Posted Thursday, July 9, 2009
State lawmakers are working to beat a July 14th budget deadline. If they don't act, Governor Strickland hints he might shut down state government. Voters, meanwhile, are showing signs of budget fatigue. A new poll shows the Governor's popularity falling and a majority now favorably inclined toward casino gambling. As General Motors emerges from bankruptcy, we'll discuss the likely impact on consumers and investors; and an underground fire in a Stark County landfill shows signs of abating after years of smoke and odor. Senator Sherrod Brown tells what he likes and doesn't like about the health reform plan. Join us Thursday at 9:00 for the weekly reporters' roundtable.
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What I really want reporters to question congressmen on for health care are
1) How can we have a public plan and private plan competition when a public plan couldn’t be sued (can’t sue government) for denying treatment for treatment because it wasn’t proven cost effective enough (1% improvement for a hefty cost - $100,000) when a private plan would be sued and lose because they didn’t do enough? Public plan would have lower cost, weeding out the higher cost plans (private ones). Juries already give high damages when an insurance company didn’t cover a legitimate treatment, even if the treatment isn’t proven to be effective. Because there is no push to put limits on punitive side, it makes it impossible for private plans to compete.
2) How can S. Brown and others say that attacks of government rationing are outright lies? Only, way this will work is to ration (not a bad thing, just not popular). Note, Brown today pointed out that we already have rationing as some people don’t have insurance. Great point. He and Obama said that the doctors and patients would decide what treatments to do (via education). However, he did go on to say a health plan would reimburse more for a proven cost-effective treatment but not as much for a less proven treatment. Isn’t that rationing - as treatment A is 90% reimbursed and treatment B is 50% reimbursed? That’s forcing a doctor and patient hand. A government plan would pick and choose which treatments to cover without anyone able to legally challenge it.
Note, this is going on already for Plan D coverage (drugs). Some drugs are covered and others are not. Obama said that government won’t interfere with the patient/doctor relationship as they are the best at choosing what’s best. Yet, my spouse, can’t prescribe some drugs because they are not covered by her patient’s Part D plan (even public plans need to limit cost covered by government reimbursement to run the plan). A plan covers generic alternatives, yet she can’t use some generics as they have different doses of certain chemicals making her prescriptions non-effective (as the %s determine how they interact with sensitive make-up of the brain). Patients complain that the drug isn’t working ... yet the doctor has no recourse as the plan’s reimbursement procedures determine what drug is used not the doctor.
There will be rationing ... We need to ask the hard questions on health care of how much do we spend for how much effectiveness now before a plan is placed when it’s too late.
We may say we spend 3x as much as other countries with a lower life expectancy to show for it. Yet, what we don’t realize is that life expectancy has more to do on preventative care (our diet, exercise and other factors) which is not per se your doctor’s quality of care rather our quality of life and chooses we each make. We have the best end-of-life care. The question is do we want to keep on spending as much on it. These are the questions we need to ask.