The October 13, 2008 edition of Grand Rounds is now up at Notes of an Anesthesioboist. Great reading for anyone interested in the latest from the health and medical blogospere.
Next week’s Grand Rounds will be hosted by Christian Sinclair, M.D. at Pallimed. The theme –”Changing Goals of Care.”
"I cannot apply for Social Security Disability because I have the functional capacity to do some other type of part-time work. I paid for insurance with COBRA religiously, at a cost of $460 per month. In May, I forgot to mail my payment by one day. My insurance was cancelled retroactively to March 31—so now even if I were able to find insurance, the preexisting conditions apply.
"I have applied for Medicaid and that is a possibility because my child is handicapped and has Medicaid. But right now, I have nothing and I will have to pay the geneticist out of pocket. I now function at about 40 percent of the capacity I had a year ago, and I have 30 percent of the income I had for the last 10 years. The level of pain that I have from joint erosion is often unbearable. Is this how the medical profession treats its own, when we cease to function at the level we once did? I am trying to have some faith, but there are days when it is too hard to think about surviving.
"I know I'm not the only one going through this and that makes it even more wrong. It's so hard to fight the system; they wait until we're down to kick us harder and we don't have the strength to fight back," Lisa shared.
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Sponsored by the California Nurses Association/National Nurses Organizing Committee
Eighty-two percent of Americans think the U.S. healthcare system should be fundamentally changed or completely rebuilt (Commonwealth Fund, Aug. 7, 2008). America's nurses know that only single-payer, improved and expanded Medicare for all will fix our broken system and the tragedy of our devastated families. HR 676, by U.S. Rep John Conyers, is the most comprehensive, cost effective way to achieve guaranteed healthcare for all.
For more information, or to contact this patient: Liz Jacobs, RN 510/273-2232.
Senators John McCain and Barack Obama final debate tonight at Hofstra University will cover a host of issues. Health care reform is should be a major topic of discussion. The financial insecurity Americans feel in the face of the current economic crisis is exacerbated by concerns over health insurance. Can they afford the coverage they have? Will they be uninsured — and uninsurable — if they lose their job?
How the candidates approach health care reform says a great deal about their approach to governing. Senator McCain’s plan is primarily market-driven and uses the regulatory powers of government lightly. Senator Obama’s approach relies more heavily on government intervention and more dramatically regulates carriers, pharmacies and health care providers.
Neither of their health care reform plans are very detailed. And I’ve written before, they demonstrate the candidate’s attitudes and principles towards reform mor than dogmatic policy; they are a starting point for debate rather than specific legislative demands. I’ve also pointed out that both reform packages contain serious flaws. So the two Senators have a lot of explaining to do. Here’s a few questions that would be a good start:
Senator McCain would allow benefit plans approved for sale in any state to be sold in every state. This would lead to a rush to the bottom as carriers file their plans in the most lenient state they can find. It would mean that voters in a state would have no say in how health plans sold to them are regulated. How would Senator McCain mitigate these inevitable outcomes? Does he think states have no right to regulate health insurance sold to its citizens?
Senator Obama would require carriers to sell policies to anyone applying for coverage and prevent them from excluding pre-existing conditions. Yet he does not require adults to buy coverage. They could simply wait until the need for medical care arises and then buy insurance. It’s the equivalent of waiting until after your car hits a tree to buy auto insurance. New York and New Jersey have similar rules. It’s no surprise that the average cost of individual coverage in those states is twice that in California. Senator Obama claims his top priority is to make health care coverage more affordable. How does he reconcile this contradiction?
Senator McCain wants to treat the value of health insurance as taxable income to workers and replace this with a tax credit of $2,500 for an individual and $5,000 for a family. In many ways this would be a more fair and progressive use of the tax code than the status quo. After all, higher paid executives are in higher tax brackets, and consequently receive a bigger tax deduction, than their lower paid colleagues. This would change under Senator McCain’s plan. Executives would be hit with a bigger tax bill, but receive tax credit as everyone else. Given a more progressive system, why does Senator Obama reject this approach?
The tax credit in Senator McCain’s plan is supposed to make buying coverage affordable for America’s families. However, medical inflation increases at a far greater rate than general inflation. Senator McCain’s tax credits don’t increase with inflation at all. Since the cost of medical care is the primary driver of health insurance premiums, the tax credits will cover a smaller percentage of premiums over time. Eventually, the tax credits won’t offset enough of the cost (let alone offset the impact of losing the tax deduction). How would Senator McCain deal with this problem?
Speaking of health care costs, how do Senators McCain and Obama intend to tame that beast? Yes, they both support a greater emphasis on prevention and leveraging technology. Everyone does — and these steps will have an impact. However, an aging population demanding the latest technology for an increasing number of ailments will soon overwhelm this benefit. So, beyond the obvious and widely shared solutions, does either candidate offer any unique approach to controlling rising medical costs?
Senator McCain’s tax credits would allow individuals to purchase coverage in the marketplace; Senator Obma would drive consumers into a government-run “exchange.” What do they like about the other’s approach? What don’t they like about it?
And wouldn’t it be fun to hear them talk about consolidation among hospitals, which in some communities have created health care monopolies? Or discuss whether for-profit health insurance companies have any place in America’s health care system?
The odds of any of these questions being addressed is small. Really, really small. Intead, all we’re likely to get from the debate tonight are snippets of their stump speeches. These will express their mutual desire to make health care coverage accessible and affordable. Then they’ll attack the other’s approach as “the same deregulation that got us into the banking mess” or “a big step down the road to socialized medicine.”
We deserve to hear more about their health care reform plans. Even a little in-depth dialogue on the subject would be nice. Unlikely, but nice.
Posted in Health Care Reform, Healthcare Reform, Politics, Presidential Election Tagged: Barack Obama, guarantee issue, John McCain, presidential debate, purchasing pools, tax credits 
I met 73 year old Bob Nelson at one of our diner stops. Bob started his career as a firefighter in 1949. After suffering a stroke and several other health problems, Bob finanly retired a couple of years ago. But now, becase he cannot afford all of his own meds, he is going back to work to earn enough money to stay on his prescribed treatments. Bob told me he will be teaching some emergency preparedness classes to newer firefighters.
At every stop, we heard from folks like Bob — hard-working, tough-minded people who are trying to hang on to their jobs and homes, their retirement dreams and their lives in the face of mounting pressures and sometimes daunting illnesses.
The nurses seemed to listen and instruct about what they see as reasonable solutions for the healthcare crisis as if laying out a sort of healthcare reform discharge plan for the nation: healthcare for all is the answer for the ailing system. Everybody in and nobody out. It's the plan RNs hope we'll get to if we demand it of our leaders and of one another.
For now, they'll be on the bus, around the corner, in the diners, down the block and in shopping center and hospital parking lots and out among their neighbors and fellow citizens offering a vision that can be trusted as far more free of outside influences or hidden agendas than any other reform positions citizens must wade through during election cycles.