WaPo: 2009 Health Care Reform -- good luck

A cautionary note ..

Because Congress has passed bill after bill on Obama's wish list and because Democrats hold overwhelming majorities in both the House and Senate, some may think there can be no repetition of the fiasco of 1993-94, when Bill and Hillary Clinton saw their effort at health-care reform die without a whimper.

Insiders know better. Last week, I went to see the four top officials of the National Coalition on Health Care, perhaps the broadest consortium in the field, including labor, religious, professional and medical groups and a smattering of businesses. It has long advocated the kind of comprehensive overhaul of health care that Obama aims to achieve.

These advocates applaud administration efforts to engage the players in the insurance, hospital and pharmaceutical industries in their talks -- and the willingness of those groups to "stay at the table."

But once there is specific legislation, they say, each of these groups will start bargaining hard to protect its own interests. And some of them -- local hospitals, for example -- have real clout with members of Congress ..

Obama will have to carry much of the burden of advocacy himself -- if outside events don't intrude, as they did on Bill Clinton. The president has shown his willingness to bargain, signaling, for example, that he would now consider taxing some employer-provided benefits, an approach he denounced when John McCain endorsed it during the campaign.

But it will take much more than that to win what promises to be an epic struggle.

USA health care -- how much pain?

Why Medical Onshoring (patent-pending)?

Consider the existing alternative -- the $2.4T (trillion) U.S. health care system.

• High costs, putting tremendous financial strain on patients, families, employers, health plans/payors, providers, and taxpayers.
• Uneven coverage and quality -- even with single-payer groups like VA.
• Ruinous medical-malpractice costs, driving up (1) costs and (2) resulting in mostly-wasteful "defensive medicine" to deter malpractice lawsuits -- between $250B (billion) and $500B in wasted costs.
• High administrative costs due to poor management and billing practices -- between $750B (billion) and $1T (trillion) in wasted costs.

This is on top of the USA's self-inflicted medical problems -- smoking, poor diet, alcoholism, drug abuse, and dangerous lifestyles -- as much as $750B (billion) in wasted costs.

Fixing half those issues would free up hundreds of billions of dollars spent on health care now -- wouldn't it?

Editorial note: as a new company, Medical Onshoring (patent-pending) is not shackled to the past. By requiring top performance and med-mal reforms, we will provide the maximal surgical service possible.

'Universal Healthcare' -- panacea or pipe-dream?

Will "universal health care" solve the USA's medical-care crisis?

Hmm .. consider these case studies ..

Case 1: Bill Clinton. An MD on duty, 24x7 between 1992-2000. In 2004, has to be rushed to heart surgery. Hecka' job, universal healthcare.

Case 2: David Letterman. Medical/health insurance for a multi-millionaire. In 2000, emergency heart surgery required.

Case 3: Tim Russert. Medical/health insurance for a network VP. Died suddenly of a heart attack.

There's a myth that 'universal healthcare' will solve everything.

It won't. It never will. Get used to it.

All we can hope for, is for people to their best. People treat patients -- not bureaucrats.

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More details ..

What will health reform do for the unhealthiest Americans?

.. Consider the shoppers at the Save-A-Lot supermarket in Hamlin, West Virginia. At the beginning of the month, when the food stamps arrive, they snap up buckets of lard so big that the label says: “Warning—Children can fall into bucket and drown.” The manager, Key-Ray Adkins, shrugs: “People now say lard isn’t good for you. But it’s what we grew up with.”

Thinking and "developing policy" are not the same as knowing, engaging, and authentically teaching.

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The Cost of Smoking

What does a pack of cigarettes cost a smoker, the smoker's family, and society?

This longitudinal study on the private and social costs of smoking calculates that the cost of smoking to a 24-year-old woman smoker is $86,000 over a lifetime; for a 24-year-old male smoker the cost is $183,000.

The total social cost of smoking over a lifetime—including both private costs to the smoker and costs imposed on others (including second-hand smoke and costs of Medicare, Medicaid, and Social Security)—comes to $106,000 for a woman and $220,00 for a man. The cost per pack over a lifetime of smoking: almost $40.00.

The first study to quantify the cost of smoking in this way, or in such depth, this accessible book not only adds a weapon to the arsenal of anti-smoking messages but also provides a framework for assessment that can be applied to other health behaviors.

The findings on the effects of smoking on Medicare and Medicaid will be surprising and perhaps controversial, for the authors estimate the costs to be much lower than the damage awards being paid to 46 states as a result of the 1998 Master Settlement Agreement.

Does "universal healthcare" make smoking a moral hazard?

Yes. By attaching no direct penalty for smoking (sin taxes do not always count), in effect non-smokers subsidize the medical cost of smokers. Logical, clear and simple.

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Cost of obesity

Six in ten people in the United States are overweight, with a third crossing the boundary into obesity. The extra weight leads to at least 100,000 deaths annually. Obese people are at a much higher risk for heart attacks, strokes, diabetes, arthritis and some cancers.

Doctors call people obese if their weight in kilograms is more than 30 times bigger than their height in meters squared. This is known as a high body mass index, or BMI.

Even kids are getting fatter. Nineteen percent of children between the ages of 6 and 11 are overweight, up from 4% in the 1970s. Doctors are turning to intensive behavioral therapy to try to keep these children from gaining more weight.

The economic cost of all this extra fat is immense. Direct medical costs are easiest to calculate, coming in at $93 billion, or 9%, of our national medical bill.

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Cost of Alcohol Abuse

Your boss might want to forget about making you wear that BlackBerry and take away your bourbon instead.

Businesses spend big bucks on both the little, addictive wireless e-mail gadgets and programs that screen for and treat problem drinkers. Both make back the cost of investment.

But searching for alcohol abusers brings in $2.15 for every dollar spent, compared to a mere $1.62 for keeping workers connected with Blackberrys.

In fact, just by surveying employees and offering counseling sessions of 30 minutes or less, employers might be able to put a big dent in the $35 billion that excessive drinking adds to health care coverage annually, according to the George Washington University researchers who came up with the comparison.

What is striking is that the GWU researchers don't recommend counseling only alcoholics, who require years of treatment, but also people who aren't addicts but simply drink too much.

"Since there are so many more people who drink in hazardous or harmful amounts, about 60% of the costs of alcohol to society are from people who are not dependent," says Eric Goplerud, who heads an alcohol abuse program at GWU called Ensuring Solutions.

"There are people who drink even though they have sore stomachs, or drink and get into a fight and get hurt or engage in unprotected sex."

Each year, alcohol abuse costs the United States an estimated $185 billion, according to the National Institute on Alcohol Abuse and Alcoholism. But only $26 billion, 14% of the total, comes from direct medical costs or treating alcoholics.

Almost half, a whopping $88 billion, comes from lost productivity--a combination of all those hangovers that keep us out of work on Monday mornings, as well as other alcohol-related diseases. People who drink too much and too often are at greater risk for diabetes and several kinds of cancer, according to some studies.

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Cost of Drug Abuse

The economic cost to U.S. society of drug abuse was an estimated $97.7 billion in 1992, according to recent calculations. The new cost estimate continues a pattern of strong and steady increase since 1975, when the first of five previous cost estimates was made.

The current estimate is 50 percent higher than the most recent previous estimate - which was made for 1985 - even after adjustment for population growth and inflation.

The parallel cost to society for alcohol abuse was estimated at $148 billion, bringing the total cost for substance abuse in 1992 to $246 billion. This total represents a cost of $965 for every person in the United States in 1992. The per-person cost for drug abuse alone was $383.

Medical care -- more than the surgeon's fee

Much has been made about the cost of medical care and "the benefits of medical tourism." Well, to quote an old professor -- "it is a little more complicated than that."

The price/cost? That's getting easier to find. Here's the reported cost of a heart transplant --

http://wiki.answers.com/Q/How_much_does_a_heart_transplant_cost

Is that enough?

Of course not. So many other factors -- pre-surgery, your GP, after-surgery.

Complicated. Not atom-splitting. But not simple, either.