The Politics Of Fear

I have held off on blogging on the Health Care Reform debate up to this point for a couple of reasons. I have spent the last 17 years of my working life in the health care system, at various levels, so I may be a bit biased in my opinions. I also wanted to wait and read at least a good draft version of the bill proposed before I blogged on the subject. The last week has made that silence impossible.

I thought I had reached some level of acceptance of the scare tactics used to make people believe a certain way about the issues we face in this nation. From terrorism to the stimulus, opponents and lobbyists have tried to scare you into believing that everything just short of your actual death may be the outcome of legislation proposed by the current Administration. But now, they have gone so far as to have you believe, among other senseless items, that passing health care reform could ACTUALLY mean your death if you are a senior on Medicare. This just takes fear mongering to new lows.

HB 3200 is the current legislation proposed by the House, and in regards to this "Death Panel" as some mindless public figures have referred to it, it simply does not exist. What it does indicate is if you or your family are facing end of life issues and need input and consultation in the decision making process, Medicare will reimburse for those services. They do not currently. It also indicates limits on how often you can do this, so costs are not ramped up by an ongoing consultation that results in no decision. It is not reviewing the medical viability of a client and determining if their life continues to justify the costs incurred. These claims are just moronic, and are so counterproductive to a process that has been so badly needed for so long. I clarified this issue with a close friend this weekend who had been fed by the fear machine, and even after clearing up the specifics of it, her response was "Well, that may be what it says now, but they could always change it." Are you kidding me? Is that supposed to be logic on which you base the decision not to support legislation? I have to admit that I found myself speechless for more than a moment before I replied with "Well, I guess we could argue that with any legislation, but shouldn't we save that fight for then, and stick to the real issues now?".

This is just one of many conversations I have had with people close to me about myths in this proposed bill. I am going to try and cover some of the most common ones and try to explain them in as simple a fashion as I possibly can.

"The government wants to take over health care and make all of our decisions for us." This is a pretty standard argument where you fill in the blank after "the government wants to take over _________". If I can't make a valid debate, I'll default to this position. The government already oversees Medicare and Medicaid, along with the VA for veterans. This bill simply addresses significant flaws in the current Medicare/Medicaid system, and introduces the option of a government managed public insurance option. This public option would allow individuals and groups to solicit their insurance needs to a provider that will not discriminate because you are only looking for coverage for your family, or because as an employer, you are only looking to cover 15 employees. If I want to buy a plasma tv, I can shop between stores to see who has the best price on the best set with the best service plan. I can do this for a tv, but if I try the same thing for health care coverage for my employees, I had better clear several months as I get staff to fill out health surveys regarding any pre-existing conditions any of them might have. If you are lucky enough to be accepted, you are then subjected to at least annual increases in premiums and co-pays and reductions in approved services. I can see why we wouldn't want an alternative to that.

"The public option will put the private insurance companies out of business, going against our free market economy.". As of right now, there are approximately 47 million uninsured people in this country. The goal of this bill is to reduce that number to almost zero. That means 47 million more customers. If you believe the government can't run good healthcare, then these customers will sign up with private insurers, adding to their already record profits. The only way private insurance companies will go out of business with the advent of a new public option is if this new option has better service with a better price. That is the very nature of a free market economy. I can see why we wouldn't want that.

"This bill will add trillions to the already staggering deficit.". Any time a new program is implemented at any government level, it will have an initial cost. But the costs it will save will actually reduce not only our current budget deficits, but will begin to chip away at the national debt. How? Well, by creating competition on the market, prices of things like medical equipment and prescription medications will come down, reducing the costs to Medicare and Medicaid. By integrating medical records into a national database, patient information and treatment history will be a click away, eliminating repeat treatments and redundancy in patient care, making care more efficient and less costly. On a completely uncovered point, many people have their insurance premiums taken out in pre-tax plans from their paychecks. As premiums come down, there will be more taxable income, and more revenue for the government. 17 years in healthcare have taught me that many providers count on the inefficiencies to increase what they can bill insurance companies and Medicare for. This is why Medicare introduced their Prospective Payment System (PPS) several years ago. This system identified standard treatment rates for specific procedures, forcing providers to make treatment more efficient and standardized. More systems like this and better standards for treatment will help reduce costs dramatically. I can see why we wouldn't want that.

"This bill will mandate government reviews for patients on Medicare to determine if continuing care is cost effective.". These would be the "Death Panels" I mentioned earlier, and if you have watched the news over the last several days, you have probably seen these rumors played out at town halls across the country. The bill simply provides for reimbursement for end of life consultations regarding things like living wills and hospice care. These are not mandated, and you can still make these decisions without any consultation with anyone. This makes sure that the patient's wishes and care is the top priority when end of life issues arise. My dad has been in and out of the hospital for the past 3 weeks, battling an illness that may ultimately take his life. He has a living will, and we have talked about his wishes, and we have shared that with the doctors and staff at the hospital. Several members of our family work in health care, so we are fortunate enough to be informed on both the disease process and end of life care. Not everyone has this benefit and may need to consult professionals to make an informed decisions. This bill would make sure that service is covered. I can see why we wouldn't want that.

"I'm going to be forced to switch my insurance, and I am completely happy with my coverage.". I'm just not sure how many ways it can be explained that there is absolutely nothing in this bill that mandates people change their coverage for any reason. If you are on an employer's plan and they consider changing, your complaint is with them, not this bill. This bill is designed to give MORE choices, not LESS. I can see why we wouldn't want that.

These are some of the biggest rumors out there that are just simply nonsense, but people just don't want to think logically. Then you add to it the lobbyist organizations who are feeding these myths and rallying people to disrupt these town hall meetings and you have created a perfect environment for violence and stagnation instead of healthy debate and sharing of REAL information.

I mentioned my dad being in the hospital earlier. While my mom and our family are facing end of life issues, we are also facing an unreal co-pay that grows each time he has been re-admitted for the same issue. My dad is on Medicare, and of course has a supplemental insurance provider, as Medicare does not cover everything. They pay hundreds of dollars a month for prescription medications that would be a fraction of that if they could get them shipped from Canada, their primary care physician cannot follow them in the hospital, meaning we get to train a new set of hospital docs most every time he has to go to the hospital, requiring one of us to be at the hospital from 7am-8pm to make sure we see the docs, as you never know when they will come in, and once they do, they are in and out in 2 minutes if you are not there to ask questions. We have battled this for almost a decade now, and it is tiresome. We have always had great nurses and aides, the unsung heroes of this business, but the docs normally follow a mandate from the hospital which is dictated by what insurance companies will cover. This bill seeks to put more control and power in the hands of the patients and the families, as well as letting us keep some more of our hard earned money, and maybe, just maybe, focus all of our attention on the man who needs it the most right now. I can see why we wouldn't want that.