1) Mammogram Guideline Changes Kickstart Healthcare Politicking:
2) Life Expectancy Milestone Reached:
3) Obama's Speech: What's an Internist To Do?:
4) Hospitals and Debt Collectors: Two Extremes:
5) FDA Finally Cleaning House?:
DocGurl: So, Dr. Pundit, most people know that Congress passed something that's being called "healthcare reform," but lots of us - particularly those people without insurance, or those people watching their COBRA payments eat up all their unemployment benefits - are wondering, specifically, what's in it for me? If the devil is in the details, we're hoping you're here to exorcise (exercise?) that devil for us. You're an oft-quoted expert, but this behemoth legislation-passing has been a tortured process, with millions of lives, mega-money, and even bigger egos at stake. Are you feeling up to the challenge of explaining it in a nutshell?
DocPund: Wow, that's a pretty loaded question, and one that I feel is probably most appropriately handled by many and not just via the pontifications of one geeky health policy wonk. I'll take a stab at it, though.
Essentially, the bill just passed in the House of Representatives is a referendum of sorts -- meaning, no matter which side of the political aisle your beliefs lie, there's one thing all Americans can agree on. The increasing numbers (we're on the brink of 50 million) of uninsured in this country have served as a wakeup call to all politicians and lawmakers that healthcare access and affordability are under siege by statistics like these, and that something has to be done. Hence, we are witnessing the passage of a bill whose seeds of reason and debate are at least 35 years in the making. That there has to be a debate on this is the easy part; getting a solution to which Republicans and Democrats can agree -- well, that's a different beast altogether. The Senate will soon get its chance.
DocGurl: Is this really healthcare reform? In other words, what monster-by-committee did our Congressional Dr. Frankensteins make?
DocPund: Many times, policyspeak comes down to semantics. I think that is what's going on here is that the art behind getting an initiative passed has much to do with perceptions. Since we all know that lawmakers and their staffs are usually loathe to read entire bills (in this case upwards of 2000 pages), framing a party's ideology in terms their constituencies are willing to accept makes the process a whole lot easier.
DocGurl: Has this legislation pissed off absolutely everybody? Or does it just seem that way?
DocPund: I think that ongoing media coverage has added fuel to the proverbial fire. The overwhelming attention the reform debate attained just prior to the end-of-summer recess in the Congress was reflected in the various healthcare townhalls all across the country. Talk about a good idea gone very badly. I don't think anyone could have predicted the media circus revolving around these events billed as ostensible constructive dialogue. With passage of the HR 3962 bill, I don't think that either ideological side really has traded converts -- people are waiting to see what the Senate does with this.
DocGurl: Who's getting the shaft the most, in your opinion - the passionate progressives who went hard for Obama because he was going to represent REAL change, or the right wing for the vast new deficit-busting this legislation represents to them?
DocPund: With regard to health reform, labels given to the process are just as predictable in their origins as the parties that manufacture them. For many, if not all, Republicans, true reform involves overhauling the healthcare system if taxes aren't raised or imposed to get it done. For Democrats, on the other hand, those critical of the Republicans' motives are terming this "insurance reform" (as opposed to "health reform"), a nod to the corporate back-scratching the latter are famous for in implementing fiscal policy. So, is this really reform of healthcare? Depends on whom you ask.
DocGurl: So then who's doing a secret happy-dance? The progressives, because they got something done to loosen insurance companies' stranglehold on health, or the right, because of the Starkey abortion-banning amendment?
DocPund: Right now, I really don't think either side is claiming victory...in the truest sense of the word. We are definitely in a holding pattern with regard to this legislation. In fact, there is the real possibility that the Senate will not take up serious debate until January 2010, as Majority Leader Harry Reid -- seen by many (even in his own party) as possessing anything but strong leadership qualities -- is taking his own sweet time tweaking the bill, making sure that the Congressional Budget Office estimates square with President Obama's fiscal goals prior to putting forth the motion for the Senate to proceed.
DocGurl: If we ban funding for abortion nationally, does this mean we can now elect a woman-dominated panel to legislate restrictions on impotence and prostate treatment? Why not?
DocPund: Doc, as long we live in a male dominated legislative political "society", don't look for any concessions that can affect their, um, potency as voting body. I will say that threat to a woman's right to choose, while a backdrop to the House structure of the bill to attain passage, will -- while heavily politicized -- be modified to strike such a provision from entering Senate passage, ultimately becoming law, and heading down the slippery slope toward repeal of Rowe v Wade.
DocGurl: That's the politics - now the important stuff. As with all crimes, so the saying goes, follow the money. Who won out, financially? How much are we talking about? After all, once we're talking more than fifty bucks, most of us can't imagine it any more.
DocPund: I think that the fiscal issue before us is what is often termed as the "cost curve" by the Obama administration. He and his team of economic advisers are essentially getting behind a measure that will pass the muster of the arbiter of cost of all bills passed by the legislature: the Congressional Budget Office, or CBO. With the recent vote of 60-39 to allow senate debate to occur, at the very least, the scored pricetag assumed by the CBO is somewhere in the neighborhood of $850 billion over ten years -- all while predicting a reduction in the U.S. deficit by about $130 billion over that time frame.
DocGurl: Seems like the bill, as it stands, allows states to worsen healthcare coverage, but bans them from improving it - true or false? Isn't this a blow to the states-rights folks?
DocPund: It seems the further along we go on watching this bill meander its way through both houses of Congress, the only thing that seems certain is that the language present in its current incarnation will not be there once President Obama places his pen to paper for its signature. Although, among other things, the bill sets out to expand Medicaid programs and eliminate the use of insurance companies' provisions of pre-existing claims denials, one can assume that this bill's final form will probably be more of a benefit to Big Insurance and not the individual patient, ultimately really doing little to increase healthcare access on a sweeping level.
DocGurl: When can the average American sign up for insurance he/she couldn't get before? How much will it cost?
DocPund: These changes to healthcare coverage will be fashioned out in a gradual manner. There really is not a set date to "sign up" for plans and programs. For instance, individual states would have to determine when to implement an enrollment period when federally matched funds are available for Medicaid programs over the next three to five years.
DocGurl: Bottom line - should I hold my breath? And if I do, will I just pass out and then start breathing again, thereby demonstrating the futility of waiting for real change?
DocPund: This last question really piggybacks off the previous one. Whatever initiatives are begun as a result of whatever form the reform bill takes once Obama signs it will depend on many factors. These factors, in turn, will affect what is offered to patients-as-healthcare-consumers. Although no one can really predict when reform changes will infiltrate the healthcare marketplace, one can bet that they will be at the benefit of the marketplace itself and not the individual patient. So, holding your breath in this case would not only be an exercise in futility but also would result in death by asphyxiation -- something which no amount of health reform would benefit.
What do you think? Is this the bill that makes ALL of America angry? Or will it make a positive difference to your life? Share in the comments section and keep up on the latest health issues in the news, and healthcare reform insanity/hilarity by signing up for a Doc Gurley RSS feed with the tiny orange button at the top. Do you want to be on the inside, fast track of news and tips? Get on the Twitter bandwagon and follow Doc Gurley! Also check out Doc Gurley's Joy Habit twitter feed - and get fun, effective tips on how to de-stress for the holidays, right to your smartphone (hurry, before Black Friday hits!).
Got a thingie on your doohickey? Or are you pondering how to tell your doctor he's a jerk? Send your burning healthcare questions to Doc Gurley by emailing docgurleyatgmaildotcom. Doc Gurley cannot answer every question, and she cannot practice medicine through a keyboard (not even with her stethoscope pressed firmly against the monitor) but be assured - your questions will be kept strictly confidential and identifying traits are changed.
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