Jackson County Democrats

Do we as individuals have the ethics to care about our neighbor - roughly 50% of Americans who are without primary health care coverage.

Power Point Presentation By John Forsyth, M.D.  When you click on this link, a box will appear asking if you want to save or open a zip file that contains the Power Point Presentation.  This zip file is contained on our JCDP web site and will not hurt your computer if you save or open the file. My suggestion is that you save the 1.88 MB file on your computer, then open it from there. click on slide show - from the beginning.  -- JCDP Web Master   The presentation summary is written below the following introduction.

On April 13th, John Forsyth, M.D. made an excellent presentation covering all the important details regarding health care reform.  What undergirds all the facts is one key element that defines the dilema: do we as individuals have the ethical will to care about our fellow Americans, roughly 50% of whom are without primary health care coverage.  What struck me the deepest was the thought of a loved one, a child or a sick father who can't work, laying there ill without help.  We are supposed to be good people - we must care enough to take action or we cannot consider ourselves to be good.  Action is what determines and defines who we are. 

Please read this important piece of detailed information and become infomed.  Then take action and write your legislator by email (To send a message to your State Senator or State Representative, this secure form finds your rep and sends for you ).  Tell them to support health care reform - to do whatever it takes.  I want to express deep gratitude for everyone who is working so very hard for health care reform, and thank John Forsyth for being one of those people.  I have paraphrased the presentation below. - Linda Sturgeon

 Health Care Reform – 2009: Is it still possible?

Complexity,  Uncertainty and Difficulty pervade Health Care Reform.

Cost is the leading barrier to health care reform. The cost of health care in the United States is twice that of any other developed country in the world. Only half of our population has access to basic health care.  If you have insurance, you get health care; without it you don’t.  In 2007, 16% had none; 14% had health care coverage for only part of the year; 12% had only catastrophic coverage.  That is, 42% of the populace were without primary health care insurance.  Since last October the statistics have been pushing 50% of our population with no access to primary care.  Picture yourself with a sick child and no one to call for help.  You wait anxiously to see if she’ll get better.  Unless you are very poor, your only option is to go to emergency care. 

The study in 2007 measured the quality of health care using 17 measures (e.g. infant mortality). Of the 23 most developed countries the United States ranked in the bottom 1/3^rd or 66% out of 100.   The quality of our nation’s health care sytem is 2/3rds lower than other developed countries.  In a class at medical school that grade would be 1 point above frank failure. 

We have an ethics problem on our hands. Over the past 25 years, there has been a goal reversal in health care delivery. The primary objective of health care was once to take good care of the patient. Now profit has become the priority for much of the health care industry. Profit is the reason we pay twice as much as any other  developed country, and have problems with cost, quality, ethics. 

What we are talking about is unnecessary human suffering because our health care system is inefficient, costly and inaccessible.  Honest, hard working people suffer because of our system doesn't serve them.  And there is a polarizing effect – in the last 10 years, 20% of our population had 80% of  the disease.  Also this group of people accounts for 80% of  the cost of health care.  Data describes this demographic as lower wage earners, less educated, susceptible to more serious disease, more chronic disease, more genetic disease, and more mental illness.  This group has poorer health habits, the two major ones being smoking and obesity (and the health problems they cause).  The insurance companies have willfully avoided covering this group. 

What are the possibilities for reform? 

Three attitudes affect how people respond to the crisis:

Pessimistic:  One attitude is that the problem so great that it’s just too expensive to fix.  Pessimists point to the dilema the Oregon legislature faces of a short fall in the 2009-10 budget of $ 4.4 billion dollars, and think it has to cut back good programs instead of putting $1.2 billion into a program for health care reform. 

Simplistic, naïve:  During the recent primaries there was talk that focusing on prevention would take care of ‘things’, or granting sufficient tax credits would do the trick. 

Realistic, specific:  Realists know we have to cut costs through multiple mechanisms. Universal coverage would reduce the current cost shifting, but we’d still need evidence based guidelines for payments. For example, the Commonwealth Fund did a study two years ago and put numbers to each proposal for costs and savings.  The study developed a format to pay more for medical practices that would achieve results based on proven science, and less for unnecessary procedures.  The downside was that most emergencies fall into a gray area where diagnosis is based on too little information about a patient.  Unfortunately, none of these efforts would reduce costs by more than 2% over time.

We can cut administrative costs.  Data confirms that private sector insurance has carried a 15.4% overhead cost for administration, while Medicare's administrative costs were 1.4%  although these may rise as our crisis deepens.  To be effective it will be necessary to reduce private insurance costs to 5%. 

One ubiquitous impediment to cost-cutting is the variety of the 25-30 reporting forms that competing companies require from providers.  Minnesota has come up with a solution that has become a model: it created one standardized form for all insurance companies.  In the two years since the state began using the new form it has saved $800 million!  With such savings we could fund the entire health care movement in Oregon!

Where else must the needed cuts to come from?

Unfortunately  40%  of health care costs are related to human behavior.  Changing human behavior is difficult (e.g. We have no one good way or good treatment to stop cigarette smoking).  Those who suffer most from obesity, smoking and other social behaviors, have least access to a doctor.  

Defensive medicine by caregivers also increases costs, which is why medical professionals tend to be in favor of tort reform.  To keep from being sued, a doctor must document what a person doesn’t have.  A Price-Waterhouse study paid for by insurers estimated that a 1/3 cost reduction could be achieved.  No genuinely unbiased study has been done, but we need some system of mediation to determine what is truly malpractice in order to cut costs. 

We also need to realign incentives.  The health care system has been focused on treating sickness; we do need a turn to prevention.  Kaiser/Permanente has been doing this for 50 years.  Unfortunately there hasn’t been much gain in decreasing costs because to date Kaiser is the only insurance company making the effort.  To create a system of preventative medicine is a goal that requires the will of all stake-holders.

A 15-year Dartmouth/Atlas study showed cost differences between regions of the country for the same health services.  There are, in fact, five economic regions in Oregon.  For instance, in Florida and Georgia appendectomies cost three times as much as they do in Medford, OR.  Peter Orzag, the President's Director of the Office of Management and Budget thinks this 30% variation in costs across the nation is the most cost-effective place to start changing the way we deliver health care, and could result in a 10% cost saving- which is 'real money'! 

By end of 90’s we saw that deregulation of market forces was not the solution to problem.  Walmart led the way by selling generic drugs for $4 per prescriptions per month and still made a profit.  We would get significant savings by using generic medications. 

An Update of health care reform in Oregon and the U.S. Congress

Oregon can be proud to be one of the first states with a comprehensive health plan, creating the Oregon Health Plan  20 years ago.  In 2007, with the passage of SB329 (Bates-Westlund) the Oregon Health Fund Board (OHFB) was created to devise a plan for affordable health care by 2009.  For over a year, the people of Oregon met in town hall meetings with the OHFB addressing  problems with access to primary care, preventive care, and palliative care.  The Board wrote a plan that included 13 social justice and market fairness principles, and 11 goals.  See powerpoint (download at top of article) for details. 

The report of the OHFB was accepted by the Legislature in 2008 and it's recommendations were incorportated into the Omnibus HB2009 (Greenlich, etal) and is currently in the process of amendment.  Important provisions inlude adoption of the Commonwealth Fund recommendations for cost cutting, and the creation of an Oregon Health Authority of experts to oversee the projected 6-10 year reform process.  The latest timeline for passage is late May with Governor Kulongoski signing it into law in July. The Legislature is intending to pay for this in part by a 4% Provider Tax paid by large hospitals and insurers, money that will be reimbursed to pay for services to patients.

In addition, the Department of Human Services has offered seven bills to restructure state agencies to comply with the Omnibus Bill, the Oregon Medical Association has four other pertinent bills relating to hospital adminstration and care, and an electionic POLST registry for end-of-life care (what many recognize as the 'pink sheet' directive will be made accessible on-line to any healthcare professional wherever a patient needs help).  If passed by State legislature, ePOLST will be implemented in 2009.  It is problematic, however, whether there will be money for mental health, dental coverage, or for nursing education in the short run. 

At the Federal level most conservatives who originally co-sponsored Ron Wyden’s Healthy Americans Act are no longer supporting it.  It’s in it’s 3^rd edition. His alternative to the Obama/HCAN/OHFB proposals has been vetted by the Congressional Budget Office which determined it would be budget neutral by 2014.  It does not include a public insurance plan, and is the most integrated with conservative ideas. 

The Obama/HCAN/OHFB proposals do include a public Insurance option that would be in competition with insurance agencies, although Obama himself has endorsed a mandate for children only at this point in the negotiations.  Industry criticism is that people would opt for public care plan and they would lose market share (although European examples are evidence against this notion). 

The implementation of a federal plan would be administered by a board like the Federal Reseve, and would be expensive, costing $60-$100 billion a year.  Should a comprehensive federal bill pass, it is not clear whether Oregon would need an Oregon Health Authority.  ARRA (The Federal Stimulus Package) and the latest Federal Budget increase health care funding by 19%  (See list in powerpoint).

S-CHIP passed Congress in February, and will be matched by the current state legislature and 3,000 new children will be eligible for this program. 

 A crucial question is how to fund Oregon’s share of Federal Medicaid dollars: $2 of federal money must be matched with $1 from  Oregon.  Because of the outrageous cut-back in state spending during the last decade, a billion dollars was left in the federal treasury last year that Oregon was entitled to, but could not access. We want to make sure the Federal Stimulus and Budget monies for 2009 are accessible in the future for health care to Oregonians.

Barriers to health care reform:

Unfunded Mandates: The enactment of underfunded measures is a recurring problem.  Laws will be on the books without the money appropriated to support them.  For instance, OHP worked well for 6-8 years, but an economic downturn and a conservative legislature defunded it to the extent that last year OHP could help only 1/6^th of the Oregonians is used to, and new need grows as unemployment rises. 

Complexity:  It’s hard to forge something effective.

Complacency:  The 50% of us have good health care and aren’t very aware of the plight of others, and the comfort of access is taken for granted, making some folks indifferent to the need for a better system.

Lobbying: The U.S. health care and insurance industries can be relied on to fight against health care reform that impacts their bottom line.  Hospitals are legally required to take care of everyone who come through their doors, so they are in a bind, making them interested in health care reform. 

Misleading language regarding the issues and research is another problem. 

Avoidance:  We may not have the will as a society and legislature to take adequate cost cutting measures. 

The great black cloud of the current economic crisis is an obstacle. 

Hope, however, is definitely in the Air:

We have strong leadership in our state and country. Governor John Kitzhopper, Senator Allen Bates, Rep. Peter Buckley and Rep. Mitch Greenlich, Tom Daschel, Peter Orzack and, most importantly, President Barack Obama, are in our corner.

Our current caregivers are good people.  They won’t go away. When we change our system in Southern Oregon we won’t see a difference in quality of care.   

US history tells us that in hard times compassion and community show their strength.  Local models inlude OHP; VOLPACT - a collaboration between our three area hospitals and 90% of our doctors to give charitable care ($3.5 million last year), to our most needy people; a program called "Every Child" that connects families to the area Community Health Clinics, and Oregon leads the nation in palliative end-of-life care at ½ the cost.

At all levels of political life, health care reform is on the move.

Audience Questions for Dr. Forsythe:

Q:  Does the Legislature need to propose a referendum to get rid of the kicker and/or reform the initiative process in order to make more general fund monies available to pay for health care reform?  Bill Thorndike answered that the question is, do we cordon off funds for specific needs on a permanent basis (like Oregon's Highway Fund) or do we let the legislature decide the level of funding every two years?  In the current environment, will mechanisms for funding be part of HB2009 or will funds be apporpriated from monies in the general fund? 

Q: Is there going to be government support of education for doctors?  New graduates owe about $150k.  Alan Bates has introduced partial solution: If you graduate and will work in an underserved area, the state will pay your debt. 

Q:  Florida pays twice as much Medicare than Oregon (and gets $2 per $1 matching federal funds), what is going to be done about that?  Peter Orzag says he’s going to fix this and that this is the biggest thing we can do to save health care costs.

Q:  Regarding the prescription of drugs.  Some doctors prescribe the drugs promoted by the most recent pharmaceutical sales person – and there’ve been gifts to physicians – what is going to be done about this?  There’s a real movement in last 5 years by the Dept of Ethics at the State of Oregon Medical School that has been pushing forward on this.

Q: How do you control human behavior? That’s a hard one.  A  person may shop for a doctor who will give them meds they want. or prescriptions that may not be needed.

Q: Is there a relationship between the density of doctors and and medical costs?  It depends of the kind of doctors.  Specialists tend to use intensive care and tech at much greater rate, with more expense.

Q: Can we get pharmaceutical companies to come on board to reduce costs?  Brand names make money, especially while they are under patent. A: My guess is that if their resistance meets with overwhelming public pressure, they may have to accept fewer profits.

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