Comments on: For the People: A Mercy Killing.

By: Jamie Lipari

Jamie Lipari — Wed, 08 Sep 2010 03:19:55 +0000

At South Coast Recovery, we pride ourselves on making this complicated time time as comforting as imaginable.

By: Lilia Sole

Lilia Sole — Wed, 08 Sep 2010 03:17:14 +0000

Recovery is a difficult and challenging commitment.

By: bigT

bigT — Wed, 23 Dec 2009 03:41:05 +0000

Jake,

Good article and good points. This bill is not perfect and it does not contain every provision we would all like in reform (public option). However, I am of the mind that we must not, and cannot, lose the progress we’ve made so far with the legislation that is going to pass the Senate side. The big winner after the final legislation is passed will be the American people.

Here are a few things this bill will accomplish These are important reforms that people need now:

– Extend coverage to 31 million Americans, the largest expansion of coverage since the creation of Medicare.

– Ensure that you can choose your own doctor.

– Finally stop insurance companies from denying coverage due to a pre-existing condition.

– Make sure you will never be charged exorbitant premiums on the basis of your age, health, or gender.

– Guarantee you will never lose your coverage just because you get sick or injured.

– Protect you from outrageous out-of-pocket expenditures by establishing lifetime and annual limits.

– Allow young people to stay on their parents’ coverage until they’re 26 years old.

– Create health insurance exchanges, or “one-stop shops” for individuals purchasing insurance, where insurance companies are forced to compete for new customers.

– Lower premiums for families, according to the non-partisan Congressional Budget Office — especially for struggling folks who will receive subsidies.

– Help small businesses provide health care coverage to their employees with tax credits and by allowing them to purchase coverage through the exchanges.

– Improve and strengthen Medicare by eliminating waste and fraud (without cutting basic benefits), beginning to close the Medicare Part D donut hole, and extending the life of the Medicare trust fund.

– Create jobs by reining in costs — fostering competition, reducing waste and inefficiency, and starting to reward doctors and hospitals for quality, not quantity, of care.

– Cut the deficit by over $130 billion in the next 10 years.

It’s a long list. But that’s only because this bill represents the most significant health reform our nation has seen since the creation of Medicare.

I also believe, that when the House and Senate versions are conferenced together, we will have a bill that will begin to improve the lives of countless Americans without health insurance.

Lastly, as with many other pieces of legislation, this will represeant a start. A great start, from which additional reforms and changes can be enacted moving forward. Remember that the original Medicare bill passed in the 60s is not the same one we have today. It’s been worked on and improved upon since. I think that is the nature of our democracy.

By: xavier

xavier — Tue, 22 Dec 2009 10:42:44 +0000

Jake, your writing on the issue has been a compass for me before. I wish we could pull the plug on this whole concoction Congress has Frankensteined for us. I feel it started out with good intentions during the Presidential campaigns, and then became a matter of political survival for the President and the Democratic leadership. Most tellingly, I think it’s the ultimate example of how America has not gotten the “change” that was promised by Obama because the way they’ve gotten to the point that they’re at in this so-called “reform” is no different from past legislative processes. It is how our legislative system is structured. Those with power and money control it. And it’s frankly scary what they are about to ram down all of our throats, a bitter pill with God knows what negative side effects in the name of better health as defined by the insurance companies and greedy legislators looking to keep their seats by bringing home the pork.

By: Big Tex

Big Tex — Tue, 22 Dec 2009 05:00:34 +0000

Great column Jake! Very insightful, I believe I was in the same boat you were in at the beginning of this circus, now it seems as if they’ve stretched this thing so far it seems nothing to what President Obama wanted for our Nation. I have full faith in the President, but I have to ask where his leadership has been in all this? I expected him to have a stronger voice with these Legislators and push for all the changes needed for a good health bill. It is sad to think what kind of cheap piece of legislation will be left for our children to bear.

By: John Silver

John Silver — Tue, 22 Dec 2009 03:58:47 +0000

We can indeed create a healthcare system that works! It will take some innovative thinking, some compromises, and some determination, but unfortunately, these skills are completely absent in this health care debate. First, we have to recognize that the free market system does NOT work in healthcare, and that, on multiple levels, the current “system” is on the verge of collapse. Second, we need to realize that the biggest bang for our collective buck will come from restructuring the delivery system. Third, we have to stop calling whatever it is that Congress is doing now healthcare reform.
Philosophically, we have to answer three primary questions that will require a sustained public debate.1) Is healthcare a right or a privilege? As it stands now, it’s a privilege until it becomes life threatening. 2) Do we want a healthcare system that chases the last red corpuscle around, or do we want a system that truly empowers the quality of life as much as mere existence. 3) Are we, as a public, passive recipients of healthcare, or are we active participants in demanding healthy environments and striving for healthy lives?
Structural changes must deal with four main areas, access, the practice of medicine, secondary and tertiary system administration, and financing. By opening the front doors of access, we can entrain more people into the system. I have yet to understand the obstinate refusal on the part of the State Medical Associations in allowing ARNP’s to practice independently with prescriptive authority. The studies are OVERWHELMING in support of this, 42 States have allowed independent practice, 10 full prescriptive authority, and not one of these states have suffered ill consequences. Given the growing shortage of primary care physicians, this selfish and paternalistic position is completely illogical. The key to long term health is getting more and more people (especially women) into the healthcare process. Women are the key determinants of the health status and relationship of the family to the health care system. Nurse practitioners are well grounded in providing health care and health education to underserved populations, especially women, often with innovative and out-of-the-box- solutions.
The practice of medicine has to be changed. We need to create a community based primary care provider system which is rewarded for keeping patients out of the high cost medical centers, and a medical center physician/provider core which is NOT rewarded for keeping people IN the hospital. We should do away with payments for providers in the secondary and tertiary systems and make them employees, working regular shifts and providing care/interventions/diagnostics around the clock. Trying to force an around-the-clock care system into a 9-5 business model is inefficient and wasteful. Malpractice rates can be adjusted based on the performance of the entire medical staff, thus creating an empowered peer review process which would demand excellence.
We need also to look at how the healthcare system is administered. If we want to create true community based healthcare systems, then we need to restructure that system. Each secondary/tertiary hospital would be assigned a geographic area, and then made accountable for the delivery of services. Nursing homes, rehab facilities, and even home health services would fall under the control of the community system, doing away with the compartmentalized for-profit entities. Thus, significant corporate/administrative savings would be evident as well as retention of profits into the not-for-profit community system. No more stockholders, no more corporate overhead, no more wasteful bribery to physicians for services. I believe this system should be put under the control of nursing in order to balance out the ethical forces. Yes, CFO’s would still be needed for financial direction, but we could focus on services with both long term and short term benefits. It would amount to a social contract with nursing, and we could then hold nursing accountable for the results.
The financing of this system is also important. Physicians deserve to get paid for services, no one argues that. They also need protection from exorbitant malpractice and/or pity awards. The community system will need stand-by revenues as well as operational reimbursement. We can do all this with the revenue we have, since we currently spend between 30 and 40% in administrative fees and around 25% in the last two weeks of life. An actualized healthcare system can begin to significantly reduce this. In terms of taxes, we now tax cigarettes (#2 cause of morbidity) and alcohol (#3 cause of morbidity) but not the #1 cause, junk and fatty foods. This tax alone would generate enough revenue to fund Medicaid in every State and have enough left over to activate a true public health force. Vital systems within the health care system should not be paying for utilities or utility system service. Consider this the public contribution, since we will in all possibility be able to eliminate all or at least a significant portion of the county and state homeowners tax in those districts currently paying for health care!
Now we have to ask ourselves if we have the legal/social power to do all this? YES. In 1935, Congress enacted the PUHCA (Public Utility Holding Corporation Act) legislation, essentially taking over the access, distribution, and cost of (primarily) electricity. This is the model we have to look at. After all, health care and health education serve us all in the long run. We can do all this, but it will require talking to each other, compromise, and the generation of political will. Let’s talk!