The Final Push for Health Care Legislation Begins
http://thedianerehmshow.org/shows/2010-03-15/final-push-health-care-legislation-begins
President Barack Obama listens during a meeting in the Roosevelt Room of the White House, March 11, 2010.
The final push for health care legislation begins. President Obama delays an overseas trip in an effort to move stalled health care legislation through Congress. The prospects for passing a bill.
Guests
Norman Ornstein
is resident scholar at the American Enterprise Institute; coauthor with Thomas Mann of "The Broken Branch: How Congress Is Failing America and How to Get It Back on Track."
Mary Agnes Carey
senior correspondent with Kaiser Health News. She most recently served as associate editor for CQ HealthBeat, a daily report on health care policy. She has also served as Capitol Hill Bureau Chief for CQ.
Ezra Klein
Washington Post staff writer.
Comments
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I hope healthcare passes. *crosses fingers*
It astounds me how Ms. Page's experts consistently refuse to address the elephant in the room. The OB/GYN caller from Kentucky hit the nail on the head. I have been practicing radiology for 35 years, and I agree with her completely. To think we can cover more people and decrease costs is absurd. As the Dr. said, we must change utilization patterns. That means two things: first we must stop practicing formulaic (algothythmic ) medicine. For example, today if a patient says that he bumped his head, we automatically get a CT scan "just to be sure" everything is O.K., even though clinical suspicion may be quite low. It is quick and easy and prevents litigation. I can tell you that 90-95% of these scans will be normal. How do we cut out some of the 90% that are not needed? We must allow clinicians to use judgement. We can eliminate 75% of those scans by deciding clinically if they are really necessary. The problem is that in doing so, we are likely to miss 1 or 2 of the positive scans, regardless of whether the findings are trivial or significant. So the real question is, "Will we accept 80-90% accuracy to reduce costs 75%?" Those 1 or 2 cases may offset cost savings by litigation, and nobody is going to get it right all the time. How much do we want to pay, or can we afford to pay, for those two cases? The easy way out is to do all 100 scans according to the current protocol being taught and used. Whether we like it or not, certainty in medicine is rare. Even when we do all 100, something is probably missed somewhere.
Second, we must ration medicine. How do we do it? I suggest we let the patients do it. Patients must take some responsibility for their own health. For instance, we should not do coronary bypass surgery on a smoker. We should not do back surgery on an overweight patient. These risk factors are ones that the patient can control. A large number of diabetic patients could be controlled by diet alone, if they would stay on the diet. Of course some would cry discrimination. But it is discrimination when I am forced to spend my tax dollars on procedures that are doomed to failure in these patients. At the very least, the premiums for coverage for patients who are high risk because of self-induced controllable probems should be higher.
In fact, we have the technical ability to do more than this country can afford to do, and we cannot afford to do everything for everybody. There will always be a new procedure on the horizon. We should not waste money performing them when we know the chance of success is marginal. That would really be practicing "results-based medicine". It requires us as a society to address complicated problems and make difficult decisions. The bills being debated are at best insurance reform. We are sweeping the real issues of health care reform under the rug.
Perhaps I and my OB/GYN colleague should form a young-old coalition.
Morgan Eiland, Birmingham, Alabama
I have worked in health care for almost 40 years and I am a faculty member at a medical school in Massachusetts. Contrary to public perception, most folks in Massachusetts support health care reform and certainly the health care providers support reform. Its the insurance companies and Big Pharma that oppose reform. This bill may not be perfect but it points in the right direction.
Superb guests, all objective and highly informed.
This type of measured, knowledgeable conversation is what can only be found on NPR, and the DR show does it best!
I wish the president had pushed harder earlier, but perhaps he understands the attention span of Americans and the requirement to peak at the right moment better than most give him credit
For my small business and employees,
http://www.thirdcoastkites.com
we sure hope he is successful in this first step, and that indeed this is just the beginning of reform.
Dear Eliand,
You had a long post (which I enjoyed) and addressed good points, among them, who gets the medicine? and how do we ration the care. To be certain these problems will be addressed as taxes go up and care gets thinner. It is merely too political to state this outright NOW. Americans in favor of this bill still believe that they will get something for nothing. Eventually the bills must get paid. I realize that health care is NOT free. Everyone must get paid.
As for extra tests? Personally I do not mind paying for an extra CT scan if it is MY head on the table, nor the extra tests for my blood work when there is a chance I have Lyme disease or whatever my doctor legitimately suspects. I'm not in favor of 80% medicine. After all I AM PAYING for it!
Problems arise when people who can not take care of themselves believe it is your duty to do so. For example the overweight knee replacements, the heavy drinker, the smoker, the diabetic who refuses to regulate their diet. People don't understand that their PRIMARY CARE PROVIDER is not a DR, NP, PA, nurse or technician. It is themselves!
The thought that the government will force me to purchase health care insurance is sickening! I should choose to purchase it and at the level I'm comfortable with. For some reason we have developed the illusion that health care is a 'human right'.
The fact is heath care is NOT a human right it is a service. Like other services we purchase, food, cable TV it is not a right. This bill aims to simply make us pay for our own health care, and the health care for others. Frankly I'm not sure how to stop this bill from getting rammed down our throats.
Today in this country we have a great model for socialized medicine run by the government, the VA hospital system. My fear is this bill walks a slippery slope and will take us closer to that model. I hope I'm wrong.
Can I join your young-old coalition? I'd expect >95% care but I'd pay my own way!
Scott
Every USA citizen should have medical coverage, NOT medical insurance, There are 2 different things. Insurance drives medical costs up and up. If you want to pay less for MEDICAL CARE go to the Doctor and ask for discount for paying at the time of service. You will get a huge discount.
Insurance companies should get out of being the "middle man" of medical care.
Did anyone asked what the Doctors want to provide a better care for their patients?
I am a Doctor and I want to practice medicine, get paid on the day that I worked (not 6 months later from the insurance) and not having to hire 4 people to process a claim. This is the craziest medical system I have seen. My father was a Doctor in another country and he was getting paid "today"
Let the goverment give money to US citizens and let them go to whoever Doctor they want. Fire the insurance company and half of the politician too. Politicians should be "ostricized" like in ancient Greece. One gets fired every year, no matter what.
Diana I love your "non-objective show" . True Journalism.
Ted,
You also make a great point! I think Robin Williams had a joke to this effect. "Politicians and baby diapers should both be changed frequently... and for the same reason". Keep being a Dr.
-Scott