Vol. LXIII, No. 31
Wednesday, August 5, 2009
Hosting a live, one-hour town hall telephone meeting on health care reform with constituents last week, Congressman Rush Holt (D-12) began by saying, This is a perennial topic; it goes back to Teddy Roosevelt, Franklin Delano Roosevelt, Harry Truman, and Bill Clinton. Its been 15 years since Congress discussed health care reform, and the need has become more serious. Ive heard many stories about Americans who were denied care or cant afford medical care in the past few months.
Mr. Holt said that he and other members of the House Committee on Education and Labor had just spent an all-night session marking up the recently-introduced Americas Affordable Health Choice Act. He summed up the bill by saying that it would extend coverage to almost all Americans; improve the quality of care; expand preventive care; and reduce costs. People happy with their current coverage, he noted, will be able to keep it, while those without insurance, or whose insurance is currently unsatisfactory, will be helped.
Once the bill has passed in the House, Mr. Holt said, it will go to the Senate, and any differences with the Senate will have to be reconciled. He noted that health care reform is a high priority for the President and Senate leaders, and that it was likely that some form of the bill would pass this year.
Once passed, the legislation would be implemented at various stages over the coming years, Mr. Holt said, adding that some things will be noticeable immediately, others will be enacted in 2013, 2014. He emphasized the stable coverage the act would provide, whether you lose your job or change jobs. And, he noted, you cant be denied for pre-existing conditions. There would also be parity for mental health coverage and substance abuse coverage.
A number of changes would apply to all available health care insurance coverage, Mr. Holt said, noting that there is a certain amount of uniformity among states, and these constants will help in making life decisions like marriage and choosing a place to live, so that theyre not dictated by fear of losing health care insurance.
For seniors, it would do away (too gradually, in my mind) with the so-called doughnut hole in prescription coverage where coverage falls off a cliff and seniors are not covered, he added.
College of New Jersey Nursing School Dean Susan Bakewell-Sachs joined Mr. Holt on the line to discuss the bills emphasis on transitioning toward wellness care, and the fact that the legislation would try to address the current shortage in nursing faculty and resulting nursing shortage.
Another guest, George T. DiFerdinando, Jr. of the New Jersey Center for Health Preparedness at UMDNJ, encouraged participants to think about or ask their own physicians or nurse practitioners about how they are trained, how they practice medicine, and how they themselves experience the health care system. Many medical students graduate with an average of $180,000 in loan debts, Mr. DiFerdinando noted. As a result, graduates often choose specialties where they can quickly earn more money, and fewer and fewer young doctors go into family and internal medicine.
The evenings first question came from a woman on Medicare who wondered why Medicare couldnt be extended to everyone. My daughter lives in France, where they pay almost nothing for health care, and their life span is longer than ours; I dont see why we cant have it here, she said.
There are a number of countries that provide various versions of universal health care coverage, replied Mr. Holt. Whats interesting is that each one is different; theyve all developed their universal coverage based on their history. One of the lessons for us is that if you wanted to go to a single payer, universal coverage like Medicare, the transition itself, with a $2 trillion health economy, would be nearly impossible to do in one fell swoop. Thats why the President said were going to work with the system weve got, and bring everyone in in various ways. I agree that Medicare works well, and its not a bad model for the entire country; it could be expanded, but the transition would be economically devastating.
Jim Lehrer recently reported that obesity represents $10 million of our health care costs. said the second caller. If there can be laws about wearing seat belts in cars and helmets on motorcycles, he asked, why not legislation regarding obesity?
I would like to point out that in the legislation that is taking shape in Congress now, there is attention to prevention and wellness, answered Mr. Holt. The emphasis will shift to wellness. With regard to other health-related behaviors like sugar in the school diet, lack of physical exercise — there are some things that can be done legislatively, other things that we have to exhort individuals to do. In the legislation currently being considered, there is funding to help doctors in hospitals engage in wellness education, and other things that would engage in obesity prevention. We do have to address the American lifestyle; this legislation pays some attention to that.
In response to a question about whether a person can go back to their original private plan if they opt for the government plan but dont like it, Mr. Holt returned to the incremental nature of the changes that will be involved in enacting the new legislation. In the first year, people without insurance, and people employed by very small businesses, could go to the exchange. In the second year, employees of slightly larger businesses could join, and in the third year, the commissioner could open it up to everybody. By five years, it would definitely be open to everybody. But you could shift back to a private plan.
The results of a mid-telephone-meeting poll asking listeners to rate their degree of concern about six questions regarding health care showed that one-third were most concerned about health care costs; fewer than ten percent worried about access to health care; one-fourth worried about the quality of their health care; ten percent were afraid of losing their health care; five percent cited pre-existing conditions as a pre-eminent concern; and 20 percent said that the current system works.
Mr. Holt was perhaps most emphatic in his response to the question of why everyone should be included in health care reform. The choice is between doing this reform or condemning Americans to live sicker, die younger, and pay more than they have to, he said. The current system is excellent for some people, but on average, it is not what it should or could be. Noting that the bill provides for the creation of a comparative effectiveness research center, he described how data would be collected determining, for example, the most effective way of treating prostate cancer. We could let each doctor comb through the literature to find the answer, but thats not very efficient. This will be a good use of taxpayer money.
The dozens and dozens of people still in the telephone queue at the end of Mr. Holts allotted hour were encouraged to leave recordings of their questions, to which he said he would respond later.
To read more about Mr. Holts position on health care reform see http://holt.house.gov/HealthCare.shtml.
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