Death Panels Should Have Been Named Moral and Ethical Reasoning

  What Broke My Father’s Heart 

James Wise

Class: HCA300

 
                                                                       Introduction

            This week’s course study took us down the path of reading a true story written by Katy Butler, regarding the end of life experience of her Father who was put on a pacemaker.  The story was heart wrenching as may be expected considering the nature of our topic, death.  Her family was upper middle class, her father a retired professor.  They were known to be educated, even prepared for end of life experience with both having signed living wills.  Katy suggests that the healthcare system is profit focused and towards that end keeps a person alive as long as possible, disregarding value of life.  She explains that her father has dementia, and already he could not do all his ALD,s which was left up to her mother to perform on his behalf in changing diapers, giving baths and more.  Her research lead her to lobbyist from drug and medical equipment companies who that pay over 500 million to get policies that reward doctor as she terms it as overtreatment. 

She exclaimed that she is given more Government-mandated consumer information on a new car then medical procedure counseling, such is it a good idea to put a pacemaker in a man who barely has a mind.  Ironically, her father was not for it but because of his dementia it was left up to mom.  As well informed, as her mother was she was put in a life or death decision with the surgical team advising the pacemaker. Katy points out, that the new healthcare bill had a provision, called ”end of life counseling;” to determine value of life and if the procedure is worth the outcome of the patient.  However, this was to become known as “Death Panels” and removed from the bill, the very thing that would have stopped the pacemaker from being put in her father.  After years of grief, service in mom helping her estranged husband do to dementia, he passed away with the pacemaker still shooting electrical pulses to his now dead heart. 

All About The Money

   

         I am in complete agreement with Katy Butler concerning the money trail and underlining motivation.  She also point out that 30% of  elderly who are deathly ill wish for death or trade one good day then two more years of illness.  Comparably, she showed statistics that 30% of Medicaid/Medicare cost is from overtreatment.  Her rational is sound when she says, “if a patient says no to a procedure then there goes the money, no one is paid.”  In my support of Katy, I have, in many other courses shown that the worse disparities in health care are formed when profit is the motivating factor.    In her family’s case, it turned her joyful mother and their shared joy into a nightmare, resulting in thoughts that cause guilt because you want it all to end.

     

       We are called the sandwich generation because science has created longevity of life.  In today’s world many are raising their children and caring for their ageing mother or father as well.  The young parents are now sandwiched into taking care of two generations and often times the ailing parent is harder to care for. This puts so much more stress in life and strains family systems to point of even breaking.  Such was the case in my personal story when my mother in law moved in with our family.  She was both mentally ill and physically incapable and she stayed with us for three years.  Personally experiencing the downward spiral of my mother in law and the twenty so procedures to keep her going was the most depressing time of my life.  In the end, it was one of the factors that broke up my marriage; an experience I still shutter over to this day.   It was my first real glimpse in health care’s great machine, often playing on my ex-wife emotions they would get yet another procedure underway.  In my mother in laws case it was overtreatment with each procedure as she worsened from each and everyone. Not only were the doctors paid but also my family paid the price as well with heated discussions that our predicament created.      It was indeed a path into nightmarish madness watching a love one slowly and with no personal dignity left finely pass away. 

Common Sense or Policy

            I do not fault medical science, in fact I applaud each new breakthrough with much vigor.  Medical science continues to enhance life in many ways.  Policy drives market in the direction towards maximum profit and policy form from special interest groups or lobbyist.  Anytime a policy is not based in common sense thent I almost guarantee a lobbyist was behind its creation.  Who was behind the coinage of “Death Panels” when it was based in common sense not the automatic model that says maybe one more procedure will fix the problem.  Simply there must be transparency in our health system that does not compromise value of life when achieving longevity. 

   

         Concerning life-supporting equipment such as pacemakers they have great use and help people live, long lives that they would have been deprived of.  In contrast, I would highly question putting the device in a 81 year old man suffering from dementia in the story I summarized here.  In such decisions in life, perhaps the hardest concerning death, needs good counsel with all considerations on the table.  In my personal experience with my mother in law, it was always a hurried process when it came to a new procedure.  We should have called death panels’ moral and ethical reasoning.  In conclusion, I will order the Do Not Resuscitate bracelet and wear it from now on, because simply I do not want to trade quality of life for longevity. 

Reference:

Butler, Katy (2010)  What Broke My Father’s heart The New York Times

            Retrieved on November 27, 2010, from

                       

                        http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=3&_r=1

2014 changes our health care landscape!

Policy and Politics in Health Care
James Wise
Class: HCA303
 
Abstract

Imagine for a moment the future of health care. Upon awaking we can look at our health monitor that tracks 300 aspects of our personal wellness plan with personalized definable health goals. Then with a few clicks, we can monitor our 90-year-old mother’s health status 1000 miles away because the monitor is connect to a health information system. We can set appointments through this portal, order our medications, and access reliable literature concerning our health care issues. Furthermore, we have access to all aspects of our health record with all the ability of my health monitoring transferred to my mobile smart phone. This is just one of the policy driven directions our government is taking. Another is health insurance for all by the year 2014. Focus has been put on preventative care in the area of obesity and smoking with movements like Lets Move.gov headed by the first lady, and quit smoking central dot com that gives you a national list by organization or state that offers free nicotine gum and patches. We will highlight these policies in the effectiveness of potential effect, costs, equity, and fairness.

Health Informatics

All that was suggested in the abstract concerning health monitoring is already a reality it is just the matter of plugging it all in on a national level. HealthInfoNet is a company funded by Government mandates is doing just that. In light of new federal rules, several of the services HealthInfoNet offers will help make many health care providers and hospitals adopting and using electronic medical records (EMR), eligible to receive federal incentive payments from the Centers for Medicare and Medicaid Services (CMS). Furthermore, on July 13 this year, Health and Human Services (HHS) Secretary Kathleen Sebelius announced two long awaited "final rules" that define stage one meaningful use and certification of EMR technology outlined in the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.

The stage one meaningful use criteria include fifteen "core" measures that must be demonstrated by both hospitals and physician practices. Hospitals and physician practices must also demonstrate compliance with five "other" criteria chosen by each provider organization from a "menu" of ten additional criteria. To trigger stage one meaningful use incentive payments, most providers and hospitals must demonstrate compliance with these criteria by April of 2012.

The one notable exception will be physician practices that qualify for incentive payments under Medicaid. These practices can secure meaningful use incentive payments prior to installing a certified EMR so that funds may be applied to the cost of investing in an EMR solution. Under the Act, health care providers and hospitals can qualify for Medicare and/or Medicaid incentive payments if they meet stage one meaningful use criteria. In total 17 billion in stimulus funding has been allocated in the future of information exchange and being the new reality by 2020, states HealthInfoNet (2010).

Policies Addressing the Obese

Obesity has been the new epidemic in America with 60% of our population overweight with 34% being obese. Asserts the New York Times(2010). The cost on health care is in the billions from complications and the onset of chronic diseases like diabetes or cardiac problems to name just two. The policies in this area are complicated because of the infusion of so many government programs that overlap each other. Policy is needed to unite the many agencies involved in governing the United States’ food and nutrition landscape. The U.S. Department of Agriculture (USDA), the National Institutes of Health (NIH), the Food and Drug Administration (FDA), the Department of Health and Human Services (DHHS), and the Centers for Disease Control and Prevention (CDC) are among the numerous federal agencies overseeing the nation’s food supply. These agencies sometimes work at cross-purposes and, such as in the case of the USDA, there are clear conflicts of priorities within the agency itself. The USDA establishes national nutrition policy, but it’s more important aim is to help the agriculture industry be profitable by maximizing food sales. The following are some examples of public policy changes that could be made in government to improve nutrition.

• Move nutrition policy and programs from the USDA to the Centers for Disease Control and Prevention. The USDA is typically headed by someone from the food or agriculture industry and exists to promote the business of agriculture, which is to sell as much food as possible. This priority often conflicts with good health policy.

• Design agriculture policy (such as the Farm Bill) with health as a principal consideration.

• Change the fundamental economics of food. Create incentives that help consumers buy healthy food, instead of incentives that make the unhealthiest foods also the most affordable.

We applaud the efforts of Lets Move.org; this is Government policy at its finest. The purpose is to reduce or eradicate childhood obesity in a generation. Their scope is complex and filters into school lunch programs, and local mandates to build parks, recreation centers, bike trails and more. Government incentives to help implement these programs, as well as building a rich resource to raise awareness with parents, Chefs being trained in nutrition in culinary academes. This effort could effectively lower obesity in America and provide billions saved in our health system.

A Smoke Free America

In the last two years many have noticed the price of cigarettes inflated, in some place as much as 50%. Simply, smoking is the most irrational behavior our society engages in that lead to major morbidity factors costing our health system billions once again. Government has not only raised the tax on cigarettes which has effectively resulted in many new non-smokers but have many state level programs that administer free aids in helping the smoker quite. This program has been very effective and continues to yield favorable results Among Americans, smoking rates shrunk by nearly half in three decades (from the mid-1960s to mid-1990s), falling to 23% of adults by 1997. It remains at 23.1% but with an increasing population since 1997 asserts the (American Heart Association, 2010). We conclude this as a good policy in promoting behavioral change in our populace by approaching both sides, the negative in taxes on cigarettes and the positive help in empowering the person to quit smoking in providing support and free aids.
Health Insurance for All

The new healthcare reform bill or as many call “Obama Care” has a slow timeline as we prepare to embrace so many entering a new open system. The leveling of the playing field does not take place until 2014, but make no mistake it is a leveling, and all preparation is taking place now to make the change happen.

The primus after all, is based on the ideology that health care is a rite of passage and no one should be left out. When we talk about natural rights we, as a nation knows it come with a dear price to maintain our freedoms. In the military, it takes hard training, personal discipline, and a desire to win the day. How do you achieve this is in a civilian populace without consequences to adverse actions that are counterproductive to our health system? The simple answer is you cannot without consequences, it is law that we must have auto insurance, because of the great risk of catastrophic event accruing in an accident. This will be reality for us in 2014 concerning health insurance and fines leveled for those who choose not to have insurance and can afford it. This is on a personal, family, and business level so all are affected. Let us take a look at the bill first on a individual level.

Require all individuals to have “acceptable health coverage.” Those without coverage pay a penalty of 2.5% of modified adjusted gross income up to the cost of the average national premium for self-only or family coverage under a basic plan in the Health Insurance Exchange. Exceptions granted for dependents, religious objections, and financial hardship.

And on a business level; require employers to offer coverage to their employees and contribute at least 72.5% of the premium cost for single coverage and 65% of the premium cost for family coverage of the lowest cost plan that meets the essential benefits package requirements or pay 8% of payroll into the Health Insurance Exchange Trust Fund. E&L Committee amendment: Provide hardship exemptions for employers that would be negatively affected by job losses as a result of requirement. Eliminate or reduce the pay or play assessment for small employers with annual payroll of less than $400,000 ( KFF 2010).

Furthermore, public health care expands Expand Medicaid to all individuals (children, pregnant women, parents, and adults without dependent children) with incomes up to 133% federal poverty level or (FPL). Newly eligible, non-traditional (childless adults) Medicaid beneficiaries may enroll in coverage through the Exchange if they were enrolled in qualified health coverage during the six months before becoming Medicaid eligible. Replace full federal financing for Medicaid coverage expansions with 100% federal financing through 2014 and 90% federal financing beginning in year 2015 (KFF 2010).

Affect on Insurance Stake Holders

Many may see this as the day of great reckoning, and the change to an open market. No longer will insurance companies deny you coverage because of a pre-existing condition, new regulations go into effect concerning premium levels, cannot drop a client from a plan or deny expensive life saving procedures. The plan creates a National Health Insurance Exchange, through which individuals and employers (phasing-in eligibility for employers starting with smallest employers) can purchase qualified insurance, including from private health plans and the public health insurance option. The public option has four plan tiers with the basic plan covering 70% of your medical encounters per year set in the context of your affordability based on income that sets the price of your premium.

Many believe this will infuse competition, a perspective we agree with in our personal vocation. Our company will be Medicaid certified next week in preparation of the new health care funding options that will happen. We work with the most disenfranchised souls in providing shelter for the homeless vets, department of correction, probation, and community release. We provide a therapeutic community and empower our clients through classes, counsel, to help them back into the main stream of society. The new Government policies will greatly increase our client base, being able to provide services for the homeless we could not reach before.

What is the Cost, Who’s Paying for it?

Universally speaking, everyone is shouldering the responsibility of a rite to health care then without the changes that are coming. Clearly, the Government is competing for the first time with for- profit insurance companies, setting the rules in their public health exchange require private insurance to comply. The Congressional Budget Office estimates the net cost of the proposal (less payments from employers and uninsured individuals) to be $1.042 trillion over ten years, of only half is pay for by new policy changes in mainly Medicare and Medicaid. So where does the 500.021 billion come from to finance our new health care bill? You may have guessed it, the redistribution of wealth.

The remaining costs are financed through a surcharge imposed on families with incomes above $350,000 and individuals with incomes above $280,000. The surcharge is equal to 1% for families with modified adjusted gross income between $350,000 and $500,000; 1.5% for families with modified adjusted gross income between $500,000 and $1,000,000; and 5.4% for families with modified adjusted gross income greater than $1,000,000. These surcharge percentages maybe adjusted if federal health reform achieves greater than expected savings. The largest source of new revenue will come from an excise tax on high cost insurance, which CBO estimates will raise $201 billion over ten years. Additional revenue provisions will generate $196 billion over the same time period CBO estimates the proposal will reduce the deficit by $81 billion over ten years (KFF 2010).

Conclusions

We have explored many areas of policy changes in health care concerns, proposed needed policies changes in our food production, and referenced clearly the policies that are soon coming. Preventative care is and needs to always be the focus point, changing behavior in a society is challenging for a Government in the context of freedom and choices. Dare we exist chained to our government even though this bill may holds aspects of this scenario? We agree in most part of the policy changes, and the simplistic but powerful approach to healthier children and obesity issues. The proven good direction in tobacco usage, simply a policy that has been holding ground for many years now. Information Health Management Systems have the most potential in lowering cost in major disparities in our current system. Efficiency is at the speed on electronics, vast databases with evident based favorable results will be accessed to determine proper cost effective procedures lowering mistakes and tort law cases. Administration cost will shrink when all information is in electronic format and storage, also eliminating many mistakes found in paper filing. Algorithms in these management information systems will find and highlight any abnormalities found in the progressing of a patient’s medical record (e.g., diagnosis does not match treatment). We cannot forget the personal empowerment spoken in our abstract and patient accessibility to their health records and monitoring your health condition. Nothing can be changed unless there is awareness to the issues; information technology continues to open the window to a broader awareness.

Without question the new health care bill opens access to everyone, makes everyone responsible to attain health insurance or pay the fine. It levels the playing field in Government competing with large insurance giants; it will break down barriers for new companies to come into this reformed market. The only issue is the redistribution of wealth in making the wealthy bear half of the cost. A better policy would have addressed this differently and not hold that aspect we mentioned earlier being a slave to government. A luxury tax placed on all non-inessential products and services, the higher the price of the product or service, the higher the percentage of tax. This does not target a particular social class; however, it will be the rich taxed the most in this policy.

Although, they will be taxed on some luxurious privilege, they want, and they will not feel the sting of being obligated to the Government to finance health care for all. It is our thought that this would generate more money because all classes are involved in a luxury tax. Here is where we see the new health care bill greatly flawed and singles out one social class from all others, and simply there is no equality in that action. It creates entitlements for many and payment for them from few. More wisdom is needed here and hopefully ratification, it strikes controversy in whether it is a violation of constitutional rights.

Reference:

Jonas, S., Kovner. A. (2008). Health Care Delivery in the United States. New York, NY.
Springer publishing company.

HealthInoNet.org (2010) HealthInfoNet Positioned to Help Providers Achieve Meaningful Use.
Retrieved on September 11, 2010, from http://www.hinfonet.org/news.html

The New York Times. (2010). Obesity Rates Hit Plateau in U.S., Data Suggest. Retrieved on
September 11, 2010, from http://www.nytimes.com/2010/01/14/health/14obese.html?_r=1

CDC.Gov. (1999) Overweight and Obesity. Retrieved on September 11, 2010, from
http://www.cdc.gov/obesity/stateprograms/index.html

Fastlane.Dot.Gov. (2010) DOT, First Lady and Childhood Obesity Task Force share Important-
Goals: Let’s Move. Retrieved on September 11, 2010, from
http://fastlane.dot.gov/2010/05/dot-first-lady-childhood-obesity-task-force-share-goal-lets-move.html

Let’s Move: America’s Move to Raise a Healthier Generation of Kids. (2010) Retrieved on
On September 11, 2010, from http://www.letsmove.gov/

American Heart Association. (2010). Cigarette smoking statistics. Retrieved on September 11,
2010, from http://www.americanstroke.com/presenter.jhtml?identifier=4559

Kaiser Family Foundation or KFF (2010) Health reform law, the patient protection and
affordability act, and health care and education reconciliation act of 2010. Retrieved on
September 11, 2010, from
http://www.kff.org/healthreform/upload/housesenatebill_final.pdf

Taking Your Health to a Personal Level

Professor,

Well said! I believe patient behavior has been a complete disconnect concerning a wellness plan, when you are not directly paying for it and strains the system from scarce resources.

It was true in my personal journey when diagnosed diabetic, caring the Cadillac card of Blue Cross and Blue Shield at the time. I cared little to comply because my plan had no restrictions to health care and I continued to take the easy way out by medication, insulin, ER visits if my blood sugar became to high because I ate the wrong things that day.

Through one tragic experience to the next I lost coverage, could not afford to gap it with COBRA, and the walls went up and I had no access to health care. I had to spend down to lower paying jobs so I could get on a Government program for diabetics. Realizing that this was a self defeating course and would lead to poverty I had to take a hard look at my wellness plan.

I turned to folkways, and alternate medication found in natural herbs. I achieved 12% body fat through diet and exercise, I learned the value of meditation and how it greatly combats stress which causes sugar spikes. In short I reversed my chronic condition, caused by healthy life style changes alone.

I am no miracle, but stand in awe of what is possible, when you apply what you learn by incorporating it in every day living. Insurance companies do not support wellness or their policies would reflect that direction. Rather they exploit the system and lobbied for restrictive measures when profits fall. Through large contracts they get the better price, far bellow an individual cost with no insurance. This is why the system is not transparent to the general public. It would be refreshing to see a billboard of prices for services on the wall.

Policy Answers:

Deflating premium when less resources are used in a definable period for a policy holder. In contrast inflated premiums when more resources are used. This would promote wellness.

Concerning chronic disease, you have to be even more focused and disciplined so in that respect the same scale should be used in changing premiums. With diabetics, we have blood work every three months that gives you a blood sugar level average for the last 120 days. This is a definable scale on how well the patient is practicing good life style changes or just using the system as I once entertained.

I am convinced Large insurance giants are out for the quick profit when they should be striking a cord for sustainability. However, they can always rely on Government bailouts when their greed crosses the line to RED.

Why is My Health Insurance Premiums Rising?

It is all in the new healthcare reform why prices in premiums are souring. It is the timeline in which the landscaping changes take place in our health system, none of which starts until 2014. Until then insurance companies are not being regulated or force to insure high risks, with no raise in premiums. Insurance companies are gaining profits in the front end of the plan, knowing that these margins will never be as great after 2014.

Here is what the plan details that year:

In 2014, most of the bill's most heralded benefits take effect. This is the year when the state insurance exchanges go on-line, with subsidized coverage available in the form of tax credits, and when Medicaid will be expanded to cover individuals making up to 133 percent of the Federal poverty level (currently about $28,300 for a family of four).

Insurers will be prohibited from denying coverage to adults with pre-existing conditions and charging higher premiums to individuals with chronic conditions starting this year, and they will be required to cover maternity care the same as all other medical procedures.

Furthermore, this year mandates kick in: individuals who do not have insurance and cannot prove hardship will pay a $95 fine, rising to $695 by 2016. Families without insurance will pay fines of up to $2,250, indexed for inflation after 2016. Employers with more than 50 employees that have any employees enrolled in subsidized coverage through the exchanges will pay a penalty of $2000 times the number of workers employed minus 30.

Some say that the Presidential Administration planned it this way for us to grow in rage towards insurance companies, but that would suggest Obama is despairing the people to bring his point home. I am more inclined to believe that the bill was pushed through to quickly without weighing all the cause and effects within the context of the complexities in stakeholders within our health system.

When you introduce change, it must come with the new restraints at the very beginning of implementation not wait four long years later. Because of this lack of vision, the bill is causing another crises in an already struggling economy. I dare say but this is just the beginning of the premium hikes, and increasing health care cost do to a flawed bill.

Reference:

Smith, Sandy (2010) Health care bill summery and timeline. Retrieved on September, 9, 2010, from http://www.huliq.com/8738/92142/health-care-bill-summary-and-timeline

Theories of Government Intervention in Health Care

Theories of Government Intervention in Health Care
James Wise
Class: HCA205


Abstract

We will explore two conflicting theories concerning Government intervention in the health care market. The first theories we will explore are the special interest group theory (Becker, 1983) and second the public interest theory (Johnson-Lans, 2004). Once we introduce these two theories, we will contrast Government’s current intervention in the health care market. In conclusion we will share our view using fact-based rational.

Special Interest Group Theory

Entrenched in political survival, politicians create legislative programs that compliment a special interest groups’ agenda for the return for votes that keep political representatives in office. Lobbying for legislative changes is an expensive endeavor, including organizing a legitimate counter political movement, inform the public, gaining petitions, and finely engage in lobbying. With that considered it leaves the general public out of important decision making when it comes to the health care market. In this theory special interest groups receive wealth transfer in scarce resources causing the general public to pick-up the cost in inefficiencies created by this model. Furthermore the political negotiations process consumes large amount of money that would be better used in productive purposes.

Public Interest Theory

We introduce this model as the more perfect in theory when contrasting the special interest group model. The core of this theory is Government intervenes in the best interest of society. This means several interventions through encouraging competition, providing information, and reducing harmful externalities or the fatal phrase “redistributing income in society.” This encompasses addressing market failures, in imperfect information “lack of transparency”, and breaking up monopolistic behaviors. By now we can clearly see these two theories are in direct conflict with one another; both continuing to compete with each other for Government intervention. So our question is which theory is currently the prominent one in our health care market? We will explore this question in our next section Current Health Care Trends, with fact-based rational.

Current Health Care Trends

Let us take a look into mergers which is a reliable snapshot on which theory is dominate in our current health care system. Mergers and consolidations have been increasing in our health care system at an alarming rate and to a point where companies have formed to help companies in a merger. Woodard and Lindstrom assert that health care organizations are consolidating at an unprecedented rate. With the number of mergers and acquisitions not likely to abate, healthcare organizations will need to become involved in strategic planning to manage the effects of this transaction activity and exert more control over the direction it will take. In particular, healthcare organizations need to know how to respond when their organizations are approached about a consolidation opportunity and how to determine whether a consolidation transaction would be strategically advantageous.
Furthermore hospitals and long-term health care are becoming the largest mergers in our current health care system. Market Watch explains the trend in health care mergers and acquisitions for the last ten years. NORWALK, Conn., Apr 08, 2010 (BUSINESS WIRE). More than $7.5 billion was committed to fund 459 mergers and acquisitions of home health care companies announced during the 10-year period ended December 31, 2009, according to DealSearchOnline.com. The largest of these transactions, the acquisition of Apria Healthcare Group by The Blackstone Group for nearly $1.6 billion, was announced in 2008. The deal between Apria and Blackstone is almost twice the size of the next-largest home health transaction for the same 10-year period: the acquisition of Option Care, Inc. by Walgreen Co. for $850 million, which was announced in 2007. Option Care itself was on the buy-side in 27 of the home health care mergers and acquisitions announced during the same 10-year period, while Apria Healthcare Group was on the buy-side in 15 of the home health care mergers and acquisitions announced during the decade.
Clearly these fact based examples show the special interest groups is the theory most dominate in our current health care system. We will now contrast this to current Government intervention within the public interest theory in our conclusions.

Conclusions

So far we have only shown the dominate special interest theory; however our Government is making inroads to addressing public interest theory. The new health care reform has achieved greater access, eliminated penalties to pre-existing conditions, and continually informs the populist in a myriad of official government website that address every aspect of healthcare. Furthermore the Government is taking a hard look at antitrust laws under the rule of reason. Alonso-Zaldivar (2010) assert that Washington, in a blunt warning to the health insurance industry, the Obama administration said Monday it won't hesitate to block mergers that threaten to stifle competition. Justice Department antitrust chief Christine Varney told a lawyers' conference that vigorous enforcement of anti-monopoly laws is vital to the success of the new health care law, particularly in trying to control rising premiums. In conclusion we see these changes important in favor of public interest, but we are also seeing the price as it relates to special interest groups. Simply the Obama administration has acted upon public interest concerns rather than special interest groups causing perhaps political suicide in his acceptance rate. We admire his sacrifice in his attempt to make health care a more competitive market and closer to the perfectly competitive market.

Reference:

Sultz, Harry A.. Health Care USA, 6th Edition. Jones & Bartlett Publishers

Dewar, Diane, (2010). Essentials of Health Economics, Jones & Bartlett Publishers

Business Wire. (2010) Key Stats on Home Health Care Mergers and Acquisitions for 10-Year Period Ended
December 31, 2009 Generated by DealSearchOnline.com. Retrieved on June 5, 2010, from
http://www.marketwatch.com/story/key-stats-on-home-health-care-mergers-and-acquisitions-for-10-year-period-ended-december-31-2009-generated-by-dealsearchonlinecom-2010-04-08

Health Care Financial Management (1997) Analyzing and executing mergers and acquisitions –
managing healthcare mergers. Retrieved on June 5, 2010, from
http://findarticles.com/p/articles/mi_m3257/is_n5_v51/ai_19645353/

The Huffington Post (2010) Justice Department: Expect “Vigorous” Scrutiny of Health Insurance Mergers.
Retrieved on June 5, 2010, from http://www.huffingtonpost.com/2010/05/24/justice-department-health-
insurance-mergers_n_588150.html

Disparity found in insurance

For those who are uninsured, or under-insured my prayers are with you. for I am one of them and understand the disparity this causes. First I will tell my story, then explain why this situation is present and my hope for the future.

At one time in my life I had the best of the best Blue Cross and Blue Shield have to offer. It was in this time I had found out that I was a diabetic, I had access to any specialist in any field in the medical community. I was an executive and my premium was paid for by the company, any co-pays I en cured was submitted to my company and I was reimburse. So essentially my health care was free. Through the possibility of losing my family I resigned my position with the company not knowing what would befall me concerning my access to health care. Cobra was the first to contact me to breach my coverage but the premium for the same benefits were nearly $900.00 per month, hardly affordable being recently unemployed. With luck my wife went back to her old job and they bridged the gap from when she left and she received full benefits and I was added to her policy. The insurance was comparable to Blue Cross, and Blue Shield so I felt no disparity in this transition. However a year later we divorced and my coverage was lost permanently. It has been four years now that I have been without any insurance and my disparity abounds. Currently I have a chronic sinus infection that requires a specialist and possibly an operation to correct. Way beyond my ability to pay for so my condition remains and has been almost a year now that I continue to dispare over this. I have found in this time because of the pre-existing condition I am unable to get coverage for a year even if I elect to get insurance through my workplace which at the moment does not even offer health care insurance. So I am left without choice, access, and help.

The system we have in place now is problematic in two areas and leaves everyone without choice, although this is what we are always hearing in the news today that people want to keep their choice. Insurance as it stands now is coupled to your employment and you get what they have to offer, and if you were to lose that job you lose your insurance. Cobra is sadly not the answer to bridging the gap because in most cases it is unaffordable.

Why insurance companies came up with the idea of employment based health care was to broaden their customer base and offset high risk patients. If that was not enough for them to offset cost the insurance through lobbying set up the pre-excisting condition clause to thwart obvious risks. All of which has made them money a lot of money and in contrast threw many of us in complete despair. To make matters even worst and to allow insurance companies to gain even more financially they came up with policies that are laughable. I just recently reviewed a policy from a friend who works for Burger King and was enraged by what I saw. With high co-pays, limitations, and capitations it would be better just to burn the policy to keep warm at least then it would be beneficial to the employee.

Outcomes from these money driven policies are devastating our heath care system. People will seek health care through emergency rooms but it has a high price tag which ends up on your credit report for non payment and is only for acute problems. Chronic conditions cannot be address in an acute setting so in the end you get the diagnosis and sent home with little to no help and a large bill.

The future has to hold these concepts for it to change and combat disparity. Quality and safety driven not financially driven. Pre-existing condition clause must be eliminated. True portability is only achieved when you can take your insurance plan from one job to the next. The very concept of insurance has humble beginnings to thwart catastrophe by pooling money together within a community and when catastrophe happens to one all contribute to eliminate the dispair of one or a few. Sadly as it stands now insurance companies are causing the disparity by doing everything they can do to eliminate the risk and by so doing leaving millions without any help or access to their health care needs. Furthermore, we must bring into public focus what we have learned with informatics and how it is changing the landscape of health care delivery and putting the decision making more in the consumer hands. A consumer driven market creates choices, lowers cost, and infuses competition. In contrast a business driven market creates monopolies and takes away choice.

A Classroom Discussion: Healthcare Reform

Dear Cynthia, Janice, Deborah, and Julie, you ladies are so kind and each of you collectively conveys the fears and mistrust of our Government. Rightly so with our house speaker, our press secretary, and our President who seems to have never left the campaign trail? Know that I voted for Barrack Obama and had great expectations and in some areas have met them with foreign policies, but our domestic climate is turning into pure frustration with what is becoming the majority of Americans.
This anger that is being repeated daily in town hall meetings is not just over healthcare reform it encompasses much more. No one wanted a bailout when Bush past the first one through congress. Then to add salt to the wound a much larger stimulus package was rammed through without most senators even reading the thousand page detailed report. Now it seems that they want to do the same with healthcare that has been in a flux of debate for 30 years with only a few hardened answers. This does not show transparency or compliance to the people’s wishes. We do not trust the Government because they have shown to be irresponsible by passing a stimulus that has far reaching changes that will be felt for generations to come basically without our say.
Papers, articles, and news stories say that the town hall meetings have not been productive because the people show up with their own opinions that cannot be changed and thus making it counterproductive. In my simple opinion it is very productive. We elect our senators to pour over complicated proposals, work out the details and come up with a plan that is best for the people none of which is happening. Instead it is becoming a culture clash on every level. Large and powerful social groups and their ideologies are trying to prevail in changing the American landscape in ways that conflict our constitution and the wisdom of our founding fathers. The motivation is big money and status quo.
Julie, I would also like to take politics out of healthcare but it is too late. Once Medicare was born it has been in the control and care of the Government. As it stands now with Medicare and Medicaid, the millions who show up at the ER that cannot pay, that cost is absorbed by the Government and is estimated that the Government is paying over 50% of healthcare cost at present time. This is contrast by large insurance executives still receiving millions in bonuses.
Our insurance system needs to be re-structured but this is hard to achieve because they have monopolized and holds all the cards. Not only money, they have created jobs for millions and each hand feeds the other. However a bold move could eradicate the monopoly by making all healthcares and insurance companies a non-profit organization. I believe any vocation that deals with life and death or the quality of life should focus on quality and value added not profit. Healthcare needs to be individualized and no longer offered through employment that coupling was to generate a large client base to offset the cost of those who where chronically ill and so the insurance company could make bigger profits. With the fall of GM mainly because of their healthcare commitments to their employees shows this concept to be a failure for companies while insurance companies still make a profit. Actuaries for insurance companies state that the only way preventative healthcare would be profitable for them is a portable insurance policies that stays with the insured person for life. As it stands now if you loose your job or change jobs, you get a new insurance plan and from a different company. So it is not cost productive to invest in a client’s preventative care, then that client changes insurance carriers.
I guess I am more of a socialist then a capitalist, I do not believe in monopolies the game we all have played only yields one winner. The Idea of redistribution of wealth by over taxing the rich as much as 60% for those who make over 2 million in the new healthcare plan is just crazy; the rich give our society jobs. Here is a more creative approach and it will generate money from every class. Simply a luxury tax; tax all non essential products and services at different tax brackets the higher the cost of the item. Along with that, change the tariff tax to stop run away over seas companies. This effectively distributes money without the feeling the Government is robbing you.
Tort law must be addressed with capitations and patient responsibility focus concerning compliance to your wellness plan. In the nature of law you should never be able to sue anyone for anything, it becomes let’s make a deal to thwart bad PR and we the people pay the cost.
Finally infuse competition with our monopolized pharmaceutical companies by allowing Medicare to purchase medication from the lowest bidder world wide. To compete they would have to lower their price that is inline with the world market not their monopolized one.
Well I felt like I have carried on long enough, but your responses compelled me to share.

Current issues: Healthcare Reform:

With rising healthcare concerns I was inspired to write this thought. I am very upset with Barrack Obama not rolling up his sleeves and getting into the details of the new healthcare reform. Where each change affects another and then another. Each move must contrast the good and negative affect and find an acceptable balance or an elimination of windfall gains. With capitations on tort law suites; do you ever hear someone winning five million in damages and ever fund the system that wrong them for improvement of healthcare? A person of good conscious would be compelled to. High yielding law suites hurts everyone; it is not just about one person’s loss, when does a society become the number of one? It sure seems that way or maybe a society of two the lawyer sure gets his hansom share! But in the end we are all paying for that wrongful death with higher malpractice insurance as well as higher premiums for the insured. I would hope that Great learning develops great minds, but at late I am dismayed.
One global concept to use to start working your primus in healthcare reform should be in “Marketing Power”; allow me to explain this principle.
Some observers believe that provider market power explains much of the outlier status of U.S. health expenditures compared with those of other nations. According to this view, when payers have market power, costs rise more slowly; when providers or suppliers wield market clout, costs increase more rapidly. When health insurance developed in Canada, the market power of the sole payers of health services, provincial governments, enabled those payers to restrict prices paid to hospitals and physicians. In contrast, the U.S. health insurance industry was initially dominated by Blue Cross and Blue Shield, institutions that were controlled by hospitals and physicians. This uncontested provider market power allowed lucrative reimbursement formulas for hospitals and physicians. These formulas were replicated in Medicare as a result of the influence of Blue Cross, Blue Shield, the American Hospital Association, and the American Medical Association over the writing of Medicare regulations. In addition, the pharmaceutical industry has deterred most governmental regulation of drug prices by using its influence over legislators. The result of the historical domination of providers and suppliers over payers has been a price structure far different from that of health care in most developed nations.
Provider market power can be curbed in 2 ways: by the countervailing power of purchasers and payers (governmental and private) and by governmental regulation.
Regulation of hospital and physician prices began to appear in the 1980s; the countervailing power of purchasers and payers grew in the late 1980s and early to mid-1990s, but then waned. However, the prices of health services preceding those developments were already high relative to prices in other nations, and this historical gap has persisted.

Reference:

Thomas Bodenheimer, MD, Department of Family and Community Medicine, University of
California, San Francisco Retrieved from; Annals of Internal Medicine