The New York Times has an editorial today that brings up some important points about President Obama's 10 year (used to be eight year) healthcare initiative.

63 billion dollars a year may sound like a lot of money, but compared to the 2 TRILLION dollars a year that Americans spend on healthcare now, its a drop in the bucket.

If we are to reach his stated goal of improving healthcare affordability and making healthcare efficient by 2019, we may need to spend a lot more. To get univeral healthcare, even more than that.

You know, The Canadian healthcare system works. That's why it's being ignored.

We could learn a lot from the Canadians. They all love it.

The lies we hear about it being dysfunctional are right wing propaganda which even the most right wing Canadians laugh at.

The New York Times puts it very well.

"President Obama has shown both courage and sound judgment pressing for quick action on comprehensive health care reform, even in the midst of the country's deep economic crisis. He has rightly stressed the urgency of reining in skyrocketing health care costs that are straining the budgets of families, businesses, and federal and state governments.

But his proposals, for all of their ambition, do not fully answer two central questions: how to cover tens of millions of uninsured Americans, and how to reform the health care system to reduce costs and improve the quality of care.

Mr. Obama has decided to let Congress thrash out the details of those issues, with the White House providing guidance along the way. Democratic leaders in Congress, many of whom are far more versed in the issues than the president is, will have to step up and fashion an effective bill. If they falter, Mr. Obama will need to step in with a clear vision and vigorous leadership.

To his credit, the president has tackled the first tough issue of how to pay for expanded coverage and systemic reforms. His budget has proposed huge expenditures -- $634 billion over 10 years -- as a down payment, and it clearly specifies where to find the money.

Half would come from raising taxes on the rich, another quarter from eliminating unjustified subsidies for private plans that participate in Medicare, and other big chunks from reducing payments to drug companies, hospitals and the home health care industry.

Yet even the administration admits that $634 billion will not be enough to reach universal coverage: some experts think it will take at least twice that amount. "

There's more...

Chronically ill U.S. patients have the least access, the worst coordination of care, and the worst medical safety experiences among patients in the developed world's eight most developed nations, a new study released last week in Health Affairs In Chronic Condition: Experiences Of Patients With Complex Health Care Needs, In Eight Countries, 2008
- shows. Regardless of the fact that we pay more, we get far less. In essence, this study also shows beyond a shadow of a doubt that the US is rationing healthcare. Healthcare that the chronically ill in most other developed nations usually receive is unaffordable to many chronically ill adults in the US.

For the chronically ill in the US, this often results in tragic outcomes that are completely preventable.

http://content.healthaffairs.org/cgi/con tent/full/hlthaff.28.1.w1/DC1

In Chronic Condition:
Experiences Of Patients With
Complex Health Care Needs,
In Eight Countries, 2008

Chronically ill U.S. patients have the most negative access,
coordination, and safety experiences.

by Cathy Schoen, Robin Osborn, Sabrina K.H. How,
Michelle M. Doty, and Jordon Peugh

ABSTRACT:

This 2008 survey of chronically ill adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States finds major differences among countries in access, safety, and care efficiency. U.S. patients were at particularly high risk of forgoing care because of costs and of experiencing inefficient, poorly organized care, or errors. The Dutch, who have a strong primary care infrastructure, report notably positive access and coordination experiences. Still, deficits in care management during hospital discharge or when seeing multiple doctors occurred in all countries. Findings highlight the need for system innovations to improve outcomes for patients with complex chronic conditions. [Health Affairs 28, no. 1 (2009): w1-w16 (published online 13 November 2008; 10.1377/hlthaff.28.1.w1)]

Medical science advances and improved living standards have saved lives and contributed to longer life expectancy, yet industrialized nations now face the growing challenge of caring for patients with chronic diseases. Health systems initially designed to respond to acute, episodic illness increasingly care for patients with ongoing conditions, where the goals include preventing complications or deterioration rather than cure. Often coping with multiple conditions, chronically ill patients may see multiple clinicians at different care sites, increasing the risks of errors and poor care coordination. Across industrialized nations, chronically ill patients account for a disproportionate share of national health spending, placing them at the center of initiatives to improve health system performance.1

Experiences of chronically ill patients, especially those with recent hospitalizations or serious illnesses, offer unique perspectives. To learn from such patients, the 2008 Commonwealth Fund International Health Policy Survey interviewed adults with chronic conditions who had recent health care experiences in eight countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States. Including France for the first time, the survey builds on an annual series that informs a symposium with ministers and policy experts from surveyed countries. This study focuses on access, coordination, safety, and care management experiences.

The countries participating in the survey represent a diverse mix of insurance designs and primary care systems. Among the eight countries, the United States stands out for having the most expensive system ($7,000 per capita compared to under $3,500 in the other countries as of 2006), for its gaps in coverage, and for high cost sharing even for patients with insurance.2 The other seven countries have systems with comprehensive minimum benefits and universal coverage. Canada, the Netherlands, and the United Kingdom have no cost sharing for primary care. France's insurance system protects patients with specific chronic illnesses from coinsurance. Germany limits cost sharing to 1 percent of income for the chronically ill and 2 percent for all households.3 The Netherlands, New Zealand, and the United Kingdom require patients to register with a general practitioner (GP) who acts as a gateway to more specialized care. The Netherlands and the United Kingdom are noted for their strong primary care foundations.4

There's more...

A few weeks ago, the AFL-CIO
released the results of an online survey conducted between January and March of this year. But, the news seemed to have been blanketed out by the election news.

For those who don't realize what is happening with healthcare, it should be a wake up call. The results indicate very strongly that our current healthcare model is in s atste of immediate crisis. The postwar social contract is disintegrating.

What this says to me is that people who are wondering who to vote for should consider the implications a few years out, because the priorities of Barack Obama and Hillary Clinton healthcare plans are very different.
Only Hillary Clinton addresses this affordability problem credibly. Obama's own economic advisor has admitted that Obama's plan wont be able to cover the sickest 20% of all Americans. Instead, he concentrates on helping insurance companies by reducing their risk when they provide healthcare for people who are already employed. Meanwhile, literally millins of people are finding that they cannot afford needed care, EVEN THOUGH THEY ARE TECHNICALLY 'INSURED'.

Its my feeling that many people don't realize that the cost of healthcare and, perhaps more importantly, what plans they pay for COVER, under the two different Democratic candidates healthcare plans will in all probability be VERY different for almost everybody. Poor and unemployed people will receive healthcare for free under Clinton. Not under Obama. For MANY, MANY people the premium cap will mean the difference between healthcare they can afford with Hillary Clinton and no healthcare they can afford under Obama. Under Obama-care LIKE NOW, in all probability MANY often will have to go without, even if they technically have 'insurance'.
(McCain is even worse)

They should consider this very carefully.

Neither Obama (and McCain) have anything that even remotely looks like
Clinton's premium cap. Both buy into the failed
'consumer driven healthcare' model.

However, this model is failing a lot of people because they simply do not have the money to pay for the things that the newer-style 'consumer directed healthcare' plans don't cover. So they go without, or make terrible choices, like
giving up food to pay for drugs or doctor visits.

This situation is rapidly getting worse. And neither Obama or McCain is leaving working families with a workable SOLUTION.

Instead, they repeat the "Choice mantra". The whole concept of 'choice' is a cruel hoax for working people because as costs are shifted to them they really have no choices. They buy the cheap plans - the only ones they can afford, which get the health insurers off the hook, legally, for lots of money, and then they have no recourse when they get sick or injured. They 'chose' the cheap plan THAT COVERS FAR LESS.

As the survey and many other studies show, these days, simply 'having' many forms of health insurance IS NO GUARANTEE OF GETTING HEALTHCARE YOU NEED OR OF IT BEING AFFORDABLE.

The "consumer directed" healthcare model touted by Barack Obama and John McCain is failing millions of people catastrophically.

Hillary Clinton's heathcare plan is the only plan that will limit out of pocket expenses to 10% of a family's income. This will mean that insurance for many low income people will be FAR LESS EXPENSIVE than under the other two plans. She does this by using the bargaining power inherent to her universal healthcare mandate. Many low income people will pay almost nothing for healthcare. The cheapest plans available under the other two candidates will be far more expensive, especially for people who are not in a large employer group (McCain is trying to eliminate employer group plans) and those with pre-existing conditions of any kind, even people who have simply seen a doctor for minor issues.

Add on top of this that Obama is going to allow only sick people to buy his plans and it becomes clear that under Obama, this adverse selection may make end up making his healthcare plans very expensive. Insurance companies are not welfare agencies.

Its obvious, the false 'choice' touted by 'consumer directed healthcare' is at the root of many people's insurance problems.

For example, the survey found:

There's more...

As someone with chronic illness, I have been trying to articulate to people who may not understand the mechanics of having a chronic illness why I am terrified that Obama-care may become the only healthcare option for Americans who cannot afford the rising costs of health insurance.

I think this is the best way to explain it. Obama is talking up so called "Choice" but many people don't have choice - Obama is not only offering an option that will not help enough, he also takes advantage of them and their poverty and fear of the cost to derail health care reforms that should be coming given Americans expressed opinions.

"Choice" is Obama's argment, and coincidentally, its is also the mantra of so called "Consumer Driven" health care movement. This is the same movement that gave us HSAs. HSA's as the Newspeak goes, 'gives us more choice'... 'gives us more control over our health' etc. BUT THE DEVIL IS IN THE DETAILS..

the problem is, many people DON'T have a choice BECAUSE THEY DON'T HAVE THE MONEY TO PAY FOR ONE.

Consumer Driven healthcare is a slick way to move costs from employers to consumers and indemnify insurers (and reduce the costs of employers, as well as absolve them of any vestigal responsibility for employee healthcare) from lawsuits that they would otherwise face.

For example, many employers offer cash strapped 'choices' of a number of different healthcare options. But many people pick the cheapest one, because they don't make enough to buy the comprehensive coverage.

A plan might offer a very high deductible. Or it might have a cap on benefits. Or, it might not cover drugs. Or the insurer may be a bad one, one that makes collecting benefits difficult. (they vary quite a bit.)

Its getting worse and worse.

Another point I am trying to make is that Obama has promised to give us 'affordability' but as far as I can tell, he has not proposed anything that WILL actually lower costs. He is not a very strong bargainer, perhaps? Or maybe, he has already committed to avoid those hard decisions in some backroom deal.
It certainly looks that way. Why?

Because its as if the health insurers, the drug companies, the hospital chains, etc. had drawn up a plan that would preserve their high profits, and Obama had put it forward with his name on it.

Who will pay more than anyone else, for the care, or the lack of care - they receive? People. Us. And in the long run, that will backfire by making people unhealthier.

Some choice!

Is the insurance industry giving anything up in exchange for this huge MANDATE Obama will be giving them? No.

Here (below) are some bullet points on so called consumer driven health care. Obviously, it fails in some crucial respects, and these failures are one of the reasons why bankruptcies due to medical expenses are skyrocketing. Like most Americans, most who find themselves in this situation started out 'insured'. The costs are simply being shifted to consumers.

There's more...