Got Health Care?[Posted by Sarah Whites-Koditschek on May 7, 2008]LISTEN TO "Got Health Care?" (24MB MP3) In January, we did a show about the Oregon Health Plan. After freezing enrollment in 2002, the OHP opened up 5,000 spots in the state-sponsored health insurance plan. But even with the additional spots, the State Medicaid Office still estimates that Oregon has approximately 455,000 uninsured adults. This large number has lead politicians to start working on some big picture changes to the way people in this state access insurance. Last year, the legislature created the Oregon Health Trust Board. This seven-member board was tasked with proposing changes to the current system. To come up with those proposals they're conducting a series of 14 "Health Conversations" with people around the state. This week they're in Newport and Astoria. Tomorrow on Think Out Loud we'll discuss some of the scenarios being hashed out around the state at these Health Conversations. They're designed to get a sense of what people generally want out of health care. Here are two scenarios: Felicia Ward and Andrea Foley are single mothers of young children. They both work full-time as housekeepers in different motels at the coast. According to a new law, their income level is low enough to qualify them for full state subsidy to pay for private health insurance for themselves and their children. Because of Oregon's health reform, both Felicia and Andrea now have health insurance for themselves and their children. Is this the kind of change you would like to see in Oregon's future health care system? How important is it for everyone to have access to affordable health insurance? Should the state subsidize private health insurance for those who can’t afford it? Is it feasible? Or is it even the state’s responsibility at all? Here is the second scenario: Albert Haley owns a small vineyard that relies heavily on immigrant workers. A new state law requires him to offer his workers health insurance or pay into a state pool where they can buy health insurance individually. Albert doesn't much like the requirement, but he likes having a choice. He doesn't want to shop around for health insurance. Paying into the pool works for him. But he's not sure the arrangement will really help all of his workers. A lot of them can't afford to pay the premiums and he heard that immigrants who have been in the country for less than five years aren't eligible for public subsidies. Will a separate insurance pool benefit small businesses? Large businesses? Should the US be providing health care for immigrant workers?
In regards to maternity care, any universal health care system must include coverage for private midwifery care and the option of home birth or birth at a birth center. Not only is it much more cost effective to have midwifery care, which is about $4000 for all prenatal, delivery and postnatal care as compared to tens of thousands or more for hospital births, but it has been shown to be as safe or safer than birth within a hospital for women with normal pregnancies.
By using OBs for high risk mothers, which is what they are trained for, we could save millions of dollars each year and have healthier maternal care here in Oregon and give women the choices they need. Thank you, Sara Kiperman Certified Doula and Childbirth Educator Original Birth
With regards to the vineyard scenario, the fact that Albert needs a benefit administrator to evaluate the health care system is part of the problem. Employers should not have to spend more time thinking about health care but rather think about their business.
I think that businesses should contribute towards the pool and small/large contribution can be determined by what level of administration they can absorb. Ideally, it would be a simple payroll deduction or tax that would remove the need to have a benefit administrator. Payroll taxes for benefits are common so I hope this would be appropriate for businesses and simple enough that it would work for them. Businesses don't necessarily take immigration status into account for hiring so we shouldn't take that into account for health care.
I heard a comment about getting rid of insurance companies. I work at an insurance company and agree that the fact that insurance companies have moved towards not covering people who need it is a problem. But what insurance companies are good at doing is 1) tracking eligibility and benefit info and 2) paying claims. Insurance companies are good at holding data and matching payment to the right providers. In other words, they are effective middlemen and no one is really ready to take over that role.
With Drugs and devices, since there is so much money that can be made in the US with these products, americans get these products first and pay for them. Countries that have price fixes or control introduction of new technologies get these products after these companies have made all the money that they can in the US. Every health care country has some form of rationing. With some countries, it's access to complex procedures, with some its access to certain drugs. In the US, we ration care by providing everything to some and nothing to some. If we want to reduce what we will pay for drugs and devices, we will have to recognize that we will not be able to access new products as quickly as we want.
As for new drugs and devices, the companies are forced to make the profits before the patents expire, therefore for a "short" time new drugs are priced enormously higher than older drugs. I have wondered if the following would work:
Give the drug companies longer patents, perhaps even non-expiring, if the companies would agree from day 1 to sell the drug at a reasonable price, say some set cost above manufacturing cost and/or to allow generics to be manufactured with a small royalty. The idea is for the inventor of the drug to get the same return, but spread out over a much longer period of time.
I have no problem with government subsidies paying for immigrant workers' health insurance, but only after every one of American born citizens' health insurance is taken care of. As long as we have American born citizens who desire health care that they can't provide on their own, they should be given top priority.
Re: the scenario you have verbally mentioned twice now, but is not in print.
A Man with a two month old baby and a wife with health problems changes jobs, the new job's health insurance doesn't kick in for six months. Why doesn't the Man buy his old employer's health insurance through COBRA? If it is because he doesn't have the money, then why are people having babies before they can afford them; before they have six months saved up for emergencies? Health care and therefore health care insurance is expensive, it should be taken into account when "family planning". One problem is that many people think it is a right and should be provided to them at an artificially low cost. Sorry this doesn't answer the question regarding costs trade off, but the question wasn't asked correctly.
Why do we always have to pretend that we have to reinvent the wheel in regard to health care? There are working examples around the world that we can look to; Canada, France, Great Britain, Sweden, Norway, Cuba, etc.
And the greatest irony is that the greatest, most powerful military in the world is a shining example of how socialism can work. The US military is a single payer universal healthcare system owned by the government! The great fighter of socialism is socialist at the very core.(corps?) They are on the cutting edge of research and on technology. They don’t make a monetary profit but they do make a social profit by taking care of US soldiers and their families, and the citizens of this US benefit greatly. We could learn from others, but will we? Hasn’t it all been tried before? And what about Kitzhabers plan? Who benefits from keeping things in a state of confusion and unresolved? That great old legal question; cui bono? Sheesh.
I think that universal health care in other countries is hard super impose on the United States for a few reasons. The first is that countries like Cuba offer horrible health care. Yes it's free, but it's far from the standards of medicinal practice we have in the United States. I would prefer to pay for my care in the United States then going to a Cuban hospital.
Places like France and Great Britain have great health care, probably better then the United States, but they pay through the nose in taxes to make it universal. I personally would be willing to pay that rate of taxes for great universal health care, but I'm sure there's a lot of other Americans that wouldn't, namely the rich. I certainly think in a perfect world universal health care would work, but we live in a country that is all about winners and losers, and when it comes to health care, the current winners don't care about the losers (which is wrong), and unless there's a huge shift in wealthy American opinion, it's hard to see universal health care happening in America.
I own a small business with eight employees. We pay for health insurance for all of our employees but not for spouses or children. Each employee’s coverage costs over $500 a month. We have chosen a very comprehensive plan with no deductible, low co-pay, alternative care, dental and optical coverage. I feel it is a basic right to have health insurance. I feel I have a responsibility to provide this for my employees. I have an employee whose partner has high medical needs with constant care needed from brain cancer. I feel it is my responsibility to make choices that will best cover my employees as a group with individual needs. For example- that we choose a carrier that will cover my employees specific providers reducing their out of pocket costs.
It is hard to make these choices when the economy is slumping and our business becomes much more competitive. How do we keep competitive in the market place with other companies that may be able to provide the same service for less than we can, but without providing the level of benefits that we feel obligated to provide for our employees- health care and retirement? As a consumer I always ask what benefits are provided to a companies employees. I try to make my decisions just not on the lowest bid, but on the best company for the job, the community, while offering a fair price. I would support a universal health care business tax, but would people be covered at the needed level? Would business be providing secondary insurance to supplement an ailing universal program while paying additional taxes?
health care system consists of these parties:
the patient/taxpayer/population - currently shouldering the whole burden the medical community - currently doing fine the insurance companies- making out like bandits the government - not yet involved. I think health care is a right. the burden of health care is out of balance in the parties above, that is why we are talking about this. no one should be turned down for insurance or care. rates insurance companies can charge should be controlled. the bill should be shared by patient/employer/government. preventive care should be encouraged/stressed and offered very cheaply.
I was disappointed that the host did not seem to understand the underlying dynamics regarding these community meetings and the role of the Health Fund Board. The Board was established by legislation passed during the 2007 session. There are six sub-committees, two workgroups and a separate advisory council working on particular areas. These groups will present reports to the seven-member Health Fund Board during the coming months. The Health Fund Board will analyze and assess these reports and any recommendations they contain to create its comprehensive recommendations for a health care reform proposal for Oregon. This proposal will then be presented to the 2009 Legislature.
It is important to note that while the sub-committees and workgroups have discussed some of the ideas presented by the host, NO DECISIONS HAVE BEEN MADE. The community meetings were conceived by the Oregon Health Forum, Oregon Health Decisions and the Oregon Health Reform Collaborative, in order to ensure that the Health Fund Board heard the voices and thoughts of Oregonians from around the state. The Northwest Health Foundation is funding the 14 meetings. While the Oregon Health Fund Board is an eager participant -- the Executive Director and at least one Board Member is scheduled to attend EVERY MEETING -- these meetings are not being coordinated or facilitated by the Health Fund Board. This is an important point -- Oregonians have an opportunity to provide input to the Health Fund Board through these convening organizations. The conveners of these meetings do not have a specific agenda with respect to health care reform. They have partnered with the American Leadership Forum of Oregon to provide neutral facilitators at every meeting. The reports that will be submitted to the Oregon Health Fund board will compliment the work of the experts on the subcommittees and workgroups and give the Board members an opportunity to compare the needs and values of Oregonians with the data and work of those experts BEFORE compiling a comprehensive plan. It was disconcerting to hear your host imply that decisions have been already been made -- THAT IS NOT THE CASE! Oregonian need to take the time to attend these meetings and have their voices heard and counted. The implication that decisions have already been made is a disservice to this important effort.
Hey Policywonk,
You clearly know this stuff. And yes, those subcommittees you mentioned are looking at lots of crucial variables, including financial structures, minimum coverage, who would be eligible for public subsidies, etc. And the comments being gathered at the community meetings going on right now will be incorporated into that process as you describe, culminating in the Health Fund Board making a recommendation for health care reform to the 2009 legislature. But the legislature is expecting the plan they get after this public input process will fit in with a basic framework outlined in Senate Bill 329. I just spoke with Senator Ben Westlund, one of the co-sponsors of SB 329. He says the process underway right now is “not a completely white canvas for the Oregon Health Fund Board to paint whatever picture they want. There are some colors already on the picture.” SB 329 creates the Oregon Health Fund. Money in the fund will come from premiums paid by employers, employees and other individuals who want to participate and some federal funds. The board overseeing the fund will contract with companies to provide health insurance to people who’ve paid into the fund. All those people will have Oregon Health Cards. Everyone in Oregon will be required to have some kind of insurance. (How to enforce that is among the issues still being determined!) Getting insurance by buying into the Oregon Health Fund will be one option for anyone who lives or works in Oregon. There is just $1 in the Fund so far, but Westlund says while that is "next to no money, it sends a loud signal to the artists that are painting this picture right now that that's really the direction we want to go." Still, Westlund concurs it is possible the framework could change through this public process. After all, the initial draft of SB 329 was significantly changed after similar public input. Specifically, Westlund says, the Health Fund Board was originally going to be made up of 15 health care professionals. Someone at a public meeting said that seemed like the usual suspects who didn't want reform. The board size was cut in half and the majority of members can't have significant ties to the health care industry.
Problems
1. One of the discussion starters was “What are you, the consumer, willing to give up so more people can have health care?” This perpetrates the falsehood put out by insurance companies that it’s obvious that we can’t afford to cover everyone, so health care consumers obviously have to give something up for a universal system to work. The result was that no one brought up the trade offs from the insurance and medical provider side, such as bloated CEO salaries and the TV advertising paid for by the pharmaceutical companies. The only exception to this was a comment by one of the tables in Newport about building a new system rather than starting from where we are to make changes. The table spokesperson did not say to abolish the pharmaceutical companies, but their statement was deliberately misquoted by your guest, and the host agreed that no, we can’t give up the wonderful benefits we’ve gotten from medicines. There are millions of dollars of waste on the provider/insurance side that can be brought in to the discussion and be part of the solution. 2. There was no mention of the fact that this board is starting from scratch to redo what John Kitzhaber has spent the last several years doing, all over the state. Are the results of his extensive polling of public opinion going to be ignored? 3. It was several times assumed that since we have a for-profit system, that that’s what we have to stick with. First, we don’t have a completely for-profit health care system. It has been going in that direction in the last 10-20 years, but there are still many community, non-profit health care providers, one very large one here in Corvallis. If the hosts are going to facilitate these kinds of discussions, they need to be much more educated about the issues they lead discussions about, and also, they need to reject narrowing the discussion by starting out with erroneous assumptions.
During the whole discussion I was waiting for someone to mention an essential part of any health care reform and that is... sufficent number of health care providers that are willing to accept reduced insurance payments. I work in a nonprofit clinic and I know first hand how difficult it is to find specialists who will take our patients. As it is, fewer and fewer providers of any ilk are accepting Medicare patients and more are severely limiting the number of Medicad patients they will take. Has any thought been given to this problem? Without providers all the insurance in the world will not solve the problem
I tried unsuccessfully to call the show on May 8th to make this comment. Health care funding as proposed by Governor Kulongoski's board will make little headway until Occupational Health and Safety and Environmental Health REGULATIONS are put in place and enforced. How many people attempt health care access to treat conditions related to Occ Health and Environmental health? A Lot of People. Think back pain, arm pain, depression related to fatigue, obesity, asthma, diabetes. Corporations don't want to pick up the bill but they are the entities with the money and they do a very good job creating environments for disease. See our workplaces, our rivers, our air, etc. Capitalism desires all people to pay their way by working. Provide safe and healthy jobs in a clean work environment to meet this desire. Reduce overworking people, and put more people to work. Will corporate profits be reduced, yes. Will citizen health be improved? Yes.
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05/08/2008 9:11:46 AM
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