Posts under ‘health insurance’

The Obama-Biden Transition Team is requesting that all interested citizens pay a visit to the transition’s website, Change.gov, and voice ideas and concerns regarding American health care and health care reform. By clicking here, you can go directly to the web page dedicated to the health care agenda and submit your opinions and views.

The Obama-Biden web page discusses health care in this manner:

“On health care reform, the American people are too often offered two extremes — government-run health care with higher taxes or letting the insurance companies operate without rules. Barack Obama and Joe Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference.

“The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans. Under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats.

“Under the plan, if you like your current health insurance, nothing changes, except your costs will go down by as much as $2,500 per year. If you don’t have health insurance, you will have a choice of new, affordable health insurance options.”

Allegedly, the plan would:

• Require insurance companies to cover pre-existing conditions so all Americans regardless of their health status or history can get comprehensive benefits at fair and stable premiums.
• Create a new Small Business Health Tax Credit to help small businesses provide affordable health insurance to their employees.
• Lower costs for businesses by covering a portion of the catastrophic health costs they pay in return for lower premiums for employees.
• Prevent insurers from overcharging doctors for their malpractice insurance and invest in proven strategies to reduce preventable medical errors.
• Make employer contributions more fair by requiring large employers that do not offer coverage or make a meaningful contribution to the cost of quality health coverage for their employees to contribute a percentage of payroll toward the costs of their employees’ health care.
• Establish a National Health Insurance Exchange with a range of private insurance options as well as a new public plan based on benefits available to members of Congress that will allow individuals and small businesses to buy affordable health coverage.
• Ensure everyone who needs it will receive a tax credit for their premiums.
• Lower drug costs by allowing the importation of safe medicines from other developed countries, increasing the use of generic drugs in public programs, and taking on drug companies that block cheaper generic medicines from the market.
• Require hospitals to collect and report health care cost and quality data.
• Reduce the costs of catastrophic illnesses for employers and their employees.
• Reform the insurance market to increase competition by taking on anticompetitive activity that drives up prices without improving quality of care.

I am personally dubious that insurance company practices can be sufficiently reformed to prevent abuses. I am also dubious that such a ponderous system administered by both the federal government and employers will not prove incredibly complex and difficult to manage for employers, government officials, insurers, providers, and consumers alike.

In terms of the plan, I would also like to see the following:

• details regarding a more robust national plan of preventive health care initiatives
• sufficient funding for public health initiatives
• sufficient funding for emergency preparedness and the national Medical Reserve Corps
• a comprehensive plan to decrease the nursing shortage, including grants and loan forgiveness
• a plan to assuage the nationwide shortage of primary care physicians
• a plan to create an Office of the National Nurse

Despite my reservations, doubts, and dubiousness, it is indeed exciting to see a new administration apparently dedicated to transparency, as well as the active participation of all Americans in the process of change that is underway.

Meanwhile, I am willing to suspend my disbelief, listen to the conversation, join in on the conversation when I have something useful to say, and watch as the story unfolds. These are exciting and nerve-wracking times, and I do indeed hope that the change that has been promised will indeed be delivered. Until that time, patience is one virtue we will all need to put into practice.

Please be so kind as to click here to read a new article that I’ve posted on Nurse Linkup about the plight of the uninsured in America.

It is a sad day for poor, uninsured children in America. President Bush used his veto powers to veto a bipartisan bill passed by both houses of Congress which would have expanded health insurance for over 10 million uninsured children whose parents earn too much to qualify for Medicaid but cannot afford private insurance on their own. Bush cited the notion that the expanded program might—gasp!—lead to something akin to soclialized medicine, an event which all Americans know will certainly lead to the fall of Western Civilization as we know it (one can only hope!).

According to NPR and their Congressional sources, the President has it all backwards. SCHIP is not at all a government-run health insurance program. Rather, it allows families who earn up to 300 percent of the poverty level to receive government assistance in purchasing private health insurance for their children. Contrary to the President’s admonition that it would remove individual choice from the equation, these families would choose from competing private plans. As for New York’s attempt to increase the income level to four times the federal poverty level, that addition was scrapped.

Interestingly, the bill was negotiated largely by Republicans in an effort to assuage Bush’s anticipated complaints, and many Republicans now face the decision to choose to override a presidential veto for an issue which is popular in both houses of Congress, in both political parties, backed by 43 governors, and among a majority of Americans.

As stated in the San Fransisco Chronicle today,

The timing of the veto sets up an unenviable comparison for the White House. The president just sent a request to Congress for $189 billion to pay for the wars in Iraq and Afghanistan next year. By contrast, the expanded children’s health program would cost $60 billion over five years.

“While he continues to demand billions to fund his flawed war policies, he is telling the most vulnerable segment of our society that there just isn’t enough money for them to have adequate health care,” said Rep. Ellen Tauscher, D-Walnut Creek.

aegis \EE-jis\, noun:
1. Protection; support.
2. Sponsorship; patronage.
3. Guidance, direction, or control.
4. A shield or protective armor; — applied in mythology to the shield of Zeus.

Health insurance, like the shield of Zeus, is meant to be the aegis of the masses, not something available only to the priviledged few. Organizations around the country are galvanizing for a further push towards coverage for all citizens as healthcare costs skyrocket and preventive healthcare is superceded by use of emergency rooms for primary care issues. With costs escalating exponentially, more and more employers are shedding—or at least eviscerating—their employee coverage, with the working poor left out in the cold, as usual. As often happens, California and Massachusetts are leading the way, being watched as litmus tests for the rest of the nation, everyone on the edge of their seats to see if these efforts fail like all of their predecessors, either from lack of political will or economic fears fed by a jittery Wall Street.

What will it take for this country to insure everyone, when the numbers of uninsured Americans continues to climb? As of August of last year, The Center on Budget and Policy Priorities reported that the number of uninsured Americans stood at 46.6 million in 2005, a shocking 15.9% of the total population. Additionally, the 2006 CBPP report underscored the fact that “the number of children who are uninsured rose from 7.9 million in 2004 to 8.3 million in 2005.”

What do those numbers say about our society and how can citizens force their legislators to tackle such a contentious issue? For those of us in the healthcare fields, seeing the effects of poor health coverage on the ground, the continued effects of this emergent situation will only exacerbate the overall poor health of the American citizenry. With no health insurance, low earning power, a frozen minimum wage, exorbitant rents, high gas prices and increasing food costs, the working poor are left to their own devices, often faced with devastating hospital bills and nowhere to turn. Cheap foods laden with sugar and fat feed the obesity epidemic, and the poor feel they have no other choice but to fill their children’s bellies with such fare. And those children, developing diabetes in record numbers, will only further stress the healthcare infrastructure as they age and face complications from poorly controlled chronic illness. (And we thought the care of the Baby Boomers would break the bank.)

It is a stark and frightening picture, but just like global warming, there is a window of opportunity to turn the tide before the levees break and there is no turning back. Burying our heads in the proverbial health insurance sand will do little to assuage the coming calamity, and meanwhile millions of children go to sleep not only hungry, but with no means to have their basic health needs met. Something has to give, and it had better give soon. We will all bear responsibility for the outcome—just as we will vis-a-vis climate change—and the potential for success has to be our driving engine.

There must be an aegis, a shield, and that protection is long, long overdue. From where will it emerge?

deus ex machina: an agent who appears unexpectedly to solve an apparently insoluble difficulty.

Healthcare in this country is in crisis. Rising drug costs, millions of uninsured Americans, bankrupt hospitals, Big Pharma run amok—the most powerful and influential nation in the world still cannot care well enough for all of its citizens. While Senators and members of Congress have health coverage to die for (pun intended), so many of the working poor are denied even the most minimal of coverage. Seniors are forced to choose between paying for prescriptions or groceries, and insurance companies continue to deny certain types of care as costs skyrocket out of control.

Enter the deus ex machina, or at least the hope for some solution which will fall out of the sky and save us. Is it Canadian-style universal healthcare? Is it a market system? (Oh wait, that already failed miserably, right?) Where will we find our panacea of preventive medicine and cost containment?

In Massachusetts and California, governors and legislatures grapple with critical universal coverage mandates which could break the bank, but may just be one answer which could be followed by other states around the country if they succeed. I would never have imagined that Arnold Schwarzenegger, that movie-star playing a politician, would be the one who could actually pull it off. If he does, I’ll gladly eat my hat. And here in New England, in Massachusetts specifically, perhaps Deval Patrick—the first African-American governor of that state, and only the second in all of U.S. history—is also poised to tackle universal healthcare which is mandated by law to swing into action on July 1st of this year. And who knows, maybe Nancy Pelosi will perform the miraculous, only to be thwarted by a cantankerous and staid Senate. (Talk about The Bride Stripped Bare By Her Bachelors, even.)

My patients are relatively lucky, receiving the benefits of a cutting-edge program which provides that with high quality care, timely follow-up, and personalized service. Still, drugs are denied, certain procedures and equipment are not covered, and certain specialties are becoming almost impossible to refer patients to as those provider groups stop accepting Medicaid all together. Something has to give, and usually the first thing to go is quality and equality.

So is there a deus ex machina? Will someone or something save us? Will Arnold’s proclamations bear fruit, his iconic super-hero status actually managing to be the springboard to bring healthcare to the disenfranchised? Or will Deval Patrick, a descendant of the disenfranchised himself, turn a tide that has been carrying the poor out to sea for decades? Both of these scenarios are possible, and still others are yet to be born, or are now being hatched in minds around the country. But the rest of us cannot necessarily sit on our laurels and wait for others to solve the dilemma. Letters to the editor, calls to legislators, op-ed pieces, dreams and meditations, or even water-cooler chat—all are potential places for the birth of a kernel of an idea that could turn the tide. So, where is the deus ex machina? Apparently it is us.