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Health Care Legislation: It's A Debate

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“”I am always uneasy when I start on something I cannot at least faintly see the end of the road.”

This is a quote from a letter dated December 27, 1954, written by then President Dwight D. Eisenhower to Oveta Culp Hobby, Secretary of Health, Education and Welfare about his Health care budget.

The Dwight D. Eisenhower Presidential Library sponsored a forum on a historical, yet current subject on Wednesday, November 4th in Abilene, Kansas. My husband and I were two of approximately 30 people in attendance.

The Eisenhower Presidential Library Auditorium is an impressive, well run venue in this small town. We were seated around large round tables. The meeting lasted approximately two hours. Erika Imbody of the Kansas State University Institute for Civic Discourse and Democracy began by setting discussion ground rules aimed at promoting better citizen dialogue on tough issues. No party affiliations were disclosed. The central issue presented for discussion was, "How can we get the health care we require in the face of rising costs?"

At first glance, the three topics, "Reduce the Threat of Financial Ruin, Restrain Out-of-Control Costs and Provide Coverage as a Right" might sound leading in content. However, we were asked to look carefully at three subtopics, "What Should Be Done, Arguments in Favor, Trade-Offs. Finally, it asked for "Opposing Voices" for discussion.

Agreement that financial ruin by a major health problem is a worry for Americans of all ages. Solutions for discussion at our table included the requirement of all to have a form of health-care coverage, requiring employers to provide health insurance coverage which could hurt small businesses, and bigger pools to spread out costs, (small group pools is a major concern for rural areas). Trade offs include affordable plans with higher deductibles discourage routine health care which inturn create major health problems.

Restraining out of control costs included a discussion of greater government control in this area. A retired health care employee added health care procedures are expensive. High drug costs in place to cover required research with the trade-off of no new drugs was a focal point. Again, the rural aspect of the availability of expensive procedures those of us in more populated areas take for granted. There is agreement that attention needs to be placed on the cost of health care with further discussion who would conduct the oversight.

Finally, providing coverage as a right. Agreement on the fact that no one should be denied coverage because of preexisting conditions or loss of income. Agreement that in America, we cannot deny insurance to someone who chooses to live an unhealthy lifestyle. Question of exactly how many do not have coverage and if those with current coverage would abandon policies for a less expensive government type policy. This discussion led to financing of a government health plan, higher taxes and who should pay.

As a final conclusion Ms. Imbody asked for an open discussion which revealed all tables discussed similar issues and all ages were in agreement with concerns about the future. Also, everyone agrees it is an extremely complex matter.

The only time currently health care legislation was mentioned is as we leave. Here is the list of names and email addresses of legislators if we want to voice our opinion.

PRESIDENT OF THE UNITED STATES Barack Obama The White House 1600 Pennsylvania Avenue Washington, DC 20500 202.456.111 – comments 202.456.1414 – switchboard 202.456.2461 – fax

The U.S. Department of Health and Human Services Secretary Kathleen Sebelius 200 Independence Avenue, S.W. Washington, D.C. 20201 1.877.696.6775

US SENATE United States Senator Sam Brownback 612 S. Kansas Ave. Topeka, KS 66603 785.233.2503 - Topeka 202.228.1265 - Washington DC 316.264.8066 - Wichita 913.492.6378 - Overland Park 620.231.6040 - Pittsburg 620.275.1124 - Garden City 202.228.1265 – Washington DC Fax http://brownback.senate.gov

United States Senator Pat Roberts 444 SE Quincy Ave., Rm. 392 Topeka, KS 66683 785.295.2745 - Topeka 202.224.4774 - Washington DC 316.263.0416 - Wichita 913.451.9343 - Overland Park 620.227.2244 - Dodge City 202.224.3514 – Washington DC Fax http://roberts.senate.gov

US CONGRESS Congressman Jerry Moran - 1st District 1200 Main St., Suite 402 PO Box 249 Hays, KS 67601 785.628.6401 - Hays 202.225.2715 - Washington DC 620.665.6138 - Hutchinson 202.225.5124 – Washington, DC Fax www.jerrymoran.house.gov

Congresswoman Lynn Jenkins - 2nd District 3550 SW 5th Street Topeka, KS 66601 202.225.6601 - Washington DC  785.234.LYNN (5966) – Topeka 620.231.LYNN (5966) – Pittsburg 202.225.7986 – Washington DC Fax http://lynnjenkins.house.gov

KANSAS Governor Mark Parkinson Capitol, 300 SW 10th Ave., Ste. 212S Topeka, KS 66612-1590 Voice 1.877.KSWORKS (1.877.579.6757) Local 785.296.3232 For the Hearing Impaired 1.800.766.3777 www.governor.ks.gov/contact

Lt. Governor Troy Findley State Capitol, 2nd Floor 300 SW 10th Ave. Topeka, KS 66612 Toll-Free 1-800-748-4408 Local 785.296.2213 Fax 785.296.5669 For the Hearing Impaired 1.800-766.3777 Lt.Governor@ks.gov

INSURANCE COMMISSIONER Sandy Praeger 420 SW 9th Street Topeka, KS 66612 785.296.3071 1.800.432.2484 (in Kansas only) commissioner@ksinsurance.org

Comments

notajayhawk 4 years, 5 months ago

Um - yep.

As I said, the problem isn't who pays for it, it's unaffordable no matter how we pay for it.

The current House bill is a monstrosity. There were ways to address the problems with the current system that didn't require 2000 pages of legislation and the government getting into the health insurance business. One of the worst problems with the current 'solution' is that it's so monstrous and complex, when it fails to fix the problem (or makes it worse) we won't even know what part(s) of it are bad.

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Linda Hanney 4 years, 5 months ago

notajayhawk-- good points. Just not sure if what has passed the House is the best answer. Are we throwing money at a system that needs repair but haven't diagnosed the problem yet?

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notajayhawk 4 years, 5 months ago

Part of the problem is that not every hospital needs to provide MRIs, and not every patient needs to have one.

Okay, MRI's may not be the best example of what I'm talking about, but I'm old enough to remember the hospital commission in the state where I grew up denying permission for our local hospital to get a CAT scanner because two nearby hospitals had one. (So a local neurologist bought his own instead - which is fine, if his practice could support it.)

Now it's a commonplace piece of diagnostic equipment, and I suppose it's a good thing they're available everywhere - but that leads to another problem - because every hospital has one, it seems almost every pateint gets scanned. You can't go to the ER with a stomach ache without getting sent down for a CAT scan. And a whole lot of other tests. And if you're back in two days, they repeat them all.

Again, a piece of diagnostic equipment that's become common isn't the best example, and rural hospitals do need to be well equipped. But how about urban areas? In a medium-large city with a dozen hospitals, does each one of them have to have the best trauma unit, the best specialized transplant capabilities, cancer units, etc.? Not only do the services become redundant, resources are diverted to advertising to take one another's patients (how much do you figure KU med pays Tom Skerrit?).

Then there's the over-utilization of specialists. A family member of mine got an animal bite (it's a pet and they knew rabies was not an issue). The ER set her up with antibiotics and an appointment to see an orthopedist 3 days later. The orthopedist told them he was supposed to see if the swelling responded to the antibiotics, and if it didn't he'd have to look at other options (including possible surgery). But it was too early to tell and she had to come back in a week when the antibiotics were finished. Now, why in he did the ER schedule the appointment for before the antibiotics had run their course, and why couldn't the person's family physician - or a nurse, for that matter, check the swelling at that time to see if a referral to the orthopod was warranted? For that matter, why couldn't she have been sent home with discharge instructions that said 'Return in 10 days IF swelling persists?'

A huge portion of our healthcare spending - I read somewhere, I think it was in an article in AARP's magazine, that's it's something like 40% - is for unnecessary testing and procedures. How much would the cost to this country be reduced if THAT was brought under control?

The really obscene part is that insurance - public or private - makes the situation worse, not better. If you're insured, what incentive do you have to shop around and/or work with your provider for cheaper alternatives and to eliminate unnecessary billing? For that matter, do you even KNOW what those procedures cost, beyond your co-pay?

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Linda Hanney 4 years, 5 months ago

notajayhawk--you've made a good point. Yes, high charges for all types of medicine and medical procedures came up in the discussion. There are always the stories of $10 Kleenexes, hidden charges for care, and the cost of malpractice insurance. A point was made that rural hospitals can't always afford to purchase the high cost equipment which in turn causes them to lose business. So, there was talk of pooling resources.

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notajayhawk 4 years, 5 months ago

"Agreement that financial ruin by a major health problem is a worry for Americans of all ages. Solutions for discussion at our table included the requirement of all to have a form of health-care coverage ..."

"Finally, providing coverage as a right. Agreement on the fact that no one should be denied coverage because of preexisting conditions or loss of income. Agreement that in America, we cannot deny insurance to someone who chooses to live an unhealthy lifestyle."

And herein lies the problem with the healthcare debate - nobody talks about anything but health insurance.

Linda, in your discussions, did it occur to anyone that the problem is what healthcare costs, not who pays for it? Sooner or later, we ALL pay for it, out of pocket, through premiums, or in taxes. When an emergency room visit costs more than a new car, when a short hospital stay for minor surgery costs more than a year's income, the problem is not whether or not you have insurance:

IT

COSTS

TOO

MUCH!

Everyone should have access to healthcare, I agree. However, if the service delivery was affordable, then NO ONE would need insurance at all.

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Ronda Miller 4 years, 5 months ago

Thanks for the reply, Linda.

I agree that most Americans are rather clueless when it comes to the issues at hand. How can we not be with that much material to cover? It is terrific that this is being done. I'll have to check my calendar and see if I can make it that evening. Probably late for me after working. I usually get off around 5:30....and would need a shower. I love the facility though and have been through a couple of times with the family. It is time to do it again!

It is a huge issue and I agree we shouldn't push it through too quickly, but having said that I realize people are dying now and they needed it yesterday.

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Linda Hanney 4 years, 5 months ago

Ronda, thank you! The next meeting is November 17, National Issues Forum, "Economic Security," 7:00 p.m., Visitors Center Auditorium. This will be the first of this series which will be presented at Presidential Libraries throughout the United States. The author of materials will be there. It would be a good one to attend.

I came away feeling like I need to know more about the issue and hopeful the Congress men and women are feeling the same way. My feeling is this is too big an issue to push through quickly.

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Ronda Miller 4 years, 5 months ago

WOW, that was some meeting, Linda! I can see why it is taking so long and there are so many pages to go through to resolve this issue.

I think there has to be some ways to slash all the asides though and break on through to the other side. The inherent problem of course being we all want/need/know someone who has to be an exception to one thing - if not several things.

"Agreement that in America, we cannot deny insurance to someone who chooses to live an unhealthy lifestyle." No but we do and should charge them more should we not? :)

When is the next meeting such as this? Did you come away feeling hopeful or exhausted?

Thanks so much for presenting this - well written and interesting.

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