Friday, March 6, 2009

Health Care Reform - YES WE CAN!

Much excitement at the White House yesterday as President Obama launched the Health Care Reform session. Go to Health Care Reform to find out what was discussed then come back over here and share your comments and thoughts....

By the way, here is a list of the attendee's - interesting to note that the only Pharma exec there was Kindler from Pfizer....
White House Forum on Health Reform Attendees
Everyday Americans
In December, 2008 the Transition's Health Policy Team solicited everyday Americans to hold Health Care Community Discussions around the country. The seven everyday Americans listed below all conveyed problems with the current health care system, expressed a desire to reform the system, and hosted discussions in their communities on health care issues. They were invited to participate in Thursday's White House Forum on Health Reform.

Travis Ulerick is a 24-year old firefighter from Dublin, Indiana. He started out as a firefighter and first responder for the volunteer fire department on June 28, 2000. When the fire department became the sole EMS provider for the southwestern portion of Wayne County in 2007, Ulerick was one of the four crew members hired to work full-time on the department's ambulance. He graduated from nearby Lincoln High School, and is currently a senior at Ball State University in Muncie, Indiana. Travis hosted a health care community discussion with other local first responders, doctors, and everyday Americans in January in the bay of Dublin's fire station. Recently HHS staff followed Travis around his job, and he will be featured in an upcoming video on the new healthreform.gov website. *NOTE: Travis Ulerick will introduce the President at the opening session.

Julia Denton is a 52-year old Republican from Yorktown, Virginia. Her husband is an active duty Air Force dentist with more than 23 years service. Julia currently devotes her time to caretaking and advocacy on behalf of her son Matthew, who was born with a rare genetic disorder resulting in multiple disabilities. Although Julia was a volunteer for the McCain/Palin campaign during the general election, she is now committed to the Obama health plan. She hosted a health care community discussion in December and since has continued to support the health reform effort.

Siavash Sarlati is a 24-year old Iranian-born, American citizen, and a medical student at the University of Wisconsin. After completing high school, he pursued a degree in Biochemistry from the University of Wisconsin-Madison, graduating with honors. Siavash is currently a second-year medical student at the University of Wisconsin School of Medicine and Public Health, and he hopes to pursue a Masters in Public Health. Siavash hosted a health care community discussion in December. He is interested in doing his residency in an under-served urban area.

Yvonne Rubie is a 57-year old from Brooklyn, New York. She is an active volunteer at House of the Lord Church, where she hosted a health care community discussion in December. Yvonne has a master's degree in public health and uses her skills to promote health and wellness through health fairs, church discussions, and information sessions on diabetes. In an effort to continue the community discussion, she is in the process of planning an event in May focusing on elder care. Yvonne is committed to improving health care at both the national and local level.

James Stoffer is a 54-year old teacher and small-business owner from Delafield, Wisconsin. As the owner of a malt shop, James is all too familiar with the high costs of insurance. Although his family has a history of cancer, he cannot afford the checkups due to cost. He spoke about insurance being an obstacle to fulfilling his lifelong dream of owning his own business and fears that the current system limits other entrepreneurs.

Jose Oliva is a 63-year old Mexican-born, United States Citizen from El Paso, Texas. Jose works as a Customs and Border Protection Officer along the Texas-Mexico border. He is a veteran who served in the United States Air Force from May 1965 through May 1969, and all his higher education costs were paid through the GI bill and part-time employment. Jose and his wife have been married for 38 years and have four grown children. In December, Jose hosted a health care community discussion, where group participants discussed challenges to people in impoverished areas of the country. Jose believes that the biggest challenge in reforming health care is by improving access to all Americans.

Angela Diggs is a 42-year old Washington D.C. native, who is the administrator of the Congress Heights Senior Wellness Center, which is a partnership of the District of Columbia Office on Aging and Providence Hospital's Wellness Institute. The center provides health and wellness classes for seniors on D.C.'s southwest side. In December, Angela helped organize a health care community discussion.

Members of Congress Expected to Attend

Majority Leader Harry Reid (D-NV)
Minority Leader Mitch McConnell (R-KY)
Sen. Dick Durbin (D-IL) ¿ Assistant Majority Leader
Sen. Edward Kennedy (D-MA) ¿ Chairman, HELP Committee
Sen. Mike Enzi (R-WY) ¿ Ranking Member, HELP Committee
Sen. Max Baucus (D-MT) ¿ Chairman, Finance Committee
Sen. Charles Grassley (R-IA) ¿ Ranking Member, Finance Committee
Sen. Jay Rockefeller (D-WV) ¿ Chairman, Health Subcommittee of the Finance
Committee
Sen. Orrin Hatch (R-UT) ¿ Ranking Member, Health Subcommittee (Finance
Committee)
Sen. Tom Harkin (D-IA) ¿ Chairman, Appropriations Subcommittee on Health Care
Sen. Arlen Specter (R-PA) ¿ Ranking Member, Appropriations Subcommittee on Health Care
Sen. Byron Dorgan (D-ND)
Sen. Chris Dodd (D-CT)
Sen. Robert Bennett (R-UT)
Sen. Bernie Sanders (I-VT)
Sen. Debbie Stabenow (D-MI)
Sen. Barbara Mikulski (D-MD)
Sen. Sherrod Brown (D-OH)
Sen. Sheldon Whitehouse (D-RI)
Sen. Jeanne Shaheen (D-NH)
Sen. Jeff Bingaman (D-NM)
Sen. Ron Wyden (D-OR)
Sen. Judd Gregg (R-NH)
Speaker Nancy Pelosi
Rep. Steny Hoyer (D-MD) ¿ House Majority Leader
Rep. Eric Cantor (R-VA) ¿ Republican Whip
Rep. Xavier Becerra (D-CA) ¿ Vice Chair of Democratic Caucus
Rep. Henry Waxman (D-CA) ¿ Chairman, Energy & Commerce Committee
Rep. Joe Barton (R-TX) ¿ Ranking Member, Energy & Commerce Committee
Rep. Charles Rangel (D-NY) ¿ Chairman, Ways and Means Committee
Rep. Dave Camp (R-MI) ¿ Ranking Member, Ways and Means Committee
Rep. George Miller (D-CA) ¿ Chairman, Education and Labor Committee
Rep. Buck McKeon (R-CA) ¿ Ranking Member, Education and Labor Committee
Rep. John Dingell (D-MI) ¿ Chairman Emeritus of Energy & Commerce Committee
Rep. Frank Pallone (D-NJ) ¿ Chairman, Health Subcommittee for Energy &
Commerce
Rep. Nathan Deal (R-GA) ¿ Ranking Member, Health Subcommittee for Energy & Commerce
Rep. Pete Stark (by phone) (D-CA) ¿ Chairman, Health Subcommittee of Ways and Means
Rep. Wally Herger (R-CA) ¿ Ranking Member, Health Subcommittee, Ways and
Means
Rep. Rob Andrews (D-NJ) ¿ Chair, Education & Labor Subcommittee on Health, Labor, et al.
Rep. John Conyers (D-MI)
Rep. Baron Hill (D-IN)
Rep. Jan Schakowsky (D-IL)
Rep. Jo Ann Emerson (R-MO)
Rep. Allyson Schwartz (D-PA)
Rep. Earl Pomeroy (D-ND)
Rep. Roy Blunt (R-MO)
Rep. Rosa DeLauro (D-CT)
Rep. Donna Christensen (D-VI)
Rep. Tim Murphy (R-PA)
Rep. Michael Burgess (R-TX)
Rep. Lois Capps (D-CA)
Rep. Patrick Kennedy (D-RI)
Rep. Jim Cooper (D-TN)
Rep. Lucille Roybal-Allard (D-CA)
Rep. Mike Ross (D-AR)
Community Leaders and Stakeholders Expected to Attend
(in alphabetical order by organization name)
AARP, Bill Novelli, President
ADAPT, Bobby Coward
AFL-CIO, Gerry Shea, Assistant to the President for Governmental Affairs
AFSCME, Gerry McEntee, President
AFT, Randy Weingarten, President
AIDS Action Rebecca Haag President and CEO
Alliance for Retired Americans, Ed Coyle, Executive Director
America's Health Insurance Plans, Karen Ignani, President and CEO
American Cancer Society, Daniel Smith, President
American College of Physicians, Jeff Harris, President
American Academy of Pediatrics, David Tayloe, President
American College of Cardiology, W. Douglas Weaver, President
American Academy of Family Physicians, Ted Epperly, President
American Diabetes Association, Larry Hausner, CEO
American Heart Association, Timothy J. Gardner, President
American Hospital Association, Rich Umbdenstock, President
American Medical Association, Nancy Nielsen, President
American Nurses Association, Rebecca Patton, President
Asian and Pacific Islander Health Forum, Dr. Ho Tran, Executive Director
Association of Asian Pacific Community Health Organizations, Jeff Caballero, Executive Director
Building and Construction Trades Department, Mark Ayers, President
Better Health Care Together, Jody Hoffman, Executive Director
Blue Cross Blue Shield Association, Scott Serota, CEO
Campaign for America's Future, Roger Hickey, Founder and Co-Director
Campaign for Mental Health Reform, William Emmett, Director
Catholic Health Association, Sister Carol Keehan, President and CEO
CCD Health Task Force, Peter Thomas
CED, Charlie Kolb, CEO
Center for American Progress, John Podesta, President and CEO
Change to Win, Anna Burger, Chair
Children's Defense Fund, Marian Wright Edelman, Founding President
Columbia University Mailman School of Public Health, Irwin E. Redlener, M.D.
Communications Workers of America, Larry Cohen, President
Families USA, Ron Pollack, President
Federation of American Hospitals, Chip Kahn, President
General Mills, Ken Powell, President and CEO
Health Care for America Now, Richard Kirsch, National Campaign Manager
Hispanic Medical Association, Elena Rios, President
Human Rights Campaign, Joe Solmonese, President
Jennings Policy Strategies Group, Inc, Chris Jennings, President
League of United Latin American Citizens, Brent Wilkes, Executive Director
Markle Foundation, Zoe Baird, President
National Association of Counties, Valerie Brown, Incoming NACO Chair
National Association of Manufacturers, John Engler, President and CEO
National Association of People with AIDS, Frank Oldham, President and CEO
National Association of Community Health Centers, Tom Van Coverden, President and CEO
National Council of La Raza, Janet Murguia, President and CEO
National Jewish Hospital, Dr. Michael Salem, President
National Congress of American Indians, Jacqueline L. Johnson Pata, Executive Director
National Federation of Independent Businesses, Dan Danner, President
National Indian Health Board, Stacey Bohlen, Executive Director
National Medical Association, Mohammad Akhter, Executive Director
National Partnership for Women and Families, Debra Ness, President
National Business Group on Health, Helen Darling, President
National Association of Children's Hospitals, Larry McAndrews, President and CEO
National Association of Public Hospitals, Larry Gage, President
National Rural Health Association, Dennis Berens, President
National Coalition on Health Care, Henry Simmons, Founder
National Association for Home Care & Hospice, Val Halamandaris, President
National Women's Law Center, Marcia Greenberger, President
National Minority AIDS Council, Paul Kawata, President
National Gay and Lesbian Task Force, Rea Carey, President
National Hispanic Health Alliance, Dr. Jane Delgado, President
National Education Association, Dennis Van Roekel, President
Pfizer, Jeffrey Kindler, CEO
Pharmaceutical Research and Manufacturers of America (PhRMA), Billy Tauzin, President and CEO
Physicians for a National Health Plan, Dr. Oliver Fein, Director
PICO, Scott Hersey Reed, Executive Director
Planned Parenthood Federation of America, Cecile Richards, President
Racial and Ethnic Disparities Health Coalition, Fredette West, President
Robert Wood Johnson Foundation, Dr. Risa Lavizzo-Mourey, President and CEO
SEIU, Dennis Rivera, Chair
SEIU, Andy Stern, President
Small Business Majority, John Arensmeyer, Founder and CEO
Teamsters, Jim Hoffa, President
Trust for America's Health, Jeff Levi, Executive Director
UAW, Ronald Gettelfinger, President
UFCW, Joe Hansen, President
University of Chicago Medical School, Eric Whitaker, Executive Vice President For Strategic Affiliations
University of Miami, Donna Shalala, President
USW, Leo Gerard, President
US Chamber, Tom Donohue, President

58 comments:

  1. Did you know that there is still private medical insurance in Canada? A friend of mine gets hers through her job. Why? Because the standard of universal care is lame. Another friend who swears by their system tells me that he pays a few hundred dollars a month for his family's universal care. It is a forced payment. I asked the friend with private insurance if she has to pay the forced amount even though she has her own insurance. She does. Universal health care is not free healthcare. Not only is it not free but there is little incentive for people to go into the medical field. Their system is a big HMO. For some people that may seem fine because an HMO is better than no health care at all (aside from medicaid). For those who are used to a better quality of care with their doctors not being incentivised to treat less, this is going to be horrible. It is not coincidental that people from Canada come here for all kinds of procedures. It is also no wonder that Kindler is attending this meeting to see how many of Pfizer's products will have to be reduced in cost to compete. Cost reduction results in quality reduction. It is a little surprising that he was the only drug company CEO on the list. Maybe the others are hoping it will not happen. It will.
    No one wants to see someone go without needed medical attention. There is good and bad in what is about to happen. The down side is that we will have less options. In this time when jobs are supposed to be created there will be less work in the medical field at a lower wage. I wonder if that is good for the public. Everyone is covered but getting treated may not be simple. Have you ever had to go to a state-run medical facility? My aunt who depends on her state facility deals with long waits and never gets the same doctor twice. She sometimes goes 2 or 3 times because visit #one is a new doctor trying to get familiarized with her condition. This is why the electronic records program will be necessary. I have had the same doctor for about 15 years. He doesn't have to read a chart to know my general history. I'd bet money he will be retiring early. I am not confident that our job provided insurance will remain available. Why should they provide it if the government will. Job reductions in the area of insurance companies. There will be more government jobs though. Interesting because those with government jobs have better retirement packages at the cost of taxpayers who may have no retirement package at all. Que Sera Sera.

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  2. Former Marketing, thank you for posting this. The Health Care Reform Web site is a cool site. It was interesting to read U.S. citizens' views on health care reform. Here is one:

    "From Welaka, Florida: 'All feel there must be an overhaul of drug company marketing techniques and drugs from other countries should be easier to obtain.'

    These are issues that have been discussed here on PharmaLittle as well. By the way, I did not see the American Psychiatric Association (APA) on the attendee's list. Maybe they were represented by PhRMA.

    Check out Danny Carlat's post on psychiatry leadership's commentary in this month's American Journal of Psychiatry (the official journal of the APA). Click on Nancy to visit The Carlat Psychiatry Blog.

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  3. The public needs to understand what changes will be made. There are a lot of scary stories going around, i.e., the elderly, sick, disabled will not receive good healthcare; people will be forced to take certain meds, the government will say what treatments a pt can receive.

    We need to know the truth.

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  4. In Reply to Anonymous,

    I am American who has been living in Canada for quite some time. I followed this blog over here since the sign off of Pharmalot.

    Health Care isn't free in Canada and that is a good thing! We pay for it through our taxes. Additionally we pay for "private" coverage through our employers. The private coverage pays for extra's not in the government program. But, no matter how you slice and dice it, it is very cost effective and the care we get is great.

    No health care should be provided free, we must pay something. This allows us to voice our concern on how to improve it and ensure that integrity is kept in the system. The additional money paid for private insurance helps to defray drug and device costs used in treatment of any illness that is not administered in the hospital. However, the exception is essential drugs, which are covered in most cases by the Provincial (State) drug programs. In most Provinces this means that essential drugs that cost 10's of thousands of dollars per year per patient are covered by the government with only a small co pay per year being paid by the patient.

    However, it isn't perfect, each Province has their own drug/health care coverage program, so there is some inequity in the programs across Canada. Canadians are working to improve this.

    The health care system is very transportable, I can go anywhere in Canada for treatment and I am still covered. I am not forced to go to any particular doctor, and if I believe that I have not been given appropriate care, I can sue, and Canadians do sue, but way less then what happens in the US.

    Additionally, Doctors are considered government workers, they do not work in the "for profit" mindset of American doctors, in "for profit" hospital systems.

    What is more, the government is very concerned about all the issues that may prevent citizens from achieving good health. There are many government sponsored programs to help overcome childhood obesity, childhood illnesses, and to help Canadians in general adopt a healthier lifestyle. This is critical and we all play an important role, after all it is our taxes that pay for healthcare. We all understand our individual responsibility to ensure that our costs are kept in check, otherwise the tax bill goes up.

    It isn't perfect, if you ask enough people you can find some who don't like it at all.

    Now, here is the kicker, I was diagnosed a few years ago with a rare disease that is life threatening. My American family worried that Canad would not be able to provide adequate care for me and insisted that I come to the States for a second opinion. Well, I paid through the nose, to hear exactly the same advice I received in Canada, in fact I would even have to say my Canadian Doctor is more innovative. This is a critical point when you consider that I was having my second opinion at Sloan Kettering in NYC...


    Was I forced to take certain drugs? No, in fact, I successful argued against a very popular treatment and am now being treated with a novel treatment that works much better for me. Like everything it is in the patients own interest to educate themselves. If you do not, then you must do what you are told, because you cannot be proactive in the decision making process.
    Yes, there are many Canadians who go to the States, my belief is that some are ill informed to do so. Sometimes, though, it is to receive treatment that might not be available in Canada, although this is very rarely the case. Can I tell you how many Americans come here? Lot's, they pay out of pocket to come here and they do not complain, our "market prices" are much less lower than in the US as we are not allowed to charge for a profit....

    The People of the United States of American, my family and friends, all deserve to have access to health care and affordable drugs. People have got to accept responsibility for their own health and I feel very strongly that government has an integral part to play in all of this. Governments are "For the People, Of the People and By the People". It is through the government programs that all stakeholders can sit down together and truly put forward a plan that protects, serves and improves the health and livelihood of the people.

    At the end of the day, I would ask everyone to try to discern what motivates the critics of health care reform for US citizens.

    This is one American who is living under a Universal Health Care program and hasn't lost their house, livelihood and dignity because of a diagnosis of a serious and expensive disease.

    My hopes and prayers are for all Americans to experience what this is like.

    I voted for Obama....

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  5. I am the anon poster of the first comment. Thank you anon poster #2 for your comments.

    The point of my posting was to make people aware first that universal healthcare is not free. There is a huge misconception here and you have cleared that up. You also cleared up that private insurance is still necessary to cover costs not covered by universal healthcare. I do wonder if Canadians are concerned about what will happen to the cost of their medications as our government will be attempting to get more of Canada's cheaper medications. Supply and demand.

    If you think of universal care as being paid for by the government you must ask yourself who the goverment really is. It is the population, despite DCs opinion on the matter. So when you say the government pays this much with a small co-pay from patients, what you are really saying is that the tax payer really foots the whole bill. Our taxes will go up to reduce the cost per visit. I didn't say that we would be forced to go to any particular doctor, what I am suggesting is that our doctors will lose the incentive to continue. Put yourself in their position for a second. They paid a small fortune for their education and government is going to take control over how they conduct business. This may reduce cost for the public but I doubt it. There are suggestions that goverment pays for their education as an incentive. In what area have you seen the government being effective in whatever they control.

    Your scariest comment is this:
    "Was I forced to take certain drugs? No, in fact, I successful argued against a very popular treatment and am now being treated with a novel treatment that works much better for me. Like everything it is in the patients own interest to educate themselves. If you do not, then you must do what you are told, because you cannot be proactive in the decision making process."

    Which backs up my assertion that government will be telling people what medications they must take.

    I'm not trying to yank anyone's chain here. I just believe that there is a deliberate move to keep people uninformed about the reality of the situation. It is not as it seems.

    Seems we don't disagree at all. It does not matter what political party you are affiliated with. What matters is that the public is being excluded from being able to make an informed decision.

    Again, Thanks so much.

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  6. I guess this is to Anon I, who I assume is the same person who posted the stuff from the ER physicians group, etc. on the preemption thread.

    A few thoughts:

    1. There is already "controlled" health care, but it is not based on comparative efficacy studies in most cases. It is based on what your private insurance is willing to cover. As we all know, the criteria for what gets into formularies varies a great deal. Cost is certainly central. That's why so many folks in the military ended up on Baycol. Bayer underbid the other statin manufacturers. The rest is...unhappy history.

    2. As I understand Anon 2, nobody forced him/her to do anything. A popular treatment was rejected, as many of us reject conventional treatment, for a range of reasons--we disagree with the ascribed risk/benefit analysis, we don't think it applies to our own case, etc.. This happens in American, and Canadian, medicine every day.

    3. I see no evidence whatsover of a public "being excluded from being able to make an informed decision" in any healthcare proposal. Where do you find that?

    Indeed, a genuine comparative efficacy center, independent of the usual influences, would provide us the _most_ informed possible choices, based on population studies and, critically, in the context of our particular circumstances.

    Might we sometimes have to fight/argue for an "unconventional" approach? Of course. There is nothing new about that.

    Obviously, this _is_ a political discussion. Anon 1 takes the classic conservative view, which is fine. "In what area have you seen the government being effective in whatever they control?"

    Medicare, for one.

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  7. anon 1 here.

    I am not the person who commented on the "ER physicians group, etc. on the preemption thread."

    I am more than familiar with risk/benefit ratios and what government intervention means in that area. Ed wrote my story and you would be very familiar with me if you were a Pharmalot resident. I am not a conservative but an independent. I am painfully aware of the role of government in the medical decision making process, via FDA.
    The difference between this site and Pharmalot is that there were people on all sides of the fence over there. Take what I have posted or leave it. I don't care. My intentions are not evil rantings attempting to undo the mindset of those who are determined that they are right. I simply hate that people are buying this hook, line, and sinker, without fulling understanding what is going on. If that is your choice then I won't pollute this site with any further requests to look at things rationally.

    "Canadians are working to improve this."
    and they have been at it for how many years?

    "No health care should be provided free, we must pay something. This allows us to voice our concern on how to improve it and ensure that integrity is kept in the system."
    our own representitives do not listen to us but sit and play politics.

    "If you do not, then you must do what you are told, because you cannot be proactive in the decision making process."
    the majority of doctors sneer at you if they think you are googling your own diseases.

    I miss Ed!

    For JiM (because he is always asking things of the class),
    Is the role of this site to not question things outside of what is fed to us by the main stream media?

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  8. To Anon 1 - Absolutely, re: questioing things. You now do, indeed, sound familiar. And we all miss Ed and Pharmalot!

    I'm not sure I see that people are not responding thoughtfully, as they are capable, up thread. Meaning, I don't see that your views are just being "rejected" without reflection. But that's pobably in the eye/ear of the reader.

    Anyway, good to see you here if you are who I imagine!

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  9. This is the American/Canadian Anon...

    I am not sure why you think we are not questioning things here, we certainly are. Mainstream media is trying to tell us that health care reform is like some kind of communist government that will take the rights away from all Americans. This is not true.

    Main Stream media has also been trying to tell us that Preemption would have been a good thing. Yet, Preemption would have denied the rights of citizens to sue in the event of harm or injury from FDA drugs. If you have been following this blog, you do know that 9 FDA reviewers have come forward and let President Obama know what is wrong with the FDA.

    You posted your points on Health Care reform and, being someone who lives under the Canadian Health Care system which you brought up, of course it makes sense for me to tell my story.

    42 million Americans do not have access to health care. Some of these are my fellow patients, they are my friends and some are family members. Not one Canadian citizen is denied access to health care in Canada - not one.

    Let's be clear, I am not sure we will ever have a health care program that will always be 100% for everyone, asking for that is impossible. It is a "living program" and must continue to change as diseases and treatments are better understood. We are not going to launch a program and say - good, we are done with that.

    If a doctor sneers at you, go find another doctor. Eventually the doctors will understand that we live in a modern age, they in fact are not gods, and we will question them like we question our car mechanics, lawyers, real estate agents,dentist...etc.

    As for the politicians, well we have a vote.

    None of this is easy, it requires us to stay informed and to have our voice heard in the process.

    I am for fixing health care in the US because 42 million Americans deserve to have access to it, just like everyone else.

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  10. Trying to UnderstandMarch 8, 2009 at 3:37 PM

    American/Canadian Anon,

    You said "The additional money paid for private insurance helps to defray drug and device costs used in treatment of any illness that is not administered in the hospital."

    What happens in situations where people are not carrying private insurance? How do they cover those additional costs? Do they use the ER as their family practitioner for the coverage?

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  11. To Trying to Understand,

    If you are working then you have private insurance and it is covered, if not, the provincial government covers it for you through one of their programs, but you have to qualify based on lack of income, etc.

    Additional private insurance is not an option. If you are working you must pay something into it, although I think in some cases you can opt for different plans. The additional private insurance through employers also defrays the cost of dental care, physiotherapy, eye care, in some cases it covers a capped amount of therapeutic massage, it will also cover the costs of chiropractors, and psychiatry and/or therapy.

    Yes, in some areas there is a shortage of family physicians and people do abuse the ER, especially with cold and flu season. There are a few plans underway to address this issue. Like I said, the system is not perfect, but no one who needs treatment gets denied.

    Someone wondered about the lack of incentive for doctors who are considered as government workers. Let's be clear, they still earn a very decent salary, almost commiserate with their American counterparts.

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  12. Trying to UnderstandMarch 9, 2009 at 10:04 PM

    Sorry to say that this sounds exactly like what we have now only with a higher tax burden.

    Currently if you have a low enough income you can qualify for state health plan coverage or medicaid. Currently it is illegal for hospitals to turn you away at the ER which does not cover dental care, eye exams, or physical massage. Currently people use the ER as their primary care provider. Currently those who have insurance cover the cost of those who can not cover their own bills, by way of higher bills for services. There are catholic hospitals who base your cost on your income. There are also amazing university teaching facilities that charge the same way. There are a lot of non-profit hospitals. There are prescription assistance plans. There are nurse practitioners who charge based on income.

    For the additional huge cost to the tax payer all we will get is... well... an aditional cost to the tax payer. That and our doctors becoming government employees which keeps them from standing up for what they believe is right in leu of what the government thinks is right.

    Thanks for playing along. Did I miss anything?

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  13. Dear Trying to Understand,

    Yes, you missed very much.

    Canadians go to the ER who shouldn't go to the ER, they should go to their doctor or they should go to one of the very numerous drop in clinics, where they will get full service, regardless of their income. If they do not have the money for drugs to treat their illness, it will be given to them, usually on the spot. The doctor will then fill out a form and the government will take over with their support program. Otherwise, if you have additional private coverage you go to the pharmacy and get your own drug.

    You go to whatever doctor you want to go to, the government does not decide who you can see. You simply make the appointment yourself, you bring your provincial healthcare card which is processed much like a credit card, you see no bills, you pay nothing. No one asks where you live, what you earn or what coverage you have unless you have no coverage to cover prescriptions. In the event you do not have additional coverage, your doctor fills out a form and the provincial plan kicks in.

    However, I am intrigued by your comment that doctors becoming "government employees" keeps them from standing up for what they believe in? Where do you derive this from? You seem to have your own opinion on this that at best is misinformed. All this to say that the Doctors here have plenty of voice and power and in all cases have the final word on what they believe is best for the patient, it is also up to the patient to either go along with it, or get another opinion.

    So, you pay higher taxes, but have peace of mind that if you do get a debilitating illness you will not be put at financial ruin, which to me is very much like saving for a rainy day. Or you can keep all your marbles to yourself and not share anything with anyone, but if and when you get sick, you can stand idly by and watch your nest egg evaporate. Now of course, you will be the one deciding on who gets it and how much, but believe me, it will disappear in a flash...

    Pay now or pay later. Benjamin Franklin said, "Certainty? In this world nothing is certain but death and taxes"

    I rather like the idea that the society I am living in is filled with people who do not have to worry about access to healthcare or have to go begging to strangers for charitable help if they have the misfortune of being diagnosed with a debilitating disease. I like the idea that I have something to do with the peace of mind that we all share, that I am part of a bigger community of people who can show some kindness to my fellow citizen. If things are good for me and I can afford to pay a little more so that someone who is not so well off can be helped, then what is wrong with that?

    Here is the Canadian Health Care site, feel free to browse through it....

    http://www.hc-sc.gc.ca/hcs-sss/index-eng.php

    In closing, I have had to deal with the system in the US and this one here in Canada, its a no brainer, the Canadian system wins...

    American/Canadian Anon...

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  14. Trying to UnderstandMarch 10, 2009 at 1:40 PM

    Can/Am Anon and others,

    I really do appreciate your part in this discussion because it allows the readers here to understand the differences. I could not have fully explained without you explaining the Canadian system. In fact you have opened my eyes to several things.
    As I said before, I do not believe that most people know that this is not an across the board free treatment situation after a deduction from wages, if you work. They think it is totally free if you do not work. I personally know people that would swear that you and I are all wrong.

    Just to clear up a couple more little items, if you will, let me paint a scenario or two.

    You are 21 years old and you work in a retail clothing store. Recently, because of the downturn in sales, you are only getting 20 hours per week. You are healthy. Is money going to be taken from your small paycheck toward medical care that you may not need right now? What you cannot afford is to lose part of your pay. Are part time workers forced to pay into the universal system? Kids who work at McDonalds after school? Housewives that pick up a few hours somewhere for something to do?

    Or say you are 35 and have a wife and a couple of kids. You really need insurance in this scenario, by the way, but is it the most important thing at the moment? You are making around 40 grand a year. With the cost of living being what it is, you really cannot afford to lose a dime of your income and still feed your children, pay your housing and utilities, to keep your car running and to insure it. This is a huge incentive to be as safe and healthy as possible already. Is this family going to be able to build a nest egg anyway? Not a chance. So barring the occasional illness, will they want a constant hand taking from their very shallow pocket? They might well rather hope and thrive for wellness instead of lose part of their income, and depend on the options available now, in the event that an illness comes up. Children's hospitals will provide wonderful care for serious illnesses on donations from generous people who can afford to donate.

    Is there a wage small enough that you do not pay into the socialized system through payroll deductions? I believe you said that all workers pay into it. Some workers who believe they are getting something for free are really going to be damaged and surprised because they do not fully understand what is going to happen. Maybe to the extent that they are pushed into the role of needing instead of providing for their own families. The ones just on the edge that are hanging on and do not want government support.
    You know, there are still a lot of very proud people in this country that do not want government help, even if it means they have to live within their means. They pay their bills and stick with their jobs.

    The insurance I have allows me to get care wherever I need it in the country too, as when I am travelling and such. I have never seen insurance that didn't allow for that. I believe you mean for when you are between jobs?

    It really does not seem fair to those who are providing themselves with insurance, even if it means staying with a less than wonderful job, to have to provide for those who choose not to make the same effort.
    I'm not talking about those who have lost jobs. I am talking about my own siblings who choose to work jobs that allow them to draw unemployment in the winter instead of working. They job hop. They won't stick with anything if they get bored or if they have the slightest issue with a boss, etc..
    It is not that I don't want them to be cared for if they get sick (or anyone else for that matter), but it does rub me the wrong way that responsible people are going to pay more for the good of purposefully, less responsible, people to have equal everything. And it makes me wonder what is the incentive to be responsible when you can do as well not to be. I could take my income and buy the latest of every gadget, as my siblings do, and live only in the moment. I want a future. Don't take my future because they choose to not strive for one.

    As for health care issues taking away a person's nest egg. This system is going to take from mine, in that, I will have less to contribute to it. How is this beneficial to the Social Security System or to the next generation who will be paying more to make up for the higher Social Security payments that are inevitable to attempt to keep up with the increasing cost of living?
    We shouldn't be taxed, but rewarded, for our efforts to provide for ourselves now and later. Under universal care we will be paying twice for what we already have now. We are not wealthy people by any stretch of the imagination.

    I guess if everyone was equally responsible, as they are physically able, I would have much less problem with this system. The truth is that people take advantage of these types of programs all the time. I could lay out some real stories out about people lying to SSDI to get and retain payments, and being encouraged to lie so they can get their next check. My tax dollars are already supporting people who should not be getting a free ride. It is too easy to take advantage of government programs.

    How about those of us doing fine on our own be left alone to continue to do fine? We ARE making sacrifices to maintain what little we have.

    Really doesn't this bother anyone but me? I know socialism is all the rage. It is hard to swallow when you were raised to believe that you are responsible for yourself. When you have worked your whole life based on that premise. It is not only a shifting of wealth but stature. Everyone is equal despite how they conduct themselves. Why conduct yourself responsibly anymore?

    Time will tell. Do you know that to become a resident of Canada you must meet several criteria? This is to be sure you will not be a drain on their system. If we are going to have a system that is so easily abused can we at least make sure people coming in are capable of being beneficial instead of being a drain?

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  15. Dear Trying to Understand,(abbreviation equals TTU)

    Here are the answers to your questions:

    TTU Said: As I said before, I do not believe that most people know that this is not an across the board free treatment situation after a deduction from wages, if you work. They think it is totally free if you do not work. I personally know people that would swear that you and I are all wrong.

    Answer from American/Canadian Anon: As I have stated, if you are working you most assuredly are paying taxes to pay for the National health care program and you are also going to pay into your employers supplemental program for ancillary health care. All of this is however, pro rated to your salary.

    TTU Said: Just to clear up a couple more little items, if you will, let me paint a scenario or two.
    You are 21 years old and you work in a retail clothing store. Recently, because of the downturn in sales, you are only getting 20 hours per week. You are healthy. Is money going to be taken from your small paycheck toward medical care that you may not need right now? What you cannot afford is to lose part of your pay. Are part time workers forced to pay into the universal system? Kids who work at McDonalds after school? Housewives that pick up a few hours somewhere for something to do?

    American/Canadian Anon says:

    If you have a very low salary, whatever you pay gets reimbursed, or you do not pay at all, it depends on which province you live in and how much you earn.

    TTU Said: Or say you are 35 and have a wife and a couple of kids. You really need insurance in this scenario, by the way, but is it the most important thing at the moment? You are making around 40 grand a year. With the cost of living being what it is, you really cannot afford to lose a dime of your income and still feed your children, pay your housing and utilities, to keep your car running and to insure it. This is a huge incentive to be as safe and healthy as possible already. Is this family going to be able to build a nest egg anyway? Not a chance. So barring the occasional illness, will they want a constant hand taking from their very shallow pocket? They might well rather hope and thrive for wellness instead of lose part of their income, and depend on the options available now, in the event that an illness comes up. Children's hospitals will provide wonderful care for serious illnesses on donations from generous people who can afford to donate.

    American/Canadian Anon says: First of all I can say I have lived this scenario. And to answer your question, of course I need insurance right now with small kids, and it is the top of my list of things that are important. Why? Because I am working, my kids are in either pre-school or after school programs, or hopefully playing sports. They are at risk for childhood illnesses and sports related injuries. However, in the scenario you present, the amount of taxes I pay for this coverage is minimal and really not an issue at all. Additionally, I am not willing to not be able to provide dental care for my children, which this program does, depending on the age of the children.

    TTU Said: Is there a wage small enough that you do not pay into the socialized system through payroll deductions? I believe you said that all workers pay into it. Some workers who believe they are getting something for free are really going to be damaged and surprised because they do not fully understand what is going to happen. Maybe to the extent that they are pushed into the role of needing instead of providing for their own families. The ones just on the edge that are hanging on and do not want government support.

    American/Canadian Anon says: Yes, if you are earning a minimum wage, you are still covered and you do not pay into the system.

    TTU Said: You know, there are still a lot of very proud people in this country that do not want government help, even if it means they have to live within their means. They pay their bills and stick with their jobs.

    American/Canadian Anon says: This is not considered government help, you are entitled to it. It is your right, it part of the Canadian charter of rights, it is as basic as motherhood and apple pie. It is not charity.

    TTU Said: The insurance I have allows me to get care wherever I need it in the country too, as when I am travelling and such. I have never seen insurance that didn't allow for that. I believe you mean for when you are between jobs?

    American/Canadian Anon says: No, I mean that whether you work or not, no matter where you go in Canada you are covered. And by the way, if you get sick while abroad, in some cases you are covered as well.

    TTU Said: It really does not seem fair to those who are providing themselves with insurance, even if it means staying with a less than wonderful job, to have to provide for those who choose not to make the same effort.

    I'm not talking about those who have lost jobs. I am talking about my own siblings who choose to work jobs that allow them to draw unemployment in the winter instead of working. They job hop. They won't stick with anything if they get bored or if they have the slightest issue with a boss, etc..
    It is not that I don't want them to be cared for if they get sick (or anyone else for that matter), but it does rub me the wrong way that responsible people are going to pay more for the good of purposefully, less responsible, people to have equal everything. And it makes me wonder what is the incentive to be responsible when you can do as well not to be. I could take my income and buy the latest of every gadget, as my siblings do, and live only in the moment. I want a future. Don't take my future because they choose to not strive for one.

    American/Canadian Anon says: As you can see it, doesn’t affect what you can or cannot do. Honestly though, why are you worrying about what other people might have and what you might miss? Is this really important? The incentive to be responsible is for your own personal benefit and growth is not so that you can compare yourself to the Jones family or your siblings for that matter. If I am not mistaken, the max you can be charged on an annual basis for healthcare is $1,500.00 Canadian. But this is not what you will be charged if you earn minimum wage, or do not have a job at all. This is a small amount to pay for peace of mind.

    TTU Said: As for health care issues taking away a person's nest egg. This system is going to take from mine, in that, I will have less to contribute to it. How is this beneficial to the Social Security System or to the next generation who will be paying more to make up for the higher Social Security payments that are inevitable to attempt to keep up with the increasing cost of living?
    We shouldn't be taxed, but rewarded, for our efforts to provide for ourselves now and later. Under universal care we will be paying twice for what we already have now. We are not wealthy people by any stretch of the imagination.

    American/Canadian Anon says: Canadians have the highest savings among North Americans. Here are some statistics: 70% of Canadians pay off their credit card debt every month versus half of that in the US. Credit card debt in Canada runs at about $3,800 per month versus $8,200 in the US. Canadians have bigger equity in their homes. Canadians by nature are more conservative and even though they are in general in a better place financially than their American cousins, they plan to batten down the hatches and cut back on spending wherever possible while riding out these tough financial times. Clearly, Canadians are not having a problem meeting their monthly financial obligations.

    TTU Said: I guess if everyone was equally responsible, as they are physically able, I would have much less problem with this system. The truth is that people take advantage of these types of programs all the time. I could lay out some real stories out about people lying to SSDI to get and retain payments, and being encouraged to lie so they can get their next check. My tax dollars are already supporting people who should not be getting a free ride. It is too easy to take advantage of government programs.

    American/Canadian Anon says: Whenever people lie and cheat the system then they are lying and cheating themselves. It is a short term strategy. I honestly feel sorry for people who spend their entire life living in “fear” of being found out as a fraud and a fake. It is of no concern to me and I do not worry about what other people do. Can you imagine having to live your entire life looking over your shoulder wondering when the lies you have been living will finally catch up with you – they will catch up with you. In spite of my serious life threatening illness I enjoy being a full fledged member of society, well enough to work and pay taxes. I could have applied to long term disability, but that would have seriously limited my choices to go and do whatever I want to, when I want to. No thanks!!!

    TTU Said: How about those of us doing fine on our own be left alone to continue to do fine? We ARE making sacrifices to maintain what little we have.

    American/Canadian Anon says: You are paying for these people anyway, through your tax dollars. If you really feel strong about this then you have the freedom to go live in a country where there are no taxes. But I would like to say that the cost of the Iraq war for Americans is astronomical, how much better it would have been if that money would have been spent curing cancer or implementing a health care program or providing homes for the homeless and food for those starving in the US or for programs to truly get people up on their feet? See how much the war has cost: http://www.nationalpriorities.org/costofwar_home

    TTU Said: Really doesn't this bother anyone but me? I know socialism is all the rage. It is hard to swallow when you were raised to believe that you are responsible for yourself. When you have worked your whole life based on that premise. It is not only a shifting of wealth but stature. Everyone is equal despite how they conduct themselves. Why conduct yourself responsibly anymore?

    American/Canadian Anon says: You misunderstand something, Canada is not socialistic by any stretch of the imagination. Canada is actually a very democratic society. Let’s be clear, not everyone is equal despite how they conduct themselves. But, everyone is equal who needs access to basic health care. As I mentioned before, the only reason a person needs to conduct themselves responsibly is for their own reasons of personal growth and integrity. I think that universal healthcare speaks more to the intent of the quote from this very famous American document: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness. --That to secure these rights, Governments are instituted among Men, deriving their just powers from the consent of the governed, --That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness.”

    TTU Said: Time will tell. Do you know that to become a resident of Canada you must meet several criteria? This is to be sure you will not be a drain on their system. If we are going to have a system that is so easily abused can we at least make sure people coming in are capable of being beneficial instead of being a drain?

    American/Canadian Anon says: Here are the requirements to become a Canadian Resident: Canada Immigration (Permanent Resident) Visas are given to qualified skilled workers, Provincial Nominees, business persons and to close family members of Canadian citizens and permanent residents. For the record these are roughly the same requirements to obtain residency in the US (legally anyway).

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  16. Can/Am Anon,

    Those really are not the requirements for gaining US citizenship at all. Do you not have requirements for some higher education, job longevity, some study in a second language? Maybe I am misinformed.

    Regardless, you sort of misinterpreted what I said and in some instances evaded in others.
    It is not about worrying about what the Joneses are doing. It is about Jones not doing his part because I am doing it for him.
    As for looking over one's shoulder while cheating, one person I know was told how to cheat by the Social Security Administration. Trust me, she's not sweating it.
    It is nice that you all have it so together up there, that does not take away from the fact that I will lose income toward my nest egg, or some other vital need. Geeee, just when you think you have done well to not allow your investments to be in the stock market.

    "That whenever any Form of Government becomes destructive of these ends, it is the Right of the People to alter or to abolish it, and to institute new Government, laying its foundation on such principles and organizing its powers in such form, as to them shall seem most likely to effect their Safety and Happiness."

    I could prove you wrong here, incidentally. That is the very argument I used. Do you know our FDA? They seem to be exempt which is partly why I'm worried about anymore government making policy about my healthcare. My right to Life, Health, and the Pursuit of Happiness has been abandoned by my government. But I won't get into that here.

    I think this has become long enough that no one will read it anyway. Skimming will certainly not serve either of us well. We simply have a different take on the situation. Still, and again, thank you for helping to explain what universal healthcare really is.

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  17. Dear TTU,

    Actually those really are the requirements to gain residency, look it up for yourself. You have to speak one of the two official languages in Canada, which is English or French. Here's the website: http://www.cic.gc.ca/english/immigrate/index.asp

    I guess I can only speak from my personal experience that in spite of having a serious life threatening illness, I have not touched my personal savings (nest egg), yet I have received drugs and treatment in excess of $500,000 which is way more than I have ever paid into the system.

    But you are right, there could be an entire website and blog set up for just this debate. We are not doing it the full justice it deserves...

    Trust in ones government is key...

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  18. I enjoyed your debate and I must admit I am still ambivalent about universal healthcare. I am a former federal employee and I am covered under Blue/Cross Blue Sheild and I must admit am somewhat ignorant of the catastophic loss provisions. That being said one of my deepeset concerns is the main proposal being floated around now is to allow the uninsured access to the FEHBP and my fear is that my premiums, which already rise at a level above inflation, will increase exponentially as individuals who are unable to contribute are allowed to enter. It has been my experience since Reagan that a large part of the budget cutbacks have been made at the expense of the Federal Workforce. Unlike certain State employees are pensions and benefits are not protected and can be changed by acts of congress. If you want to see the debilitating affects of the Reagan changes just review the Goverment Pension Offset Provisions.

    ReplyDelete
  19. I'd like to suggest that someone find the transcript for this meeting. This is all preliminary so if you have anything to say about the current thinking you might pick up your pen and paper now. I am not fast enough to type verbatim. They really don't seem anywhere close to a solid plan yet.

    Sitting here listening to C-SPAN2 at this very moment. This is coming from a session earlier today 3/10 where the Finance Committee is questioning Peter Orszag. Orszag just said that the intent is that I.T. will allow government to offer our doctors suggestions for treatments, and if they use those suggestions the doctors will get incentives.

    Grassley brought up that projected claims suggesting that 118 million tax payers, currently insured, will lose their private coverage. Grassley went on to question about private insurance competing with federally provided health care and asked if Obama is true to his word when he said that people will be able to keep their current covereage if they choose to. He also mentioned quality concerns (thank you Senator Grassley).

    Peter Orszag has said many times that this or that is on the table.

    Senator Pat Roberts is now questioning Orszag about the dangers of the US bringing in drugs from other countries and wondering if we can guarentee bioequivalency, through CMS. Thoughts about CMS replacing the FDA. Orszag has full faith in FDA (ya me too. sarcasm) and does not seem concerned that CMS will replace FDA. Senator Roberts is saying that there are concerns that doctors may opt out of the medicaid system because of comparative medication decisions by the government as not always being the right medication.

    They are now talking about reinventing off-patent drugs (which has long been my hard fought issue, as you all know) to reduce costs... brought up by Senator Schumer, asking how to keep costs down but requiring RE-NAMING DRUGS THAT ARE ALTERED TO REDUCE COSTS.
    Seems we were heard when they messed up our drug after all! Of course you can't sue city hall, can you? Nevermind that it was fraud and endangerment! (thank you Senator Schumer)

    Trying to channel people into specific drugs, brought up by Mike Enzi, excludes veterans from getting the drugs they want, according to Medicare's formulary.
    Enzi also talking about how the public thinks this program will be free. And how to work out how this will be funded.

    A lot of talk about how and to whom the money will be distributed, Grassley wants to know that people in states with a smaller populus will get the same level of care as those in larger states, by population.

    Orszag says,
    Let's assume there is a 'best practice' in place... you get a larger payment if you follow the best practice. Also, if you follow the best practice system there is little chance of malpractice suits (overall healthcare preemption, no?). This IS an HMO, people.

    More talk of 'best pratices' suggestions as preventing medical malpractice. When asked if he agreed with comparative effectiveness research, he says it is not only about doctors but that someone has to decide pricing of everything... I can't keep up, he's all over the place.

    There are concerns about people in government blocking certain treatments by certain companies to the benefit of other companies.

    Incentives to stop smoking, over eating, and lack of exercize.

    If we end up with a board making decisions we will regret it. John Ensign

    Government runs into difficulty in trying to set pricing. Ensign
    He is worried about an HMO pricing system. And what do you do about illegals using our ERs?

    The president's plan did not cover unauthorized imigrants, says Orszag.

    Senator Hatch, is speaking of figures of innovations and the time they get to generic makers. There is too much difference from patient to patient in effectiveness, and Hatch is worried about "clinical comparitiveness" in drugs again. (thank you Mr. Hatch)

    Wyden, if you make a comparitive cost choice there will be benefits to private insurance holders. He is talking financial incentives for patients through 'insurance schemes'.

    Grassley, wonders about the total amount of revenue created by the cap and trade tax, exesses of which would go to help the people. Orszag really has no clue what amount they are looking at as they try to work out the budget for the next 10 years.

    Sorry folks, that's it, C-SPAN is experiencing technical difficulties.

    Like I said this is not verbatim. Hopefully you get the gist and should look into it further. Pardon grammar, spelling, and punctuation mistakes. And please do not take my word for everything but look into it yourself.
    If I missed thanking any of the wonderful and honorable people who addressed changing existing drugs, thank you endlessly. I will be watching.

    Just A Thought

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  20. When I typed "The president's plan did not cover unauthorized imigrants, says Orszag."
    I meant that they had not covered illegal aliens in the discussion as of yet.

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  21. Dear Just A thought,

    Thanks very much for this, and we will certainly look into getting the transcript.

    ReplyDelete
  22. Not the transcript but I have attached a link to Senator Baucus' Healthcare proposals.
    I have not read through it thoroughly so I will reserve Judgment.


    http://finance.senate.gov/healthreform2009/finalwhitepaper.pdf

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  23. Link to Testimony of Peter Orzgag:


    http://finance.senate.gov/hearings/testimony/2009test/031009potest.pdf

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  24. This is a great discussion. Re: U.S. Senate Committee on Finance hearing on health care reform, March 10 - Senator Chuck Grassley got to the heart of the matter when he said,

    “Whatever changes Congress makes to the health care system, we must ensure that at the end of
    the day, health care decisions are made by two people – the patient and their doctor. I support
    making sure patients and doctors have the most up-to-date and effective information. But I
    cannot support reforms that allow some government bureaucrat to interfere with a doctor’s ability to practice medicine. We shouldn’t put the government in charge of your health care decisions about what doctor you can see and what treatments you can have.”

    http://finance.senate.gov/hearings/statements/031009cg.pdf

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  25. Thanks All,

    I am reading through all of it, I hope to post a summary shortly...

    ReplyDelete
  26. Roy Poses over at Health Care Renewal blogged today on "A Health Care CEO Who Didn't Put His Own Pay First," a must-read. Click on my name to get to the site.

    ReplyDelete
  27. Hi everyone,

    When I began trying to relay what was going on in the Senate Finance Committee hearing Tuesday night, I really had no idea what was going to be brought up along the way. Imagine my reaction when the Senators started questioning things about bioequivalency and reformulating off-patent drugs. I honestly jumped out of my chair. And for the moment I felt as if I had helped to achieve something important. Maybe helped toward changing very dangerous policy. Why I thought they were speaking directly to Dilantin, I don't know. And later I felt guilty and arrogant. My high dropped like a rock.
    I've wanted to cry several times along the way (for a year and a half now?) but the tears wouldn't spill (except in reading the stories of others in my same situation). Frustrating because you think a good cleansing cry might help somehow. But yesterday wasn't the right kind of cry when I finally broke down. It felt empty. It felt selfish to think about what I go through daily since Dilantin was changed if the end result is that no one will be blindsided again. We have never been the kind of people to catch a break. I think there is no getting past injustices. It was humbling.

    Ed Silverman and Pharmalot with the Dilantin article (and many other articles too), and all of the kind and decent FDA personnel that stood up- have made herculean efforts toward bringing attention to what is going on.

    I'd like to tell you a little about what has happened to me and why the current thinking of our Senators is so vital. I was having problems that I didn't understand and which made the daily functions of life nearly impossible. It wasn't until many years later that it was discovered that I have epilepsy (oh no, not the E word). No one wants to say that word but would rather call it a "seizure disorder", to what, remove the stigma? That thinking has kept people ignorant for far too long. I had no idea what epilepsy meant except that people with this condition flop around on the floor. There are a lot of different kinds of seizures. I worked some of the years of my life, as I could, trying to do all of the normal things. Epileptics are forced to be fighters because it is a struggle even maintaining relationships as people visibly recoil when they find out what you have. It's ridiculous.
    It wasn't until someone witnessed me having a grand mal seizure that I was finally diagnosed. At that point my epilepsy had kept me from working for several years. I do not meet the time worked criteria to get disability, and even if I had, I missed the window for disability because I was misdiagnosed for so long. My doctor advised me against applying once I was diagnosed. So fortunately I have been married to a good man who has done everything in his power to stay in jobs that provided insurance. We have always lived under poverty or near poverty standards as a one income household. My husband has been forced to work positions above his education to keep us afloat. He is finally in a decent paying job with excellent insurance benefits. Insurance we may lose under the heath care reform plan. He has never drawn unemployment and we have never taken one thing from any social program. We pay plenty into them though.
    It is interesting what you find you are capable of doing when you must and my husband has kept us hanging on.
    What I found we Dilantin users collectively could not do was to lay down and take it when so many people were being harmed. I could go on and on about how our own discovery process went and what was revealed, but this is going to be long enough as it is.

    Maybe Nathan can explain to you how an excipient reads on a list for a reformulated drug, as being the same ingredient on the prior list. How it does not mean they are the same. Some excipients vary a great deal.
    Whoever is looking into reformulations needs to keep in mind that the role of excipients determine how active ingredients are delivered into the system, and if those excipients are changed (even if the name remains the same), the result can be a VERY different product. It is as important as having the same amount of active ingredient, maybe more so, you cannot have drugs without excipients to determine dissolution. To deny that is to reduce the importance of chemists and all of R&D. Pharmacists seem to think that if there is the same amount of active ingredient then drugs are exchangeable. That is scary thinking where some drugs are concerned.
    I refuse to accept that Pfizer could not have said 'no way, buddy, do you know what that might do?', but they still contend the FDA asked them to do it, so they did. Get real.

    So here you have patients disagreeing with FDA and a respected drug maker, trying to explain to our doctors.
    This is why the thought of "Best Practice" and further government intervention into the doctor/patient relationship scares the shit out of me. And I was glad to hear one of the Senators bring up concerns that one company may be favored over another where "Best Practice" is concerned. Currently Pfizer does not have the best phenytoin, for instance. But they are the biggest name that makes the stuff.

    Where "clinical comparitiveness" is concerned:
    While drugs may have to be renamed when they are altered to lower cost, to compete with generic drugs, they will probably still be changed. For people who need very precise dosing it is like the drug companies giveth health and the drug companies taketh health away.
    What needs to take place, rather than drug companies reducing effectiveness to compete with the FDAs lower standard for generic bioequivalence- the generic makers should have to make drugs more equal to the standards approved under the scrutiny of the New Drug Applications of innovator drugs. Otherwise there really is no point in making good drugs at all. Of course that doesn't reduce cost. Please don't tell me how caring these drug companies are. They will be gaining approvals, based on one dose studies, filing ANDAs to be approved by the office of generics for drugs that require careful titration over months. It doesn't make any sense to have good science and then toss it out the window to save a dime later. Not unless you're an accountant. And the truth is, they cost insurers (and our government soon) more in increased office visits and lab tests. They cost the consumer more when people cannot maintain good health. But yeah, the drug companies will save.

    I about lost it altogether when the FDA tried to put a black box warning for suicidal ideation on epilepsy drugs, based on such flimsy numbers that it was easily voted down. Still, they came back and added the warning, minus the black box. This whole thing of one hand washing the other, when Dilantin was ruined, made that warning feel like a personal attack. In fact, I won't go into some views about discrimination against people with epilepsy by some of the actions that have been taken. Whatever. Just stop messing with me. Know that every morning I am curled up in a ball for a few hours with my headphones on, cranking the most obnoxious music I can find, to try to ride out what my current medication is doing to me. If they're okay with that then they are on the right path.
    How can they ruin effective treatments and then, while we no longer have our well being, say that we have suicidal ideation problems? I resent them for it but I am not going to kill myself over it. Dilantin, pre-reformulation, is the only thing that allowed me to be well. They made the battle harder.
    So go ahead and make your new treatments, just, let's be honest here... Do any of you big pharmaceutical companies intend to allow that good work to remain in tact at the first opportunity to reduce your costs?

    In closing, If you think for one second that I trust the government to be honest about what treatment is best for me when they have a stake in those treatments- think again.
    I no longer understand this country.
    I do pray the Senate Finance Committee can reduce the damage. They give me hope.

    Keep fighting the good fight. I'll peek in on occasion.

    ReplyDelete
  28. The issue of National Health Care may become moot. In the link provided the New York Times reported that a large number of physicians are opting out of the Medicare System.
    The fact that participation in Medicare is not mandatory defeats the argument that in countries with socialized medicine waiting times for simple procedures and regular visits are much longer then here in the United States.
    There are currently 40 million Americans covered under the Medicare System and the simple fact is for many of these individuals waiting times and access to medical coverage is probably much worse then it is in those countries who offer socialized medicine.
    So my advice to those who oppose any form of socialized medicine, remember that unless you are able to afford your own coverage past the age of 65 you too may find yourself with Medicare Coverage yet few places that will accept it. Also, I believe some Employer retirement plans will allow their retirees access to their health insurance plans until such time as the retiree becomes eligible for Medicare.


    http://www.nytimes.com/2009/04/02/business/retirementspecial/02health.html?em

    ReplyDelete
  29. James definitely right about the last point (not that he isn't about others!). My guess would be that there will be very few employees that will sustain med benefits for retirees who are medicare-eligible unless they have one very solid contract provision about this.

    ReplyDelete
  30. In Response to James' Apri 4 comment and NYT link.

    Are these doctors only going to be seeing rich people?

    If most people are retiring with no insurance--that is what is happening--and that will only get worse--the only insurance will be Medicare. Most folks won’t have the money for the doctor plans mentioned in the link. If docs accepting Medicare become few and far between, people will go without physician care.

    Probably not all that bad of a situation.

    See: What’s Making Us Sick Is an Epidemic of Diagnoses - New York Times

    ReplyDelete
  31. Red Riding Hood

    Great Article, I agree entirely with the position of the author. However, you knew there had to a however, the problem described by the author is exactly the reason health care is disproportionately distributed. I am sure the majority of individuals who were diagnosed with some condition are covered by either insurance or Medicare and a lot of money is wasted on unnecessary treatments.
    The problem is this over diagnosis is fostered by the pharmaceutical industry and plays right into the hands of an American Public all to willing to look for a cure in a pill form rather than making the necessary lifestyle changes necessary to improve their overall health.
    The author cites diabetes and cholesterol as two areas where the standards for diagnosis have been changed. Fasting glucose levels have been reduced to 99 and below, and the levels of LDL have reached the point, at least in my opinion, of being absurd. Changes in standards should be adopted if there is a correlation that can be drawn where the new standards can accurately predict a future health benefit and actually show an increase in longevity. Recent statistics point to the fact that the life expectancy of Americans is expected to drop, so while I cannot prove a cause and effect it would seem the more medications we take the shorter we live. In both instances cited above, the problems diagnosed by increased standards can be addressed, for the most part, without medication.
    Getting back to the point of my previous post, 60 Minutes had a segment on Sunday devoted to budget cuts at the University of Nevada, Las Vegas. The University is short on funds so they decided to drop out patient oncology care. The patients for the most part were those who did not have insurance because they had lost their jobs and were unable to qualify for State assistance; they received letters from the hospital informing them that the oncology clinic was closed and the patients needed to find alternative providers. The only providers in the area were all profit oriented hospitals and the patients interviewed were told they were not eligible for treatment. The segment concluded with the fact that some of these patients did eventually receive some type of care but I am sure that a number of individuals are unable to secure basic care and will ultimately die from their disease. So in the end your assessment will be correct, there will be less visits to physicians and those unable to pay will die, while those with the necessary resources will enjoy the best medical care available. It is fast approaching the best of times and the worst of times and that’s okay as long you belong to the former group.

    JimK

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