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A(nother) public option
The U.S. government has a long history of health roles
By JANET PEARSON Associate Editor
Published:
8/30/2009 2:23 AM
Last Modified: 8/30/2009 3:31 AM
To hear some of our congressmen tell it, there's nothing scarier than the prospect of the government running something. The government can't possibly do anywhere near as good a job as the private sector, and government involvement, they insist, can only make a bad situation worse.
But surveys show that two of the U.S. government's biggest service providers — Medicare and the Veterans Health Administration — are sometimes rated highly in measures of consumer satisfaction, quality, cost containment and efficiency.
So what gives? Are Americans really that fearful of government-run health care, or is something else at work here?
"Why be afraid of government?" is the headline on a recent commentary on
CNN.com
written by Julian E. Zelizer, professor of history and public affairs at Princeton University's Woodrow Wilson School. He details the history and achievements of the federal Medicare health care program, launched by President Lyndon Johnson in the summer of 1964, with an 81-year-old Harry Truman at his side.
Life before Medicare
Before Medicare, only about 50 percent of Americans ages 65 and older had hospital coverage; within five years, 97 percent had such coverage, according to Zelizer. The same trend occurred with physician coverage.
Today, more than 40 million elderly Americans rely entirely on Medicare, and millions of other Americans with a variety of health needs rely on a related federal-state program, Medicaid, for
care.
Despite initial opposition to Medicare from some providers, hospitals and doctors also now rely on it. Doctors, in fact, have "turned out to be among the program's biggest beneficiaries," writes Zelizer.
Medicare also has forced hospitals to contain costs through a modernized payment system adopted in the 1980s.
Zelizer references surveys showing high levels of satisfaction with Medicare, including one showing 70-percent satisfaction level among Medicare recipients, compared with only 51-percent satisfaction level with private insurance.
Medicare and Medicaid now provide assistance for not only elderly care, but also long-term disabilities, kidney disease, the blind, low-income children, pregnant women and infants, and prescription drugs. Needless to say, most recipients would not receive this care without federal help.
It's a similar story with the veterans health care system, once considered a symbol for the worst care imaginable. There was some basis for that view. Phillip Longman, the author of "The Best Care Anywhere: Why VA Health Care is Better Than Yours," recounts in a 2005 Washington Monthly article the horrific discovery in 1993 of three veterans' bodies found near a Virginia veterans center. The VHA admitted its search for the three missing patients had been "cursory." Longman has since expanded the article into a widely referenced book with the same title.
Reinventing veterans' care
Longman recounts how disturbing revelations fueled a flurry of activity in the mid-1990s, including new legislation, increased funding and aggressive leadership, that combined to transform the VHA into a world leader in health care.
Now, the VHA can boast of multiple high rankings on various measures of quality of care, including one by the National Committee for Quality Assurance, whose "seal of approval is the gold standard in the health care industry." In 2005, The VHA outperformed the nation's highest-ranked hospitals — including Mayo Clinic, Johns Hopkins and Massachusetts General — in all of the NCQA's 17 performance measures.
Longman also cites good scores on satisfaction surveys, including one showing an 81 percent satisfaction level among VHA hospital patients, compared to only — only — 77 percent for Medicare and Medicaid patients.
One achievement responsible for such rankings is the VHA's integrated health information system, described by the Institute of Medicine as "one of the best in the nation." The Obama administration is pushing for adoption of such records systems across the country.
This ever-advancing system, since adopted in some foreign countries, enables medical providers to not only vastly reduce medical errors, but also to "improve diagnoses and implement coordinated, evidence-based care." This system can quickly identify veterans nationwide in need of a particular treatment. It can pinpoint the source of a frightening new health risk with amazing speed and accuracy. It can save busy doctors countless hours of scampering around facilities in pursuit of paperwork.
Systems such as the VHA, somehow replicated for non-veterans, would minimize "discontinuities in care and record keeping" and ensure that the "same evidence-based protocols of medicine would be practiced."
Noting that "Americans live shorter lives, with more disabilities, than people in countries that spend barely half as much per person on health care," Longman insists that "pouring more money into the current system won't change that."
"VHA's success shows that Americans clearly could have higher-quality health care at lower cost. But if we presume — and it is safe to do so — that Americans are not going to accept the idea of government-run health care any time soon, it's still worth thinking about how the private health-care industry might be restructured to allow it to do what the VHA has done."
Opponents of government programs understandably want to maintain their freedom of choice, but the harsh reality, Longman asserts, is that they really have little choice now. "Most people don't buy their own health care; their employers do." And when employees can make a choice, they often base their choices on such inappropriate criteria as a friend's recommendation or a doctor's bedside manner.
Nobody's perfect
Needless to say, Medicare and the VHA aren't perfect. The Department of Veterans Affairs is still red-faced over notices recently sent to hundreds of veterans mistakenly informing them they had Lou Gehrig's disease. And problems at military hospitals brought on by the volume of injured soldiers returning from the Iraq and Afghanistan wars — brought to light by egregious cases at Walter Reed Army Medical Center — have yet to be fully addressed.
And as some senators and representatives have pointed out, fraud, waste and some inefficiencies still exist in the federal systems. Several recent Government Accountability Office reports have detailed specific fraud and overpayment problems with Medicare. But guess what? The problems typically originated with private insurers and providers. At least there was a government watchdog standing by to pinpoint problems and recommend fixes.
The point is government can do some things pretty well, and so can the private sector. Both also face continuing challenges. The question really isn't whether we should have government-run health care; we already do. The question is how much more should there be, and what kinds of collaboration should there be between the two sectors.
Janet Pearson 581-8328
janet.pearson@tulsaworld.com
By JANET PEARSON Associate Editor
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Pat Smith
, Duryea, Pa. (8/30/2009 6:53:06 AM)
For decades our government has done a very good job of saving taxpayers’ money with inadequate Veterans Affairs funding.
President Obama recently made excellent leadership appointments to Veterans Affairs. Even with their proven leadership abilities, and impeccable credentials, both Secretary Eric Shinseki and Deputy Secretary W. Scott Gould are facing the cumulative inadequacies of decades past. The tiny fuse of overmedication that has kept this whole VA system operational for 30-some years now desperately needs to be replaced with major re-wiring.
This young generation of veterans should not have to experience the palliative treatment of health care most veterans using the VA have experienced for decades. It would be great to see the VA step into the 21st century as the leader in world-class health care.
But after decades of under-funding, this proposed new VA budget is not enough. For our new leadership to achieve its full potential along with world-class VA health care, a one-time, additional funding of $20 billion for a ‘21st century investment in VA healthcare’ is desperately needed.
The VA has many good doctors working there who will feel much relief to actually have the opportunity to treat their patients instead of just medicating their symptoms.
Report Comment
Stupid is, as Stupid Does
, Owasso (8/30/2009 10:14:47 AM)
Another columnist out of touch with reality. A recent audit by the CBO showed that fraud was rampant in the Medicare program to the tune (in excess of) $80 billion dollars. Congressional Budget Office (an actual non-partisan office)........$80 billion dollars of fraud..sound like its ran pretty efficient to me.
Report Comment
merrill
, (8/30/2009 10:20:12 AM)
Actually Vets would be better off under HR 676 National Health Insurance. Then the quality of treatment would not be tied to who's in the white house. Since 1980 vet care took a dive under republican administrations practicing Reaganomics aka wreckanomics. Bush/Cheney may well go down in history as the worst.
I say vets would be miles ahead under HR 676 so far as receiving treatment for all ailments. It would eliminate a lot of "red tape" and I mean a lot.
Bring all of us under one umbrella as a matter of fiscal responsibilty and ending delays for treatment
that vets are confronted with day in and day out.
WE put vets in harms way NOT by their choice therfore WE agreed to care for them no matter what which includes their dependents. It is OUR responsibility that poltiicians TOO OFTEN want to pretend otherwise.
Of course denying treatment of major problems directly connected to a war zone is a means to keep the cost of war down..... at the expense of our troops and their dependents. NO WAY JOSE'!
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merrill
, (8/30/2009 10:30:18 AM)
The fraud associated with Medicare comes from the white collar crowd such as the Sen. Bill Frist family...yes those guys who wear the bible and flags on their sleeves.
Politicians as Shareholders and Insurers Wrongfully Charging Consumers Billions = BIG TIME CORRUPTION is fraud at its' finest all coming from corporate america. Both of these situations have been covered in the Washington Post recently.
Medicare For All Insurance would make it easier for the watch dogs to catch fraud. All billing would need to pass through the same microscrope.
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tulsamiddleoftheroad
, Tulsa (8/30/2009 11:08:54 AM)
For sure! The private industry does great, just ask Madoff! The private industry never rips anybody off, denies coverage, nor do they let high school graduates determine if you get that critical care that may save your life. I say let there be competition with government insurance and lets see who comes out on top, probably the private insurers, but only after they lower the premium rate increases and start covering more.
Report Comment
B-Aware
, (8/30/2009 2:35:35 PM)
"Stupid is" (above) probably is not stupid. He probably is merely gullible, the way most of the angry demonstrators at the town hall meetings are gullible. They argue against their own self interest, thinking they are protecting themselves. They believe claims that are fed to them by companies who really are protecting their own interests.
You complain about fraud in Medicare. The fraud is committed by private health industry providers (doctors, hospitals, and equipment suppliers), not by the government. Do you think those providers don't also defraud us through private insurance companies?
A doctor I know was ordered by a Tulsa hospital to pad his medical bills by raising the seriousness level of the conditions he treated. He refused, and he was fired. He sued, and he won.
Another doctor at another hospital was requested to review his billing to see whether higher charges might be in order. He declined and, in his case, nothing happened.
Ill-informed (not necessarily stupid) people at town halls yell, "I don't want a government takeover of my health care." Nobody wants a government "takeover." We do want government competition that would force insurance companies to pay their executives less than the millions they are now making, and to stop denying care for desperately ill people. But, people are told this "could" lead to total government control.
By this kind of non-reasoning, we should abolish the police department, because policemen could arrest or shoot us without cause. We should revoke the "concealed carry" permits because our neighbors could shoot us. And we should abolish the military because armies have been known to overthrow their own governments.
Far-fetched? Yes, of course. But so are the fear tactics being used by Freedom Watch and the Republican National Committee. One of the bills in Congress would provide for panels of experts to recommend to my doctors and yours the most effective and cost-efficient treatments for certain medical conditions. The aim is to save money for all of us, as well as give us the best treatment. But, for the fear mongers, this "could" lead to denial of the care we need.
So could our present system of insurance. As a matter of fact, it already does that every day.
Report Comment
Davezter
, (8/30/2009 4:58:52 PM)
It is so refreshing to read most of the above comments. There are reasonable and level-headed people who live around here!
Report Comment
OU@BVAR
, Bella Vista (8/30/2009 5:01:35 PM)
Medicare has a fraud unit that goes after fraud. It is not well known but it is there.
Also, no one points out that our country could not function as it does if everything furnised by the covernment was taken away. Highways water , utilities. waste management electric grids. Every private company in business is indebted to the government in some way.
Are we a society who says I got mine the heck with you. For every individual that has pulled him or herself by their own bootstraps, there are thousands who have been shot down by an uncaring society that doesn't want to share with those deadbeats.
Most successes have a lot of luck of being in the right place at the right time with the right skin, the right religion or the right parents.
We need to give the others a break and pass health reform.
Report Comment
mustang67
, (8/31/2009 12:51:02 PM)
wow, I think some of my democratic buddies binally got around to commenting. It is refreshing.
Report Comment
independent
, (9/1/2009 10:29:26 AM)
How about the fact that these social programs are bankrupt?
Report Comment
Stupid is, as Stupid Does
, Owasso (9/5/2009 12:41:51 AM)
Davezter, and many uneducated ones also. To use the argument of police, military in the course of this debate is ludicrous. National Defense is actually one of the few task of our government, as dictated by a fore fathers.
If universal health care is so important, lets pay for it with a national health care sales tax.
Report Comment
52favoriteteacher
, Broken Arrow for 19 yrs (9/5/2009 6:40:35 AM)
private continues to be the best
Report Comment
Stupid is, as Stupid Does
, Owasso (9/8/2009 12:57:29 AM)
I have an argument for all to ponder?!?!? Why not universal health care for all Americans? I have been embedded with the military since 2004. I have watched the military provide free medical care at every military clinic and hospital to the local nationals of that country (Iraq and Afghanistan) (Im not saying I disagree with it). All they have to do is walk in and ask for it. If a foreign national can get free medical care as paid for my the United States government, why can't an American enjoy the same benefit?????? Can't argue with that can you Democrat...actually put forth one for your argument.
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