Why Health Care Can't Wait

I am fortunate to be the longest serving Member in the history of the United States House of Representatives. I've been a witness, a participant, and a leader in some historical and important moments in our country's history, including the civil rights movement and the enactment of the National Environmental Policy Act, the 1973 Endangered Species Act, and Medicare in 1965. Yet I believe today we face one of the most important decisions in our Nation's history--how to address the insolvency of our health care system that threatens to decimate our country's budget, stability, and overall wellbeing. For 19,420 days, it has been my goal to ensure access to quality, affordable health care for every American. I have been committed to this since my first day in office and today, more than five decades later, my commitment remains steadfast. The resolve to achieve universal health care is just as noble as it was when I first entered Congress, but the urgency is far greater.

Our current system is failing the patients. People are having to choose between feeding their families, paying their bills, or filling their prescriptions. Copays and other fees are so high that even people with health insurance are opting not to see a physician. Further, the most simple, cost-effective, and efficient medical procedures, such as check-ups, physicals, and other preventative measures, are being forgone for more expensive, reactive treatments.

For years, people made the case against a heath care overhaul, claiming it would ration medical care. I would say that because of our failure to act, that is what we now have. Instead of taking care of our people, the best health care goes to those who can afford to pay for it.

Health care providers themselves are unable to navigate the inefficiency of our health care system. Primary care doctors, our first line of defense and the physicians most likely to serve underserved populations, can no longer maintain their practices. They can't keep up with payroll because of slow turn around on constantly shrinking reimbursements. We are driving doctors running small family practices into merging with mega-offices, where patients do not experience the kind of personal, quality care Americans need.

Our failing health care system is also hurting our businesses and industries. Everyday, our businesses are forced to choose between providing much needed health care for their employees or surviving to see another quarter. Many years ago, my father and Walter Reuther used to discuss how health care would eventually break the back of our industries. Our current system has placed American businesses at a competitive disadvantage in the world market. I see it nearly every day in Michigan with our automakers, which need a leveled playing field to compete with automakers in countries with national health care. In a time of such severe economic crisis, we simply cannot afford to let our companies fail under the weight of our inaction.

Our states are struggling under the weight of increasing unemployment and health care costs. States, which spend over 20 percent of their budgets on health care, are seeing 1.1 million new enrollees in Medicaid for every one percent increase in unemployment. Many of those newly unemployed do not consider COBRA a viable option. As Families USA recently reported, COBRA coverage would consume nearly 84 percent of family unemployment benefits - a price that is too great for many families to even consider. So, those people are forced to go without medical insurance. At a time when people need it most, the 45 million people without insurance--more than combined populations of California and Connecticut--are racking up debt at an even greater rate. In fact, medical debt has been cited as a factor in half of the home foreclosures wreaking havoc on our financial system.

With our economy under strain, our patients, businesses, and states suffering, it is apparent that we need to act now to reform the health care system that hemorrhages money to stabilize our economy. Right now, health care spending is 16 percent of GDP, or $2.3 trillion, and is growing at a staggering rate. Health care costs have been cited by the Congressional Budget Office as the most important factor in achieving long term fiscal balance.

If we are to succeed in making the necessary changes to reform our health care system, we must begin the process immediately. I know of which I speak, as I served as Chairman of the House Committee on Energy and Commerce during our last major push to reform health care in 1994. Too much time passed between a superb February 1993 speech by President Clinton, which won the solid support of the Nation, and the time the legislation arrived in Congress. Inertia stalled, and it became too easy for critics to derail the process. Special interests also commandeered the discussion, pouring as much as $500 million into lobbying against reform.

We cannot allow, nor afford, that to happen again. Our current financial stability and the health of future generations rests in our willingness to take action. We need a system that would lower costs and increase quality of health care, while making it universally available.

I know that Congress has the ability and the ingenuity to create a new approach to health care, however, it is clear that we must not let our window of opportunity go by. We must put forth a plan that will provide the American people with security and the flexibility to choose what's best for themselves and their families. However, for this to work, emphasis must also be put on ensuring that universal coverage truly is universal in that it covers those that are healthy and those that are sick. Congress must guarantee that health insurance does not exclude pre-existing conditions or limit care for families buying their own insurance. For these families and small businesses, we must also increase competition in the insurance market so that affordable options are available. Congress will have to be vigilant in its oversight, to ensure federal dollars that are being spent on health care are being spent wisely, and not simply to line the pockets of corporate executives and insurers.

As we move towards national coverage, we have to ensure that we have the public health infrastructure necessary to support additional patients. This includes addressing education and training of the next generation of health professionals, new investment into research and development for cures to chronic and debilitating diseases, disease management programs to improve outcomes, and improving access to school-based health care and support services.

These are lofty goals; however, they are also achievable goals. I firmly believe that if Congress ensures that everyone is invested, that means individuals, small and large employers, providers, insurers, state and federal governments, we can deliver a health care reform bill to President Obama by the end of the year. Through collaborative thinking and collective action, we can and we will put together a good, bipartisan bill that will ensure the working men and women in this country will never have to worry about access to health care. [You can read my letter to President Obama here (pdf).]

I know that this requires much work on my part, and for those that know me well, you know I never back away from a challenge. For more than 50 years, I have fought for universal coverage, and there has been no better opportunity than now. I will not let this window slip by, and I urge my friends, my colleagues, and the American people to join with me in making 2009 the year major health care reform legislation is delivered to the Oval Office.

Comments

[healthkris]

Yes! Yes! Yes!

New American Health Talk Radio AM 1440 link in at

http://www.soundlantern.com/UpdatedUser.do?UsId=8987

[FaceReality2]

"Many thousands of people die in the U.S. each year — from 18,000 to more than 100,000, depending on how one defines preventable death — due to lack of medical care. These deaths are so much a part of everyday reality for millions of ordinary people in the U.S. that they are not even news. Nor are the facts that 102 million people have insufficient health care coverage, that 44 per cent of terminally ill patients worry about how they or their families are going to pay their medical bills, that the inability to pay medical bills is a primary cause of family bankruptcy in the U.S., and that more than 50 per cent of spending on health care by elderly Americans is still not covered by Medicare.

"The insurance and pharmaceutical industries are largely responsible for the scandalous situation of the medical care non-system. In 2007, insurance company profits were $12 billion and pharmaceutical industry profits $40 billion. These industries buy and influence the political process by donating money to leading politicians whose decisions affect their interests. According to the Center for Responsive Politics, the insurance industry contributed $2,185,727 and the drug industry $1,927,159 to the Obama campaign.

"With a smaller amount of public funds, France and the majority of developed countries provide comprehensive coverage that will be a dream for the majority of our people."

See: http://www.pnhp.org/news/2009/february/a_sworn_foe_of_singl.php

[FaceReality2]

"We have 900 billing clerks at Duke (900 bed hospital). I’m not sure we have a nurse per bed, but we have a billing clerk per bed. It’s obscene."

Dr. Uwe Reinhardt, hearing on healthcare reform, US Senate Finance Committee, November 19, 2008

"This is how we do “market-based” care: 30% of the health care dollar goes to administration. Canadian hospitals average 2 billing clerks."

Kenneth Brummel-Smith, M.D.
Charlotte Edwards Maguire Professor & Chair,
Department of Geriatrics
Florida State University College of Medicine

[FaceReality2]

Why we won't have a decent universal health care system (at least until the present system collapses under its own cost--which may not be far off).

The politicians who are beholden to the medical industrial complex (which is almost all of them) will fight every issue tooth and nail. For example, the insurance industry will try to keep the coverage at an insufficient minimum so they have room to sell "supplement" policies. The medical device industry wants to keep ripping off the government as it has been doing to Medicare since inception, and the pharmas want to keep selling drugs at the whatever prices they set as they do under Bush's Medicare Part D.

Consider the vested interests in the present system:

* Millions of jobs depend on the current structure of the health system (like the millions of people shuffling paper for the insurance bureaucracy).
o 1 of every 11 jobs in the US are in the health care sector;
o 1 of every 7 dollars in the US economy is related to health care.
* While 16% of Americans don't have health insurance, 84% do.
* There is a lot of 'trapped equity' in the current system that no one is going to walk away from without making sure that their economic interests are addressed. http://www.wecandobetter.org/political-environment

The sad thing is we don't need to spend more money (or much more money) to have great universal care, we just need to do it more efficiently.

[FaceReality2]

The Archimedes Movement has some ideas that make good sense:

* We cannot solve the health care crisis by simply giving everyone insurance coverage
* All Americans should be eligible for and have timely access to effective treatment for at least the same set of essential health conditions (“core benefit”)
* The core benefit should be portable and not tied to employment.
* In terms of financing, we believe the first emphasis should be on the public resources already being spent on health care.
* We must explicitly recognize the reality of fiscal limits and that we cannot purchase everything for everyone.
* We must acknowledge the inevitability of at least a two-tiered system; that people with more disposable income will always be able to purchase more than people with fewer resources. People should be able to purchase additional services that may not be covered in the core benefit. The challenge is to ensure that the core benefit (the “floor”) is adequate to provide for the health of all Americans.
* Individuals should be more directly involved in their own health care decisions.
* It is important to promote healthy behaviors through strategies that focus on both individual choices (responsibility) and environmental influences.
* Co-payments should be used not simply to shift costs to individuals, but rather to influence individual behavior by placing lower co-payments (or no co-payments) for highly effective procedures backed by good scientific evidence and higher co-payments on lower priority interventions.

http://www.wecandobetter.org/framework-for-a-new-health-system

[FaceReality2]

"Insurance bureaucracy and paperwork consume 31% of every health care dollar."

In return for 31% of every health care dollar, the insurance companies have contributed what? What has been their contribution to the health of the American people? The creation of a risk pool? We can do that without them. Aside from that, what has been their contribution, a paperwork nightmare?

[scooperss]

Maybe you need to do something about the latest thing to be happening with medical practices.

I used to go to a very nice GP clinic until they were bought out by AN INSURANCE COMPANY. This particular company owns the INSURANCE COMPANY owns the DOCTORS, owns the HOSPITALS, and owns a RESCUE SQUAD/AMBULANCE COMPANY.

It's created a monopoly and where there used to be decent medical care, there is no longer much of a choice.

[FaceReality2]

Monopoly pricing. Beautiful. "Your money or your life."

[FaceReality2]

Check out The Archimedes Movement (based in Oregon):

http://wecandobetter.org/principles

1. Equity. All individuals must be eligible for and have timely access to effective treatment for at least the same set of essential health conditions.
2. Financing. Financing of the health care system must be equitable, broadly based and affordable.
3. Population benefit. The public must be engaged in identifying priorities
4. Responsibility. Responsibility for optimizing health must be shared by individuals, employers, health systems and communities.
5. Education.
6. Choice and Dignity. Health care and health promotion systems must provide services in ways that support choice and dignity for individuals.
7. Effectiveness. The relationship between specific health interventions and their desired health outcomes must be backed by unbiased, objective medical evidence when possible. When evidence based practice is not possible, health interventions and their desired outcomes must reflect successful clinical practice.
8. Efficiency.
9. Explicit decision-making. Decision-making will be clearly defined and accessible to the public, including lines of accountability, opportunities for public engagement and how public input will be used in decision-making.
10. Transparency.
11. Economic sustainability. Health service expenditures must be managed to ensure sustainability over the long term, using efficient planning, budgeting and coordination of resources and reserves, based on public values that respect the inherent worth of all Americans and recognizing the impact that public and private health expenditures have on each other.
12. Aligned financial incentives.
13. Wellness.
14. Community-based.

[Luvial]

The highest priority for healthcare reform should be universal access. Ten of millions of Americans do not have access to healthcare. When 500,000 people lose their jobs each month, most will also lose their healthcare. It seems almost immoral to spend billions of stimulus tax dollars for installing EMRs, Electronic Medical Records, before everyone has access to healthcare. If you cannot afford to see a doctor, it matters not whether the doctor writes his notes on paper or into a computer. I am not against EMRs, I just think universal access is the top priority. There seems to be a general lack of compassion for the needy in America and in the priorities of Congress. Another reason EMR adoption should be not be rushed into is patient privacy. How many people want or understand the implications of aggregated, computerized medical records? Patient privacy and control over your medical data is not even a topic of discussion in America. It will be, though, when current and potential abuses become better known. Medical data is a very valuable commodity . Patients not corporations should benefit from their monetization.

[Lionsden]

"Consider this. We have recently had a big national debate over national health care. Advocates and opponents argued long and loud over whether it could work, what was fair, how to pay for it, and so forth. But almost nobody raised the basic issue: Where does the federal government get the power to legislate in this area? The answer is: Nowhere. The Constitution lists 18 specific legislative powers of Congress, and not a one of them covers national health care."

Joseph Sobran "How Tyranny Came To America"
http://www.fightthebias.com/Resources/Rec_Read/how_tyranny_came_to_america.htm

[RoloTomassi]

BS propaganda that has no merit whatsoever.

[FaceReality2]

Someone, preferably a doctor, please explain how the following procedures could possibly cost so much (thanks to krocklin for these numbers).

$90,000 for four days in the hospital due to a "minor heart attack."

$55,000 for two days in the hospital for gall bladder removal.

$410,000 for an angioplasty.

Does the fact that the hospitals and doctors have a virtual monopoly have something to do with it? If you need emergency surgery, you cannot shop around.

[Lionsden]

Face:

Did you want auto mechanics to get in on the action? LOL

[FaceReality2]

Is this what docs in other industrialized nations charge? No.

Ever heard of the term "monopoly pricing?" Competition is supposed to keep prices low. Maybe we don't have sufficient competition among doctors. Is the number of doctors kept artificially low by the political machinations of the physician organizations? We can't afford more medical schools, or we don't have enough intelligent people to become doctors, or what?

I saw a 60 Minutes segment sometime ago where people were getting first class surgical care in India (heart procedures, joint replacement, etc) at a fraction of the cost here, even after the travel expenses. Maybe that's the answer. Let the docs here see how they like competing with foreign providers (hell, most likely the doc you get here through your HMO or PPO is a foreigner anyway).

[FaceReality2]

If GM, Ford and Chrysler had gotten behind Hillary's plan in the 90's, maybe they wouldn't be on the verge of bankruptcy now. That may be their single greatest business blunder.

We will not have universal health care unless big business wants it. The politicians only do what their paymasters tell them to do.

[ncmom54]

I worked with a lady who had a mamogram that had to be re-done because they noticed a 'shadow'. She did & everything was fine... but when she wanted to change insurance companies the next year.. get this, they told her everything could be covered at the 'basic' price (all she could afford) EXCEPT HER LEFT BREAST! all because of a shadow that could have been a bad picture? she hasn't had another mmgrm since.

[FaceReality2]

Many of us are afraid to go to the doc for fear he will find something that will raise our premiums or prevent us from getting insurance at all. I am still being penalized (by denial of coverage) for a Prozac prescription I had 15 years ago. Is this the system we want?

[larry278]

If we get universal health & dental care, physicians & all others who work in the healing arts will forget a procedure we Americans developed & still use: the bill fold biopsy, It's done to see if the patient has insurance or money to pay for medical care. No insurance or money, no care. The bill fold biopsy is very costly. You can die if you don't have insurance or money. John Dingell & Edw Kennedy can tell you of those who died because a bill fold biopsy showed that no one would pay for their medical care.

[bgoodric]

Rep. Dingell: What about H.R. 676, "Medicare for All"? Are you a sponsor? If you aren't yet, please become one!

[ConnecticutMan1]

Not just yeah but HELL YEAH and HOOAH!

John Conyers, Dennis Kucinich OR even Mike Moore should be nominated for the HHS job. And I am only half kidding about Moore. Because, at least, Moore - being from car country - gets the real problems with health care and how it relates to the global economy. How can an American corporation compete with the rest of the world with the 4 to 5 dollar per hour per employee disadvantage our completely broken system gives them?