Thursday, September 10, 2009

Getting up to speed on health care reform...

I've been out of the loop for a couple of months - being home with the kids has taken more out of me, mentally and physically, than I expected. School started yesterday and my days are empty again - how can it be that I already I miss the noise, the fighting and the noontime cuddles?

But I've also missed a lot of the health care debate - and it's important for me to get up to speed. Psoriatic Arthritis is a chronic condition... and many of us with PsA are looking at huge medical and drug expenses for the rest of our lives. The decisions being made right now in Washington could deeply influence my health (and many of yours) for the long term.

So, yesterday, at my favorite gluten free cafe, I turned to the conservative writers that every liberal loves to love (Andrew Sullivan and David Brooks). And they both spoke very highly of Atlantic Monthly's cover article, called "How American Healthcare Killed My Father", written by David Goldhill... they both suggested that Obama should read it as he moves forward with health care reform.

So I read it too... and I hope the president reads it. It's long. It's heartbreaking. It's complicated. And it is really good. Goldhill pushes past the current focus on financing health insurance, and digs deep into what is really faulty at many levels with America's health care system, including:
A wasteful insurance system; distorted incentives; a bias toward treatment; moral hazard; hidden costs and a lack of transparency; curbed competition; service to the wrong customer. These are the problems at the foundation of our health-care system, resulting in a slow rot and requiring more and more money just to keep the system from collapsing.
And his solution goes much farther than the solution Obama presented last night - he would like to see more consumer-centered health care system which would:
not rely on a single form of financing for health-care purchases; it would make use of different sorts of financing for different elements of care—with routine care funded largely out of our incomes; major, predictable expenses (including much end-of-life care) funded by savings and credit; and massive, unpredictable expenses funded by insurance.
If you skip to page 6 of this article, you'll find thorough description of his plan for a more consumer driven health care system. It isn't a perfect plan (which he admits) but it is a compelling one. As someone who has huge monthly medical bills, I was first terrified by his plan - what? I'd pay for my Remicade out of my savings? But the more I read, and the more I thought about my year and a half trying tackling treatment for Psoriatic Arthritis, the more his plan made sense. Goldhill calculates that if we took all the money we spend in our lifetimes to pay for health insurance and sock it away, we would have over 1.7 million dollars each, to spend on our own health care. And if we have control over where we spend that money, hospitals and clinics would have to become more competitive (and transparent), raising quality.

Imagine, all of us with Psoriatic Arthritis, with 1.77 million each to spend on our health care. What changes could we make, in the quality of our clinics, our rheumatologists, the drugs we're offered, merely by having more choice? I'm getting all tingly just thinking about it.

Take a look at the article. It's a revolutionary idea, and educational. I liked it.


  1. Jenny, the Humira I take costs $40,000 a year. I should live another 30 years if I match my parents. Without factoring in increases in costs, that one medication alone would cost me $1.2 million dollars going forward. I've already lived 56 years, so a good part of that $1.7 million would already have been gone under that system before I even got PsA - pregnancy and childbirth twice, years of birth control pills, surgeries, hospitalizations, well-care, everyday medications for infections, tests and stuff over many years trying to find out what was wrong with me (the PsA), etc. Plus I'd have already paid $120,000 for the 3 years I've been on Humira. And what about the fact that I may develop diabetes (like my father) or get cancer (like my mother), either of which would require great additional expense?

    I know $1.7 million sounds like a lot of money, but for those of us with autoimmune conditions, it really is NOT enough!!!!

    I see the handwriting on the wall. The governnent cannot support maintaining all of us with RA, PsA, Crohn's, etc. on biological drugs. Therefore, NONE of us will get them. Except those few VERY wealthy souls who can afford to spend millions of their own on treatment. That is the price you and I will pay for providing basic medical care to the uninsured. A lifetime of suffering.

  2. It is scary, isn't it. I've done those numbers sometimes myself, and yes, 1.7 seems like a lot, and then it seems like not so much. BUT, what I wonder is: how much of that price that you and I pay for our healthcare has been inflated by the current insurance system. Does it really have to be $40,000 a year for Humira? If there was more competition in the market (including generic biologics) wouldn't our health care costs go down?

    I think what scares me most is not a new health system, but what happens to those of us with chronic illness DURING the "reformation".

    Thanks for reading! I have had quite a dry spell - I was so glad to see a comment today. We all have to keep thinking and talking and arguing and writing about this stuff, and educating each other (without calling each other liars!!) ;-)

  3. Yes, but things like allowing generic biologics, getting rid of waste in Medicare and Medicaid, etc. - none of these require a drastic overhaul immediately to implement. Why not makes those kinds of moves incrementally and see what happens? We are being asked to exhibit an awful lot of blind faith...

    Why not prove that these kinds of measures can lower costs, since they are so "sure" they will?

  4. I think it's a great idea too. Like the HSA's - when people have control of their healthcare dollars, they shop around more and spend dollars more wisely. HSA's belong to the patient and carry over year to year, you can leave them to survivors when you die. You can use them for any health issue, vision, dental, supplements, over the counter meds, alternative care too. Most people don't realize that most private insurances have a lifetime limit, often 1-2 million $$ - something I learned when I went to work for Medtronic and had to verify coverage for insulin pumps. Also, drug prices will eventually go down. When a drug is made, the company that made it solely holds the patent for a limited time like 7-15 years, then it will go public and other companies can make a generic or competing brand and the price goes down. That's to prevent monopoly. It's true for medical devices as well. They set the prices high at 1st to recuop the $$ invested - it takes years and much research and cost to get drugs on the market - thanks to the FDA. It's good and bad.