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Healthcare Reform: Which Comes First – Lives or Money?

As Congress continues to struggle with healthcare reform, I suggest that there is one way to look at it that might make the arguments simpler than they currently are.
money or people
I see only two points of view. No matter who you are or what your interest in reform is, you fall into one of these categories:

Lives First
(Then Money)

or

Money First
(Then Lives)

Lives First” people understand that lives are more important than money.  Not that money isn’t also important.  It’s just that they believe that aspects such as no insurance denials for pre-existing conditions, or making sure rewards are in place for innovation, or assuring access for everyone (everyone must participate) or making sure there is focus on health outcomes improvement — are more important than how reform will initially be paid for.

Money First” people understand that controlling costs and reining in spending are more important than worrying about who gets what kind of options for care or access.  They understand that yes, people die or get sicker (and more expensive) when they don’t have access, but that denying access to some means others can get better care. They tell the Lives First people that if money isn’t the first consideration, then it will mean rationing for all, as if that is something new. (A bogus argument, by the way, because rationing is already a part of our care.)

Some generalizations, although I realize there are exceptions:

The Lives First people are often people who have had their access challenged due to cost (or they have watched a friend or loved one who has desperately needed access and could not afford it.)  I’ve been there.  Although I had high deductible health insurance when I suffered my misdiagnosis, the co-pays were back breakers. I lost every penny I had in savings just trying to keep up — all for the privilege of proving the medical experts were wrong.

The Money First people are typically people who do have access, either because their employer subsidizes their health insurance or because they are already age 65 and older and have Medicare.  They see reform as something that will impinge on their income because it certainly won’t get in the way of THEIR access.  They don’t need to worry about other people’s lives.  They only need to worry about their money. (I have to wonder about the Medicare recipients who think money is more important – do they have this conversation with their children?)

Based on that description, which do you think I am?  There’s probably not much question in your mind — but this may surprise you: My husband and I have good healthcare coverage because he is retired from the Air Force and that gives us access to a government payment system for the rest of both our lives.  Healthcare reform will end up costing us more money than we pay now, there’s no doubt.  Based on my own generalizations, you might expect me to be a Money First person….

But of course, I am not.  I hear from too many of those people who don’t have access, who have bankrupted because of medical needs, who work up to four or five jobs just so they can buy into a high deductible, catastrophic plan, just like I had. They get sicker, or they lose a loved one, not because the care wasn’t available, but because they could not afford it, or because they were denied care since they had no insurance.

Don’t get me wrong.  I understand that money is an extremely important consideration in the debate. We need to be responsible about the money questions, and yes, I get the “don’t want to mortgage our children’s future” argument. I believe we need both points of view to hammer out the best approach.

But, if you are a Money First person, I ask you to consider that Lives First may be the more fiscally responsible approach.  If we build a new healthcare system that assures access, even if it’s quite expensive to begin with, then over the longer term, we will be “building” a healthier populous — one that won’t need as much of the same kind of expensive access we have today.  In the long run, the system will cost far less with healthier people who won’t have to go bankrupt just to get the care they need.

Ask yourself: What’s more important to you? And which profile is yours? I wonder if maybe you’ve even put yourself into the wrong category to begin with? Does this food for thought shift your thinking at all?

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Do you have concerns about healthcare reform?  Have a rumor or concern you want clarified?  Pose it here and we’ll try to uncover the truth.

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Healthcare Reform “Senior Death Warrants” Email Should Be Put to Death Itself

fear

As predicted, the fearmongering, half truths and out-and-out lies about healthcare reform have begun in earnest.  I received an email from a dear and respected friend yesterday and was appalled at the dis-information it contained.

So I’ve decided to share the email with you and show you where it is wrong and why you need to question anything you hear in these kinds of emails, blog posts and other pieces you may read.

The email, called SENIOR DEATH WARRANTS is printed here in its entirety.  I’ve footnoted my responses below.

The actress Natasha Richardson died after falling skiing in Canada. It
took eight hours to drive her to a hospital. If Canada had our healthcare she might be alive today.
In the United States, we have medical evacuation helicopters that would have gotten her to the hospital in 30 minutes. (untrue – see comment 1)

In England anyone over 59 cannot receive heart repairs or stents or bypass because it is not covered as being too expensive and not needed.  (untrue - see comment 2)

Obama wants to have a healthcare system just like Canada’s and England’s. (untrue - see comment 3)

I got this today and am sending it on. If Obama’s plans in other areas don’t scare you, this should! Please do not let Obama sign senior death warrants!!

Everybody that is on this mailing list is either a senior citizen, is
getting close or knows somebody that is.  (true!)

Most of you know by now that the Senate version (at least) of the “stimulus” Bill includes provisions for extensive rationing of health care for senior citizens. (untrue – see comment 4)

The author of this part of the bill, former senator and tax evader, Tom Daschle was credited today by Bloomberg (untrue - see comment 5) with the following statement:

Bloomberg: Daschle says “health-care reform will not be pain free. Seniors should be more accepting of the conditions that come with age instead of treating them.”
(untrue see comment 6)

If this does not sufficiently raise your ire, just remember that our esteemed Senators and Congressmen have their own healthcare plan that is first dollar or very low co-pay which they are guaranteed the remainder of their lives and are not subject to this new law if it passes. (true!)

Please use the power of the Internet to get this message out. Talk it up at the grassroots level.

We have an election coming up in one year and nine months, and we have the ability to address and reverse the dangerous direction the Obama administration and it allies have begun and in the interim, we can make their lives miserable. Lets do this! (see comment 7)

Comment 1: Natasha Richardson fell and hit her head, and refused to be taken by ambulance to the hospital.  No one can be treated if they don’t seek treatment.  Yes, later her husband phoned for help, but by then it was too late.  Could they have taken her by helicopter for help if she had been in the US?  Maybe — but we will never know.  This form of condemnation of Canada’s healthcare system is purely speculation.  No matter what country anyone lives in, they won’t get care if they refuse help.  News articles indicate that helicopters are available for transport in many areas in Canada, but not remote areas.  That is true in the US, too.

Comment 2: I went straight to some doctors in the UK for this answer ( I network with many doctors in England on Twitter.)  They assure me that there is no such policy.  One even asked me “is that a serious question?”

Comment 3: I have scoured the Internet and can find no where where any bona fide news organization has reported that Mr. Obama has made any such statement.  There are blogs, comments and editorials on some news websites, but no hard news anywhere that reports this statement or any statement like it.

Comment 4: The stimulus bill has nothing to do with quality of care or delivery of care.  It does contain $57 billion for development of an electronic medical records system which will eventually cut the cost of care and will improve the safety and delivery of care.  Will rationing take place?  Of course it will.  It already does.  But that has nothing to do with the stimulus bill!

Comment 5: Bloomberg has never quoted Tom Dashle saying any such thing!  I checked in with one of my favorite resources, Politifact and they spell out exactly how this rumor came to be.

Comment 6: In fact, that quote came from Betsy McCaughey in the form of a letter to the editor.  And while I have admired Dr. McCaughey’s work in hospital acquired infections for many years, I believe she is WAY off base by making such a statement.  Inflaming an already contentious argument does not help. (Update: McCaughey is truly going off the deep end, now making statements that the healthcare reform will will make it mandatory for Medicare recipients to go through required counseling to tell them how to end their lives sooner.)

Comment 7: Healthcare reform is going to happen.  We can make it easier on ourselves by dealing in the truth, and helping the cause.  Or we can make it far more difficult on everyone by fearmongering and inflaming.  Sending an email full of half-truths, lies and speculation doesn’t help!  If you truly want to get involved at the grassroots level, then I ask you to instead contact your local congress person and share your feelings about what is important to you.

Read more about the Senior Death Warrant at my About.com blog.

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Do you have concerns about healthcare reform?  Have a rumor or concern you want clarified?  Pose it here and we’ll try to uncover the truth.

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We’re Looking for You!

businessman pointing

Paying for healthcare is getting more and more difficult, whether it’s affording insurance premiums, paying for expensive drug prescriptions or managing without coverage at all.  And there’s no sign that it will get any easier anytime soon, as we all know too well.

I’ve been contacted by a TV news network to help recruit two patients who need help managing their healthcare costs.  Do you fit either of these profiles?

  1. Someone who is recently laid-off, or for some reason no longer has health insurance and needs a medical procedure. Not a life threatening medical problem, but still serious enough that you know you need to get the procedure.  We will work with you to negotiate costs with the hospital (we will talk with the hospital first).
  2. Someone who has insurance and has a condition which creates an ongoing need for a prescription drug — several drugs if possible.   Perhaps you’ve recently been laid off and you’re using COBRA?  Or maybe your employer doesn’t pay for your healthcare.  We will work with you to lower the cost of your drugs.

In both cases, we’re hoping to find someone who lives in Upstate New York or the New York City area.

If you fit either profile or know someone who does, and you (or they) are willing to be on TV, please send me an email at: tv@epadvocate.com

We will choose the people we’ll work with by Monday, April 6.

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Snooping – Medical Records Access Made Easy

I exchange thoughts with healthcare IT people on a daily basis over at Twitter.  So many of them seem perplexed at why we patients look at putting our medical records on the internet with trepidation.

Then along comes this video from Elizabeth Cohen at CNN.  In a matter of minutes, she was able to pull up one of her CNN colleague’s medical records, his kids’ records… She could see which doctors they’ve visited, what took place during those meetings…


HIPAA is supposed to protect us from others getting our medical records right?

We don’t want potential employers finding out we have to take meds to control blood pressure or cholesterol every day — it’s not their business!

And consider this scenario:  you have no health insurance, or maybe you’ve just been laid off and you’ve lost your insurance.  Now you need new insurance.  Well guess what?  Insurers are looking behind the scenes to find reasons to turn you down. Regardless of how easy it is for others to get your medical records, the Medical Information Bureau makes it easy for insurers anyway.

Here’s my opinion on this issue:  I absolutely believe our health records need to be online, both to improve our health and to save money.  Both are reason enough to do make medical records accessible digitally.

I do NOT believe patients should be putting their own health information online through Google or Microsoft Health Vault or any of the free applications out there, and I very much object to those large organizations (like the Mayo Clinic) which are getting in bed with these two privacy-sucking behemoths.  Those “free” applications are not free.  I’ve written about that extensively in the past.

I do believe patients can keep track of their own records, digitally, through any of the pay-for-service PHR (personal health record) programs.  You can read about the differences between the free and service fee PHR programs.

Now the government is looking at ways to move all our records online, and they are ready to throw $20 billion into the project.  I support that — with this caveat:  part of that money must make sure that our records can’t get into the wrong hands — including Elizabeth Cohen’s (Elizabeth, you know I love ya!) — because while Elizabeth is only showing us the potentials, not everyone has our best interests or good motives for doing so.

By the way, Elizabeth takes time in the video to tell us how to protect our records.  Take a look.  It will serve you well.

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Electronic Medical Records and Privacy – Oil and Water

recordsI’ve written many times before about electronic medical records, personal health records and privacy.  They can’t effectively be used in the same sentence unless you bring up oil and water, too.  They just don’t mix.

An incident right here in my office spawned this post.  Twice in the past week, a stranger’s medical records have arrived through my fax machine!  They come from an orthopedic practice, are several pages long, and regard a police officer who had back surgery and is not working, collecting worker’s comp.  They are very personal, detailed….

And I should NOT have copies!  The fact that they were sent to the wrong fax number — twice — is a huge HIPAA violation.  Yet, I guarantee you, this happens every day.

Why do I raise this point to you?  Because concerns over privacy and medical records are huge.  But that’s not new !  In fact, when it comes to medical records, regardless of HIPAA laws or anyone’s policies to the contrary, if someone wants your medical records, they can get them.

Here are some additional examples of privacy violations to give you a sense of what I mean:

Further, there are many people who can access our records whether we want them to or not.  They include any payers who will pay on our behalf, such as health insurers or Medicare. Law enforcement personnel can access our records, too, if they believe they need them to prove a case.

What’s the bottom line here? If you want your records to be private, then it is up to YOU to make sure they stay as private as possible.  Especially now that our new president is planning to throw money into the electronic medical records pot.

Our records are going to end up online.  And I believe they should.  It’s efficient, and I believe there are enough ways they can contribute positively to both our health, and our health system, that it’s a smart move.

But that doesn’t mean we patients have to make stupid choices about putting them online ourselves.  There are a handful of PHR programs out there like Microsoft’s health vault and google’s health program, plus others that aren’t beholden to the HIPAA privacy laws. And, very frighteningly, large health organizations are working with these companies to put your records online.  The Cleveland Clinic is working with Microsoft, as is the Mayo Clinic.

So when it comes to making smart choices, begin by making smart decisions about how your records will go online.  Do NOT choose one of the free PHR (personal health records) applications that keep your records online, that does not fall under the auspices of HIPAA.  There are plenty of good PHR storage apps online that charge you a fee, that may be more secure.

You may also want to ask about your doctor’s use of electronic medical records, and how they are being implemented.  Specifically you want to know if the storage mechanism your doctor uses falls under HIPAA’s regulations.  And if they tell you your records are being managed by one of these big conglomerates that are (so called) free?  Personally — I would find another doctor to work with.

Your records will never be completely protected from someone who might want them.  But there’s a difference between letting the medical records cat out the door, and leaving the door open.

Learn more:

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