Rachel Pritchett interviewed several health care professionals resulting in her article on health care reform in today’s Kitsap Sun. I started to make a few comments in response, and then decided to put it here in COPD and Other Stuff.

Following is the url to Rachel’s article and my comments to excerpts of her story.
http://www.kitsapsun.com/news/2009/aug/02/local-leaders-weigh-in-on-health-care-reform/unday, August 2, 2009

“Barbara Malich, CEO of Peninsula Community Health Services, said much of the reform talk is about expanding coverage, but rarely about improving access. Policies may lack dental care or mental-health coverage, causing even those who are insured to pay full freight or go without, she said.”
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Patient here: Dentistry and mental health should be part of the health care picture for patients. I know patients whose doctor will not take Medicare premiums, forcing the patient to pay out of pocket. That is fine for those who can afford it but what happens to the folks who can’t afford it? What happens to them?

How well can the body be when a tooth is infected or other dental problems?
Teeth and mouth attach to the body…why do we separate one from the other? Good dental care is vital to one’s health.
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‘Brian Wicks, president of The Doctors Clinic…“Right now, we’ve got everybody paid (based on units) of work performed, not compensated for coordination of care and disease prevention,” he said.…

Reform also should include incentives for providers to look at alternatives to traditional end-of-life care that often subjects patients to long stays in intensive-care units and risky and expensive surgeries. Instead, he said, providers should be encouraged to discuss options outside of surgery and the ICUs.

“Nobody compensates us for having that kind of group meeting to coordinate the care for that patient.” Wicks said.

To prevent widespread duplication of medical tests, providers should be able to access patients’ electronic records, even if those records are with a different provider, he said. Providers often end up ordering tests that have already been done because they can’t see the whole patient history, he said.’
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Speaking as a patient:
When duplicate x-rays are taken within days of each other by different clinics (urgent care – surgeon) under the same umbrella, same town, is it currently ‘normal’ practice to order the second set only to squeeze the Medicare system? The reason given to this patient by the second doctor (surgeon) was that the first sets of x-rays were not clear enough.

If health reform passes, will the second doctor be unable to retake x-rays even though they are unsatisfactory to her/him?
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“Huge savings can be made if reform moves toward a “value-based” payment system, according to Gary Kaplan, CEO of Virginia Mason Medical Center, which has a clinic on Bainbridge Island.

That means providers no longer would be rewarded in Medicare and other reimbursements for performing more tests than necessary, but for providing only treatment that is reasonable.”
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Patient speaking: I think you are selling doctors short. Fifteen years ago, Virginia Mason had at least one straight up doctor who did not order a battery of tests when he could have, with dad on Medicare and two follow up insurances, we would not have known the difference.

The doctor examined dad, told us what was wrong…and asked if dad wanted to go through more extensive testing that, in his opinion, would give exactly the same diagnosis. The doctor explained dad’s options, answered our questions, even answered questions we had not thought to ask. We were satisfied and dad’s inner ear imbalance unfolded as the good doctor told us it would.
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“Scott Bosch, chief executive officer of Harrison Medical Center, is among local provider chiefs hoping reform will help provide insurance for more of the 47 million people who now lack it.

His hospitals spend $30 million annually covering bad-debt and charity cases, with much of that loss coming from uninsured people seeking help through Harrison emergency rooms and urgent cares. If more of those people had insurance, Harrison’s losses might be less…”.”
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Patient speaking: How can health care reform be addressed until the illegal alien dilemma is solved? What percent of the 47 million people without health insurance are non-citizens of this country?

Government has not proved successful with Social Security, Medicare or Medicaid – what bright light have the for’s seen that tell them that our government can run a health care system any better?
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“Guy Stitt, president of AMI International Naval Analysts & Advisors of Bremerton, said reform should stop the practice of gender discrimination by insurance companies. It costs him twice as much to insure a 26-year-old female as a 26-year-old male on average, he said. … a woman in her 50s costs him 40 percent more than a man of the same age….”
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Patient speaking: Why? What makes the insurance companies discriminate in such a manner? I know males pay more for car insurance…because they are in more accidents than women drivers are in at the same age.

The males higher auto insurance costs don’t reflect on his employment health care costs to his employer . Why, assuming woman have more medical costs than men, (keeping their sons, husbands and fathers healthy) force employers to favor male employees over females due to the increased health insurance cost to the business owner?
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“Just about all the providers and insurers contacted by the Kitsap Sun said they were glad the topic has been moved to the top of national discussion. They also anticipate some kind of reform — maybe a lot less than hoped for — will pass in the fall…”
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Patient here: Change is needed, but not if it takes away from our free enterprise system – the same system my immigrant family came here for – to become Americans. They dreamt of a country, America, where their ideas and hard work are compensated and where the only limitation was a person’s imagination and willingness to work.

Medicare and Medicaid penalize doctors by telling them what they will pay for each procedure…never mind the doctor office overhead and skyrocketing insurance costs. . Add to it the cost of repaying their horrendous medical school debt.

My PCP is indispensable to my health. I trust her and we are in a health care partnership. The two doctors I tried after my previous doctor died did not work out. They might have been good doctors but I didn’t like them. How can anyone form a partnership with a doctor they don’t like?
Doctoring is more than a diagnosis. For the good of our health, we should have the freedom to choose our doctor.

I saw the results of a patient forced to see a doctor barely able to be civil to her. The doctor might well have a different attitude with a patient not on Medicare and able to pay his set fees.

How many patients thrive and get better or the best they can be when forced to see doctors they don’t like or trust and vice versa?

Yes, for health care reform, but do not jump on a hurried agreement that penalizes patients, doctors, hospitals, health care workers or taxpayers and our own government in the long run.

More later… Sharon O’Hara