Time is running out for sensible health care
The Congressional Budget Office report on the newest version of the Republican health care bill is not out yet. Predictably, under this plan many millions will lose coverage. It is a no brainer that lack of insurance equals poor health and even loss of life.
As a physician, I have seen this far too often. A young woman with Cystic Fibrosis lost her insurance when she decided to quit her job as a legal assistant and go back to school. She had trouble qualifying for a state health plan. For a year, she could not afford to take her medications and keep needed visits with her care givers. She lost weight and precious lung function. She is still struggling to recover her previous health.
Increasingly, children in our country are on state insurance, like the Public Aid in Illinois. The same is true for individuals afflicted with chronic illnesses like asthma, sickle cell disease and cancer. The changes proposed would hit these groups, the elderly and the rural populations disproportionately more. I wonder how our Republican representatives can be blind to these facts. For some it might be a symptom of the privilege of being rich all your life.
Cost savings for the federal government appears to be the main driving force behind the Republican plan. The CBO projects billions of dollars in savings over the next 10 years. This is largely from cutting out the poorest from access to health care.
The items that are driving up costs and degrading health care are entirely ignored in this bill.
One is "Big Pharma" that has driven up prices of medications, old and new, based on "market forces." Much of this increase in profit is legitimized as the need to recompense the shareholders. Some goes to pay ungodly remunerations to CEOs. Still some in promoting medications to physicians and patients through sales representatives, advertisements in print, electronic media and increasingly on TV. The United States and New Zealand are the only two countries in the world that allow direct marketing of medications to patients on TV. It is not uncommon for newer and highly effective biologicals, many are cancer fighting medications, to cost in the hundreds of thousands of dollars a year.
Another driver of cost is the insurance carrier, who has primary loyalty to the shareholder and not the patient. These insurance carriers keep coming up with layers upon layers of diabolically complex plans that get narrower in coverage, increase copays, reduce reimbursements to care providers and care receivers alike and maximize profits to the insurance company. The copays and deductibles have gone up to such a large extent that often the middle-class client with insurance is paying it all out of pocket. This has essentially disenfranchised the middle class to the extent that often they are worse off than those on state insurance. "One serious illness away from bankruptcy" is a fact for most.
Physicians are plagued by the phenomenon of "prior authorization" where they are pleading with their "peers" who are employed by the insurance company. Often this "peer" may be a non-practicing physician judging the practice of a skilled specialist. There is need for oversight over an inept physician. Often this process is designed to save money for the insurance company. The Immune Deficiency foundation met as a delegation to plead with an insurance carrier that was denying lifesaving gamma globulin replacement therapy to patients with immune deficiency.
To compete for private insurance clients, hospitals are running up huge debts building newer and ever fancier facilities. The administrative costs keep going up to meet with complex regulations. Hospital CEO's are paid like industry leaders. The rationale is that medicine is big business and a hospital CEO, who may be running a billion-dollar enterprise, deserves to be paid in millions. This line of logic ignores the fact that the business of medicine is not like making electronics or cars; it should be a not-for-profit entity.
Another area of cost saving would come from sensible tort reform. The threat of a lawsuit, combined with incentives to practice good medicine can change the defensive practice of medicine that would save real dollars. The incompetent physician or surgeon needs to be thrown off the bus, but the honest practitioner who makes a human error should not be thrown under the bus.
None of these issues are addressed in the healthcare reform bill. Cost savings for the patients would accrue from changes in these areas and result in better health care. Cutting people off of insurance, setting lifetime limits in coverage may save money for the federal budget but hurt the patient's health and pocketbook. It is up to ordinary citizens to understand the nuances of health care and demand a fair, just and sensible system from our political representatives.
Javeed Akhter is a physician and freelance writer from Oak Brook.