Diagnosing Healthcare Reform; Dudes tryin hard to sell the lie.

step lightly, the shit gets deep in here.


[link to www.aolhealth.com]

By Liz Neporent

Are you confused about healthcare reform? You’re not alone. Even many of the so-called experts admit their heads are spinning. Part of the problem is that there are no less than four bills winding their way through Congress: three in the House and one in the Senate. Besides being thousands of pages long, they are moving targets, changing on a daily basis. No one knows exactly what the final bill will look like -- or if there will be a bill at all.

For a simplified explanation and what all of this means to the average American, we turned to Jeffery Kahn, Ph.D., Director and Professor, Center for Bioethics at the University of Minnesota (Boynton) who is also president of the Association of Bioethics Program Directors (ABPD), a group dedicated to maintaining the ethics and integrity of healthcare and medicine. He was able to provide a healthy perspective on this hot-button issue.

AOL Health: Many people find the current healthcare reform initiative confusing. We understand it is changing all the time, but can you give us the highlights?

Kahn: The bill is likely to include some sort of entity that will be responsible for assessing quality of care as a way of controlling costs. There is likely to be some centralized process that will make it clear which kinds of healthcare delivery are appropriate. When treating someone with a certain diagnosis and lifestyle factors, it is possible that there will be a list of treatments deemed appropriate and a list of treatments that are deemed inappropriate and therefore not covered by insurance. This may be different from what we have now, and it may restrict some treatments that are currently available to patients. Some people argue that this is simply a way of restricting choice, but the other side of the argument is that it will provide better quality, lead to fewer errors and more effective treatment, and in the process control costs.

Whatever happens, it will be a first step. I think President Obama had a vision, which he has had to ratchet back to a certain extent. It’s likely reform will take place in a more stepwise approach than he originally planned. We’ll get something this time around, but not what some people have hoped for and not what others have feared.

AOL Health: But how can it lead to better quality if it is not customized? Won’t it deny treatment to special cases that fall outside the guidelines?

Kahn: I am totally reading tea leaves here, but I suspect there will be a review process where the physician could argue a patient falls outside of the curve in the following ways and therefore should have access to treatments not on the approved list. There will be some hoops for people to jump through. But that is how it is right now. If you want to get a certain kind of care, your insurance has to approve it. It’s not clear to anyone how it will differ from the current system. Perhaps there might be a different entity to which a patient or physician might go and hopefully get approvals for treatments outside the guidelines.

AOL Health: But doesn’t that take medicine out of the hands of medical professionals?

Kahn: A little bit, but that is also the complaint about how it works now. Physicians can’t practice medicine the way they want to; they have to wait for somebody at an insurance company to say yes, that’s OK. Hopefully this will be managed better. Part of the goal here is to use evidence-based medicine -- medicine that has been thoroughly researched and tested for effectiveness -- to deliver higher quality care in a way that is cost effective. Those aren’t bad things.

AOL Health: Why is the public option for health insurance such a flashpoint issue for so many people?

Kahn: Well, the White House has signaled that they are willing to back away from the so-called public option. The idea is that the government could offer a publically funded government provided healthcare or insurance program that will compete with the private insurance companies and therefore provide people with an option they might not otherwise have, and in the process this will create a competitive environment to drive costs down. And remember, Medicare is a public, government-run delivery system for healthcare that has existed for decades. A large portion of the population already uses this and depends upon it to help pay for their healthcare.

AOL Health: The whole idea of preventative medicine seems to be missing from the dialogue. Why is that?

Kahn: Yes, that’s true! Many medical professionals are really unhappy about this. Reform doesn’t seem to include preventative or primary care -- it still seems to be focused on treating people who are sick. That is not good public health. I don’t know if there is anything I can say about this. What we are actually talking about now is health insurance reform -- and that is absolutely different from healthcare reform. You may have noticed that Obama has actually started to use the term health insurance reform and not healthcare reform. And frankly, that’s a more modest goal.

AOL Health: So what about this fear of so-called “Grandma rationing,” the idea that if Grandma is too old she will be denied healthcare?

Kahn: I don’t think the intention is to deprive anyone of the healthcare they need. The term is meant to be applied in the more technical terms of controlling costs, and we certainly have to do that in a more rational way than we are doing it now. I don’t think we are heading toward a system that tells Grandma or anyone else that they can’t have healthcare anymore because they are old. That is not where things are going.

And while we are on the topics of misconceptions about what is going to happen to Grandma, this notion of death panels grew out a provision in one of the bills that provides resources to physicians to have conversations with patients and families about end-of-life issues. That is a very positive thing -- and every physician you speak to will tell you that they’ve been waiting for it for a long time. This is really important stuff, and right now there is no incentive for such things. The panels are not set up to tell people they don’t deserve care, but to prepare them for what is coming in the later stages of their lives.

Also, I don’t think it would be right to say that we don’t ration healthcare now. We do: It is only available to people who can afford insurance or can pay for healthcare directly out of pocket. If you cannot, you are in effect, “rationed out of the system.” The problem is, the people who tend to be rationed out now are the most disenfranchised -- they are not voting and they are not the ones standing up at town hall meetings. So is that acceptable? I don’t think so.

AOL Health: Why do so many people support the idea of keeping things as is?

Kahn: I don’t believe people love their health insurance companies. Certainly not if they have to use them -- often they have to fight to get the care they need. Many of us don’t have to interact with them unless something medically bad happens, and that’s when our opinion changes. Medical bills are behind more than 60 percent of U.S. personal bankruptcies, and 75 percent of those people have medical insurance but are still overwhelmed by their medical debts. People have to spend their life savings and mortgage their futures to keep themselves alive. That’s crazy! That is the system we have allowed to take root. But in the meantime, we think any change will be worse than what we already have. Perhaps it’s a case of the devil you know versus the devil you don’t.

AOL Health: Americans seem to be suffering from “trillion dollar fatigue” from all of the bailouts. Won’t healthcare reform be the straw that breaks the camel’s back?

Kahn: We thought it was acceptable to bail out AIG, but we don’t think it is worth investing our money to provide high quality healthcare for our citizens? I don’t understand why we feel it is not a good investment to ensure our citizens are healthy. Certainly, cost will be a major issue. But again, cost is an issue now, just in a different way. Right now we spend more per capita on healthcare than any other country in the world and we don’t have the best outcomes. We certainly have the highest quality medical care available, but somehow the costs and the outcomes don’t square with our ability to deliver it. How do we get high quality at lower costs and provide it to everyone across the board? That’s the magic formula.

Last Edited by Phennommennonn on 09/03/2009 11:37 PM