Broad health-care reform needed, not just budget adjustments

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Health-care reform is certain to be one of the bigger items on the national agenda between now and November, right after the economy and jobs, which are interrelated.

The economy is coming back after the Great Recession. But the recovery is very slow, resulting in continued high unemployment here and nationwide.

Whenever the economy falters, the number of uninsured and Medicaid recipients goes up. The Center for Studying Health System Change found that employer-based health insurance dropped from 63.6 percent to 53.5 percent nationwide from 2007 to 2010.

Similarly, a Gallup study showed that the total uninsured in the United States rose from 15 percent to 17 percent from 2008 to 2011. The 2011 Georgia rate is even higher, 22 percent, one of the highest nationally.

Furthermore, many of the insured have to pay more and more of the premium cost as employers cost shift. We are undergoing forced health-care rationing caused by economics.

NOW IS THE time for good Americans and Georgians to pull together and take care of the less-fortunate who have lost their jobs because of circumstances beyond their control. But many elected officials are not moving in that direction.

U.S. Rep. Paul Broun of Athens is cosponsoring a bill that is a bold attempt to do away with Medicaid in its current form and convert it to a block grant to states. This bill is modeled after the discredited attempt by the House to convert Medicare into a state block grant program, doing away with Medicare as we know it. It will certainly fail in the Senate and is only a political ploy in an election year.

As the former director of health planning for the state of Georgia, I like giving states a say in how money is spent. But this new bill is just plain bad legislation that dumps the growing Medicaid problem onto each state. It will hurt low-income citizens in Georgia who already are hurting because of an economy that has never fully recovered.

Doing away with Medicaid as we know it is not the way to control costs. It results in rationing care to the needy based on a budget, without addressing underlying systemic problems.

There is a closely related attempt by U.S. Rep. Paul Ryan and others to supposedly “reform” Medicare, this time via a proposal to convert Medicare into a private insurance program. Again, Rep. Ryan is shortsighted in his approach, substituting budgeting gimmicks for real progress in solving foundational issues.

Rather than moving for broader change, creating a more efficient system that can maximize high-quality outputs, he is concerned simply with budgeting and shifting the costs away from the national government and onto someone else.

Strangely enough, he is simultaneously proposing House Resolution 452, a bill that repeals the Independent Payment Advisory Board. This nonpolitical board is part of the Medicare Decisions Accountability Act of 2011, and was specifically set up to keep the politics out of health care and to make Medicare cost-effective.

What is the solution? Not the Affordable Care Act, or “Obamacare.” Even if the individual mandate survives the legal challenges at the Supreme Court, the ACA still does not change the system. Insurance companies still will maximize profits and cost will rise.

THE ALTERNATIVE is to do what the rest of the developed world has done: single-payer Medicare for all, with private physicians providing care just like they do for most people right now.

In 2000, the World Health Organization, a respected international group, issued a report ranking the U.S. health-care system 37th in the world. A 2010 New England Journal of Medicine article ranked us first in health-care spending but 39th for infant mortality and 36th for life expectancy.

In 2008, U.S. per-capita spending was $7538 while spending for France, with better health outcomes, was just $3,696. Clearly, more than just a budgetary adjustment is needed.

Physicians for a National Health Program has been a leader in the fight for universal Medicare. Studies by PNHP members have shown that administrative expenses for Medicare are just 3 percent, while for-profit insurance companies spend 31 percent of their revenue on marketing and other administrative costs.

During the Kennedy-Nixon debates, what later became Medicare was termed “socialism” by President Nixon. He later came to better understand and support this very popular, all-American program. Tell our elected officials to do what is right for the American people – the expansion of Medicare to cover all age groups.

(The writer is a retired health-care executive who is on the Jasper County (Ga.) Commission and Board of Health.)

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Retired Army
17512
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Retired Army 03/31/12 - 11:57 pm
2
2
Great editorial, common sense

Great editorial, common sense and decency for all Americans.

And now from the crowd who will decry this idea as picking at our "freedum", socialist, communist takover of 17% of our national economy. Worse will be the attacks because the author has the audacity to mention France of all places

Well, it is my opinion that we are about 200 years late in implementing single payer national health care for ALL. Even those dumb enough to not know that they are one diagnosis away from bankruptcy.

Health care for PROFIT must go! Let's get doctors who really want to be doctors back to being doctors instead of lackeys to big insurance companies. For those who would argue not enough to go around, fine. There are waiting lines at every medical school in America. Fund the expansion, train the professionals. America must invest in this. it is something we can do.

My daughter and son-in-law are doctors at a medium sized community hospital out west. They aren't getting rich nor are they poor. But they are doing what they set out to do. Help people in need. I'm so proud of them I could just bust and they agree with my views on health care. Get the profiteers out of medicine. Restore nobility to the profession.

Craig Spinks
817
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Craig Spinks 04/01/12 - 02:41 am
2
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RA, Well-put. Don't agree

RA,

Well-put. Don't agree with all your points but do agree with most.

By the way, I'm a patient, not a customer.

And KUDOS to Michael for presenting Mr. Bernard's view and to Sean for allowing yours.

charlesaiken
16
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charlesaiken 04/01/12 - 07:34 am
1
1
'Health care for PROFIT must

'Health care for PROFIT must go!'
So will most of the good doctors.
As for France, a French friend said in the late 90s "you Americans do not understand how good you have it. He said, "Taxes, regulations, the labor unions and the entitlement programs are killing my country".
I'm afraid my friend would not say 'how good you Americans have it' today.

charlesaiken
16
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charlesaiken 04/01/12 - 07:42 am
1
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' with better health

' with better health outcomes,'
Mr. Bernard, you are welcome to your opinion but I doubt that your statement is true

itsanotherday1
42923
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itsanotherday1 04/01/12 - 09:20 am
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2
So, you 'single payer"

So, you 'single payer" proponents want to nationalize medical services because 15% don't have coverage?

Why don't we just address that 15%? Instead of forcing them to buy health insurance, have Medicare administer a VOLUNTARY insurance program available to all, which has real premiums for those uninsured and under 65. If one then CHOOSES to not have coverage, hold them responsible for their care. If they do not voluntarily pay their bill, Uncle Sam will track you and garnish your wages in perpetuity until the bill is paid.
Providers would get their money, and the taxpayers would be paid back.

Lastly, tort reform is a MUST. We vet our new medications via the FDA more stringently than any other country in the world; yet when an insignificant percentage of patients have one of the .0001% side effects, the ambulance chasers are out in force drumming up a class action. As far as I'm concerned, it should be lawsuit proof for medical devices/pharma if the FDA has done due diligence in vetting the drugs/devices.

ny transplant
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ny transplant 04/01/12 - 09:27 am
2
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Mr Bernard is correct that

Mr Bernard is correct that socialized medicine does offer some advantages but he neglects to mention how this occurs- 1 - higher taxes 2- very little malpractice 3- end of life decisions 4- long waits for elective proceedure etc.
I personally feel we need a dual system- gov't paid healthcare is socialized and we institute 2-4 above- can't sue, decisions on care are made by panel based upon outcome not perojnsal feelings, we offer end of life comfort not heroics where we put grandma in ICU for months before death on the chance that 1 of 100 will get better and we have people wait for elective proceedures.

If you want to control the decisions then get insurance and go to private hospital and pay for the expenses

carcraft
25774
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carcraft 04/01/12 - 09:58 am
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. A 2010 New England Journal

. A 2010 New England Journal of Medicine article ranked us first in health-care spending but 39th for infant mortality and 36th for life expectancy.
I will need to look at this statement a little closer but usually this is an apple oranges situation. Any child born breathing is a "live birth" in America, even if the child is not viable past two or three days. In many countries that does not count as a live birth. The author should know this. http://www.bmj.com/content/344/bmj.e746 Or life expectancy is skewed because of young adults and teenagers (can we say gang banger and gansta wanna bes) killing each other. Take out the violent deaths and our mortality rates compare favorably with other countries . It has nothing to do with health care.
http://cafehayek.com/2009/09/on-life-expectancy-in-america.html

Riverman1
83712
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Riverman1 04/01/12 - 09:52 am
1
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Here's the problem with his

Here's the problem with his statistics and it will probably disappoint both sides of this debate. We know we spend more than any other country on health care. We also know we have a wide disparity of income with a segment of our population being poor.

You could study populations of various countries that don't have ANY health care and the countries with more affluent populations across the board would have fewer health problems and a longer life expectancy.

I'll match the health care and life expectancy of our middle and upper class populations who understand diet and stay away from unhealthy habits against any country.

carcraft
25774
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carcraft 04/01/12 - 11:04 am
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The liberals have run the US

The liberals have run the US education system and look at it. We spend more and get less results than any other country in the world. http://mat.usc.edu/u-s-education-versus-the-world-infographic/ Having completely screwed up education liberals now want to move on to health care. Why no demand to reform education and make our schools better. This alone COULD increase life expectancy and reduce crime and help decrease federal spending..any purposal to reform educatin from vouchers to reducing teacher union influance is met with weeping and whaling and screams about the poor children. Onec health care is firmly in the liberal lap I expect the same outcome...

dichotomy
32841
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dichotomy 04/01/12 - 10:33 am
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In a eutopia everyone has

In a eutopia everyone has access to great health care. Under socialized medicine everyone has access to poor, untimely, rationed health care. Under our current system, everyone has the opportunity to work, buy insurance and have access to the best health care in the world. I think we can tweek things a bit to help out the 15% without ruining the health care system for the rest of us.

The Medicare system we have today is already a bureaucratic nightmare and ripe with fraud. Can you imagine what it would be if the government and their contractor bureaucrats were processing every medical transaction for every doctors visit and medical procedure in the country. Single payer equates to delayed care, rationed care, and increased fraud. I am not willing to experience that for the benefit of the 15%.

deadline
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deadline 04/01/12 - 11:35 am
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I hate when people compare

I hate when people compare the US to any other country. Our lives and the way we live are completely different. We have single family detached homes with yards, they have flats. We have ~2 cars per family they take public transit. We pay less taxes, they are a welfare state. We have a extremely diverse population. We have 27 MRI scanners per million, they have 3.

Most Americans could not get used to that lifestyle.

carcraft
25774
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carcraft 04/01/12 - 11:58 am
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deadline- I agree. If we

deadline- I agree. If we look at education, for example, we spend more and get much less. Part is social related- more single parent families with children having children and grandparents raising the kids. The same grandparents that raised the child having the child are now raising the grandchild. Lack of father figures and home discipline contribute. Add a dysfunctional education system and it is very hard to compare. The same factors affect health care. Prostate cancer is a good example. Many Black Males don't have prostate cancer screening exams that are FREE because of a multitude of complex factors. http://www.ncbi.nlm.nih.gov/pubmed/12515993 It is as much a health care issue as a social issue!

deadline
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deadline 04/01/12 - 12:33 pm
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I also hate the fact that

I also hate the fact that "fringe" issues like the contraceptive debate take away from real issues like health care reform. They should have had a televised panel from health care docs/reps from other countries so there could have been an informative discussion that Americans understand whats at stake instead of this rhetoric about "death panels"

carcraft
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carcraft 04/01/12 - 01:23 pm
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Deadline- There will be

Deadline- There will be rationing of health care if we go to a government system. You simply canot pay for eerything for every body. Canadians were coming to the US for total hips. The wait form MRI's in England was a death sentance. The fact that we spend more on health care for the last six or so months of life than during our whole rest of our life needs to be discussed also. This is a very complex subject and for Obama and the Democrats to have shoved it down the American peoples throat because they could was bad business. Comments like "we have to pass it to know what's in it" didn't help!

socks99
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socks99 04/01/12 - 01:49 pm
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Regardless of what becomes of

Regardless of what becomes of "national health care" in the United States, the human race is likely to be "ok."

The debate over who pays, now, is the result of latent fiscal crisis: government has over-promised, and something has to give! In utopia, the government could pay ALL health care costs, and no one would ever do without health care; if the U.S. had a robust and booming economy, a national health care system might seem easy to accomplish. And while the writer cites national health care programs in "all the developed economies," he glosses over the fact that it was their GDP, productivity, and wealth that made it possible for their governments to deliver on the medical promises; and that those programs face shortfalls and austerity just as soon as their mother economic engines stumble.

If state and federal meddling in U.S. health care teaches anything, it might be that universal, top-down "help" quickly encourages costs to skyrocket! In addition, the rules and regulations, perhaps unintentionally, create an almost bullet-proof health care monopoly that KEEPS OUT competition. For instance, in the current downturn, plenty of folks cannot find work. Well, could they have studied medicine and become doctors or hospital administrators? Not really. The entry point for medicine in America is cobbled-over and guarded zealously. These guards, in my opinion, do NOT represent the interests who equate the best applicants with the best doctors; these interests, instead, represent extant service providers who are keen to KEEP OUT competition.

The human body, for the most part, requires little medical care in the course of a life. Countless public resources have ALREADY been invested in life-saving common items such as vaccines. People in America and elsewhere need not worry about access to health care provided the GOVERNMENT get out of the way and ALLOW competition!

carcraft
25774
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carcraft 04/01/12 - 02:18 pm
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socks99-I wish it were that

socks99-I wish it were that simple. Government is part of the problem but is required.An excellent example is yellow fever. NOt very common in the US today but America was a death sentance for early Americans and there was a yellow fever epidemic. Public service misqueto irradication and control have done a good job to reduce the incidence. The only disease conquered by man, small pox, required a lot of work by many governments. The reduction and treatment of STD's has been largly a government community health endeavor. Public sanitation effortz that prevent thyphus etc (proper human waste disposal for example) is and are where the government needs involvement. Micro manageing individual care is another isssue and mandating who gets what beyond basic immunizations is another issue. This isn't a simple one size government out of the way problem. Common sense realistic goals are what are needed. You can't provide every one a Lamborginni on a Volt budget. Probably a basic care plan with added fluff for those seeking it who can afford it through private funding of various private insurance plans. Fair, no, realistic yes. For example prostate cancer in a prisoner. Basic treatment for prostate cancer yes. Penile prosthesis for erectile dysfunction from treatment, NO. I don't know if I agree with heart transplant for Dick Channey. But you can get the idea!

deadline
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deadline 04/01/12 - 02:58 pm
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Carcraft, you are correct, we

Carcraft, you are correct, we spend a good majority of our health care dollars in the last year of life. If we are going to make any head way on cutting costs long-term we need to refocus those dollars into prevention. The problem is that you wont realize those savings for 20-50 years.

A small percentage of Medicare patients spend the majority of dollars for chronic diseases and their complications. The most costly 5% of medicare patients spent ~50% of all medicare expenditures, the most costly 20% spent ~80%. A proposed strategy has been moving to a patient based savings initiative.

socks99
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socks99 04/01/12 - 03:02 pm
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carcraft, I do credit

carcraft, I do credit advances made in public health; I also posit that American citizens have ALREADY paid for many of these advances; so why pretend, then, that we need to re-invent the wheel?

There simply is NO END to rising prices as long as the government and corporate world bid-up the prices of health care! Whence their influence diminishes and competition returns to the market, costs will fall, access will rise, and folks will wonder about why citizens and policy-makers had been so deluded and off-base.

carcraft
25774
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carcraft 04/01/12 - 03:38 pm
0
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Socks99- I agree with you but

Socks99- I agree with you but we need a balance, to protect citizens and set criteria, the government, to provide service and compitition, private enterprise. The balance has to be realistic. It is expensive to bring new treatment on board. I worked at the VA when the first automatic cardiac defib was implanted in this area. It was a throacic proceedure requireng the leads (wire mesh screens) be sewn directly to the heart. Today it is a simple trip to the cath lab and very similar to a pacemaker. The evolution of this required testing to a predetermined (that would be government) standard with assurance to the recipiant that the device would work. Now there is evidence that there have been too many of these devices implanted. Where do the criteria etc for implanting them come from? Free enterprise? The government? Cardiothoracic surgeons? Right now there are panels of Doctors associations tring to come up with good guide lines for care and treatment of conditions based on best scientific data. It is fun to try to sort through the evolution of some of the recomendations. I can go on with device and treatment etc for hours. Take cardiac vessel stints. Taking care of those folks is a challange. The goernment needs to help insure there is ethical considerations in the guide lines etc. But again one size doesn't fit all. this is tough period!

Little Lamb
45869
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Little Lamb 04/01/12 - 04:13 pm
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1
Deadline posted at 2:58

Deadline posted at 2:58 p.m.:

We spend a good majority of our health care dollars in the last year of life. If we are going to make any head way on cutting costs long-term we need to refocus those dollars into prevention.

What we need are death panels. They are in the Patient Affordability Health Care Act (i.e., Hillarycare or Pelosicare or Obamacare), but they don't kick in until 2014, long after Obama is untouchable.

carcraft
25774
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carcraft 04/01/12 - 05:44 pm
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Little Lamb- The other thing

Little Lamb- The other thing that really bothered me during the health care debate was how Obama lied. Obama lied about his mother's health insurance (she had excellent insurance and health care). Obama's mother's problem was with disability insurance. She bought her policy after the illness was diagnosed. Obama lied about patient's etc yet the press never really called him out on it. The other problem with Obama care wass that it was front loaded to make it appear cheaper than it really was.

desertcat6
1140
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desertcat6 04/01/12 - 06:23 pm
1
1
Just because everyone will

Just because everyone will need healthcare isn't a good enough reason to nationalize healthcare. Despite all the talk, medical care isn't a basic human right. Its a benefit of a modern and productive society. Caregivers and research scientists are compensated for their efforts and people/citizens strive to obtain it to ensure the health of their loved ones.

Insurance just happens to be the vehicle by which most of us pay for it, and, yes, the cost has increased. MEDICARE is a government run insurance program for the elderly and disabled that fails to pay the market price, forces us all to contribute, and can't cover its costs.

MEDICAID is simply free government healthcare paid for by higher wage earning citizens for low income citizens with virtually no incentives for getting off of it. MEDICAID dictates prices at the low end, and, like MEDICARE, skews the market price for medical care for everyone else. Yet, some how, forced participation in private insurance or government run MEDICARE for everyone is the solution?

I'm sorry, but I disagree. Healthcare payment and provision can be fixed without the direct intervention of our government at the individual level for every single citizen in our country. Doubling down now and taking a nationalized healthcare stance is short-sighted, politically motivated, and economically dangerous to our nation.

carcraft
25774
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carcraft 04/01/12 - 07:15 pm
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desertcat I think we need

desertcat I think we need government to help set standards and serve as a moderator. To insure standards in production of equipment and medication. The government also needs to control and prevent manopolies and manipulaiton of markets and to help insure out come reports are accurate. Look at the Cox inhibitor problems that developed because of bad studies.

desertcat6
1140
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desertcat6 04/01/12 - 09:11 pm
0
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Government has authority to

Government has authority to regulate commerce - your examples support that authority. Adding to that is the need for open competition among health insurance across state lines.

Gage Creed
17184
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Gage Creed 03/24/13 - 07:37 pm
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Outward appearances would

Outward appearances would indicate some sort of "sweetheart" deal awaits Mr. Bernard.

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