Category Archives: Health

Contacts: Rickenmann, mental health advocates, McMullen

As Doug Ross might testify, I make a point of breaking my fast most mornings in a place where I’m likely to run into newsmakers who tell me things I was not trying to find out, but needed to know anyway (to sorta, kinda paraphrase Dirk Gently).

At this time I will head off those of you who think this is an elitist pursuit by saying I also frequent Wal-Mart — but there, few people come up to me and tell me things I can publish.

Anyway, in keeping with my sporadic efforts to let you know about folks I interact with (part of the whole transparency thing, letting you know who might be trying to influence what you read on the editorial page, yadda-yadda), here’s this morning’s list of folks who dropped by my table:

Daniel Rickenmann, who seemed to be sort of working the room, eventually got to me. No substantial discussion. I asked him what he was hearing from constituents as he campaigned for April 1, he said he’d heard a lot (understandably) about the city’s problems keeping track of money, and suggested the creation of a citizens’ fiscal review panel. At least, I think that’s what he said. Does not being sure sound lax on my part? Well, I knew I would be sitting down formally with him next Tuesday for an endorsement interview, and that will be well documented, I promise.
A group of folks — one of them a surgeon I know from USC’s medical school, but I’m leaving his name out for now since he was not the instigator of the conversation (although he can remind me of the names of the other folks later) — approached me to say that the former Department of Mental Health property on Bull Street (you know, which was supposed to be redeveloped, but which hasn’t happened?) is still needed to provide mental health services, and to help train psychiatrists. I’ve heard this before, of course, but there seemed a new urgency in their concern. The doc mentioned the name of a good source, which I wrote on my copy of the WSJ.
Ed McMullen, late of the S.C. Policy Council, joined me as I headed for the elevator. We talked briefly about several things, ending with the Wireless Cloud, about which he promised to send me a line on a source. Don’t forget me on that, Ed.

Is this what it’s like writing a diary?

Tax cigarettes more, but not because a poll said so

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By BRAD WARTHEN
EDITORIAL PAGE EDITOR
WHAT DO YOU think of the results of the latest Winthrop/ETV poll of South Carolinians, released late last week?
Here’s what I think: Thank goodness the founders of this country bequeathed us a republic rather than a system of direct democracy, and those who devised our state system sorta, kinda went along with that.
You say that’s not what you thought? Well, let’s look back at a couple of the poll’s findings:

Almost three-fourths of respondents approve of raising the state’s tax on cigarettes. Given a choice between using the proceeds to pay for health care for the poor or the governor’s proposal to reduce income taxes, five times as many chose paying for Medicaid.
Asked whether the governor should be allowed to appoint executive agency heads who are now popularly elected, three-fourths said no, they’d rather keep electing them.

I look at that first result and hail the wisdom of the electorate. Numbers like that tempt me to run around the State House and wave them at all those finger-in-the-wind lawmakers, to get them to get off their duffs and raise our lowest-in-the-nation cigarette tax.
But then I look at the second result, and I want to warn lawmakers not to govern by poll. Sound hypocritical? Let me see if I can explain my way out of this.
Poll after poll, year after year, South Carolinians say they want the cigarette tax raised. This is useful to know, because lawmakers keep trying to excuse their inaction on the tax by saying voters don’t like tax increases. These polls indicate that voters do want this tax increased.
But that’s not why it should be increased. It should be increased because it’s been thoroughly demonstrated that every dime by which we increase the cost of buying a pack of cigarettes decreases the number of kids who get hooked on tobacco. If you want to use the proceeds to pay for Medicaid, great. But that’s not the point. The point is pricing cigarettes beyond the reach of adolescents.
Any lawmaker who does not know that about the cigarette tax is one who has not been paying attention to the debate at the State House. And a lawmaker who doesn’t pay attention to the debate is one who isn’t doing his or her job.
You don’t raise a tax because you get a thumbs-up from a poll. You raise it, or lower it, or do something else, or do nothing, because you’ve done the due diligence necessary to draw intelligent conclusions about the likely consequences of such action. And that is your job as an elected representative.
In a small group — say, small enough to fit in one of those iconic New England town halls that express the ideal of direct democracy — it’s at least theoretically possible to examine an issue thoroughly. People on various sides of an issue can challenge each other with questions; those who know more about a specific issue can share their knowledge with those who know less; and all of that can take place before a vote on what to do.
Polls don’t do that. Polls derive overly simplistic conclusions from the gut, off-the-top-of-the-head reactions of folks who didn’t get a chance to study before the test. They provide useful information, but are a lousy way to make decisions.
This is true even when those crafting the poll try to maximize the respondent’s preparation with questions that sound halfway like lectures. That was the case with this poll. Consider the way the constitutional-officers question was asked: “In South Carolina, we have several statewide elected offices. These include the Secretary of State, Superintendent of Education, Comptroller General, Commissioner of Agriculture, and others. Some people believe that it would increase the efficiency and effectiveness of government if some of these positions were appointed by the governor, while others feel that they should continue to be elected and remain directly accountable to the voters. Which of these comes closer to your opinion?” The respondent then gets a choice between “Appointed by governor” and “Continue to be elected.”
I’m not a bit surprised that three-fourths of respondents answered “continued to be elected” after all that — especially after they had just been told that was the way to keep those officials “directly accountable to the voters.”
But I firmly believe that if you gave me five minutes with each of those folks, the result would be different.
First, I’d ask the respondent to name each of those elected officials. Most would know who the governor is, almost none would know all of them. Then I’d ask, how do you hold someone accountable if you don’t even know that person’s name?
I’d talk about the two current officers who had to be appointed because the ones who were elected ran afoul of the law. I’d ask whether they thought the governor — the official they know — should be held accountable for running the government day to day. Then I’d ask how they think he’s going to do that when most of the government doesn’t answer to him.
I believe most folks would change their minds. I believe that because I trust the voters.
You see, I don’t oppose government by plebiscite because I think the people are less intelligent than politicians. I know too many politicians to think that. I oppose it because it’s not the best process. If you take poll respondents and put them in a situation in which they could thoroughly study and debate an issue before voting on it, their decisions would be far better than those they’d make on the spur of the moment.
Sometimes, this process even works with politicians. But not when they spend all their time looking at polls.

S.C. Hospital Association on quality of care and safety, covering the uninsured

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Here I must apologize for falling behind reporting on the meetings we have with folks pushing various points of view. It was one of the reasons I started this blog, but pulling my notes, video and all together to fairly summarize such meetings is very time-consuming. Yesterday, I had two very interesting such meetings — one with Jay Moskowitz, president of Health Sciences South Carolina in Columbia, who is an example of the kind of classy talent our governor would prefer that we NOT attract; another with some guys from the Air Force on a host of issues from the strategic to the logistical (so wide-ranging that I can’t summarize it just in passing). Unfortunately, yesterday was so busy I didn’t get to digesting those, and probably won’t today or tomorrow.

But I will keep the backlog from stacking up any higher by telling you about a meeting we had today:

Thornton Kirby — pictured above — president and CEO of the S.C. Hospital Association, came in to talk to us about two issues:

The hospitals’ initiative on health care quality and safety, and
The plan the association is helping to back to cover the uninsured in our state.

For the sake of brevity, I’ll just give you these two video clips below, roughly covering those two subjects, and give you the two links above.

I do have some views on the matters discussed — such as my own personal view (not to be confused with the editorial board’s position, certain people would prefer for me to make absolutely clear, as if the disclaimer at the top of my main page weren’t enough) that the bigger problem in this country isn’t the one-in-seven uninsured, but the vast majority who increasingly have trouble affording the privilege of being insured.

But in Mr. Kirby’s behalf, I will cede his excellent point that my sort of comprehensive solutions can only be implemented nationally, leaving the states to do what little they can. (Which is why I was happy to see what Joel Lourie has been trying to do, just to mention something I meant to say earlier.)

Stories that tell why we need single-payer

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We continue to concentrate on the wrong thing — getting the uninsured into the present system — when we talk about health care reform.

Increasingly, those of us who are privileged to be in the system find that we can’t afford health care, either. The whole system is rotten, wasteful, too expensive and too inefficient. We pay more money to be sicker than folks in any other advanced nation.

There are a lot of problems with our system, but the biggest is the basic premise — employer-based health care through for-profit (and we’re talking for HUGE profits) private insurance companies.

If private health care coverage weren’t so expensive for all of us, the 1 in 7 who remain uncovered would be in it. But it is, and will be, expensive by definition. A profit has to be made.

A single-payer system is the logical way to go. It’s time we got logical about this monster that is now consuming 16 percent of our national economy.

I wrote this column — "‘Health care reform?’ Hush! You’ll anger the Insurance Gods!" — back in November because it’s time that people like me — in the top income quintile — started pointing out how unaffordable this wasteful system is for us, which means it’s worse for millions of others who are also in the system. An excerpt from that column:

… I make more money than most people do here in the wealthiest country in the history of the world, and I live paycheck to paycheck, in large part because of the cost of being an extremely allergic asthmatic, and needing to do what it takes to keep enough oxygen pumping to my brain to enable me to work so I can keep paying my premiums and copays. My premiums in the coming year — we’re going to a new plan — will be $274.42 on every biweekly check, not counting dental or vision care. And I’m lucky to have it. I know that, compared to most, I’ve got a sweet deal!
I’m in the top income quintile in the U.S. population, and we can’t afford cable TV, we’ve never taken a European vacation or done anything crazy like that, we haven’t bought a new car since 1986, and aside from the 401(k) I can’t touch until I retire (if I can ever afford to retire), we have no savings.
Yet I will pay my $274.42 gladly, and I will thank the one true God in whom I actually do believe that I have that insurance, and that I am in an upper-income bracket so that I can just barely pay those premiums, and that neither my wife (a cancer survivor) nor I nor either of the two children (out of five) the gods still let me cover is nearly as unhealthy as the people I see whenever I visit a hospital…

On Jan. 6, we ran an op-ed piece from B.J. Welborn that told another middle-class story. An excerpt:

But the picture is not always rosy. A recent experience made me realize that although I have a comfortable income and a good education, pay taxes and have an insurer pick up most of my health care costs, an overburdened and undermonitored health care system can leave me vulnerable and scared. Here’s my latest scare:
Last year, an out-of-state company bought my husband’s firm in Columbia. We were forced to change our insurance. This change required baffling paperwork to keep my Gleevec coming, and though we tried valiantly to figure out the process, different people at the insurance company told us different things. The process dragged out; the clock was ticking for me. Soon, three weeks passed without my lifesaving drug. I wondered if anybody cared.
I checked with my pharmacy and found it couldn’t order Gleevec from its supplier. I searched for Gleevec at other pharmacies. This drug, still in clinical trials, isn’t like a common antibiotic kept on drugstore shelves. I couldn’t find it. And even if I could find Gleevec, how would I pay for it? $3,000 this month, then $3,000 the next month?
My anxiety mounted. When I washed my face, small blemishes bled, as they do when your blood can’t do its job. I was slipping through the cracks, and I was cracking up…
The "what if" game is terrible. Millions play it, and one day, you or a
loved one could too. Anyone can get a chronic disease — diabetes, stroke,
mental illness, heart disease or cancer.
Let’s face it: You, too, could slip through the cracks of our health care
system. So, it is up to you to make our potential leaders aware of what’s
really going on. It’s not just the poor and uninsured who are hurting, it’s
also millions of hard-working, middle-class Americans who foot the bill for
others’ health care…

Then, on Friday, Feb. 1, we had this letter to the editor:

Health coverage could make writer sick
I am absolutely disgusted by the state of our nation’s health care.
I am a college-educated woman with a bachelor’s degree, an employee of a prestigious university, but most important, a wife and a mother of young children.
I live in fear that one of my family members will become seriously ill or simply require regular preventative care that my health insurance does not cover.
For example, last year, I discovered that the health insurance for S.C. state employees does not cover routine pelvic exams, and without health insurance, that type of procedure can cost almost $200. And other medical procedures aren’t covered until after I meet the $350-per-person deductible.
With one child in daycare and the costs of my children’s health care and regular childhood illnesses, I simply can’t afford to pay $200 or $350 or $550 for my own care. So I don’t go. And I hope that I don’t get sick.

MARTHA BROWN
Columbia

That letter prompted this one on today’s page:

Health insurance costs leave little for care
I read the letter “Health care coverage could make writer sick” by Martha Brown with interest.
While wholly sympathetic to her concerns, I feel, by comparison to many of us, she would be embarrassed by how good she has it.
As a provider for a healthy and active family of four, I am shackled with a monthly insurance bill in excess of $800. For this, we are provided with a policy that covers only 80 percent after a $1,000 deductible per person. It would appear that our policy was written to provide for the economic health of our insurance company, rather than that of my family.
Our provider enjoys strong local recognition, and I hope it is competitive with other carriers, but my bill has become a payment for asset protection rather than health care, and I’m not sure how well it provides for that.
“Health care is expensive” is the most common explanation received when I question our agent, doctors and others about our situation, but price is irrelevant when, after insurance payments, no money is left over for health care.
Surely, mine and Ms. Brown’s situation is not unique. We live in the greatest society that has yet existed, but our current profit-driven health care system is clearly in direct conflict with what is best for its citizens.

EDGAR PUTNAM
Columbia

More people should come forward with these stories. It’s embarrassing — neither of my two bosses, my employer or my wife, was particularly crazy about me going into such details — but this stuff needs to be available as we debate these issues. And we must debate them — the status quo is not sustainable.

‘Tom Jackson’s War’

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Here’s video I shot to go with Cindi’s column today. In it, tobacco retailer Tom Jackson explains what’s wrong with manufacturers packaging cigarettes as "cigars" and marketing them toward youth.

Health care advocacy with, um, gusto

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A regular commenter sent me a message saying "Now this is a universal healthcare lobbying group that has some real ‘cajones‘…"

Assuming that he meant "cojones" (a "cajón" is a chest or locker or box of some sort), I have to agree. This is from the group’s ad in USA Today Monday. Below a newspaper clipping with the headline, "Cheney Treated in Hospital for an Irregular Heartbeat," the ad said:

If he were anyone else,
he’d probably be dead
by now.

The patient’s history and
prognosis were grim: four
heart attacks, quadruple
bypass surgery, angioplasty,
an implanted defibrillator and
now an emergency procedure to
treat an irregular heartbeat.
For millions of Americans, this
might be a death sentence. For the
vice president, it was just another
medical treatment. And it cost him
very little.
Unlike the average American, the president, vice
president and members of Congress all enjoy
government-financed health care with few
restrictions or prohibitive fees. They are never
turned away for pre-existing conditions or denied
care for what an insurance company labels
“experimental treatments.”
The rest of us deserve no less.
We call on the presidential candidates to support
HR 676, the National Health Insurance Act—
an expanded and improved
Medicare for all that:
• provides complete medical,
dental, vision and long-term care
• eliminates deductibles, co-pays,
hidden fees
• allows you to choose your doctor, lab,
hospital, health care facility
• is completely portable and not tied to
employment
• is free from interference or second-guessing by
insurance companies.
Let’s talk about real solutions. Forcing people to
buy insurance doesn’t provide better or more universal
care. It just pads the pockets of the insurance
companies. Medicare for all puts health care
decision-making power back where it belongs—
in your hands.
Traditional Medicare for all—the single best
cure for what ails us.

This was brought to us courtesy of the California Nurses Association and the National Nurses Organizing Committee. The Web address of their effort is http://www.guaranteedhealthcare.org/.

Another group for (unspecified) health care reform

Single-payer position should be no surprise

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I continue to hear from folks who are:

a) pleased by my advocacy of a single-payer national health plan;
b) surprised by it.

This intrigues me, but I should know that it arises from the same in-the-rut thinking that I’m always ranting against here. Apparently, my position just doesn’t fit into the convenient left-vs.-right dichotomy that most folks have, unfortunately accepted as reflecting reality.

Most of the expressions of both a) and b) come from folks of the self-described "liberal" persuasion. I think this is because they have decided recently to divide the world into two portions — those who demand that our troops get out of Iraq by last year, and everybody else. Since I am definitely in the "everybody else" category, they are befuddled at my health-care position. But… he’s a warmonger, so how…?

If only they would try harder to grok the UnParty. I clearly stated my single-payer position in my very first UnParty column, the manifesto itself. Of course, the UnParty doesn’t demand adherence to that or any other fixed position. The most fundamental, non-negotiable tenet is"

First, unwavering opposition to fundamental, nonnegotiable tenets.
Within our party would be many ideas, and in each situation we would
sift through them to find the smartest possible approach to the
challenge at hand. Another day, a completely different approach might be best.

But I gave a list of particular positions that I, personally, would bring to the mix as an UnPartisan. Here are items 2 and 3:

Belief in just war theory, and in America’s obligation to use its strength for good. (Sort of like the Democrats before Vietnam.)
A single-payer national health care system — for the sake of business and
the workers. If liberals and conservatives could stop driving a wedge
between labor and capital for about five minutes, we could make this a
reality.

So — no surprises here.

Save this woman’s life! Vote for McCain

S.C. Chamber chief on health care as a competitiveness issue

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Today, I had two opportunities to bring up health care reform. One was when I went for my annual physical at mid-morning. Dr. Richard Sribnick, one of my internist’s partners, stopped to chat while I was in the lab fighting off the dizziness that always hits me when I have blood drawn (the nurse thanked him for distracting me).

He thanked me for running his recent op-ed piece — Dr. Sribnick has played a leading role in South Carolina’s effort to save Darfur — and offered the guess that I was getting a lot of feedback on my single-payer column. Sure, I said — and what was his opinion? Bottom line, he doubts that it’s the best way to go. He said he’d been at a meeting about new Medicaid rules the night before at a local hospital, and he thought the system sounded pretty messed up from a provider’s perspective.

But… he said that if the choice was between our current state of affairs and single-payer, he’d choose single-payer.

Earlier, our editorial board had met with representatives from the S.C. Chamber of Commerce. It was their annual "Competitiveness Agenda" meeting, at which they share with us their priorities for the coming legislative session.

Anyway, since they had been talking yet again about how competition today is truly international, I asked new chairman Jim Micali, chairman and president of Michelin North America, Inc., how S.C. businesses were affected by the fact that they have to pay for employee health care, while overseas competitors don’t shoulder that same burden.

His reply is contained in the video above.

Can anyone (any viable candidate, that is) say ‘single-payer?’: Column version

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By BRAD WARTHEN
Editorial Page Editor
CAN ANYONE among those with a chance of becoming president say “single-payer?” If not, forget about serious reform of the way we pay for health care.
It doesn’t even necessarily have to be “single-payer.” Any other words will do, as long as the plan they describe is equally bold, practical, understandable, and goes as far in uprooting our current impractical, wasteful and insanely complex “system.”
And the operative word is “bold.” Why? Because unless we start the conversation there, all we might hope for is that a few more of the one out of seven Americans who don’t have insurance will be in the “system” with the rest of us — if that, after the inevitable watering-down by Congress. And that’s not “reform.” Actual reform would rescue all of us from a “system” that neither American workers nor American employers can afford to keep propping up.
But the operative word to describe the health care plans put forward by the major, viable candidates is “timid.”
“Single-payer” is definitely not that — at least, not within an American context. Seen from the perspective of most advanced nations — which accept medical care as just another part of a nation’s infrastructure, like roads and post offices — it’s no big deal.
Not here, though — not by a long shot. Here, we have too many people preprogrammed to go ballistic at the mention of “single-payer.” That’s because of the identity of that payer.
It’s… well, it’s the government!
This column will now take a short break while libertarians run around shrieking until they turn blue and fall over… da-da-dum-dum, hmmm… readers might want to go look at the Sunday comics until we resume… da-dee-da-dahhh… Still screaming, so let’s get another cup of coffee… Ah, that’s good stuff…
OK, we’re back, and they’re still screaming, but we’ll just have to accept that they’re going to do that, and proceed.
“Government,” in America, is a word that we use for a free people banding together to do something that we can do far better working together than working separately. Some people don’t accept that fact. They seem to believe that “government” is some scary thing that intrudes on their lives from out there somewhere, like a spaceship full of aliens with ray guns that will turn us all into toads or something.
Those people are one of the two big reasons why you don’t hear any presidential candidates saying “single-payer” except Dennis Kucinich. You may recall recent reports that Mr. Kucinich had a close encounter with a UFO, and it was a positive experience, so I guess he’s just not scared of the aliens any more.
But the major candidates are. Or rather, they’re scared of being labeled as extremists. Also, they don’t want to offend the health insurance companies whose reason for being would disappear under “single-payer.”
Last week, I got a press release from a labor union that complained “that no Republican candidate has a plan to ensure all Americans have access to health care.” That’s true. But the union, which represents blue- and pink-collar workers in health care, was missing the fact that the leading Democrats are little better.
“Sens. Hillary Clinton and Barack Obama have been engaged in a bitter back-and-forth over whose health plan covers more people,” The Wall Street Journal reported last week. “Former Sen. John Edwards has jumped in, saying his plan is the best of all.”
But what they’re fighting over are plans that would pull varying numbers of the uninsured into the same overly expensive, wasteful, maddening system of private health insurance that the rest of us are caught in. Conveniently, they say their plans would be paid for by repealing the “Bush tax cuts for the wealthy.”
Maybe you could pay for a health plan that way — as long as it doesn’t provide real reform.
Make no mistake: A single-payer national health plan would cost a lot of money, and you would pay for it in new taxes. The good news is that most of us would probably still pay less than we currently pay in premiums.
According to the Web site of Physicians for a National Health Program, which promotes single-payer, “This is because private insurance bureaucracy and paperwork consume one-third (31 percent) of every health care dollar. Streamlining payment through a single nonprofit payer would save more than $350 billion per year, enough to provide comprehensive, high-quality coverage for all Americans.”
But when not even touchy-feely liberal Democrats have the guts to say it’s worth paying a new tax to make health care affordable for all, even when that’s the hottest domestic issue among voters (which would not be the case if the insured majority were happy), we’re in trouble.
Little wonder that Dow Jones’ MarketWatch reported last week that “Those who hope the 2008 presidential election will finally bring about drastic health-care reform may well end up finding it’s a case of politics and business as usual, experts say.” The same article noted that Hillary Clinton has received $1.8 million in contributions from accident and health insurers, followed by Barack Obama with $1.45 million, Mitt Romney with $1.09 million and Rudy Giuliani with $1.08 million.
That, by the way, is money that you and I and the guy down the street paid for health care that didn’t go to health care.
Given the odds against substantive reform — betw
een the government haters, the insurance industry and Big Pharma, all of whom have a demonstrated willingness to outlast the rest of us in any protracted political fight — the only way we’re going to see significant change is if a president is elected with a mandate for bold reform. Only a president is elected by the whole nation, so only a president would ever have that kind of juice.
Unfortunately, as previously noted, none of the viable candidates will say “single-payer.”
But I will: Single-payer. Single-payer, single-payer! Now, do you have anything better to say?

bud’s four-tiered health care system

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Just to show that I’m serious in my admiration for people who are able to articulate smart plans from scratch (rather than reacting the way I tend to do), and to further our discussion, I thought I’d give bud’s four-tiered approach to health care coverage, which first appeared as a comment back here. Compare and contrast it with Doug’s informal proposals, and with the single-payer idea I offered as a way of starting this conversation (most formally set out in HR676):

Doug, your point is well taken that funding of our health care
system is extremely complicated. I would suggest for starters a four
tiered system. These tiers would have nothing to do with age (medicare)
or income (medicaid). Instead they would focus on health care urgency
and time.

Tier 1 would be for the funding of major 1-time events. These would
include serious injuries from accidents and crime victims, heart
attacks, strokes and other narrowly defined situations. These could be
100% funded by the federal government. The list of these events would
be short and all hospitals would be required to accept the government
rate for these services.

Tier 2 would be events that are chronic such as cancer treatments,
diabetis and other longer-term illnesses. These events are more
complicated to address and hence there is likely to be some guess work
to define what ailments are included. Hospitals and doctors could
charge whatever they want depending on where they practice. Patients
could choose between the largely government-funded hospitals and those
that are mostly private (perhaps with a voucher approach). This would
allow some market incentives but would still allow everyone access to
decent care.

Tier 3 is for the preventive issues. Everyone could visit a state
clinic for shots, mammograms, colonoscopies and other screening
programs. Individuals would be required to fund a small portion of
visits beyond the basics each year. I don’t think a 100% government
funded program for tier 3 would work because some people would abuse
it. Needy folks might still be unable to afford the basics, even if
highly subsidized, but at least most people would could recieve care
without an emergency room visit.

Tier 4 would be for elective medical treatment. I see no need for
government involvement here. This would include plastic surgery,
vasectomies and liposuction.

I suspect there is a large grey area between tiers 2-4. But tier 1
should be pretty straight-forward. Some sort of blue-ribbon committee,
established by the government in a cabinet-level agency, could be
formed to place medical care into the proper category. The onurous
nature of th insurance companies profit motive would be greatly reduced
by this system.

I’m not as arrogant as I look

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Folks, it takes a certain amount of conceit to express opinions day in and day out, but it is not an unlimited commodity. I would even go so far as to say what Twain’s Hank Morgan said:

Now what a happy idea that was! — and so simple; yet it would never have occurred to me. I was born modest; not all over, but in spots; and this was one of the spots.

Well, this is one of my spots: I do not draft highly technical policy proposals. I’m a pretty fair hand at deciding what works and what doesn’t in somebody else’s policy proposals, and suggesting improvements. But I lack the confidence to take a blank sheet of paper and sketch out a full-blown projet, as the French would call it.

bud and Doug, our regular correspondents, probably have their own humble spots. This isn’t one of them. Both of them have recently sketched out a number of smart ideas about how to improve health care in this country. I admire their ability to pull something like that from thin air. I particularly admire the tiered approach that bud came up with (no offense, Doug; yours was good too).

The two of them are constantly hitting me up for projets of my own, but my brain just doesn’t roll that way — and if it did, the kind of time I would have to spend on something like that to feel confidence in it would demand that I publish it first in the actual newspaper. Dismiss me for lack of seriousness if you will, call me the critic who never creates, just criticizes. But hey, I can praise, too. That’s something.

Part of it is the aforementioned humility; part of it is my attention deficit problem. I am endlessly fascinated by everything, and I am dependent on other people to call my attention to a particular thing in order for me to focus on it effectively. Once I’m staring at it, I can get creative and sometimes even clever. But I’ve got to have that focal point.

Anyway, back on this post bud challenged me again to come up with my own original plan, and this is all I can say in reply (I tried to post it as a comment, but my browser collapsed, and I decided then that this was worth a separate post on what this blog is and what it isn’t):

bud, if reform is dependent on me coming up with the details, we’re
sunk.

Maybe if I quit my job (thereby
losing my expensive benefits) and spent a year immersing myself and
sweating over it, I could come up with something that would satisfy you, but I’m not sure I would succeed even then. But it’s a moot point. My job, and my life, demand that I address many different things a day, every day.

We all have our strengths and weaknesses. That’s one of my weaknesses. I drown in unlimited possibilities.

I can react to your details because they are finite. If I try to
come up with my own, I would never be satisfied that THESE were the
right, proper and inclusive things to consider. To give but one
example, I would NEVER have confidence in my ability to compute the
costs of a plan. A lot of people tell me they would be intimidated at having to write
a column for the newspaper. I am not. Different
strokes.

Anyway, the subject is so complex that it’s taken me a lot of years
to get to the point that I can say with confidence that what we have is
fundamentally flawed (that it’s not just case of a few uninsured; it’s
a bad deal across the board), and that the biggest thing that is wrong
is that we expect private employers to help us purchase insurance from
for-profit providers, and do so from the relatively weak position of
having purchasing pools no larger than the companies’ respective
rosters of employees.

That leads me to single-payer (and if you want to see that spelled out as a specific proposal, see HR676),
and the way I approach that — knowing how complex this is — is by
asking my readers to help me find flaws in it that maybe I’m missing.
After we go through that for a while, and I’ve heard lots of pros and
cons. I might gain the confidence to say that yes, I endorse that
bill.The bottom line is, I’m not as arrogant as I look. So if you’re
waiting for detailed plans to come from me like Minerva springing from
the brow of Zeus, you should go to another blog.

Sure, I’ve come up with "proposals" in the past. But when you see me set out something like my suggested platform for the Energy Party or the UnParty, what I’m doing is selecting from among ideas that are already out there, and which I’ve had plenty of time to mull over. I didn’t invent the gas-tax increase idea; I was persuaded to it by a lot of people whom I regard as smarter about it than I am.

I wouldn’t attempt a health care plan from scratch without a team of experts from various disciplines helping me.

Finding common ground on health care reform

12 Replies

The dialogue on this post about single-payer started out in the predictable manner — with libertarian Doug decrying the very idea that I would want him (which is the way he reads the words "we" and "us") to be a part of what I see as the common-sense sense solution to a critical need we have in common as a society.

But you have to read past that. One of the problems Doug and I have discussing issues is that he likes the "how" of specific proposals, whereas my interest lies more in the broad concept. As an INTP, I intuitively understand his frustration, but that’s the way I approach things.

And once you do get to proposals, the ideology falls away enough for Doug to say things that I agree with. For instance, he set forth these five suggestions for taming the health-care-cost monster in America:

1) Reduce drug patent lengths to allow competition from generic makers

2) Require insurance companies to offer coverage that is portable, not revokable under any circumstance, and restricted in the percentage increases in premiums to a limited range across all policies

3) Abolish HIPAA rules that only add expensive overhead costs to the system

4) If healthcare for all is a national concern, pay for it by cutting government costs in other areas rather than simply adding another tax on top of the waste already built into the government. The money is there already to easily cover every one who doesn’t have insurance.

5) Go back to the days where drug companies could not advertise on TV, radio, or print media. All that marketing cost gets passed onto consumers. I really don’t care if I ever see another commercial for Viagra, Ambien, or any other product that has "oily discharge" as a frequent side effect.

With the exception of item No. 4, which is simply a libertarian article of faith (which is why I initially read right over it), this seems like a list I could go for. (As much as I’d like to have a clean sweep,that one is just a spoiler condition. While you or I or anyone can come up with a list of federal expenditures that we could do without, that’s not how representative democracy works — such decisions are made collaboratively, and one person’s waste is another person’s essential. This fact lies at the root of so much libertarian alienation. Anyway, the bottom line is that in the real world, if you say you’ll only agree to a national health plan if you cut an equivalent amount elsewhere, you are for practical purposes saying let’s not do it at all. But in the interests of furthering dialogue, let’s set that aside.)

I was a little surprised that Doug went for No. 1 even more wholeheartedly than I would, since it’s about property rights. And I always thought that HIPAA (which I hate) was about privacy (another libertarian priority), and specifically about trying to achieve Item No. 2 by preventing insurance companies from knowing your medical history. But fine. I’m all for it. And I prefer the more direct, regulatory way of approaching No. 2 — if you insist on still having insurance companies.

I was even more pleased and surprised when Doug, later in the dialogue, proposed that we just make the plan that federal employees are on available to everybody. I would have to study this a lot more closely (and those of you who deal intimately with that system, please weigh in), but I have to applaud Doug’s willingness to do something that bold, even if it’s not single-payer.

Of course, he threw in the caveat that we could cover the cost by cutting spending elsewhere — once again, a fine idea until you try to do it, and something that can’t be an absolute condition if we want to get anything done.

But the really cool thing is that, when we get down to such specifics, we’re no longer arguing about the need for universal coverage. We’re just haggling over the price.

A moment of silence for Big Pharma

1 Reply

Sobering news led the WSJ this morning. Poor, poor Big Pharma:

Over the next few years, the pharmaceutical business will hit a wall.
Some of the top-selling drugs in industry history will
become history as patent protections expire, allowing generics to rush
in at much-lower prices. Generic competition is expected to wipe $67
billion from top companies’ annual U.S. sales between 2007 and 2012 as
more than three dozen drugs lose patent protection. That is roughly
half of the companies’ combined 2007 U.S. sales.
At the same time, the industry’s science engine has stalled. The
century-old approach of finding chemicals to treat diseases is
producing fewer and fewer drugs. Especially lacking are new
blockbusters to replace old ones like Lipitor, Plavix and Zyprexa.

Or Zyrtec, which I worry will continue to be marketed in a way that I can’t afford it. But maybe I’m just paranoid on account of that’s the way it’s worked in the past.

As the dirge begins for Big Pharma, do not send to ask for whom the bell tolls. One way or another, they’ll figure out a way to make it toll for thee.

Can anyone say, ‘single-payer?’

25 Replies

Day after day, I become more certain that we need to scrap our entire health-insurance system, and go to a single-payer national plan. It would cover everyone in a simple and straightforward manner that wouldn’t require a Ph.D. in filling out forms to navigate, it would put enough healthy (for the moment) people into the system to make it affordable for those who need care at a given moment, and would give us a gigantic bargaining bloc (forbidden in Medicare Part D, thanks to Big Pharma) for containing drug costs. In other words, it would make sense.

And here’s the really, truly amazing thing about it. Nobody, but nobody, in the political mainstream will stand up and suggest it. In fact, political candidates go to great lengths, through all kinds of gyrations, to avoid it. This is so even though I have only heard three credible reasons why not to at least suggest it, to get a conversation started:

The medical insurance industry doesn’t want it, because it does away with it’s reason to be.
Big Pharma doesn’t want it, because if we banded together, it would no longer be able to overcharge for the drugs it pays billions to advertise.
The idea of us banding together to act in our common interest offends some people’s ideology.

Yeah, I hear other objections — waits for procedures, reduction of choices — but those will be the features of ANY approach that works in lowering costs. The insurance companies have been telling what treatments we can and can’t have, and which doctors we can see, and which pharmacies and hospitals we can go to, for decades now.

Anyway, this little post isn’t about going into the details; this post is simply about the fact that we’re not even having a national conversation about whether to do this. With the exception of Dennis Kucinich, who doesn’t count because he doesn’t have a prayer of being elected, nobody is out there touting this idea, so that we can at least debate it. And rest assured, we won’t be doing anything bold in this area unless someone is elected with a mandate to do so.

There are people laboring in the field out there trying to drum up support for HR676, which would create a single-payer system, but you don’t usually hear about them. The one advocate of the approach best known to people on this blog is our regular contributor Paul DeMarco, a Marion physician, is a founding member of a group called South Carolinians for Universal Health Care that is pushing for it (I believe, and Paul will correct me if I’m wrong, that the group is affiliated with Physicians for a National Health Program. Some of his fellow single-payer advocates came to see the editorial board yesterday. The video above shows Sabra Smith, a practicing nurse and PhD student at USC School of Nursing, talking about why she got involved with Dr. DeMarco’s group.

Zyrtec update

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Here’s an interesting twist on my Sunday column. As you’ll recall, I mentioned that my current group insurance has in recent years refused to cover Zyrtec, which I found to be effective in treating my allergies. So I got this message from Zyrtec’s PR firm:

Hi
Brad,

My name is Eric Tatro, and I’m with
Cohn & Wolfe public relations. Today I read your editorial about health
insurance that was posted on your blog, and noticed that you had some trouble
getting your insurance company to pay for prescription Zyrtec.

We are working with McNeil Consumer
Healthcare, who recently announced that the FDA approved Zyrtec and Zyrtec-D 12
Hour (which combines Zyrtec with a decongestant) for use without a prescription.
I thought you and your readers might find this interesting, since allergy
sufferers will soon be able to purchase Zyrtec anywhere over-the-counter
prescriptions are sold without first having to visit an allergist or health care
professional. Also, for many allergy sufferers, Zyrtec will cost up to one-third
less than prescription Zyrtec. Both medications will be available nationwide in
January 2008.

If you would like more information,
you can find a full press kit located at http://www.ZyrtecPressKit.com. The FDA
also issued a press release on the approval, which can be found at http://www.fda.gov/bbs/topics/NEWS/2007/NEW01750.html.
Of course, please let me know if you have any questions or if I can help in any
other way.

Sincere
thanks,

-Eric

I immediately wrote back to Eric as follows:

Thanks.
Actually, I heard that last week, but it didn’t affect my column, since it
didn’t affect the fact that up to now, my insurance has refused to pay for
Zyrtec, and HAS paid for allergy shots, which was the point I was
making.

Here’s an
irony for you, though: I had already learned that my NEW insurance (that for
which I’ll be paying $274.42 every two weeks) WILL pay for a Zyrtec
prescription. Now that it’s going over-the-counter, they might NOT cover the
prescription — I’ll have to check, but that’s my strong
suspicion.

So if Zyrtec
is available to me only over the counter, and the price is only 30 percent less
than the amount that was so high my current insurance refused to pay (which had
to be really high, when you consider that they DID cover something that had a
co-pay — which would be no more than 50 percent of the total — of $81.95),
then I still won’t be able to afford it. With my high premiums, I will be very
much boxed into whatever my insurance will cover.

The only
thing that might help me would be if a generic version came available. But from
what you’re telling me, this is one of those situations where the drug goes OTC,
but doesn’t go generic — at least, not yet. Am I right about that? I hope not,
but the fact that the company considers it cost-effective to hire a PR firm to
promote the brand seems to indicate that I’m right.
Do you have
any idea of when the drug might be available in generic form? It would be very
helpful to know that.

I’ll let you know what he says back. I’ve also made a note to myself to find out at first opportunity whether I’m right about the insurance not helping if it goes OTC, but not generic. Finally, I’ve got a call in to the FDA to ask when Zyrtec will go generic. I realize those of you who don’t need Zyrtec might not care about this in the narrowest sense, but I believe this situation is what English majors (or sociologists or economists or somebody) call a microcosm. Anyway, I’ll be back to you as the plot sickens…

‘Health care reform?’ Hush! You’ll anger the Insurance Gods!

54 Replies

Redshirt1

By BRAD WARTHEN
EDITORIAL PAGE EDITOR
EVERYWHERE YOU GO in South Carolina, if there is a presidential candidate nearby (and they do seem to be everywhere), you’ll see people in red T-shirts that say “Divided We Fail.”
That’s the AARP’s way of drawing the candidates’, and everyone else’s, attention to the organization’s belief that “All Americans should have access to affordable health care, including prescription drugs, and these costs should not burden future generations.”
You’ve heard about how one in seven Americans, or some such awful number, has no health insurance. But I’m not here to talk about that. Today, I’m talking about the other six of us who have coverage. If routine — not even catastrophic, but routine — health care is “affordable” for those of us with insurance, then somebody redefined the word while my brain was imploding from trying to figure out which health plan to pick for next year.
As AARP’s Web site notes, “Whether we have good health benefits or not, it seems that insurance premiums, deductibles, and co-payments always seem to rise faster than our paychecks.”
Not that I’m complaining! I love my benefits, and I love the job that provides me with them — love it love it love it. I’ll never, ever leave it, or even threaten to. I will pay no attention to that same AARP article when it moans that “Too many Americans are locked into jobs or stopped from opening their own businesses because of worries about affording or maintaining health insurance.” Hah! “Opening their own businesses?” I’ll let the saps who don’t have families and think they’ll never get sick engage in such crazy entrepreneurial tricks as that.
To complain about our health insurance is to risk offending the Insurance Gods, and their ways are mysterious and terrifying.
Just the other day I went to my allergist’s office to get the results of my first skin tests in 20 years. I’d been getting allergy shots based on the old tests all that time, and my allergist, being a highly trained professional, thought it might be a good idea to see if I was still allergic to the same stuff. Actually, I can’t tell you for sure that the shots ever helped. So why get them? Because my insurance pays for allergy shots, but won’t pay any more for me to take Zyrtec, which I know relieved my symptoms. The Insurance Gods say I don’t need Zyrtec.
Anyway, at the end of my visit I went to pay my $50 copay, and the lady at the counter — one of those ladies who is neither a doctor nor a nurse, but one of the army of priestesses every doctor employs to perform arcane rituals all day aimed at appeasing the Insurance Gods — told me that I had a credit on my account, so today I only had to pay $17.45 cents. Timidly, I asked why I had a credit when I hadn’t paid anything lately. She shrugged and said she and her colleagues never ask, because no one understands why insurance does what it does.
But … come a little closer so I can say this softly… there are times when the Insurance Gods are not so kind. For instance:
Earlier this year, after surgery worked only briefly to relieve head-pounding sinus pain, my surgeon gave me a prescription for Allegra. I started to protest adding yet another drug to the 11 I was already taking, counting the prednisone he was putting me on, but then he said it was the generic version, so I said OK. My copay is only like $10 on generics; the Insurance Gods say generics are good.
Then my pharmacy said my copay for my 30 generic pills would be $81.95. Stunned, I asked why? They shrugged and said no one knew; the Insurance Gods just said so. I shut up and paid it, even though it meant delaying paying on my mortgage or my electricity bill or some other frill. I think the pills helped, but I certainly wasn’t going to get a refill.
I make more money than most people do here in the wealthiest country in the history of the world, and I live paycheck to paycheck, in large part because of the cost of being an extremely allergic asthmatic, and needing to do what it takes to keep enough oxygen pumping to my brain to enable me to work so I can keep paying my premiums and copays. My premiums in the coming year — we’re going to a new plan — will be $274.42 on every biweekly check, not counting dental or vision care. And I’m lucky to have it. I know that, compared to most, I’ve got a sweet deal!
I’m in the top income quintile in the U.S. population, and we can’t afford cable TV, we’ve never taken a European vacation or done anything crazy like that, we haven’t bought a new car since 1986, and aside from the 401(k) I can’t touch until I retire (if I can ever afford to retire), we have no savings.
Yet I will pay my $274.42 gladly, and I will thank the one true God in whom I actually do believe that I have that insurance, and that I am in an upper-income bracket so that I can just barely pay those premiums, and that neither my wife (a cancer survivor) nor I nor either of the two children (out of five) the gods still let me cover is nearly as unhealthy as the people I see whenever I visit a hospital.
Speaking of hospitals, I recently heard Mike Biediger, CEO of Lexington Medical Center, marveling that when he started in the business, health care soaked up 7 percent of the U.S. economy, and no one thought it could go higher. Now, he said, it’s 16 percent, and climbing.
That’s why so many physicians and corporate CEOs who once would have bellowed in rage at the sound of “socialized medicine” now believe we’ve got to do something as a nation to get this mess under control. So we’re going to do something, right? Don’t bet on it. What I’ve seen from presidential candidates thus far seems very timid, and disturbingly deferential toward the Insurance Gods (who once got very angry at one of them), and the Big Pharma Gods as well.
Mr. Biediger pointed me to a recent piece in the New England Journal of Medicine that explained that “no matter how much momentum it seems to have, no matter how many signs point to change, there is nothing inevitable about health care reform in the United States. In U.S. health policy, the status quo is deeply entrenched and, despite all its failings, the system is remarkably resistant to change, in part because many constituencies profit from it.”
And there’s not a lot we can do about it — except maybe get one of those red T-shirts, and show up every time a presidential candidate comes to town. They’ve got boxes full of them at AARP headquarter
s, and they’ll give you one for free.

Redshirt2

Daring adventures at Lexington Medical

1 Reply

Today, I was reminded of a recent contact report I failed to file at the time. It was our visit to Lexington Medical Center week before last. Mike Biediger, who runs the place, gave a tour to my boss, Henry Haitz; Mark Lett, the top editor in our newsroom; my colleague Warren Bolton; and yours truly. We got to see the hospital’s beautiful new North Tower with its capacious, well-designed rooms. We toured the operating rooms. We saw cool 3D computer scans of people’s vital parts. It was all most edifying, even though they didn’t actually let me cut on anybody.

I hadn’t written about it because I was determined to put together a video show of the tour, and haven’t found the time to edit my footage yet. But I was reminded that I should go ahead and post something today, when I took my Dad home from the place.

Ironically, less than a week after our tour, my Dad was a guest of the hospital, staying in that very North Tower we had toured. He’s been there most of the past week, and I had occasion to try out the comfortable daybeds they have built under the windows of each room. I had a nice snooze yesterday afternoon there; so I can report they work fine. Dad’s feeling much better now, by the way.

A literary footnote: Just before I went to get Dad, I was reading Zorro by Isabel Allende. I bought two copies of the book (one in English, the other in the original Spanish) at a discount sale at the beach over the summer. You might call it Peruvian pulp fiction. I was a huge "Zorro" fan as a kid — I speak of the old Walt Disney TV series. In fact my first watch was a Zorro watch (no Mickey Mouse for me), and I once had a toy épée with a piece of chalk on the end for writing Zs. Ms. Allende’s book was OK for light reading; I finished it just a few minutes ago. (Best part? She included both loyal sidekick Bernardo and lovable nemesis Sgt. Garcia as characters. Worst part? Possibly because it was written by a lady, it had too much romance and too few swordfights.) Anyway, just as I was about to go spring my Dad from the hospital, I was reading a part in which Don Diego was about to spring his father, Don Alejandro de la Vega, from a damp, dirty prison. It seemed like I saw a parallel there. Unfortunately, LMC’s new tower is much nicer than El Diablo prison, and there were no guards upon whom to scratch Zs, so as an adventure, it was a bust.

But it was nice to get Dad home.

Video to go with Cindi’s health care column

bradwarthen.com

All The News That Gives You Fits

Category Archives: Health

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I’m not as arrogant as I look

Finding common ground on health care reform

A moment of silence for Big Pharma

Can anyone say, ‘single-payer?’

Zyrtec update

‘Health care reform?’ Hush! You’ll anger the Insurance Gods!

Daring adventures at Lexington Medical

Video to go with Cindi’s health care column