News/Commentary

By Cheree Cleghorn, Editor

It’s very hard for me to understand why the answer is to put more money into the system.”  Sen. Kent Conrad, North Dakota Democrat

I am here to help you, Senator. I know many others, standing by, ready to answer your questions as well. Just give us a call. Whatever works for you, sir, we will make work on our end.

President Obama has put a preliminary price tag on reforming the health care system.

Sen. Conrad does not understand, he says.

(Having spent many years inside health care, I have identified and named a reasoning disorder which afflicts people at all levels: Willful Non-Understanding Disorder. Treatment works for only a very few but our research continues. There is no cure for the hardest cases. I fear Sen. Conrad suffers from this but cannot say without a visit to assess and diagnose.)

Objectors, like Sen. Conrad who is by no means alone, ask why we would put more money into a system which doesn’t work.

How can we not—-if the system doesn’t work?

If you bought a house and decided it was a tear-down, you still have to pay demolition and removal costs, right? All of health care in America is not in tear down condition, but if that is how one sees the system, Sen. Conrad and his allies have to reckon with the costs of blowing it up and carting it away. Read: Send money.

If you bought a house, knowing that, while it looks great, it needs new wiring, boiler, termite protection and kitchen, would you expect to spend nothing because, to the outside world, it looked great? No, you wouldn’t. Termites alone could destroy your investment.

Of course, the health care system doesn’t look great, but that is beside the point. We all want it to be great. We want it to be worthy of you, the patient, and you, the patient’s family, friends or employers. Will anyone in Congress raise a hand and say out loud, “I don’t really care whether our health care is great as long as it doesn’t cost us any more money?” I think not if he or she wishes to be re-elected.

The first step back to greatness calls for fixing things, which takes skill, funding, time and commitment. Read: Send money.

Whether a senator wants to blow the whole thing up and start over (not recommended by any credible experts) or make cuts in some places to find money to apply in others in health care (not possible in the way these folks envision it), we will be spending money. Sorry. Necessary. A nation is only as healthy as its people, Senator Conrad. Check out our health statistics. Perhaps those will raise your level of awareness about needs across the board. Read: Send money. North Dakota could use some, by the way.

In addition, there are exciting new developments on the horizon, which will make patientcare better and safer.  Isn’t that worth investing in?

In the meantime, while we are envisioning what we hope our health care system can be, where is all that money, anyway?

Although it is a cliche, my toughest professor in journalism school taught me to follow the money, even if a news story didn’t seem to be about money. “Somewhere, there always is money. Often, money is not where it is supposed to be. It is your job to check,” he would say.

Were he still alive, he would be saying those words now. I have checked. Much money is not where it is supposed to be, just as he taught me. I did not have to look hard for the money, but you have to understand. This is Washington, D.C., where it is not fashionable to look too hard at what you will read about next. Too many special interests are affected.

Many, many health care dollars spent seem to get into the accounts of the pharmaceutical companies, the medical equipment companies and the health plans—-and not nearly as many dollars as called for are coming out the other end to care-givers or patients.

Aetna, Cigna and United health plans have been sued by the AMA with a number of state medical societies in two separate lawsuits after New York Attorney General Andrew Cuomo found evidence that the database which health plans all used for reimbursing doctors understated payments owed to physicians.

Elsewhere, news late last year revealed that patients’ co-pays to doctors had been higher than their plan benefits contract stated.

The doctors have been underpaid by plans, according to the lawsuit, although plans acknowledge no wrong-doing. United has settled. The other two have not yet indicated whether they will fight it out in court or settle as United did.

The patients, it appears, have been over-paying in out-of-pocket charges, based on their employers’ plans. Calculating patient co-pays is another health plan responsibility.

Where, oh where, did that money go? Not to doctors. Not to patients, needing reimbursement for payments they made up front, in most cases.

The gentleman from North Dakota might want to ask some questions about that.

Then we have Medicare problems. Right at the top of the list is the drug benefit, which anyone can see is helpful to the elderly whose incomes are fixed.

However, it is not that simple.

Every employer in the private sector bargains for deals on pharmaceuticals but not Medicare.  It pays top prices for drugs.

Medicare now is the Windfall Profits Program for Deserving Pharmaceutical Companies.

Nonsense. If anyone can explain why this is a prudent use of taxpayer dollars, please let me know right away. It simply does not make any sense. (Maybe I have Willful Non-Understanding Disorder here, but I think, probably not. I am open to new evidence, however. I’d love to be wrong.)

Money Report:

• Care costs are not being paid in full or as agreed upon by contract to doctors or patients.

• Pharmaceutical costs for Medicare patients are paid at the highest rate charged even though they take the most medicine, making them the kind of population eligible for volume discounts were payments set up on a rational basis, as in the private sector. The more business you get from one source, the better the deal you give them. Not with Medicare in Medicare D. It bargains hard elsewhere but not in the D program. Think on that a bit.

• There is a desperate—and that is not an over-heated word in this case—-shortage of primary care doctors. They have to be paid more. We have to retain more who are retiring early. The same is true of hospital nurses. Now, it is not only money that drives these front-line care-givers out of medicine , but money is a major consideration. Read: Send money.

• Finally we come to innovation. Some excellent work is being done, for example, on how to use technology to coordinate patient records and information better (although we fuss every time about patient privacy not being high up enough on the development work list). Other innovations are in the works, too. This is just an easy example.

Does anyone actually think we can build a national electronic medical record for free—or for savings found elsewhere in the system?No, it costs time and money to convert from paper records to electronic ones.  It will cost even more to create  a truly national, secure, instantly accessible patient database so that patients can be cared for anywhere—-by doctors who know what other care they have had or what medications they take. Read: Send money.

These are only a few of the reasons why we need to put money into the health care system.

Senator Conrad, we now yield the floor to you, sir. Please. Let us know where you do want to spend money. We are eager to hear.

NPR/AP

“President Obama’s first budget will seek $634 billion over 10 years as a down payment on health care reform, a senior administration official said Wednesday.

“The official said Obama’s proposal is meant to start a dialogue with Congress over how to provide coverage for an estimated 48 million uninsured while also slowing health care costs, which amount to $2.4 trillion a year and keep rising even as the economy is shrinking.

“The senior official spoke on condition of anonymity because the budget won’t be released until Thursday.

“Obama’s request comes on top of recent health care expansions approved by Congress and also described by his administration as down payments toward overhauling the health care system. Those include $32 billion to expand coverage for the children of low-income workers and $19 billion to speed the adoption of computerized health records.

“Aside from health care, the budget will extend Obama’s signature $400 tax cut for workers, originally enacted as part of the economic stimulus plan.”

Source:  NPR/AP, February 25, 2009