Monday, June 29, 2009

President Obama: Potential for Getting Healthy? You Win!!

Let’s be clear: President Obama’s push for healthcare reform will significantly change the way people with serious medical conditions, especially among the elderly, those with disabilities, and the terminally ill, will be treated.

Well, not treated, actually.

There’s no doubt that the President’s message, hammered relentlessly at every turn, is made in starkly economic terms – that medical care is very expensive, costs need to be controlled, and resources have to be allocated in new ways.

That’s half the pitch.

Here’s the other half: Because of this problem, it’s important to see which groups of people disproportionately consume the lion’s share of medical care dollars.

We already know: People with disabilities, people with serious chronic illnesses, the terminally ill, and the elderly.

The president hasn’t gotten around to making his economic case about people with disabilities yet, but he has in terms of the elderly and the terminally ill. My take is that among the targeted groups, it’s the disability community that will raise stiff opposition. The elderly and the terminally ill are more vulnerable, and are less likely to protest.

Let me put the president’s strategy more bluntly:

"Medical care is expensive. Some people get a lot of care, others very little. Many people who get a lot of expensive care are the elderly, those with disabilities, and those who are probably not going to ever be as healthy as they used to be. We don’t have the money to pay for every expensive procedure for everyone, so we need to decide who gets the care that’ll give us most bang for the buck."

The President doesn’t say it this way, instead he uses a euphemism it’s hard not to like: Health. We must give medical care to make people healthier.

Note what’s not said: If you have no prospect of getting healthy, then the government needs to step in and decide whether or not you are worth getting the treatment.

President Obama drive this point home in his interview to the New York Times in April (all italics are mine):

And part of what I think government can do effectively is to be an honest broker in assessing and evaluating treatment options. And certainly that’s true when it comes to Medicare and Medicaid, where the taxpayers are footing the bill and we have an obligation to get those costs under control. And right now we’re footing the bill for a lot of things that don’t make people healthier.

The president drummed the “Health” theme again in his ABC News Health Care Forum at the White House last week:

But here's the problem that we have in our current health care system, is that there is a whole bunch of care that's being provided that every study, every bit of evidence that we have indicates may not be making us healthier.

And later:

And in terms of how doctors are reimbursed, it's going to be the same system that we have now, except we can start making some changes so that, for example, we're rewarding quality of outcomes rather than the number of procedures that are done. And this is true not just for doctors, it's also true for hospitals. One of the things that we could say to hospitals is, reduce your readmission rate, which is also often a sign that health outcomes have not been so good.

Now, we've put forward some specific ways of paying for the health reform that we talked about. About two-thirds of the cost would be covered by re-allocating dollars that are already in the health care system, taxpayers are already paying for it, but it's not going to stuff that's making you healthier.

Prediction: If the President has his way, expensive medical care will be redirected to the winners in this money game, those who have the potential to be healthier.

If you have a disability, if you’re elderly and in poor health, or if you have a severe chronic or terminal condition, you lose.


Jude said...

Thank you so much for this blog, and today for this post. Some of us don't have time, or ability, to compile everything that's going on in the world and I look to you for that.

Thank you Thank You Thank you.
Although I voted for Obama I have been cautious about this new healthcare thing, not knowing what it will mean for everyone, and not just your average person. My husband and I have lived without insurance for years, which has been very difficult, however, our daughter(13) has multiple disabilities and has always received most of her healthcare for free. If this were to change in any way it would be a huge huge problem for us. We live pay check to pay check now, although we aren't poor. We could not handle any more costs.
The worst thing to think about is if we were ever told that there were surgeries, or procedures, that would not be paid for and we would have to do without if we couldn't afford it.

What if, for instance, they started saying that they would no longer pay for general anesthesia for MRI's? We just wouldn't be able to do an MRI, and t hat could be disastrous. There are so many things at risk here and it is very scary to think about.

We live in MN, so we could cross the border and go live in Canada. Oh wait! they won't allow people with disabilities to move there.

Well, I guess we'll be going along for the ride with Obama then. And hopefully there will be enough of us to speak out that someone will listen.

thanks again for your article. I will post it on my blog

william Peace said...

Like it or not I must agree with you based on my experience living in London. Access to health care, particularly specialists such as a urologist, for those with a disability was difficult if not impossible. GPs considered people with disabilities "rubbish" and refused to make a referral. Basic care will exist but it will be substandard. However, a part of me wonder if even this change is better or worse than the current system. As one with terrible insurance, I pay for my own health care out side of a hospital. This is costly and affects when and how often I see the MD.