be a very interesting read and I do agree about the profit motive as I have personally seen and posted under comments somewhere else,
at least one reason for sky high medical pricing.  And I also believe it’s true that many doctors and hospitals are gouging the public. 

When I turned 50, the group ins. plan I’d had for years started charging $1,000 a month. It was going up every month it seemed They were losing members in the plan and were forcing ppl to quit the plan, which of course we had to do.

Barack Obama is staking his leadership on health care reform. Alex Spillius reports

By Alex Spillius
Jul 2009

AMERICAN health care has always been a bit of mystery to the rest of the developed world. Just why does the richest country on earth have an immunisation rate worse
than Botswana’s? Why do 38 other countries have lower infant mortality rates? And why are there 47 million people out of a population of 300 million without medical insurance?

Barack Obama, perhaps unwittingly, turned to Alice in Wonderland to try to explain the issue to his public, which can find the system as confusing as the rest of us.

“If there’s a blue pill and a red pill and the blue pill is half the price of the red pill and works just as well, why not pay half price for the thing that’s going to make you well?” he asked, before providing part of the answer. “The system right now doesn’t incentivise that.”

American doctors tend to prescribe the expensive pill because they are paid more to do so. They may also be over-inclined to remove tonsils, as the President highlighted, because “the doctor may look at the reimbursement system and say to himself, ‘You know what, I make a lot more money if I take this kid’s tonsils out’.”

As a consequence, costs have soared into the realms of fantasy: a sixth of the US economy, $2.4 trillion (£1.45 trillion), was spent on health last year.

Health care reform is Obama’s biggest domestic priority, so great that he cleared the airwaves for a prime-time press conference from the White House on Wednesday evening devoted almost entirely to the issue. He has made it his job to ensure Americans can wake in their beds safe in the belief that they have a health care system that is reliable and affordable. And the President knows that if he doesn’t get this right, he may find
he isn’t sleeping in the White House after 2012.

The goal of reforming America’s private sector-dominated system has consumed Democrats since the Second World War. All along, they have craved something akin to the National Health Service and they regard it as a deep source of national shame that so many millions are poorly cared for.

Yet as Britain was legislating for care from the cradle to the grave in 1945, the Murray-Wagner-Dingell bill, an attempt to introduce universal coverage, was failing in the US. It was defeated largely by the American Medical Association, the powerful doctors’ group, which vowed to “resist the enslavement of the medical profession” and demanded $25 from each member to pay for a highly effective lobbying of Congress.

The Democrats, however, scored a significant victory in 1964 when President Lyndon Johnson, exploiting the mass sympathy created by John
F Kennedy’s assassination, managed to push through Medicare and Medicaid, two programmes that belie the myth that there is no free care in the US. In fact, all those over 65 are covered by Medicare, while Medicaid covers about 40 per cent of the poor, most of them children. Another scheme, the State Children’s Health Insurance Program, assists children from families of modest income who earn too much for Medicaid. Hospital emergency rooms are also obliged to treat anyone who walks in, no matter how trivial the complaint. As a result they are always packed with sore throats and ankle sprains.

In the boom years, the system worked well – it still does, in fact,
from many patients’ point of view.
It represented the best of America: dynamic, entrepreneurial and driven by consumer needs rather than the diktats of central authority. Now its bad elements have come to represent the worst: bloated, excessive, over-driven by profit and mired in bureaucracy.

The US spends an annual $6,000 more per capita than any other industrialised nation on health care, but by almost every measure, its people are unhealthier. The reasons are manifold: insurance is not mandatory, so for a decade premiums for those who do want to be covered have risen three times faster than wages. Rapidly emerging new technologies have driven up costs, while doctors, as the President noted, are rewarded for services provided and not for the health of their patients.

Fear of litigation, physicians argue, has made them cautious and liable to over-prescribe and over-test. A mild complaint about poor sleep in the doctor’s surgery will see you walk out with a large prescription. A bad back? Let’s get you a scan. Didn’t show much? Let’s do an MRI. How about a spinal fusion operation, which won’t really work?

Then there are horror stories that the President says fill his letter box every day. Principal among the system’s ills is the fact that a lost job means lost insurance, because most people’s coverage is purchased by their employers.

The system is also replete with traps: insurance commonly only kicks in after two weeks with a new employer. This wasn’t much help to a glass-cutter from Virginia who, four days into a new job, woke up in hospital with a broken neck and a bill for $15,000 after a game of American football went badly wrong.

It wasn’t much help for Jim Howe’s daughter, either, who nearly died in a car crash four years ago, just days before his insurance came into effect. “The family had gone without coverage before, when I had been unemployed for short periods, but nothing had ever happened to any of us,” he said. Subsidised insurance of $1,200 a month was unaffordable when he was out of work. “It is
always just a crap shoot. You hope for the best.”

Thirteen operations and $300,000 in fees later, his daughter is on the verge of bankruptcy and her credit rating – which will affect her ability to get a mortgage – is in tatters.

By Obama’s own admission, if he was starting from scratch, he would want what is called a “single payer system”, a version of the NHS funded from the sole source of income tax. America’s multi-level structure is, however, far too complicated to demolish.

SEE THE REST HERE

doctors, as the President noted, are rewarded for services provided and not for the health of their patients.

OK, I need someone to explain this to me.  Aren’t things like payments predicated on “services provided?” I might be a bit dense here but ... doesn’t Drew for an example, get rewarded for services he provides whether its as a tech or a window cleaner?  Is Obama suggesting then, that a doctor should not be paid unless he can cure the patient?  If not, is he supposed to provide service free?  image


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Posted by peiper   United Kingdom  on 07/24/2009 at 02:54 AM   
Filed Under: • EconomicsHealth-Medicine •  
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