health care reform

This entry concludes Sunday's article on the comments of Victor DeSa, M.D., who spoke to senior citizens at Batavia's First United Methodist Church last week.

Please remember, this is a summary of DeSa's presentation and does not necessarily reflect the views of The Batavian:

Medicare, Medicaid and senior services

By requiring insurance companies to expand coverage, the new health care law will drive costs up, according to DeSa. The government has told consumers that these costs will be offset by subsidies for people making less than $80,000 per year.

These subsidies will be coming, in part, from a $500 billion cut from Medicare -- and that's where senior citizens and others eligible for Medicare should be concerned.

But this is not the only problem. Both Medicare and Medicaid, which DeSa called "the original two public options," have met with disaster. Medicaid has already failed, and Medicare is on the brink of failure.

"The government has no idea how to handle the rising costs. Their idea of handling the costs is to take a machete to (the programs) and cut."

The result is the "doctor fix," a 21-percent cut in doctors' reimbursements. This could be disastrous in a system where the cost of providing services is already greater than what the doctors receive in compensation.

For that reason, many doctors no longer accept Medicare. The Mayo Clinic in Arizona has already determined that because of the new health care legislation, it will no longer deal with the program.

"So Medicare patients are going to have fewer and fewer choices of who is going to take care of them."

With fewer doctors available, waiting periods will increase. So the direction Medicare is taking presents seniors with a double disadvantage.

The government "carved the 21-percent doctor fix out of the bill" in order to avoid upsetting America's seniors, but that doesn't mean they've addressed the cost. They are simply pushing it to the side and will have to deal with it later.

"Six months down the road, they have to still come up with a fix for this 21-percent cut that they are going to make on Medicare payments to the doctors."

So that's the story with Medicare and Medicaid. As far as insurance for retired citizens goes, people who worked in the public sector should be okay (although DeSa said it's not impossible that this could change, because "anything is possible" with what the government is doing), but people in the private sector should be concerned.

What to do?

When asked how we can change the course we've taken, DeSa answered: "We've got to kick out the guys who did this."

He appealed to the power of senior citizens -- which he became two years ago -- who are "feared in Washington because we vote."

Many seniors were suspicious when the government said that $500 billion had to be cut from Medicare to cover health care.

"If they really addressed costs the way we asked them to do, a person making $40,000 a year be able should be able to afford health care coverage without subsidies, don't you think?"

Failure to address the problem of cost in the current system was one of DeSa's main critiques of the health care bill. He said that in looking for alternative plans, we need to look for one that does address them.

Counting the costs 

There are three main factors driving health care costs:

1) Overuse

Back in the old days, when there was usually only one doctor in town and he had to go to patients' homes to treat them, people only went to the doctor when there was something really wrong.

Now, with easy access to medical examination and treatment, people will go to the doctor -- and even to the emergency room -- whenever they have a minor health concern.

"We have to change that if we want to truly address the cost of health care."

But it's not just patients -- doctors sometimes overuse the system, too.

"I hate to admit it, but there's greed in every profession. There are bad apples in every bunch, and you've got to admit it."

2) The fact that people have insurance in the first place

Strange as this may sound, this can be a problem.

"Insurance is like a credit card, but you don't have to pay every month. So there's no incentive for you to be prudent with the costs. You don't even want to know what the cost is, you just want the health care."

DeSa believes that while insurance cannot be eliminated altogether, people should reduce their dependence on it. For health purposes, they should only turn to insurance in times of emergency.

Generally speaking, the way people take care of this part of the cost is by having "skin in the game."

"If you shop around for a car or a house, why shouldn't you be able to shop around for a doctor? Especially in this day and age, with the Internet and everything."

3) Liability

"Everything from a Band-Aid to a heart valve has a mark-up depending on the risk."

In other words, the more dangerous the a product or its failure can be -- and, therefore, the greater the likelihood of a lawsuit -- the more expensive the product.

Because the liability cost is factored into the price of the product itself, "the little guy gets it in the neck every time."

DeSa fully supports the patient's right to sue when a doctor has done something wrong or is incompetent, but he also believes that the whole liability issue should be looked at when considering the cost.

Government out, skin in (the game)

Costs are going down for procedures that are not covered by insurance (Lasik surgery is one example). The reason?

Competition.

"Costs come down if there are market forces in place."

DeSa saw this in his native India, which had a socialized health care system until the early 1990s.

When he was studying at Jabalpur University in the mid '60s, the Indian government had total control of health care and sent all competing forces out of the country.

The effect of this was what DeSa called a "brain drain."

"The best and the brightest (doctors) were all leaving the country."

He sees the same thing happening here in Western New York, where there is a serious shortage of doctors.

"Over 80 percent (of young doctors surveyed at Western New York teaching institutes) say they'll train here, but they're not going to stay in New York to work. We are known as one of the most heavily taxed and over-regulated states in the country."

Our response to this situation should mirror the response taken in India back in 1990. At that time, India began to default on its World Bank loans. Finance Minister Monmohan Singh -- who is now India's Head of State -- saw that the system was not working and started the country on a different path.

"He got rid of the government, encouraged entrepreneurship and lowered taxes."

Above all, the patient must take responsibility and be in control of his/her own health care. It can't fall to the federal government to make important decisions regarding people's health care, no matter how well-intentioned they might be.

Déjá vu

In addition to drawing from the experience of his native country, DeSa also discussed two other examples of what he sees as a health care system set up for failure.

The U.S. government's new health care model is based on the Massachusetts health care model, which DeSa called "an abject failure." He cited problems related to his comments about young, healthy citizens abusing health insurance.

"Just Google 'Massachusetts Health Law -- success or failure?'"

Socialized health care has proven disastrously ineffective in Britain as well.

"Just this month, Britain recognized that its system is a failure and said they are going to change the whole thing."

Part of that change will be a shift in power from bureaucrats -- of which there are 1.5 million overseeing the United Kingdom's National Health System -- to the doctors. As good as this sounds, DeSa fears it may be too late for it to work.

"The doctors (in the UK) have no business experience. Up to this point, the government has been taking care of everything."

His concern is that U.S. doctors will share a similar fate. As his presentation drew to a close, he told everyone that under the government's new plan, there will be over 120 new bureaucracies controlling health care.

DeSa admitted right at the start of his presentation that he had a bias as a health professional. He encouraged everyone to do their own research and decide for themselves whether or not the new health care reforms are to be welcomed or feared.

Dr. Victor DeSa talked with seniors Friday about the federal government's new health care legislation. This followed his hour-long presentation, sponsored by the "Older Adult Ministries" program of Batavia's First United Methodist Church.

DeSa is a retired surgeon who had a private practice in Batavia for many years and currently serves on the United Memorial Medical Center Board of Directors. He is well renowned and respected in the community and very knowledgeable about how the health care field works -- including the role of legislation and the relationship between health care and the government.

There is a lot of misinformation about the new health care law and how it could affect  people -- especially Medicare and Medicaid recipients.

The doctor expressed disappointment in the mainstream media's handling of the topic.

"The people in the media are not doing their job," DeSa said. "The media used to look out for the common man, but now they have a bias and a preference. (Consequently), the news we get is filtered and we don't have all the information we need in order to make informed decisions."

For those who could not be there, here's the gist of DeSa's presentation (it will be divided into two parts for the reader's convenience) -- it reflects the arguments he made based on careful and meticulous research, and does not necessarily reflect the opinion of The Batavian.

Health care: rights and responsibilities

The question of whether health care is a right or a privilege came up early in the presentation. This language, said DeSa, is problematic. The real question is this:

"Is health care a right, or is it a personal responsibility?"

He pointed out that health care is considered a right in socialist countries, where people "have abrogated their rights to the government" so that the government "will take care of (them) from the cradle to the grave -- and that includes health care."

"The United States is not yet a socialist country," he said (and yes, he did emphasize yet), "so here, health care is a personal responsibility."

What he meant by this, is that each person has a certain amount of control over his/her own health (diet, exercise, etc). For instance, if someone chooses to live on bacon, cheeseburgers and cigarettes all the time, then he/she is indirectly "choosing" to have weight problems, heart problems, high blood pressure, etc.

"If I'm responsible for my own health, should everybody pay for it or should I?"

Misconceptions about U.S. health care

DeSa assured his listeners that we here in the U.S. do, in fact, have the best health care in the world. To prove it, he spent some time debunking two popular myths that lead people to believe the contrary: that our infant mortality rate is higher than in countries with socialized health care, and that lifespan is shorter in the United States than in said countries.

On infant mortality, he said: "We (in the U.S.) over-report infant deaths, while other countries under-report them. Here, we're so meticulous about reporting, that if a baby takes a couple breaths and has a couple heartbeats after birth, it's reported as infant mortality. But in developing countries, a baby dies an hour or two after being born and it's reported as a stillbirth."

He also pointed out that a large percentage of infant deaths take place in the inner-cities, where there are a lot of crack cocaine and AIDS babies.

"These babies die in spite of very good health care. Their deaths are due to social problems, not medical problems."

As far as lifespan goes, he said that longevity is about the same in this country as in those that have socialized health care; what doesn't get factored in with lifespan studies is the fact that the U.S. is the "murder and accident capital of the world."

"If you took the murders and deaths from accidents in Chicago, Detroit or New Orleans in one month, they are more than the deaths of our soldiers in Iraq or Afghanistan in one month."

In short, the evaluation of U.S. life and health often ignores social problems and unfairly puts all the blame on health care.

Universal care vs. universal insurance

...Wait a minute, aren't they the same thing? Not according to DeSa.

"We do have universal care in the U.S. The EMTALA Law ensures that no one who comes into the emergency room will be refused care -- even illegal immigrants. That's the right thing to do, the humane thing to do and the moral thing to do, and I support it."

He says there is a "subtle but important difference" between this and universal insurance, which we don't have. There are currently 47 million Americans uninsured.

The Congressional Budget Office predicts that as a result of the new health care legislation, 32 million people who were previously uninsured will be insured at the end of 10 years. However, there will still be 21 million people uninsured -- and this is in spite of the fact that the new law will require people to buy insurance!

Who are these 21 million uninsured, you ask? Young, healthy people making between $35,000 to $82,000 a year.

"When you're young, and you're starting a family, and you have mortgage payments, you have a whole host of other host of things you have to worry about. You're going to say, 'Well, I'm young, and I'm invincible...maybe I won't fall ill. I'll take the chance and hold off on buying health insurance.'"

This is going to have a couple of important consequences. First of all, DeSa said, "the IRS is going to need about 16,000 new agents to track them down."

Even if they do track them down, not much is likely to change.

"If I'm a young person," DeSa said, "and a federal agent tells me I have a choice between a fine -- which starts at $95 and over the course of seven years will go up to about $700 -- and purchasing health insurance for $12,000-$13,000, it's a no-brainer."

Secondly, these people will cycle in and out of insurance programs. Faced with a serious condition like cancer, a young person will go to an insurance company for coverage -- and they cannot be refused under the new law. But when they get better, they will forego the insurance.

"People will abuse the system. That's just human nature."

While uninsured, these individuals will be able to make partial payments for hospital visits about 27 percent of the time; the rest will be covered by the state's "uncompensated care pool," into which each hospital in the state pays.

But even this won't cover the whole cost. To whom does the remainder of the cost shift? The taxpayers.

"This varies from state to state depending on the percentage of uninsured they have, but the average each person pays is $300."

The second and final part of the article will be up soon.

In an attempt to get Americans to turn against the health insurance companies and to the Presidents plan, MoveOn.org has paid for and produced this PSA starring Will Ferrell and other celebrities sarcastically mocking insurance company executives as overpaid and pampered.  Does MoveOn really not see the hypocrisy in using overpaid, pampered celebrities to deliver the message?  Do I think health insurance executives are overpaid, yes I do, as are most CEO's in this country.  But using high-priced actors can't be the best use of spokespeople.  Notice also that they rehash antiquated statistics like 80% of Americans support the public option when the true number is almost half of that, and yes we have put that argument to rest previously.

To highlight the hypocrisy of the ad, I've attached links to Forbes list of healthcare CEO salaries as well as the net worths of the same politicians who are trashing CEO's and their salaries.  Will Ferrells yearly income is estimated in ther $31 million dollar range and I'm sure each of the other celebrities net worths equal or surpass many of the executives they feign outrage towards.

What's next, overpaid athletes in commercials demeaning the salaries of oil company CEO's?

www.opensecrets.org/pfds/overview.php

www.forbes.com/lists/2009/12/best-boss-09_CEO-Compensation-Health-Care-Equipment-Services_9Rank.html

There are a lot of problems posed in this well-written article about the problems with the proposed health care reforms: 

“There are serious questions that are associated with policy aspects of the health care reform bills that we’re seeing,” said Gail Wilensky, a veteran health care expert

Dr. Scott Gottlieb...his critique is based on related fears that the plans being discussed would inevitably lead to increased government involvement in personal medical decisions and eventually affect vital services.

But, starting out with a general distrust of government solutions, even conservatives who agree that tens of billions of dollars are wasted annually are dubious about the government’s ability to find significant savings without eventually affecting care negatively.

In the meantime, Mr. Goodman said he hoped his side could do a better job at making clear it had genuine misgivings about Mr. Obama’s proposals.

“I think the critics have approached this in the wrong way; saying there’s going to be a death panel is not the right way,” he said. “The right way to approach it is to put the burden of proof on the administration — tell us how you’re going to do that without denying care to people who are really in need.”

So someone explain to me how problems will cease to exist when the government takes over? Money needs to come from somewhere and then choices need to be made on whom and what to spend that money on. That means some people will not get the medications and treatment that they need, and may end up dying because the government chooses to not fund their treatment. In the current proposed reforms this question is not and has not been answered.

Lie #1: President Obama wants to euthanize your grandma!!!

The truth: These accusations—of "death panels" and forced euthanasia—are, of course, flatly untrue. As an article from the Associated Press puts it: "No 'death panel' in health care bill."1 What's the real deal? Reform legislation includes a provision, supported by the AARP, to offer senior citizens access to a professional medical counselor who will provide them with information on preparing a living will and other issues facing older Americans.2

If you'd like to read the actual section of the legislation that spawned these outrageous claims (Section 1233 of H.R. 3200) for yourself, here it is. It's pretty boring stuff, which is why the accusations that it creates "death panels" is so absurd. But don't take our word for it, read it yourself.

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Lie #2: Democrats are going to outlaw private insurance and force you into a government plan!!!

The truth: With reform, choices will increase, not decrease. Obama's reform plans will create a health insurance exchange, a one-stop shopping marketplace for affordable, high-quality insurance options.3 Included in the exchange is the public health insurance option—a nationwide plan with a broad network of providers—that will operate alongside private insurance companies, injecting competition into the market to drive quality up and costs down.4 If you're happy with your coverage and doctors, you can keep them.5 But the new public plan will expand choices to millions of businesses or individuals who choose to opt into it, including many who simply can't afford health care now.

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Lie #3: President Obama wants to implement Soviet-style rationing!!!

The truth: Health care reform will expand access to high-quality health insurance, and give individuals, families, and businesses more choices for coverage. Right now, big corporations decide whether to give you coverage, what doctors you get to see, and whether a particular procedure or medicine is covered—that is rationed care. And a big part of reform is to stop that.

Health care reform will do away with some of the most nefarious aspects of this rationing: discrimination for pre-existing conditions, insurers that cancel coverage when you get sick, gender discrimination, and lifetime and yearly limits on coverage.6 And outside of that, as noted above, reform will increase insurance options, not force anyone into a rationed situation.

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Lie #4: Obama is secretly plotting to cut senior citizens' Medicare benefits!!!

The truth: Health care reform plans will not reduce Medicare benefits.7 Reform includes savings from Medicare that are unrelated to patient care—in fact, the savings comes from cutting billions of dollars in overpayments to insurance companies and eliminating waste, fraud, and abuse.8

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Lie #5: Obama's health care plan will bankrupt America!!!

The truth: We need health care reform now in order to prevent bankruptcy—to control spiraling costs that affect individuals, families, small businesses, and the American economy. Right now, we spend more than $2 trillion dollars a year on health care.9 The average family premium is projected to rise to over $22,000 in the next decade10—and each year, nearly a million people face bankruptcy because of medical expenses.11 Reform, with an affordable, high-quality public option that can spur competition, is necessary to bring down skyrocketing costs. Also, President Obama's reform plans would be fully paid for over 10 years and not add a penny to the deficit.12
Sources:
1. "No 'death panel' in health care bill," Associated Press, August 10, 2009. http://www.moveon.org/r?r=51747

2. "Stop Distorting the Truth about End of Life Care," Huffington Post, July 24, 2009. http://www.moveon.org/r?r=51730

3. "Reality Check FAQs," WhiteHouse.gov, accessed August 11, 2009. http://www.whitehouse.gov/realitycheck/faq#i1

4. "Why We Need a Public Health-Care Plan," Wall Street Journal, June 24, 2009. http://www.moveon.org/r?r=51737

5. "Obama: 'If You Like Your Doctor, You Can Keep Your Doctor,'" Wall Street Journal, 15, 2009. http://www.moveon.org/r?r=51736

6. "Reality Check FAQs," WhiteHouse.gov, accessed August 10, 2009. http://www.whitehouse.gov/realitycheck/faq#r1

7. "Obama: No reduced Medicare benefits in health care reform," CNN, July 28, 2009. http://www.moveon.org/r?r=51748

8. "Reality Check FAQs," WhiteHouse.gov, accessed August 10, 2009. http://www.whitehouse.gov/realitycheck/faq#s1

9. "Reality Check FAQs," WhiteHouse.gov, accessed August 10, 2009. http://www.whitehouse.gov/realitycheck/faq#c1

10. "Premiums Run Amok," Center for American Progress, July 24, 2009. http://www.moveon.org/r?r=51667

11. "Medical bills prompt more than 60 percent of U.S. bankruptcies," CNN, June 5, 2009. http://www.moveon.org/r?r=51735

12. "Reality Check FAQs," WhiteHouse.gov, accessed August 10, 2009. http://www.whitehouse.gov/realitycheck/faq#c1
Sources for the Five Lies:
#1: "A euthanasia mandate," The Washington Times, July 29, 2009. http://www.moveon.org/r?r=51732

#2: "It's Not An Option," Investor's Business Daily, July 15, 2009. http://www.moveon.org/r?r=51743

#3: "Rationing Health Care," The Washington Times, April 21, 2009. http://www.moveon.org/r?r=51742

#4: "60 Plus Ad Is Chock Full Of Misinformation," Media Matters for America, August 8, 2009. http://www.moveon.org/r?r=51734

#5: "Obama's 'Public' Health Plan Will Bankrupt the Nation," The National Review, May 13, 2009. http://www.moveon.org/r?r=51744

It was a hot, humid night but Senator Gillibrand looked cool and comfortable at the Sweet Briar last evening. 

A small group of protesters gathered at the front entrance and were treated to the Senator walking up the hill to meet with them.

The Senator discussed issues facing local dairy farmers; jobs; and health care reform. 

Her message on health care was clear, concise and easy to understand.

Senator Kirsten Gillibrand believes that the high cost of health care is a serious problem for families and for employers, who struggle with the high cost of providing health insurance for their employees. The problem is getting worse - more than 45 million Americans, and 2.5 million New Yorkers, are uninsured and millions of families and businesses are struggling with skyrocketing health care costs. In Congress, she will continue to fight to expand health care access and protect the coverage for those at risk of losing it. In the Senate, she will work with President Obama to reform our health care system and make it work for all of us.

Comprehensive Health Care Reform

Senator Gillibrand plans to work with President Obama, Health and Human Services Secretary Sebelius, and Senators Kennedy and Baucus, Chairmen of the Senate Committee on Health and on Finance, respectively, to embark on comprehensive health care reform. 

Currently, Americans spend more on health care than any other country in the world. In 2007, average spending per person on health care was over $6000 in America, compared with approximately $3000 in Canada, Australia, and the United Kingdom.  Senator Gillibrand believes that we must get these spiraling costs under control, and take the important steps towards real reform.

Expanding Health Care Access

Senator Gillibrand is working with President Obama and his Administration to fix America's broken health care system, give power back to patients and families, and provide affordable, quality health care to every single American. Senator Gillibrand has been a leader in promoting health care access and affordability throughout her time in Congress.

In February, Senator Gillibrand worked with President Obama to reauthorize the Children's Health Insurance Program (CHIP), which was then signed into law. This law will provide 11 million lower and middle income children access to basic health care coverage.  Senator Gillibrand was a fierce advocate for this law, voting in the House of Representatives seven times to expand the program. 

In fact, she was the only Member of Congress to vote for the expansion in both the House and the Senate, and she joined President Obama at the White House when he signed the bill.

Protecting Social Security and Medicare

In the Senate, she will continue to fight to expand health care access and protect the coverage for those at risk of losing it.  In the Senate, she will work with President Obama to reform our health care system and make it work for all of us.  Senator Gillibrand has been a strong advocate for Medicare, ensuring that New York's seniors have access to quality, affordable health care.  Last summer, Senator Gillibrand voted twice for the

Medicare Improvements for Patients and Providers Act.  This new law made a number of significant improvements to Medicare including expanding coverage of Medicare preventive services, providing greater benefits for low-income seniors, and reversing a detrimental payment cut to the doctors who care for Medicare patients. Senator Gillibrand remains committed to making sure that America's seniors always have access to the health care they need.

Helping Small Businesses Provide Health Care

Senator Gillibrand has been at the forefront of new efforts to make health care more affordable for small businesses.  She cosponsored the SHOP Act to help small businesses provide health care to employees.  This legislation would create a tax credit for small businesses which provide health insurance for their workers and allow them to buy into a purchasing pool to reduce their costs.  More than 28 million uninsured individuals work for small businesses that cannot afford to offer health care.

Improving Health Care IT

To improve quality and efficiency, Senator Gillibrand has fought to increase our nation's investment in health care information technology.  In February, she voted to provide $19 billion for healthcare information technology across the country. This is important to help improve treatment, while reducing the cost of care.  Currently, one out of every five lab tests and X-rays are conducted solely because previous test results are unavailable. This waste and duplication in our system could be eliminated with improved electronic medical records and more integrated health information technology.