Tuesday, August 25, 2009

My disection of Rep McGovern's Letter

My Rep. Jim McGovern sent me an E-mail about Health Care Reform and what he is doing to make our health care system better for all of us. After having read this letter it left me with many questions. I also have the uncomfortable feeling that Rep. McGovern has not done any research on what is troubling his constituents. What follows is my attempt to open up his monologue and question him about some of his assumptions.

Dear Friend

As you know, the debate over health insurance reform is ongoing and spirited. Recently, a lot of the news coverage has focused on the “debate over the debate” – in other words, whether or not anybody yelled or booed at a town hall meeting.

I think it’s important to remember what the underlying issue is: how our health care system is broken, and what the best way is to fix it. All Americans want to improve our health care system. The failures of the current system are all heart breaking and too common. We see old people suffering in under funded nursing homes and children stricken by diseases that should have been prevented by vaccines that all children should have. We see soldiers who were wounded defending our nation and return home to be put in dirty VA hospitals and forgotten. We all can see the problem.

In many ways, we have the best health care in the world. We have the best doctors, the best hospitals, and the best technology in the world. But that doesn’t mean that the current system is perfect, or that it works well for everybody. It doesn’t mean that everybody has access to that world class care. Far from it. I guess that depends on what you believe the word access means. Anyone who goes to an emergency room is able to access health care, no question asked. But isn’t that part of the problem?

As I see it, there are three fundamental problems with the current system – uncertainty, cost and effectiveness.

First, uncertainty. The fact that nearly 44 million Americans don’t have the peace of mind that comes with health insurance is something we must address. After all, when one of those uninsured Americans gets sick and goes to the emergency room, the hospital is reimbursed by the federal government for its costs. In other words, you and I as taxpayers are paying an extra “surtax” to provide health care for people who don’t have insurance. Many people argue with the 44 million number, and with equating not being enrolled with a health insurance company with not having health care. Some young and healthy people choose not to pay for health insurance because it makes economic sense. Some people are eligible for government health care programs but have not applied for them. Every person in this group has a story and to broad brush paint them as powerless victims is sophistry.

But the vast majority of health care case work that my office does involves people who actually have health insurance. They have paid their premiums and expect that their insurance to be there for them when they need it. But when they get sick, suddenly the insurance company refuses to pay for needed care. Isn’t that the job of our Attorney General in her role overseeing the Insurance Company in our Commonwealth? Are you now saying that its not those that are uninsured, but those that actually have private insurance that are the victims? What about those that already have government health care? Are they so well provided for that you would willingly change places with them?

Under the proposals currently under consideration in Congress, insurance companies would be prohibited from employing those kinds of practices. People with insurance would finally know that they will get what they have paid for. If these people don’t know what is covered by their insurance policies today what makes you think they will be better inform tomorrow? Insurance policies are complicated things, but if you want to protect yourself and your family you must ask questions and take the time to educate yourself on your policy.

It’s important to note that more than 90 percent of all employer-sponsored plans offered today are likely to meet or exceed the bill’s minimum standard of coverage. In these cases, employees would not see any changes in how they use their plan, the doctors they choose or the care they receive. The remaining plans will have until the end of 2018 to make these common-sense adjustments. If the 10% of plans that don’t conform have ten years to make adjustments, how can you honestly say that this is urgently needed reform because of a health care crisis? How can it take 1200 pages and One Trillion Dollars to correct this modest problem?

For seniors on Medicare, the bill would reduce the size of the “donut hole” in the Medicare Part D prescription drug benefit by $500 in 2011 and then completely eliminate the “donut hole” over a period of years. The bill will eliminate co-payments for preventive services Medicare and will improve low-income subsidy programs to help ensure Medicare is affordable for those with low and modest incomes. The bill also strengthens Medicare by extending the solvency of the Medicare Trust Fund by at least five years. For years we have known that the Medicare Trust Fund is running out of money. In June of 2000 didn’t you vote no on subsidizing private insurance for Medicare Rx drug coverage (HR 4680)? Since 1997 what bills have you introduced to strengthen the Medicare Trust Fund's solvency?

Second, cost. Currently, health care expenses take up about 17% of our gross domestic product – our entire national economic output. In other words, of every dollar spent in the United States (on anything), 17 cents is spent on health care. That number is growing, and growing fast.

It is estimated that by 2080, around the time that my two kids are retired, health care will take up 50% - half – of our entire economy. That level of spending is simply unsustainable. If left unchecked, it will bankrupt us. We cannot and must not pass that kind of burden onto future generations. The figures you quote seem to be derived from the CBO report on Medicare, Medicaid, and Social Security. As these are all government run programs which you have the power to change, what you are arguing is that you need a new program of spending because your unwilling to make the changes necessary to the old program of spending?

I believe we should eliminate the waste, fraud and abuse that occur in the system. We should encourage technological innovations like electronic medical records to cut back on wasteful administrative expenses. And we should encourage preventive care to keep people from getting sick in the first place. Are you in favor of motherhood and sunshine as well? If you believe in the power of technological innovation to improve health care why haven’t you sponsored legislation that would have the previously mentioned government programs adopt these new methods to reduce overhead? There have been several attempts to use preventive care to reduce medical expenditures. We have had HMO’s for years, can you show the decrease in health care costs.

Third, effectiveness. Right now, the United States spends far more per person on health care than any other country in the world. But what does all that money get us? Even though we lead the world in spending, the life expectancy of the average American ranks 30th – right below Bosnia – in the world.

I like to use this analogy: Imagine you’re in the market for a new car. You go into the showroom, and a particular model catches your eye. When you look at the sticker price, the car is by far the most expensive one there. But when you go home and check Consumer Reports, you discover that the car ranks 30th in safety and reliability. Would you buy that car? Of course not. But when it comes to health care, we are “buying” that car every single day. According to the WHO France has the best health care system in the world, why aren’t you proposing we adopt their system? Do you advocate we adopt the health care system of Bosnia? Should we spend according to the French or Bosnian spending rates? To equate 300 million Americans to a nation of less than 4 million, ties statistical reasoning in knots. America has many unique situations that other nations don’t have to deal with. These sorts of comparisons are not just useless but are destructive to honest reasoned debate.

I believe we can and we must do better.

I know that in an era of the 24-hour news cycle, talk radio, cable news shout-fests and the Internet, there’s a lot of information flying around. Some of it is inaccurate, much of it is confusing. Health care is a big deal – people should be concerned that we do this right. There has been much over heated rhetoric about health care and people from both sides have behaved poorly. But this is an issue that cuts to the heart of how we will govern ourselves and the quality of life that our children will have. Such issues have always been contested by both thugs and statesmen. In this debate, neither point of view is free of bad actors, nor forbids the use fear mongering and name calling. It is terrible when one American calls another American a Nazi because they voice their opinion on one political issue. It is worse when such vitriol comes from the Speaker of the House. It is saddest when politicians attempt to co-opt religious leaders to support an unpopular policy.

Last week I participated in 4 health care forums hosted by local hospitals. While a very small minority of participants only wanted to disrupt the events, the vast majority of people who came had thoughtful, knowledgeable questions and concerns. In the weeks and months to come, the various health insurance reform bills in Congress will begin to take shape into one piece of legislation. At that time, I will hold a “telephone town hall,” where constituents can participate from home and let me know what they’re thinking. Please check back on my website, mcgovern.house.gov, in the next few weeks for details. I will be there, and every time that the future of our nation is determined I will be there. I will stand up and ask the questions that you may not want to hear and may not be able to answer. Our nation needs answers. Those that we have promised to take care of need answers. We must repair a system that has become "more patch than tire." How we do that I don't know. Washington didn't know how to defeat the British before he did. We have done great things in this nation and with our best effort I am certain that we can provide for those whom need our help with out changing what is best in our nation.

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