Hear Our Voices

Here is what folks are saying all over the country. I have tried to group them by themes. We will be publishing ideas people send us to help begin the national dialogue. These letters were re-printed with permission.

Would anyone be interested in a contest “listserve.” I am not sure how to organize this, but someone must.

—Kathleen

Two Suggestions From Talk Shows

Dedicate 10% of our personal income tax for health insurance for children.
—Dave Ross Show

Dedicate part of our property taxes for local health care services.
—Montana Talk Show

Congress

Make the congressmen and senators’ health care the same as the average persons. They would 'fix it' in a New York minute. The funds would miraculously appear. Just that simple.

(Ed.Note: This was said many times over.)

Marketplace

Dear Ms. O’Connor:

America seems to face a health care crisis. This presumed crisis is characterized mainly by the perceived tragedy that all Americans aren’t covered by health insurance. I use the words “seem” and “perceived “ to indicate that the so-called crisis is not properly framed. In this nation, we choose the market economy to provide us with the goods and services that we need. In the market economy (Capitalism) the invisible forces of supply and demand must rule. Since health care, in its essence, is just another marketed service, trying to address it as an inalienable human entitlement (like free speech), is folly. Furthermore, insurance (health or otherwise) is merely a mechanism, used by a pool of risk takers to finance their anticipated future demand for services. Therefore, any attempt, no matter how well intentioned, to defeat the free market for health insurance is doomed to meet with spurious result.

If we chose a state managed system to take the place of our market driven economy, as some of our international counterparts have done, we could consider the kind of tinkering that your “Health Care Magna Carta” implies. However, baring the unlikely event of economic revolution, we as the individual citizenry will continue to bear the ultimate financial responsibility for the health care (like everything else) of those who can’t provide it for themselves. Government can effectively act only as a concerned ombudsman.

Doctors, Regulations And Lawyers

Dear Kathleen:

Sorry to use just your first name but I did not have your last name to address you properly. I am a registered respiratory therapist with over thirty years experience in health care. You can not fix the monster we call health care until you fix the doctors. Each time I have seen the health care payment adjust for reimbursement (i.e.: DRG's) the doctors adjusted with the diagnosis to determine which one would cause the best reimbursement. When I first became a therapist I believed the patient should only get a breathing treatment if they needed it, I still do.

Not so, a patient had clear lungs, no pulmonary pathology, no indications for a treatment then costing $35.00 each. I approached the doctor and was told: "Don't worry you are getting paid for it." Which at the time we were on a one treatment, one payment plan. More money for the hospital. That situation brought us the DRG's. Congestive heart failure: my Waterloo, it is thought by most in the health care system to be a respiratory problem; breathing treatments upon breathing treatments.

Few if any doctors understand the problem is diuretics and not bronchodilators. Audible wheezing, of the type that can be heard from the doorway of a patient's room, is a diuretic problem not a breathing treatment problem. I have been known to give Q1H treatment to a patient with this problem without benefiting the patient, in fact making them worst: adding water into a system overloaded with water.

Now the flip side. Doctors need to be reimbursed for the excellent work they do correctly. I know a surgeon that spent eight hours reattaching a foot almost severed in an accident. His reimbursement was $336.00 for FOOT SURGERY. $42.00 an hour for saving a man's ability to walk normally. Doctors are both angels and devils. Like a law degree, a medical doctor degree is a license to print money. There is a humanitarian aspect to his work but he/she is also a bread winner for his/her family.

The Government: major payor and player. They pay for many services and they make the rules. Deficits in the federal budget pay less to medical services this fiscal year. Inflation this year is running around 4%, payment to medical service down by -5.4%. Why? I am sorry I didn't finish reading the article as my blood pressure went up. Cost go up and the payments go down. Health care in a crisis yes. Fixable? I am not so sure.

Health care insurance also make payments and they make the rules, as above. Stock markets go down, payment to the health care service will be trimmed back to spare profits. It doesn't matter what is necessary for your care, costs to the share holders will be held to ensure the stock price will be advancing on the NASDAQ or the NYSE. It does not care about your health just the health of the stock.

NOW for the final blow: lawyers. They have to understand the pressure medical professionals are under. I have said for a long time that there will be true tort reform in this country WHEN the first lawyer gets sued for malpractice and loses, then has to pay $5,000,000 to the other lawyer and the family suing him.

I am sorry for the length of this letter but it is necessary to explain the size of the task. I will try to give you an idea and win that prize as I could use the ten thousand.

Litigation

I read the article regarding the contest on Fixing Health Care System. I don't want to enter any contest, but would like to give my opinion for what it's worth.

The focus for healing the Health Care System starts and ends in the Legal arena. You solve the litigation environment, you have solved the Health Care System.

Health care in the United States is the best in the world. What has a cancerous effect on health care is the legal system which is allowed to litigate for huge amounts which equate to huge profits for the lawyer and law firm.

Put a cap on litigation awards and establish a fix amount per case that a lawyer or law firm can receive and you will see a domino effect on the Health Care System.

Formula: Reduced litigation awards; reduced insurance expenses; reduction in duplication of services; reduced Health Care System expense.

I know this formula is a simplified approach to a complex problem. However, if the legal system is not addressed as the core problem, our Health Care System will never be healed.

Prescription Drug Costs And Access

Dear Ms. Kathleen O'Connor:

There is no way I can fix America's ailing health care system but maybe this will save some money. On saving the states and Corporations 10's or 100's of millions of dollars on long-term prescription drugs for employees, at the same time providing the employee 100% reimbursement.

This is how it works:

The State or Corporation will continue to pay a percent of the cost of the family coverage in prescription drugs and share the cost of the remaining percent with the employee for prescriptions at the local pharmacy so that the employee can obtain up to 31-day supply or a 100 units (whichever is less) plus one refill to be obtained at the local pharmacy. Additional supplies may be obtained from mail order from this web site http://www.tcds.com/ A reliable source for lower priced Canadian prescription drugs that cost 50 to 80 percent less then the cost at the local pharmacy or the U.S. Drug Companies.

Long term prescription drugs are for individuals who require more than two refills or who are required to use drugs on a maintenance basis. But there is not a thing to stop the people of any state from buying their long-term prescription drugs from Canada and saving money; or the cities, counties, school districts, and Feds saving the taxpayers and consumers millions of dollars.

I am not in the health care profession so I did not enter the Contest. But a good idea is a good idea

With warm personal regards, I am,
Sincerely,

Role Of Government

Streamline Medicare and each State Medicaid plan to the bone, get more money out to the doctors.

Meanwhile, expose Managed Care for what it is by showing the horrors.

I have definite ways to expose Managed Care.

Single Primary Payor System (SPPS) for all Americans based on the Medicare model and larger payments to doctors.

Encourage Individual Responsibility

Kathleen,

The contest rules and the Magna Carta seem to encourage national health care. This is a narrow-minded view, and doesn't encourage the type of thinking that will spawn truly great reform.

If we want health care reform, then we need to eliminate government oversight and work at the state and local level to bring about a desire in the hearts of people to encourage responsible behavior and to help their neighbors in need. Government-controlled national health care is NOT the answer.

Yes, health is very important, and we need to be a caring, loving community. That community is not the federal government. Rather, it is you and I who contribute to the needs of individuals that do not have the resources to take care of themselves (whether or not they "deserve" it is irrelevant).

It's not an entitlement but rather an act of charity and kindness. It sends an entirely different message to the recipient versus the "entitlement" philosophy. The personal approach also discourages provider fraud and abuse as there is no "deep pocket".

Yes, one's health is very important, but even more important is an individual's ability, within a larger society, to accept responsibility for their own actions. Government programs become entitlements. Entitlements encourage irresponsible behavior. Let's encourage individuals in our society to take responsibility! For this we will be happier, live longer, and lead more rewarding and productive lives.

Centralized Patient Information

Saw your health care contest on the Yahoo! news sites.

I don't have time to come up with a comprehensive plan, but one way I believe we could contain significant costs is to have a centralized database of medical information for each patient.

Think about how many tests are repeated at multiple hospitals because patients don't disclose their previous hospitalizations or cannot remember where they were hospitalized—especially in large cities. I practice in Chicago and the suburbs and some patients receive care at each of the three hospitals at which I work. Having a database that can be accessed by a swipe of a patient's card and/or a PIN number with the patient's social security number would obviate the need to repeat multiple hospitalizations for chest pain when a patient had a recent coronary angiogram. It would stop the pregnant woman who complains of abdominal pain to get an ultrasound of her developing fetus from getting the same test repeated two or three times "just to make sure."

It would also prevent the problem that I just fell victim to - patients who doctor shop to get narcotic medications. I have attached a letter I received from a health insurer who was kind enough to notify me of this patient's activity. If I was able to access this patient's health history and prescriptions when he presented to the emergency department, this problem could have been averted.

The biggest counterargument I have heard from such a plan is the privacy implications. Make the database secure so that each individual accessing it must enter a code that identifies what information the individual is allowed to access. Just as with credit reports, let the names of each person accessing the list be printed on the record. And if people access the record without a justifiable reason, just as with credit data, let there be a statutory fine - say $5000.

Just a start—maybe someone could expand upon it.

Change The Paradigm

Hello, I am always impressed when one tries to figure something out. However, in the health care arena, it is important to ask the right questions. It appears to me that you are operating in a Ptolemaic (the astronomer) manner. Please read the book On the Shoulders of Giants edited by Stephen Hawking. You will get a good understanding of how people thought of the complexities of the universe. It's no different than the current health care system. The reason to read this is so that one can question how one thinks about a subject. No doubt the pre-Copernican astronomers were brilliant people but they were wrong. Hegemony always plays an important part in how we think. Last year and the year before the Canadian Medical Journal did about nine commentary articles that dealt with scientific medicine versus medical science which brings forth a realistic way of looking at good science as it relates to treatment of patients.

Studies have been done regarding health care costs, inpatient/outpatient costs, and health care practices. It is interesting that some health care lifestyles had significantly less inpatient/outpatient costs and the inpatient costs were dramatically less. This of course does not help some of the players in the health care arena. But the bottom line is to have people in the best health state possible where intervention is needed only when necessary.

Respectfully submitted,
Peter Thibodeau

Supply And Demand

Dear Kathleen,

A solution to our nation's health care problems are relatively simply using the scientific, logical method of analysis. First,define the problem and second, state a workable, fair and moral solution for all who are involved.

Since medical care costs are obviously the problem, a solution must reduce costs while maintaining available and quality medical care. Ten years ago the average medical doctor in a specialist field averaged about $500,000.00 per year with Radiologists leading in income with about $1,000,000.00 in compensation ( according to AMA records).

One might ask why do medical doctors demand these high salaries? Holders of doctorate degrees in other than medical fields average about one fifth to one tenth of the previously stated medical specialist's salary. The answer is to be found in simple supply and demand.

In my experience, four to sixteen weeks are required to make an appointment with a medical specialist. Therefore, a shortage of medical specialists is obvious in everyday experience with corresponding high medical prices charged. The AMA who control the quantity of medical students graduating in the United States states that there is an excess of medical doctors in the United States. The AMA also by most authorities have the strongest and most effective lobby in Washington. What can we do than to increase the quantity of medical doctors? A solution must involve stopping the AMA from establishing medical school admission and corresponding graduation quotas. In order to achieve this goal, the United States must build more medical schools and graduate more medical doctors.

Also, since medicine is a money making business, free market competition must be established. Requiring doctors to post and advertise their rates for services would definitely reduce medical care costs. Also, hospitals must compete in a similar manner. Capping malpractice law-suits is another requirement. I sincerely hope that these suggestions provide some assistance in reducing medical costs in America.

Sincerely,
Charles Ring

Diet And Obesity

Hello Kathleen,

I saw your national contest, "A Challenge: Build an American Health System" for $10,000 dollars for first place.

I have been thinking about this Health Care situation quite a while, especially when I had to pay for my own health care and it almost increased by 50% for no reason whatsoever. I have plenty of other good ideas, HOWEVER, that is only part of the problem.

Below are some quotes I pulled from this article I found on the Internet.

1. Diabetes alone accounts for $100 billion in health care spending each year, Thompson said.
2. In addition, more than half of Americans—56.4 percent—were over-weight, compared with 45 percent in 1991.
3. The increase has contributed to a parallel rise in diabetes, with 15 million diagnosed adult cases last year, compared with 9 million in 1991.
4. Nearly 40 million American adults are obese http://www.adrenalineadventures.net/news/330.html (NOTE: I don't need a study to tell what I can clearly see when I walk in a shopping mall or any city street.)

LOGIC: NOW, let's say if there is affordable health care. Or for that matter, even FREE Health Care. If people can't even listen to their doctors and not gorge themselves with "Biggie" meals and the like, what good will be affordable health care be?

Notice that this is OBESE, not just fat, BUT OBESE. These people are in the hospitals and clinics ALL the time... they make hospital costs skyrocket, draining everyone else's time and money...doctors that could be helping cure other diseases are spending a tremendous time on problems that ARE clearly and easily solvable... it's no wonder other diseases don't have enough funding for researching a cure.

If I took an ad in a national newspaper, no one could argue with me.

The Question That Needs To Be Asked Nationally

What good is an affordable healthcare plan (OR EVEN FREE for that matter) if people don't even do the most simplest of things of keeping their weight down and exercise?

Why don't you calculate the costs saved in the next person's healthcare premium if you could halve the number of obese people?

Just those two things will save more people's lives, prolong people's live, and make their lives enjoyable than even FREE health care.

Oh, one other thing that will make it total, "Facing the simple truth that people can't face seeing their own weight on the scale."

Sincerely,
Philip Chin

P.S.   Possible helpful solution #1

Now, I know that people eating at restaurants want big portions especially since they are paying for that. Might I suggest the mandatory "50% TO GO" bag... Half the meal or 30% should be packed to go EVEN before served... considering most jobs are office ones and people sit around all day, does one need 3 meals a day anyway? Gender and size also should be taken into account when dividing up what should be eaten for later, perhaps lunch tomorrow.... It's a simple solution that can be easily marketed to restaurant owners if done right... makes both sides , actually 3 sides happy, maybe more.

Possible helpful solution #2

I would install public FREE scales so people could monitor their progress... that's a great feedback system and let's people know where they go... regardless if anyone thinks it's insensitive.... It's also incredibly cheap as well... cheaper than any health care plan.... One less obese person draining sources at the hospitals will pay for a hundred of those scales

Make them free or at cost at gas stations, bus stops, shopping malls. Many don't use electricity, just make them sturdy and accurate....

You should LABEL these scales with a big sign, "FREE HEALTH CARE, STEP RIGHT HERE."

General Comments

I would like to say thank you for getting the ball rolling on America's health care... or lack thereof. What you are doing is quite possibly the best thing I’ve heard in a long time regarding this issue. I only hope that it works to get all Americans the health coverage we all deserve. As a 24-year-old American who has a "real" job with a small business, I can completely side with you when you say there is no health care system, only a business-to-business enterprise... the small business I work at can't afford health coverage, and as an individual, I can't afford the $200+ insurance cost a month on top of all the other required bills in my life... and it shouldn't be like that! I wish I had money to donate to your contest, but since I can't afford that, I thought I would email you and say thank you for paying attention to this pressing issue of our society!

Thank you,
Emily

1. Make health care system with less legal rules. We have too many administrators and not enough health care workers. Use a logic-based system. There’s too much legal irony in medicine.

2. The government should devolve Medicare for seniors; however, they should put the money into educating potential doctors. It costs less and doctors wouldn't have huge debts to repay.

3. Employ more health care workers. Many mistakes are made as a result of too many patients and not enough nurses. The environment is dynamic; no one knows when all hell can brake loose; code blue, "nurse my glass is empty; nurse I have to go to the bathroom, nurse move my water glass two inches closer, nurse, could you wait on me hand and foot." Etc, etc. etc.

4. Train nurses on the units, less in the classroom—they get book smart, reality stupid.

5. Health insurance companies should streamline paper work; make all form processing uniform.

Good Luck!
Alfred Kukitz

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Kathleen O’Connor, MA, Publisher, The O’ConnorReport, writes a regular column for The Seattle Times. Visit www.oconnorhealthanalyst.com for more information.