healthcare

Six months from now, we’ll be reflecting back on the landmark passage of HR 3590, the Patient Protection and Affordable Care Act.

Six months from now, the average American will have a much better understanding of the truth behind the bill. For your reading pleasure, you can refer to the actual bill language here or review a summary in plain English here or some bottom-line issues here.

Six months from now, with any luck whatsoever, the vitriol and misinformation will have died down. Even from the Tea Partiers – maybe.

Six months from now, the bill will slowly be phasing in.

And you know what? I suspect that that same average American is going to start to say “hey, this health care reform thing isn’t really a bad idea after all”. We’re already seeing a shift in public opinion. In a poll conducted by USA Today within days of the vote, 49% of Americans stated that the health care reform bill was a “good thing” and were “enthusiastic” and “pleased” with it. Four of seven major polls showed an increase in the numbers favoring the health care reform. The Kaiser Family Foundation’s latest poll found that 28 percent of respondents were now ‘strong’ supporters, up from 19 percent in January. And that was within days of the greatest attempts put forward to kill the bill.

I think that trend will continue once people fully realize what this bill means to them, and not what it means to the special interests.

Imagine this – even the stakeholders are supporting it. [insert sarcasm here] What? How could that be? It’s evil incarnate, isn’t it? Armageddon. Blasphemy!

And the political intrigue has only just begun. November is election time. What say ye, oh American voter?

The United States has recently joined the rest of the world’s industrialized nations in addressing the issue of health care reform. A little slow to the party perhaps, but still there nonetheless. There are now signs that efforts are actually being made to resolve a problem that is spiraling out of control.

It hasn’t been without it’s share of spewing of vitriol, hate and fear. In the lead-up to voting, you heard plenty of misinformation. It went well beyond the bill itself. You had conservative pundits and talking heads making statements about the demise of democracy. You might have even heard mention of the impending onset of Communism and, yes, even Armageddon. Hysteria. Fear. Chicken Little was actually making a 21st century appearance of sorts.

But it gets even more humorous.

If you want a fine example of where this country’s health care system is headed without reform, just take a look deep in the heart of Texas. It’s not a very rosy future. As I have mentioned many times before, the key elements to the discussion focus on cost, quality, and access – all issues of significant importance to Texans.

Let’s start off with some terrifying numbers. Consider this: 25% of the population of Texas are uninsured. Nationally, 20% of all Americans under the age of 65 are uninsured. As they say, everything is bigger in Texas. Ah but it gets better. The Austin American-Statesman has recently reported that 500,000 state workers – those with some of the best healthcare benefits in the state – are facing a $143 million deficit in their health care fund. That amounts to a budget increase of 14% over the next year. By 2015, the plan that provides health insurance for 193,000 retired public school employees will be insolvent. This all amounts to increases in premiums and greater out-of-pocket expenses for state workers. And when state workers are impacted (those that already have good health insurance coverage), what happens to those that have lousy or no coverage at all?

Along similar lines, Texas and California have the highest healthcare costs in the nation. In Texas, you might even be one of the 3.4 million people that forego treatment because they can’t cover the cost of care. This is second only to California, at 3.6 million.

Thus far, coverage is shrinking and costs are rising. That’s not a very healthy outlook. But, again, it gets worse.

I think it’s safe to say that the U.S. Preventive Services Task Force has opened an interesting can of worms recently at a rather inopportune moment. They have published what is, to my understanding, an evidence-based report on screening for breast cancer, including the use of mammograms. Emotional topic, without a doubt.

There have been some rather extreme responses as can often be expected when the discussion is driven by emotion. This discussion is taking place at a time when the current health care reform climate is volatile at best. People have already started proclaiming that “this is rationing of care – and exactly what health care reform is going to do”, “this will prevent women from getting the care they need”, and “hell yes, as a doctor I am still going to perform them regardless of what the study says”.

Let’s make sure that we understand the conclusions of the report.  All suggestions are given a grade that reflects the level or degree of recommendation. Recommendations are just that – recommendations, not demands or rules.

The part that seems to have everyone outraged is this:

The current versions of health care reform being proposed and debated are really starting to make me wonder. We started off with “making the system better”, “outcomes”, “efficacy”, and “coverage for all”. Now we’re talking about something that is becoming increasingly far-removed from that. And it’s getting worse.

We’re now being told – in the latest iteration of legislation - that there will only be coverage for part of the population (current estimate: 93%). We’re being told that tort reform has to be a significant factor in health care reform – yet in states in which it has occurred, there have been no savings to the patient. We’re being told that the patient will be forced to buy health insurance – in a system that has not inherently changed. It’s like taking your beat-up 1972 Ford Pinto into the shop for a quick coat of spray paint, thinking that might get you a few extra years of driving – but never looking at the oil leak or the old tires. Or the product recall.

The debate now is about protecting the status quo – and has become misguided to say the least, and unethical to say the most. But fortunately, it should now become readily apparent that there is but one solution to health care reform debate.

It’s name? Legislative reform.

Sure, this may have been in jest. But, consider for a moment what it says if it wasn’t in jest.

Tom and Ray Magliozzi write a column (and have written a book) called "Car Talk" which is syndicated nationally. They answer reader questions related to automotive issues and news, and also have a podcast. In a recent column, there was an interesting letter from a physician, the full text of which can be found here.

“You mentioned in a recent column that ethylene glycol (antifreeze) is toxic to animals. Is it also toxic to humans? I'm a doctor, and I prescribe a medicine for my patients that cleans out their colon called Go-Lytely (which makes a person do anything but go lightly). The main ingredient in Go-Lytely is polyethylene glycol, which sounds an awful lot like ethylene glycol, or antifreeze. So, when I prescribe Go-Lytely to prepare my patients for a colonoscopy, am I really prescribing antifreeze? If so, could I just tell my patients to down a gallon of Prestone and save themselves a trip to the pharmacy? – Dan

Let’s just say that I really, really hope, that this wasn’t an actual reader question.