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Cash for Granny? Health care and clunkers

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Well, the government has given us a Clunkers for Cash program. It will cost about $3 billion before it is over. Now, they want a new health care program called Seniors for Cash. In this program, you turn over any of your senior relatives or friends to the government, and the government provides cash to reduce health care costs and buries them. This program will cost at least $1 trillion. A sad day for seniors and for our government.

Bill Koch
Raleigh

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Your Aug. 2 editorial bemoaning the lack of Republican input to the health care bills overlooked a well-reported fact in both TV and printed media. That is the refusal by both Pelosi and Waxman to accept any Republican input on the issue. In fact, they refuse to bring any such suggestion up for floor discussion in the House. In the Senate, only three Republicans have had any input for consideration, by design of the majority leader.

Here are some Republican suggestions I‘ve heard: Put a cap on outlandish malpractice awards, i.e. tort reform. That would reduce the huge insurance payments for doctors, encourage more to enter or stay in general practice and reduce early retirements. Next, completely revamp the complicated Medicare reporting system. The current system fosters fraud and abuse and frustrates honest medical personnel, who frequently submit wrong information. Make portability and pre-existing condition coverage mandatory by insurance companies, some of which already do this. Have more regulation of drug companies so their prices to Americans are not worse than those to Canadians or Europeans, but still let them afford research and profit.

Let’s fix the current system and then include everyone, rather than spend a trillion dollars and let major health care problems continue to exist. That’s Republican input.

C.J. Goode Jr.
Durham

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Everybody’s talking about high medical costs these days, especially with the proposals for medical care reform at the federal level. Many reasons have been cited, from the increases in high-cost diagnostic equipment to the dollars spent on overhead at the companies managing health-care programs. There are two reasons I know of personally: lots of specialists and lots of tests.

Perhaps it was inevitable that so many medical specialties would develop as I grew older. When I was 29 or 30, I had one doctor. Now, 50 years later, I have five. Even though I needed their specialties when I was sick, or went in for surgery, what they mostly do today is “take a look” at a particular area every year. In most cases, there’s nothing to see. Seems to me my primary physician could “look at” all five areas during one annual physical. He could refer me for more testing or treatment if he saw something. That’s what my doctor did when I was 29 or 30. Fewer visits, less cost.

A friend told me about his diagnosis and treatment for arthritis of the thumb. He’d been complaining to his family doctor for some time about pains in his thumb. At first he was given some topical medication, then a non-steroidal anti-inflammatory drug (NSAID), but he’d had no success. The GP sent him to an orthopedic surgeon who specialized in hands. That doctor wrote a complete medical history. He examined the hand thoroughly. He manipulated the hand and the joints. He took X-rays from three different angles. After all this he sent my friend to a radiology lab for a CAT scan, and then scheduled him for a return visit. “You have arthritis,” he said and injected the joint with cortisone.

Alternative scenario: Primary physician concludes topical medication and NSAIDs don’t work, administers cortisone injection. Much less cost.

I had a pain on the left side of my chest. It turned out to be a strained tendon or muscle between the ribs. My chiropractor fixed it. But before I got to him, I was given an EKG in my doctor’s office, a stress EKG in the hospital and a nuclear scan of the heart. I’m glad they all turned out negative, and I don’t suppose I would be making these comments if any of them had uncovered a heart problem, but I can’t help but recognize that several thousand dollars were spent (by Medicare and my secondary insurer).

My wife went to the ER with chest pains. It turned out to be indigestion. But she had a couple of tests and was admitted overnight. Many medical reformers talk about “defensive medicine,” which causes doctors to call for tests so they can’t be sued for missing something. I’m not sure I’ve seen a solution to that problem, except changes in malpractice lawsuits. I can’t judge the validity of that argument; I can merely point out that this is another reason for increasing costs.

Of course, costs might be lower if we actually had to pay the bills. Today, most of us assume or realize that insurance will pay. If we had to pay, and we got a big number in response, might we ask why we need that second test? If my friend with the bad thumb had to pay for the CAT scan himself, he might have asked what new information it would add to the results of the X-ray and how that might change the doctor’s decision.

As I mentioned earlier, insurance company overhead continues to rise. Here’s a thought: If these companies were considered public utilities, they’d have to justify their rates to a commission and would have to live with a rate base that generated a specific return on investment. I wonder if that’s in any politician’s plan.

David Thomas
Raleigh

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Why is tort reform not being included as part of the plans to make health care in this country affordable? Lawyers and politicians will cite that the insurance premiums being levied on doctors account for only a small part of the overall health care costs in the U.S. and thus, it is not worth reforming.

However, they conveniently leave out the cost of defensive medicine that doctors are forced to practice to protect themselves from lawsuits. Doctors must routinely order tests that are not necessary and that add up to a huge amount of money each year. They also fail to mention the costs health care professionals incur defending themselves against frivolous lawsuits each year. These costs are all passed down to the consumer.

Could the reason we are not discussing this be that trial lawyers, as a group, contribute heavily to political campaigns? Politicians do not want to rein them in for fear of losing these contributions. If tort reform is not included as part of health care reform, the cost of health care will continue to spiral in this country and the expense not be sustainable.

Paul Donovan
Cary

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I am very disappointed with the GOP leadership response to the president and HR3200 (an act to provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes.) Both parties talk extensively about the health care system being broken, and they spend endless hours writing up patchwork legislation without ever spending 10 minutes trying to figure out the why of the rising costs. In addition to the need for tort reform, the main reason the system is broken is that the U.S. is subsidizing the world’s health care and subsidies.

Pharmaceutical companies are allowing others to use their patents for offshore sales and they themselves sell more cheaply to foreign health systems. This forces them to recover their development costs and profits from the U.S. market. So in effect we are subsidizing Canada, Britain etc.

Unfunded mandates are forced on hospitals to care for the indigent so those with insurance provide the subsidy, forcing insurance premiums higher and forcing the insurance to reduce risk by not insuring pre-existing conditions

Illegal aliens use the system without paying for services and transfer the costs to the rest of us. By law legal immigrants must have sponsors, who are responsible for them financially. Illegals have no such sponsor.

It’s about time Congress looks at the root cause of the problem, instead of addressing the symptoms. Instead, government actions and a refusal to enforce existing laws actually exacerbate the problem.

Anthony Pecoraro
Raleigh

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I recently learned of H.R. 676, the U.S. National Health Care Act. Please provide an in-depth feature article about this act.

There has been little substantive discussion in the media about a single-payer health insurance option — every time it is raised, opponents scream “socialism” and all discussion stops. How can we, as a country, intelligently decide what we are going to do about our national health care fiasco, when we dismiss alternatives with inflammatory and unsupported characterizations?

Please present to your audience this viable option — it is no more socialism than is Medicare. Please hurry. As a country, I fear we are losing the will to make a change. And no change is acceptance of the status quo.

Susan Musico
Clayton

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Sen. Richard Burr, in his July 30 letter, claimed that government-run health care in other countries was found wanting. He refers to the cost to taxpayers and the deficiencies in quality. He goes so far as to state “Government-run health care has produced negative results across the globe.”

If this is true, why is it that the U.S. is 30th on the U.N. list of countries with the best health care, behind many of the countries with government-run health care?

Burr and other Republicans trying to stymie real health care reform in this country constantly raise the bugaboo of deficits. I rarely heard a peep out of him when we were running up the debt by billions every month fighting an unfortunate war in Iraq.

My question is: Who does Burr represent — the insurance companies and health care industry or the people of the United States?

Sol Rabinowitz
Cary

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President Barack Obama is right in stating that ballooning health care costs are a major threat to our national economy and to standards of living for millions of Americans. Predictably, various groups with vested interests (i.e., those making a lot of money in the current system and those with an anti-Obama agenda) are anxious to block change.

Every day I hear physicians talk derisively about “Obama-care.” As a physician, I can attest that there are extremely powerful influences driving overutilization of health care resources (excessive radiology and other testing, unnecessary hospitalization, etc.) — including patient and family expectations, fear of lawsuits, time pressure, greed and an increasing burden of chronic illnesses. There are few influences that restrain excessive spending

Those who are well off will probably always be able to afford health care, but a growing number of middle-income families will be ever more squeezed unless we somehow change course. The longer we wait, the more difficult this will be, with implications for everyone.

Ted Tsomides, M.D., Ph.D.

Raleigh

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Since health care became an industry and business and ceased to be a profession, naturally, people who oppose reform have great coverage and often a vested interest in the industry.

Factually, Sen. Richard Burr’s comment that N.C.’s economy could be decimated points out his dedication for health care to remain an out-of-control industry.

A little government competition run by bureaucrats is needed to get the fat cats to pare down their top-heavy, capitalist, administrative, 37 percent of the health care dollar.

Chris David
Raleigh

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The July 23 Point of View article by Dr. Valerie Jewells ("Counterproductive savings on medical imaging") at best misses the point of what most folks need in health care, and at worst represents the type of special interest that has stymied health care reform for four decades.

Sure, imaging has improved diagnostic capabilities for some diseases. But multiple studies have shown imaging is one of the top drivers of ever-increasing costs. The United States has more MRI, PET and CT scanners than any country on earth, yet the quality of our health is ranked 37th by the World Health Organization, and we spend thousands more per person on health than any country on earth. Recently, a count of scanners found more in Wake County than in Canada.

Jewells suggests that implementing radiology benefit management (RBM) would hamper patient care and result in intolerable waits. Funny, but there seems to be no lack of good health among Canadians, Brits and the French due to fewer scanners per capita.

Usually a careful history and physical exam will determine the diagnosis and any need for scanning. Watchful waiting and selective treatment often leads to condition improvement.

Robert Harris, M.D.
Raleigh

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As I follow the current health care reform debate, I am reminded of the old Superman show from the ’50s.  In the show, the villain, after running out of bullets, throws his gun in desperation at Superman (as if this will help).

Today, opponents of reform are out of bullets and left with arguments like, “The Government will kill seniors!” and “We’ll have socialized medicine!”

How are we going to have a sincere and honest debate of the actual issues when members of Congress are working to derail the debate with distortions and lies?

No matter what side of this debate you are on, we should all expect our representatives to be truthful about the issues and condemn those who attempt to derail the conversation with lies and misrepresentations meant only to scare people.

This is not a call for bipartisanship; this is a call for grown-ups in Congress.

Scott Taylor
Garner

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Senate Republican leaders

Senate Republican leaders are railing against the Cash for Clunkers Bill, calling the program a model of government inefficiency and out-of-control spending. Republicans have made it known that they do not like the Cash for Clunkers bill. John McCain certainly doesn't like the Cash for Clunkers bill – or anything good for anyone – and he is also a vocal opponent of the health care reform package, which is seen as a step towards universal health care, or Obamacare as it's described in the press. The Republican Party seems bent on putting short term loans and whatever else they can into stopping many of Obama's programs, regardless of how good of ideas they may be. The Cash for Clunkers bill might save people from needing no fax payday loans for a car payment, and stimulate auto sales if it's allowed to work.

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About the blogger

Burgetta Eplin Wheeler is the associate editor of the Editorial pages, responsible for the Other Opinion page. She occasionally writes editorials. She can be reached at bwheeler@newsobserver.com or 829-4825.
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