Health Care - Bush's Next Battle

Radiofree west Hartford ^ | April 28, 2003 | Mark Publius

[ddodd3329]

Wars do not win elections. Harry Truman discovered that in 1952 when he was forced to concede a possible re-nomination from his party because of the Korean conflict. Lyndon Johnson suffered humiliation in the run-up to his re-election in 1968 because of the unpopularity of the Vietnam War. Even popular wars like the Gulf War in 1991 did not coat George Bush Sr. in the flag enough to win him re-election the following year. Very often, presidents have been beaten due to unforeseen issues in elections. In 2004 it appears that Democrats will use health care as their dark-horse issue and the Bush team had better be ready to counter them.

The opening salvo was fired last week by Dick Gephardt, who proposed a universal health-care scheme that would be paid for by rolling back the Bush tax cut of 2001. His quasi-socialist plan would cost almost $700 billion. It would rely on the old Clinton formula of using tax credits to achieve desired results, in this case rewarding businesses who give credits to their employees for the purchase of health-care.

For Gephardt, this plan was as much about distancing himself from other candidates as it is attacking Bush. He is not as well-financed as John Kerry or as up-and-coming as former Vermont governor Howard Dean, so he needs this. But make no mistake about it, the Democrats are going to use health care as the defining issue in 2004.

By restoring honesty and accountability to politics, President Bush has passed along a formula of sorts to the Democrats. And it goes something like this: don't ignore your campaign promises. Bush delivered on his tax cut and on education reform in 2001 as promised in his campaign. The Democrats will be looking to be squeaky clean as well, particularly after the morally-corrupt Clinton elections of the 90s. They are going to mean what they say in 2004 and that is enough to give Republicans pause.

But there is much that Republicans can do to counter the Democrats. In fact, the Republican Party can turn the table on their arch-foes quite easily. One big asset we have is right amongst our own ranks: Senator Bill Frist of Tennessee. He is a doctor - the only one in the US Senate - and has great credibility on these issues.

>>>continued<<<

[just me]

When it comes to health care and education and other matters we should have listened to Calvin Coolidge..

Quote…
“They criticize me, Coolidge said, for harping on the obvious. Perhaps someday I'll write “On the Importance of the Obvious”. If all the folks in the United States would do the few simple things they know they ought to do, most of our big problems would take care of themselves."

[prairiebreeze]

Perhaps Frist would handle this better than he has with the Pres. tax cut figure in the Senate. We can hope.

Purchasing insurance using tax credits sounds on the surface like a good idea. The problem is trying to get approved by insurance underwriters if you have had ANY type of medical condition without being either denied coverage or having months of pre-existing condition exclusions and riders attached to your policy. Once you are denied coverage (for any reason) by ANY insurance company, that information is made availabe to all insurance companies through the Medical Information Bureau and is a black mark against you in applying anywhere else.

As far as Gerphardt's plan of issuing tax credits to businesses who give employees credits for the purchase of health care, speaking for our small business, we simply can't afford to offer insurance to employees. I don't think that is the answer either.

I agree it will be a huge campaign issue and the Pres. better get moving on it. I'm just not very sure that any of the "solutions" presented in the article really hold much water.

Prairie

[Libertarianize the GOP]

So did you miss any topic on the list?

[Cameron1]

Healthcare could be fixed with the stroke of a pen. Let everyone who so chooses under the age of 65 purchase medicare. Then its portable from job to job, available for early retirement, and pays the doctor like its supposed to do.

I get so sick of my insurance for the huge deductibles and the exclusions and I work for a hospital and they provide the coverage.

[jackbill]

Once again, those who advocate taking money from one person to give it to another are winning the war.

When will it end? Never. We have passed the point of no return.

[DannyTN]

Here's what I think we should do with Healthcare:

• Pass the bill of rights to protect from excess by HMO's.
• Pass tort reform and malpractice damage to cut liability insurance costs.
• HMO's should have to share in the liability for torts and malpractice claims, because they are the ones cutting corners and blocking diagnostic tests.
• Give the Bush tax credits to individuals who have no health coverage. Everyone needs Health Insurance. Relative just had surgery, The bill was $4500, but $2000 was written off due to the contract with the insurance company. $4500 is what they charge people with no insurance, who can afford to pay to make up for the people without insurance who get services but never pay.
• I think there should be more standardization among plans. Perhaps have a few model plans and make insurance plans state any differences they have to the model. I think this would improve the public's understanding of what they are buying at the same time drive down the cost of administration due to the standardization.
• Medicare is a good program. I think we should leave it alone.
• We should promote lower costs alternatives within Medicare: like Home Health which costs $1500 a month, as opposed to Nursing Homes which costs $5000 a month, as opposed to Hospitals which cost $1500 a day.
• Any plan that allows MCO's to cut some benefits in order to offer prescription drug benefits is going to result in a big increase to the government. The reason is that people will gravitate to the plans that means the most benefit to them. Therefore it's not a zero sum trade off. And some of the benefits that may get cut are the ones that will keep the patient out of the hospital.
• We need to do something about the nursing shortage. It's driving up costs big time as firms fight to retain the few nurses left.
• We need to reduce the adversarial nature of the regulatory and survey process. It's contributing to the nursing shortage by driving good nurses out of the field. It's also continues to increase the paperwork and level of documentation required, which means more time doing paperwork and less time for care. Driving the cost up and the quality down.
• We need to reinstate Medicaid and drop Tenncare in Tennessee. I may have the opportunity to share my thoughts on Healthcare Reform with some congressmen in the near future. Would appreciate any

[Trust but Verify]

Have you seen what Medicare pays doctors and hospitals for their services? How about the regulations and paperwork. Is that something you think doctors need more of?

[TheBattman]

Has anyone done a REAL and HONEST study on what has caused health care costs to grow exponentially over the last several decades?

It seems to me that there must be some reason that cost have gone up. Insurance is far higher because of the costs the insurance companies have had to eat. But why are the costs so high in the first place?

Some of what I believe to be the problem(s) - this is obviously not all-inclusive, complete, or in any sort of order of impact. Please feel free to correct or to add items yourself:

"Free" health care to immigrants (both legal and illegal), indigent, etc.

Malpractice suits+liberal courts

Welfare mentality+medicaid


Please add to this list.....

[Bob Mc]

That pretty much covers it.

[Alberta's Child]

HMO's should have to share in the liability for torts and malpractice claims, because they are the ones cutting corners and blocking diagnostic tests.

This is a bad idea even though it would be very popular. The problem is that the HMO would become just like any other insurance companies.

The end result is that everyone will have the one HMO that can't be sued for tort, malpractice claims, denial of care, etc. -- Medicare. And that's exactly what the Democrats want.

[Alberta's Child]

A dramatic rise in the quality of the care you receive. Look how many things that used to kill us are now cured with "routine" treatments.

[ghostrider]

Whatever the reasons, 20 percent of the average American's gross income goes to pay for health insurance and perscription drugs - and the costs are growing at a much faster rate than are the salaries that pay for the healthcare costs. This is the type of desperate situation that historically has been fertile breeding ground for the rise of political despots like Adolph Hitler. Desperate people do desperate things. More and more Americans are becoming healthcare desperate - and the Democrates have a lot of despot type candidates. The future may not be so rosey as conservatives envision.

[buckalfa]

Unfortunately, you have to add greed to the list.
HealthSouth,Tennet,Columbia HCA and others have been
caught with their fingers in the cookie jar. Crooked
bookkepping, fraudulent Medicare filings, mark up on
some services of over 20 times cost steals money from
you, me and employers in terms of insurance premiums and taxes we pay towards health care. This is capitalism
run amuck and is an issue that will play into the Rats
favorin 2004.

[cksharks]

You ever thought of purchasing your own insurance?

[FITZ]

All those you mentioned but now that the welfare class believes health care is a "right", they expect to be provided free medicines, free visits to the emergency rooms every time they sneeze, free prenatal and pediatric care for all the children they care to have ---and they take no responsibility to work or even marry. Of course immigrants are pouring into the country to get in on all this free health care but a lot of it is frivolous. A lot of colds and flus don't need any medical intervention at all. Everyone should start paying their own basic health care costs ---for example if you can afford a baby, you can afford the prenatal care and doctor office bills. Only catestrophic types of health care are unaffordable.

[Jim Noble]

Since 1965, the life expectancy of people over 65 has increased by almost ten years.

That wasn't cheap. And increasing the life expectancy of those over 75 is even more expensive.

Whether or not it was wise to make the commitment to free medical care, of whatever sort, to the over 65 population regardless of their financial circumstances, it has proven to be ferociously expensive.

Much of the change has been cultural. Prior to free Medicare, there was virtually no elective surgery in this patient population (because they had to pay for it, and didn't choose to use their and their families resources in this way).

Now that it is paid for with other people's money, orthopedic, cardiac, and other elective surgery in the elderly has become a multi-hundred-billion dollar industry.

And since Medicare pays less than cost, the paying sector of the population (mostly insurance companies and employers) have had to pay rapidly increasing charges to make up the difference. HMOs and other managed care phenomena are a reaction to this, as the cash cows of the 1980s and 1990s are now in a position to insist on discounts as well.

Medicare was basically a foolish idea. Those who said it would wreck the health care system were right.

The failure of socialism is always explained by the fact that "it hasn't been tried enough". That's the stage we are at now.

If Medicare were abolished, most of the other problems would go away.

[DannyTN]

The end result is that everyone will have the one HMO that can't be sued for tort, malpractice claims, denial of care, etc. -- Medicare.

I don't think so. Medicare only applies to people over 65 and people with disabilities. Medicaid applies to indigent, except in Tennessee (Tenncare) where 25% of the state is on it.

It would just make HMO's think twice before discouraging diagnostic tests, if they get sued whenever a doctor gets sued. It would make the HMO's think a little harder about quality of care. But the cap would serve to limit liability insurance premiums since the insurance companies can at least quantify their risk.

[DannyTN]

Have you seen what Medicare pays doctors and hospitals for their services? How about the regulations and paperwork. Is that something you think doctors need more of?

Medicare does apparently have a problem with what they pay doctors. I'm not sure about Hospitals. In Home Health, I can tell you that Medicare is the only thing that is currently keeping us afloat. We lose money doing business with all of the private insurers and we only do so to maintain doctor relations. (The private insurers tend to have younger patients who don't need very many visits and they don't pay enough to cover the initial evaluation and admittance, whereas Medicare patients are older and tend to obtain services long enough to breakeven.)

I don't find the paperwork for Medicare to be any more onerous than for the private insurers. In some cases it's less. We do enough volume with Medicare to bill electronically, but we don't with most of the private insurers, so we are reduced to paper billings. Private Insurers often want copies of the clinical notes whereas Medicare is content to rely on the survey process.

But part of why I don't see a difference is because the government often requires you to do the same documentation for Non-Medicare patients as you do the Medicare patients.

A lot of the paperwork and excessive documentation comes from the state surveyor organizations which are heavily guided by Medicare. But because they are the facility licensing offices, they apply the same regulations to everyone regardless of the payor. So it's here that the documentation and the adversarial relationship needs to be rolled back.

But I would be interested in specific recommendations to improve Medicare.

[TheBattman]

A dramatic rise in the quality of the care you receive. Look how many things that used to kill us are now cured with "routine" treatment

I can see what you are saying, but along with the "quality" improvement you mention comes the fact that a lot of diseases and ailments are found before they become the catastrophic and expensive ordeal that they once did.

Simple improvements in medicine are not the primary reason for the exponential growth in the cost of medical care. If anything, diagnosis and treatment has actually become more efficient.

I think the primary cause is too many people taking a "free ride" on the system. We all know that in reality, there is no "free ride" because someone has to pay for it. If i get a cold and it gets bad enough to go to the Doctor's office, it costs me about $60 for the office visit (if they do not run any tests) and another $30-40 for prescriptions. This of course is the cost if I didn't have insurance. A person taking the "free ride" often goes to the emergency room of a hospital for the same medical attention I would get at the doctor's office. unfortunately, the emergency room is a far more expensive route. The same under $100 visit and medicine for me winds up costing $500- 1000 for the person taking the "free ride". Someone has to pay for this. That someone is you and me - both through higer taxes and through higher direct costs to us when we get medical care.