 |
|
Synopsis of Health Care Community Discussion
Dec 22, 2008 at 7:00 p.m. ~ Madelyn Helling Library Community Room, Nevada City CA
Fifty-one people attended this Community Discussion, which had been publicized in the local newspaper and on local radio stations. Those in attendance included members of the general public as well as health care providers of both conventional and alternative care. Each person received a copy of the Participant Guide.
Co-host
and
Moderator: Maureen Shepard, local certified homeopath
Co-host: Dr.
Jonathan Pierce, M.D., local physician
Scribe:
Debbie Plass, Director of Business Development, Sierra Nevada Memorial
Hospital
The event opened with introductions and an explanation that the Presidential Transition Health Policy Team is asking Americans to host and attend these Health Care Community Discussions over the holidays. The ideas, stories, and concerns presented will be captured into a report (i.e. this document) and sent to the Health Policy Team headed by Tom Daschle. The results of a Participant Survey will also be compiled and submitted.
Discussion of Questions from the
Participant Guide
Briefly, from
your own experience, what do you perceive is the biggest problem in the
health
system?
The system does not address the causes of pain or diseases, but only the symptoms.
· I’m 60 years old and my health insurance premiums went up, even though I’m well. Presumably just because of my age.
· M.D.: The current system does not have to compete with alternative or natural medicine. We need equal support for alternative. They’ll pay huge amounts for back surgery but nothing for chiropractic or acupuncture.
· M.D.: Biggest problem is access to health care. There are 47 million uninsured. Obama’s current proposal doesn’t address this.
· Physical Therapist: Need direct access to adjunct therapies so patients don’t have to keep going back to their primary physician in order to continue receiving care. Direct access in Massachusetts saved millions (of dollars).
· Physician’s Assistant: System is currently employment-based. A lot of people at the end of life don’t want most of what they get. A process for planning ahead would save money. The current system doesn’t ask people what they want.
· Affordability. I’m paying $600 per month for catastrophic insurance, and that will go up as I age. Insurance isn’t covering my husband’s Alzheimer’s medicine, which is very expensive. I’d like to see a single payer system.
How do you choose a doctor or
hospital? What are your sources of information? How should public
policy promote
quality health care providers?
· M.D.:
Most doctors won’t take new Medicare patients. There’s no freedom to
choose,
because there’s not enough M.D.s.
· M.D.:
There aren’t enough doctors in primary care. This means poor access to
care.
· I
have to choose from a list provided by my insurance company.
· Concept
of health savings accounts.
· Maybe
we should reward doctors for keeping people healthy. You get a discount
for
being a good driver, for not smoking, why not for staying well. Our
system
wants us to be sick.
· Offer
out of system/out of country options. If a procedure is too expensive
to do
here, let us go to Mexico or Canada.
Have you or your family members
ever experienced difficulty paying medical bills? What do you think
policy
makers can do to address this problem?
· Two
people in my family lost their homes due to medical bills. Our family
came from
Canada. Relatives there receive excellent care. They wouldn’t trade
their
system for ours. My wife and I pay 25% of our net income for health
insurance
despite being in our 70’s and on Medicare. I believe in the single
payer
system. We need to get insurance out of the middle (between patients
and health
care providers). This will bring down costs.
· As
we age, expenses increase because we don’t know where to stop. 80 year
old
people don’t need a heart/lung transplant. We need caps on certain
things as
people age.
· I
was turned down for insurance because of age although I was healthy.
Then I
broke my leg. The hospital is a price-gouger for non-insured people.
They
charge 3 times as much as they charge the insurance companies. My cost
was
$29,000. I tried to negotiate the charges, but they would only reduce
it by
25%.
· CEO
of local hospital: It’s a big challenge for the hospital to charge
fairly and
keep current care services. The hospital has to pay for people who
never pay
their bill. The charges are the same for everyone, but the insurance
companies
get discounts due to volume. Nobody pays the full amount.
In addition to employer-based
coverage, would you like the option to purchase a private plan through
an insurance-exchange
or a public plan like Medicare?
· I
want single payer. It will control costs and put control back with the
physicians.
· Take
the profit out of health care insurance.
· Move
away from employer-based coverage.
· Let
the employer contribute to the cost of insurance.
· Tax
the employees to provide insurance.
· The
employer-based system makes us non-competitive world-wide. For example,
the
auto companies can’t compete partly due to health insurance costs.
· Competing
insurance companies waste time and money. And they just want to deny
you
coverage.
· Get
insurance companies “out of the game”.
· Pre-school
teacher: My school originally provided health insurance, but they just
couldn’t
afford it any more. I would like insurance that’s affordable, but that
won’t
happen so I want single payer.
· Uninsured
people need universal coverage. Move to a “non-government” system with
competition.
· My
son has a life-threatening disease. He’s covered by a state program.
There’s no
access to specialists, and he’s run out of his emergency medication at
times. He
could have died. This office doesn’t answer their phones for days at a
time.
There needs to be competition among providers or we will have this kind
of
care.
· We
need competition between providers, but not between payers. We need
single
payer. You’d have more choice if there was single payer. We can design
accountability into the system.
· I
have a concern with single payer. How will the prices get set?
· The
government can’t be trusted to do it right – single payer might be too
bureaucratic.
· We're
happy with our
fire department, our police force, and our libraries. Single payer
won't be
perfect, but we will be satisfied, it will be much better than what we
have now
· I’m
concerned that if we have single payer, alternative providers will not
be covered.
· Single
payer is impractical because it will never get passed in Congress.
· At
this point in the discussion, we decided to take a “straw vote” to
determine if
people mostly wanted single payer or mostly wanted enhanced insurance
options.
Several people didn’t understand the term “single payer”. This was
explained as
something similar to “Medicare for all”. Enhanced insurance was
explained as a
system of private insurance companies which would provide universal
coverage and
where the companies could not deny physician-ordered care. In the straw
vote,
25 people wanted single payer, 5 people wanted enhanced insurance
options, and
about 20 were undecided or didn’t understand the options.
Do you know how much you or your
employer pays for health insurance? What should an employer’s role be
in a
reformed health care system?
· Due
to lack of time, we did not discuss this question. We wanted to spend
the
remaining time on prevention.
Below are examples of the types
of preventive services Americans should receive. Have you gotten the
prevention
you should have? If not, how can public policy help?
· The
system does not adequately address prevention.
· Cholesterol
screening is “false advertising” by the pharmaceutical companies. The
purpose
is to sell statin drugs.
· M.D.:
the data show cholesterol screening does pay off.
· I
don’t want these screenings because if they find something, my
insurance
company will see my records and raise my premiums.
· We
need transparent systems for development of evidence-based medicine.
· I’m
concerned that medical screenings may be forced.
How can public policy promote
healthier lifestyles?
· Policy
should put health first. Read Michael Pollen “The Omnivore’s Dilemma”.
School
lunch programs should put health first.
· Make
lifestyle changes first, use drugs as last resort.
· Nutrition
is important and should be taught in medical school.
Results of Participant
Survey:
1. What
do you perceive is the biggest problem in the health system?
a. Cost
of health
insurance - 19
b. Cost
of
health care services - 3
c.
Difficulty
finding health insurance due to a pre-existing condition - 0
d. Lack
of
emphasis on prevention - 7
e.
Quality of
health care - 2
2.
What do you think is the best way for policy makers to develop a plan
to address
the health system problems?
a.
Community
meetings like these - 18
b.
Traditional
town hall meetings - 7
c.
Surveys
that solicit ideas on reform - 2
d. A
White
House Health Care Summit - 3
e.
Congressional hearings on C-SPAN - 2
3.
After this discussion, what additional input and information would best
help
you to continue to participate in this great debate?
a. More
background information on problems in the health system - 2
b. More
information on solutions for health reform - 15
c. More
stories on how the system affects real people - 7
d. More
opportunities to discuss the issues - 9