Tom Daschle named Secretary of Health and Human Services

Barack Obama nominted Tom Daschle the former Senate Majority leader to be his Secretary of Health and Human Services.

He had been serving as a national co-chair for Obama’s campaign. Daschle wrote “Critical: What We Can Do About the Health-Care Crisis.”

Barack Obama’s Cabinet, who’s next?

Yesterday with the announcement of Bill Richardson to take Carlos Gutierrez’s spot as Commerce Secretary Barack Obama filled another spot in his cabinet. We’ve mentioned who is in. But who’s left? What positions are left that the President Elect has yet to fill?

Agriculture, Education, Energy, Health and Human Services, Housing and Urban Development, Labor, Interior, Transportation, and Veterans Affairs.

Now all cabinet positions are nominations and they have to be approved by Congress in order for them to serve in the cabinet.

Considering President-Elect Obama has such high ambitions for getting the United States off of Middle

Photo by Ethan Miller/Getty Images North America)

Eastern oil the Energy Secretary will play a key role. It seems Dan Reicher has been getting some attention lately. This would be real change, seeing as how many see him as an environmentalist. He has pushed strongly for clean energy and has advised Obama before.

Obama also will need someone who has some respect and pull to be his Secretary of Health and Human Services. If he wants to pass health care reform and start building universal health care he is going to need someone he can trust and who is well known in Washington.

Former Senate Majority Leader

The rumors about are citing Tom Daschle as that person. Recent L.A. Times reports say he has already accepted the position.

Tom Vilsack, again and again and again has been mentioned as a possible nominee to head the Agriculture department. I won’t beat this dead horse anymore.

These seem to be the most pressing cabinet positions considering the President Elect’s positions and ambitions. We can only wait and see, and speculate, about who will be named next to the cabinet of President Obama.

The Health Care Headache: Sad Coincidences (Part 1/3)

I read an article on yahoo the other day which really got my blood boiling. Check this out:

Its a sad day when any person succumbs to a rare fatal form of heart cancer early on in life. This can be said for Thomas who was diagnosed in 2001.

Hardworking and supportive of his family, he was determined to ensure that his family would receive the insurance benefits to be paid to them when his passing time came. He spent his final days working  hard to make his family’s life slightly more bearable.

Its a terrible coincidence that the day Thomas ceased employment due to his illness, the company to which he was a loyal employee changed insurance companies to one that requires the employees to work one full day to be entitled to their benefits…

… Like the $426,000.00 that Thomas’ wife should have collected, that Thomas tried to salvage for his family before he died. Looks like all that hard work spent in Thomas’ last moments to save his family’s financial situation went down the drain.

Thomas’ wife stated that she cannot afford her husband’s funeral.

The Employee Retirement Income Security Act is something the American public should rejoice over. However, its this very same act that protects employers from lawsuits.

Its also the same act that resulted in Thomas wife’s not collecting the insurance on her husband. What’s a family to do?

Politicians everywhere have stated that “the act has left more people vulnerable than it has helped.” What’s a family to do?

Finally, the supreme court refused to review the case after the company Thomas worked for succeeded in getting the case thrown out. What’s a family to do?

In the last two parts to this post, I’m going to divvy the sides and examine the health care ideals and opinions of this act as stated by Sen. Barack Obama and Sen. John McCain. I hope this family can receive some sort of help… before filing under a new tax bracket.

The Health Care Headache: A Sickening Paradox

Too much? or Too little? The American health care system has often been called “a paradox of excess and deprivation” (Enthoven and Kronick, 1989) and we’ve yet to find a middle ground. Some people are uninsured, not properly insured, and/or have medicaid/medicare coverage that physicians simply won’t take.

Picture the pregnant woman who cannot find a physician who will accept her insurance. Without proper pre-natal care, the woman will suffer from severe headaches, and will have been diagnosed with hypertension (high blood pressure) and preeclampsia (fluid retention). This woman will give birth to a stillborn baby.

Sad, I know. Unfortunately having too much medical care can also be rather harmful.
Picture the senior citizen who has minor back pain easily treated with over the counter painkillers (ibuprofen, acetaminophen etc…) To make sure the back pain is nothing to worry about, he goes to his doctor’s office and is prescribed a stronger painkiller and later develops a bleeding ulcer which resulted in a two-week hospital stay, $17,000 later.

Ridiculous, I know, but the story gets worse…

Since the 1980’s, the goal of the American Health Care system has been to reduce excess rather than fix the issue pertaining to those who lack health care.

Why?

Because rising health care costs were considered more of a problem than the lack of medical care. The executors behind this idea figured that if we can make health care more affordable, then the people who cannot afford it may be entitled to adequate health services.

Chances are, if you cannot afford healthcare as of now (and there are affordable health care plans in this country for everyone) then chances are, you won’t be able to afford it later.

This week’s topic: How do you pay for health care, and what does it get you?

Glad you asked. Lets talk about the 4 major ways of paying for health care.

Out of Pocket Payment:

So your little brother breaks his arm during football practice and is taken by your mom to the emergency room at the hospital about 15 minutes away. The orthopedist orders an x-ray and places a cast on the arm. Your mom paid about $900.00 out of pocket.

This form of payment, where the patient directly pays the physician is not a very common practice anymore. However, about a century ago, a barter system was usually used to pay for medical services. Unfortunately, paying for a house call with chickens won’t work anymore. Here’s why:

Some people believe health care is a basic human right, therefore, people who cannot afford to barter (or pay out of pocket) need an alternative to paying for health care.

There’s no constant price for health care. Just like all cars, computers, foods, and musical instruments cost different sums of money, so do different health care procedures. Who knows, chest pain may require a small bottle of aspirin: $3.50, or it could involve an endoscopic evaluation from a doctor: $600.00, or perhaps even open heart surgery, triple bypass: $75,000.00, followed by a two week hospital stay with multiple surgeries and endoscopic treatment: $250,000.00 (aspirin IV not included). This example represents the unpredictability of need and cost as well as the importance to rely on a patient’s need to rely on a physician’s recommendation. No one knows what a symptom may lead to, nor how much it costs. Sorry Farmer Zeke, those potatoes, a pig, and 2 chickens won’t cover this hospital visit.

Individual Private Insurance and Employment Based Private Insurance:
Points two and three encompass most of the American population today and is how many individuals pay for themselves (and their family’s) health care costs. Let’s take a look into how they work.

Individual insurance is financed through a steady (yet sometimes fluctuating) cost called a premium. Premiums are usually paid monthly and are usually a large enough sum of money to make the patient complain. Premiums are paid to a health care plan that will reimburse the health care professional (physician, hospital) for the services done. Cool, sounds reasonable. Read on.

The unfortunate side of this story is that sometimes, a $300.00/month Premium wont cover Little Johnny’s bone marrow transplant, especially since his family cannot afford the wider coverage and had to take out a several-thousand dollar deductible on their plan (this means that Little Johnny’s family will have to pay a large amount of the hospital bill out of pocket). If Little Johnny lives to see college after his procedure, he probably won’t be able to afford it anyway. Sad times.

In employment based insurance, works the same way as individual insurance. The main difference is that the employer will pay a premium to cover his workers and the workers will pay a small premium to pay for coverage as well. Everything after that works just about the same as individual health insurance. Again, thats nice. Read on.

A retired employee at age 70 used to pay a premium of about $25.00/month (paid by the employer). When he retired, he was shocked to find out that his premium for 70 year old retired men was raised to $100.00/month. This worker denied insurance because he could not afford it. What happens if he becomes ill? Is 70 old enough to pass away?

Finally, the fourth mechanism of paying for health care in this country is:

Government Financed Insurance:

This form of insurance (Medicare, Medicaid) was enacted by the government to cover two large demographics in America since the 1950s: The poor, and the elderly. The poor usually held jobs that did not offer a health care benefit, or were unemployed. And the elderly were unemployed due to retirement and could not afford individual health care services premiums without a steady income. What to do?

Medicare is broken up into two parts: Part A and Part B.

Part A: People over the age of 65 and collect social security are able to utilize medicare’s benefits. In fact, once you turn 65, you’re automatically enrolled in Medicare, retired or not, so long as you’ve been paying into social security for 10 years (minimum). If not, then you have to pay a monthly premium. 
People under 65 who are totally and permanently disabled can utilize medicare after 24 months of social security benefits. People requiring important medical procedures (dialysis, transplants) can be admitted to Part A without a 2-year wait.

It’s financed by Social Security, and everyone pays that special percentage out of their paycheck to cover it. You all know the one.

Services included are hospitalization, skilled nursing facilities, home health care, and hospice care. Nursing homes are covered but medicare pays nothing. Sorry!

Medicare pays “X” amount of dollars depending on how long the patient utilizes the benefit. The longer the stay at the hospital, the less Medicare pays. Sorry!!

Medicare Part B works with all the benefits of Part A, but has better coverage as a monthly premium of about 70 dollars paid by the patient (in addition to taxes and Social Security).

Part B will cover all medically necessary services, some preventative care (vaccines and scans) and will not cover outpatient medications and dental work, eye exams, and hearing tests.

Well, that was a mouth full! I think that when it comes down to it, even with the attempt of the nation to lower health care costs, people, somewhere, will never be able to afford health care to take care of their ailments. Chances are, the insurance they pay for will cover most of their needs, but as their luck will have it, they will contract a disease or medical problem that their insurance just wont cover.

When looking from an ethical standpoint, one must ask: Can anyone put a price on a human life? Do insurance companies reserve the right to declare which tumors are more deadly than others, or which fractures they’ll pay for? I wonder if Grandma and Grandpa will live long enough to see their grand children get married? If not, then, well…I hope they have good life insurance!

Be concerned. Speak out. I’m anxious to hear your comments.

This is fredbertino, who saw Liquid Tension Experiment’s 10th Year Anniversary Concert and shook hands with John Petrucci, Mike Portnoy, and Jordan Rudess yesterday, signing out.

Information provided by: Understanding Health Policy: A Clinical Approach, Fourth Edition by Bodenheimer and Grumbach (C) 2005 McGraw Hill Companies, Inc. 

The Health Care Headache: Japan’s Thinning The Waistline…Of The Entire Nation?!

Konichiwa! Now I know I said I’d speak more on the American health care system first, but this New York Times Article was too good to pass up. So, to begin my dissertation on “The Health care Headache,” I’ll start with the Japanese system and how this “mass weight loss” initiative so keenly integrates itself into the “Health care System of the Rising Sun.”

So lets pretend: Akira Nomoura works for the Nintendo Corporation in Japan, and like the other employees, he’s enrolled in his company’s insurance plan. Now, this plan is not like American insurance companies, no, no. This insurance plan is operated directly by the Nintendo corporation, and each month, about 4.0% of Akira’s salary is paid directly into the insurance plan. Nintendo will make an additional payment of about 5.0% of Akira’s salary into the company’s own plan.

Cool, a system where the companies pay into insurance programs operated by the companies themselves and does better than match the percentage of the salary the employee pays into the respective insurance plan…

…But wait, what about retired people and the unemployed?

Well, in this system, it looks as if unemployed people cannot qualify for health insurance, which is not necessarily a bad thing, considering employment is necessary for a grandeur of other things besides health care (car payments, food, water, rent, etc…)

But the retired are not left out of the equation. Hakura, a retired worker from the Nintendo corporation. Rather than paying into the Nintendo plan (which is only eligible for working employees), Her insurance has been switched to a “citizen’s insurance plan” run by the municipal government in Yokohama, where she decided to retire. Nintendo, however, does care about their dedicated, retired employees and will make payments into the municipal citizen’s insurance plan in Yokohama for Hakura. Hakura is expected, though, to pay an insurance premium to the municipal government’s plan indexed to her salary when she was working for Nintendo.

Interesting. Companies continue to pay into local government run insurance companies for their retired employees. But wait, not everyone can work for a major corporation like Nintendo, what about small business employees?

Good question. Taro works in a flower shop in Osaka that is privately owned. The flower shop does not operate their own insurance plan, but Taro (and the other employees/employer) at the flower shop are covered under the Japanese national government’s operated insurance plan. Taro will pay about 4.5% of his salary into the plan, and his employer will match it. All payments go to the Japanese National Plan.

Japan’s system is rooted in a “mandatory employment based insurance plan” and has been since 1922. Companies with 700 employees or more are required to operate their own insurance plans.

Lets outline the Japanese plan:

Workers in Large Firms -payroll tax-> Society managed insurance plan – Subsidies for retirees-> Citizen’s Health insurance plan.

Workers in Small Firms-payroll tax-> Government managed insurance plan -subsidies for retirees-> Citizen’s health insurance plan.

General Tax Subsidies -> Government managed insurance plan [small firms]-> [see small firms flow]

General Tax Subsidies -> Citizen’s health insurance plan [for retirees and self-employed]

Self Employed and Retirees -income-based premiums-> Citizen’s Health Insurance plan.

So we have covered…well, coverage. But what happens when something medical goes wrong? Well, fortunately (by the way it’s set up) this system places no restrictions on the 1) choice of hospital one goes to. 2) physician one sees. There are 3 general types of health care institutions in Japan: 1) small clinics, staffed by a physician and other employees dealing mostly with outpatient procedures, yet stocked with 1 or 2 inpatient rooms. 2) small hospitals owned by a physician and staffed by a physician staff (inpatient and outpatient). And 3) large hospitals, public and private, equipped with specialty staff and inpatient and outpatient departments. The hospitals and clinics are run, and operated by medical personnel as in…[gasp]… The physicians themselves! The patients are supplied with any and all care that they may need, so long as their paying their plan premiums that their companies (or government[s]) establish.

Physicians are paid by a fee-for-service system regulated by the government. The government also regulates the prices of medications. In Japan, there are no prescriptions. Physicians can distribute medications directly to their patients upon visit. The average patient count a physician has on a daily basis is about 66. 

Now, to the New York Times article: Japan is “tightening the belt” on the nation, not allowing men between the ages of 40 and 74 to exceed a waist size of 33.5 inches, and women 35.4 inches (as established as a guideline for Japan back in 2005 for diabetes and other health risks).

During physicals, physicians are required to measure the waists of its citizens within this age bracket and if they fail “national” inspection, are required to take health classes for 3 months time to encourage weight loss. Dieting guidance and restriction will take effect if the problem is not corrected within this 3 month time.

If you read the article in full, you’ll also learn that some physicians in Japan disagree with the nation’s policy to “shrink” the nation, in that “Japan has no need to lose weight.” Tell that to Mr. Nogiri, “the flower shop owner with a flat stomach and barely discernible love handles”, who clocked in at 33.6 inches. 0.1 inches over the National limit. I never thought I’d see the day…Mr. Nogiri: Illegally Obese.

What do you think about the Japanese Health Care system? Do you think America could benefit from such a program? Why or Why not? And how about this National initiative to “shrink” the national waist line? Is it a positive initiative? or is the Japanese government being too harsh with their waist line restrictions?

Let me know what you think. This is your health care future! If you don’t have opinions yet, find some!!

fredbertino, getting his wisdom teeth extracted tomorrow, signing out. Sayonara!

Research provided by: Understanding Health Policy: A Clinical Approach by Thomas S. Bodenheimer and Kevin Grumbach. (c) 2005

The Health Care Headache: What About Us Doctors?

There have been many health care ideas and policies thrown around since about the middle of the 20th century, yet through all the debating and discussion, it seems that most of the nations of the world have chosen to go about medical regulation in their own way. I think a microcosm of the different health care possibilities has been shown recently through the initial candidate debates, namely the first few on CNN, hosted by Youtube. But then again, most politicians don’t hold their M.D. degree, so holding them as experts on healthcare policy may not be the safest way to ensure you and your loved ones will be entitled to (or can afford) good health care.

I’m no expert on healthcare policy either, but what I can (and will) do within my next few posts is outline how the American healthcare system is run and operated today from a very objective viewpoint. I’ll also outline the healthcare systems of a few nations and run a little compare and contrast between ours and theirs. Finally, I’ll take into account of what our candidates have to say about the issue, and I’d like to see you, the populous, decide and speak about your healthcare concerns. It’s a policy unique to every citizen’s quality of life, and, well, life in general!

Be concerned. Speak out.

From Schenectady [and not an SJU student], fredbertino out.