Category Archives: Health care

Health care’s PROBLEM: Americans’ health

Education, Health care, State government

By Steve Brawner
© 2014 by Steve Brawner Communications

Arkansas legislators are preparing to meet in special session for the second time in less than a year to discuss rising school employee health insurance rates. It’s a difficult issue, but it’s a “lowercase p problem.” The “capital P Problems” are beyond what state legislators can address by themselves.

Let’s start with the “lowercase p problem.” The cost of health insurance for school employees is rising faster than the system or many employees can afford.

In a special session last October, legislators poured $43 million in one-time money into the system and added another $36 million annually from other sources as a quick fix. They also appointed a task force chaired by Sen. Jim Hendren, R-Gravette, to craft long-term solutions.

That task force has proposed two bills for legislators to discuss for now, with more on the way sometime in the future. One would, among other changes, exclude spouses of school and state employees from coverage if they can obtain it elsewhere, as is common in the private sector. The other would exclude part-time school and state employees who work less than 30 hours. That would involve a lot of school bus drivers and cafeteria workers, and it’s more controversial, even though the practice of excluding part-timers is also common in the private sector.

Legislators will be called into special session in the next few weeks if they can arrive at consensus on at least one of the bills beforehand. Other important changes can be made administratively, such as changing the way the school employees’ super-cheap bronze plan and expensive-but-generous gold plan are structured.

Health care has become the dominant issue in the state Legislature, just as it is the most contentious one in Washington. The past two legislative sessions have centered around the debate over the state’s “private option,” which uses Obamacare dollars to buy private insurance for 150,000 Arkansans who beforehand were not quite poor enough to qualify for Medicaid. As a result of this year’s primary and runoff elections, there will be two less senators supporting it. During this past fiscal session, it passed with no Senate votes to spare.

What to do about the private option is a big concern, but it’s not one of the “capital P Problems.”

One of those is the health care system itself, over which state legislators can have only limited influence. America’s health care system, pre- and post-Obamacare, is far too expensive and doesn’t allocate its resources effectively. In many cases, it doesn’t make us healthier, and in quite a few cases, it actively makes us sicker and even kills us.

That’s a Problem. But there’s a bigger one – one that deserves not only a capital P but instead all-caps. The PROBLEM is this: America is not a healthy place, and Americans are not healthy people. Sixty-nine percent of us age 20 and above are overweight, and 35.1 percent are obese, according to the Centers for Disease Control and Prevention. Eighteen percent of children ages 6-11 are obese. More than 18 percent of adults smoke cigarettes despite all the efforts that have been made to encourage them never to start. According to the National Institute on Drug Abuse, 9.2 percent of Americans age 12 and above in 2012 had used an illegal drug (including marijuana) or abused a psychotherapeutic medication during the past month.

The health care system does little to discourage these realities, but it is not the principal cause. Unhealthy daily habits and lifestyle choices are woven into the fabric of American life, and it’s not just what we eat, drink and smoke. Our lifestyles are both sedentary and stressful. We’re rushed much of the time, but from a seated position. Our lives are marked by excess in many areas and deficiencies in others, such as sleep, joyful time with family, and meaningful community activities. Most of us know we’re not living right just by looking in the mirror.

Health care systems can be engineered to encourage healthier behavior, but no system can free us from the consequences of our own choices. Our health care is unaffordable because our health is unaffordable. Ultimately, we are the problem with health care, and the solution must begin with us.

“Medicare!” vs. “Obamacare!”

Debt and deficits, Elections, Health care, Politics, U.S. Congress

Medicare vs. Obamacare. That’s what this year’s Senate race between Sen. Mark Pryor and Rep. Tom Cotton is about.

Cotton’s campaign points to Pryor being the necessary vote to pass Obamacare, and Pryor’s points to Cotton’s Medicare votes that would raise the eligibility age for future beneficiaries and create a voucher-like system where seniors would buy insurance using government subsidies.

Last week, Pryor received the endorsement of the National Committee to Protect Social Security and Medicare. He stood before seniors who held hand-lettered signs, talked about how he voted to increase benefits, and said that House members who had voted to change Medicare were irresponsible.

Vouchers are a bad idea, but Medicare really does face serious, long-term challenges. It’s 14 percent of the federal budget, and Social Security is 24 percent. The costs of those two programs are part of the reason the Congressional Budget Office projects we’ll add another $541 billion this year to our $17.6 trillion national debt. The challenges will increase as the baby boomers age and as Americans live longer.

Call it a “cut” if you want, but somehow Medicare will have to spend less than it’s projected to spend – for its sake and for the rest of the budget’s. When I asked Sen. Pryor at his press conference what changes he would support, he said reform is needed and listed a few ideas such as allowing the program to negotiate drug prices and emphasizing preventive care. When I followed up by asserting those wouldn’t be enough, he didn’t disagree, saying, “The only way we’re going to get Medicare fixed is to do this in a bipartisan way.”

That’s true. But campaigns create the environment in which officials govern after the election. When candidates win by assuring voters that actual problems aren’t really problems, it weakens the ability of Congress to create those difficult bipartisan fixes later.

Republicans have used Obamacare – and President Obama himself – to gain a 5-1 majority in the Arkansas congressional delegation and majorities in the state Legislature. The message has been simple: Obamacare is bad.

But that message ignores the health care system’s serious problems. It hasn’t insured millions of people. Before Obamacare, it cold-heartedly denied insurance to those with pre-existing conditions and stopped covering them if they cost too much money. It’s 18 percent of our gross domestic product, far more than the rest of the industrialized world. A big reason Medicare has challenges is because it’s paying to treat seniors within this system.

Republicans, including Cotton, have focused far too much on what’s wrong with Obamacare and not enough on their own ideas. “Obamcare is bad” is not a health care policy.

Cotton’s Medicare votes are becoming a bigger political problem than Pryor’s support of Obamacare, as reflected by recent polls showing Pryor in the lead. By now, everyone who’s paying attention knows that Pryor voted for Obamacare, but they’re just now learning about Cotton and Medicare.

We’ve also reached the point where the news about Obamacare is not all bad. Yes, the employer mandates have been delayed, the website rollout was a disaster, and Obama never should have said that people who liked their plans could keep them. But the latest news, that eight million people have enrolled in insurance plans, gives Democrats the ammunition they’ve needed to return fire on the issue.

In an ideal democracy, the candidates would engage in an honest debate about Medicare’s long-term sustainability and about how to fix a health care system that was broken before Obamacare and still is. That debate, mirrored across the country, would continue in a statesmanlike fashion in Congress after the election, resulting in better policies.

Instead, the candidates will shout past each other – one saying “Medicare!” and the other “Obamacare!” – until November. It’s not an ideal democracy, but it’s the one we have.

U.S. can’t afford not to invest in Alzheimer’s research

Debt and deficits, Health care

Advocates for the Alzheimer’s Association made a push in Congress this week for more funding for research. They based their argument on the costs of Alzheimer’s. This disease, which causes so much pain for patients and their families, also threatens the nation’s financial health.

According to the association, the total health care cost of caring for individuals with Alzheimer’s will be $214 billion this year, with Medicare and Medicaid paying $150 billion of that. Almost 20 percent of everything the federal government spends on Medicare is spent caring for patients with Alzheimer’s and other forms of dementia.

As the baby boomers age and as costs of care increase, the numbers become truly scary. By the middle of this century, overall annual medical costs for Alzheimer’s and other dementias are projected to rise to $1.2 trillion.

More than five million Americans now have Alzheimer’s – 200,000 of them under the age of 65. It is the country’s sixth leading cause of death. About 52,000 Arkansans have it – 8,000 of them between the ages of 65-74, according to the Alzheimer’s Association.

Progress has been made in recent years with other diseases – most notably AIDS, which was a certain death sentence a couple of decades ago until it became a national priority. Between 2000 and 2010, deaths attributed to HIV fell 42 percent. They also fell for stroke, heart disease, prostate cancer and breast cancer.

But deaths attributed to Alzheimer’s increased 68 percent over that same time period. While five approved drugs will treat the symptoms for 6-12 months in half the patients, there’s no cure, no long-term effective treatment, and no means of prevention.

Congress did increase funding for research by $100 million this year, which was a good start. However, for every $1 that the National Institutes of Health now spends on Alzheimer’s research, Medicare and Medicaid spend $265 on patient care, and it’s often not the kind of care that prolongs productivity or enhances quality of life. We’re warehousing a lot of people.

The Alzheimer’s Association says that, if the onset of Alzheimer’s could be delayed five years, the national costs of care would be cut by half. It’s asking for another $200 million for research, which is a significant increase in this kind of budgetary environment. On the other hand, it’s less than the cost of two of the Pentagon’s proposed 2,400 new F-35 Joint Strike Fighter planes – a weapons system that, as “60 Minutes” recently reported, is $163 billion over budget and seven years behind schedule.

Alzheimer’s is a clear and present danger. If we’re truly worried about America’s future, couldn’t we get by on 2,398 planes and use the savings from the other two to fund Alzheimer’s research? If not, I’m betting we can find $200 million somewhere in the federal budget.

None of this, of course, is taking into account the human toll Alzheimer’s takes on individuals and their families. Alzheimer’s is a particularly villainous disease. It robs individuals of their golden years, when they still have work to do and wisdom to offer. The mental decline can be rapid, but the physical death can stretch into decades. For loved ones, the long goodbye can be an almost unbearable mix of exhaustion, distraction, grief and guilt.

When Japan bombed Pearl Harbor, Americans mobilized for action. The same occurred when the Russians beat us into space.

Alzheimer’s is that kind of threat. Discovering a cure would be a gift to the world. Find the $200 million.

Health care finally goes digital

Health care

Arkansas’ health care system, and the rest of the country’s, is finally adopting the same communications technology that the rest of the economy adopted two decades ago.

Eventually, that will mean no more handwritten prescriptions or paper files. The same information that your doctor has about you will be available to your cardiologist.

The transition has not been easy. The transition will disrupt practices that are already busy serving patients. Some older doctors do not want to change. Parts of Arkansas are still on dialup. Plus, there are privacy concerns.

Across America, physicians are eligible for up to $64,000 in federal funds to ease the transition, while hospitals can get up to $2 million. It’s a fraction of the cost, but that’s still taxpayer money going to doctors to do something the rest of us did on our own.

There’s more at my column this week for the Arkansas News Bureau.