Forum on Health Care
Progressive Democrats of America
Forum on Health Care
August 28, 2008.
The Otero County chapter of Progressive Democrats of America hosted a panel discussion on health care. Panel members were State Representative Nate Cote (NM District 53), Gail Watters, Pharmacist, Hal Sims, Pharmacist, and Dr. Jagdev Singh, Physician and Surgeon, presented a comprehensive survey of the health care problems we are facing in Otero County, New Mexico to an interested audience of local citizens. Al Kissling of PDA NM Congressional District-2 was the moderator.
Representative Cote began by describing the problems encountered in the last regular legislative session: Governor Richardson has backed off of his proposal of universal health care for all New Mexicans. He has extended Medicare to include children up to and including age 18. “The problem is that everybody has his own idea of how a health care should be organized. How do you construct a health care plan that will cover everyone?” Cote sees the main obstruction to universal health care as those interests that want health care to be a profit making endeavor for the insurance industry. Another problem is that too few members of the state house and senate have knowledge of the health care industry and many are waiting for the health insurance companies to “fix” themselves.
Gail Watters stated that her observations as a pharmacist is that Medicare Part D was not explained very well to the consumer and information from the government has been confusing. Seniors generally do not understand how it works. The “donut hole” in most Part D plans is a big problem for those on fixed incomes. Drug commercials in the media are misleading and are prompting potential customers to make hurried decisions when they sign-up. Calling Medicare for approval for prescriptions involves long waits for the pharmacists.
The system works well for those individuals who are employed and are privately insured through their employer. Mrs. Watters explained that pharmacists experience more paper work with the insurance companies. They all have different forms and co-payments. Customers get angry with pharmacists when proscribed drugs are not covered by the insurance companies. Pharmacists must make time consuming phone calls to doctors for new instructions. Pharmacists are an easy target for the shortcomings of the insurance companies. Change is made difficult because there are so many industries (advertising, media, insurance, lawyers) feeding off the medical industry. Nate Cote added that any drug proposal that benefits the consumer is doomed from the start.
Hal Sims reminded the audience that “insurance companies and HMOs have promised to keep expenses low while offering quality care and have done neither. They have lied to the American people.” Third party payers, called Pharmacy Benefit Managers (PBMs), have worked their way into the system. PBMs negotiate contracts with employers for drug benefits, then negotiate a different contract with the pharmacist and pocket the difference. They then take the pharmacist’s customer base and try to turn them over to a mail order pharmacy, owned by the PBM. Instead of picking the lowest priced drug, they choose the drug that brings the highest profit for them. They are playing a middleman role and are increasing drug costs by 25 percent. “These people are not in the health care business, they are in the extortion business and they need to be taken out of the system.” Overall, eighty percent of the total costs of drugs are from the manufacture, and nobody touches them.
Dr. Singh gave the physicians perspective: On costs, “we pay more per capita than anyone else in the World and our results, in the developed world, are among the bottom.” This means we have a very inefficient system. We perform more procedures and have more diagnostic testing than any other country per capita. The reason is the inefficiency of the system and the way we are reimbursed. Physicians are reimbursed more for performing procedures than for their intellectual effort. This was discussed at length in a Harvard study some years ago. The government was informed of the findings and they replied that they thought physicians were over reimbursed and people doing procedures are being overpaid. They decreased the pay for the surgeons, but did not increase pay for those using their intellect and everybody lost.
There is also the simple fact that you cannot go backwards. It has become a standard in the developed world that some form of health care be made available to everybody. Another alarming fact is that 60-70 percent of the total money spent on an individual’s health care is in the last year of this person’s life. There is something wrong with this. I don’t think that we should use all our resources to keep everybody alive who is dying. There needs to be a global containment of the total cost. The decision about what should be covered in any particular year should be based on fiscal considerations and how much money would be available for that year. It should be decided upon by responsible parties which should consist of physicians who have been trained to take care of sick people and have insight into what is possible. It should not be decided by politicians or attorneys.
Another problem with our system is medical malpractice. One half of all expenses are for unnecessary tests and procedures to prevent malpractice suits. One solution to this would be no-fault insurance laws where you could only sue your own insurance company and limit malpractice suits to intentional malfeasance. Punitive fines for malfeasant or deliberate criminal behavior should go to the state and not to the lawyers
One solution to the health care insurance problems we are having would be to put everyone in the country on Medicare. Medicare should stress and support preventative care. Medicare has 43 years of relative success—better than anything else on the market. Supplemental insurance could be offered by insurance companies for individuals who want or need more coverage. There is no way to provide equal care throughout the country under our form of government. We are a capitalist society and we have a two-tiered system. We have one tier for those for people who don’t want to wait in line and one tier for those who have to wait in line. – Ken Nicholson, PDA Otero County