Richard Burr, health care bogeymen and more

Here's another batch of letters on the health care reform debate. These are online-only. Look for more letters on tomorrow's Editorial page and in the coming Sunday Forum.

Do people really think that health care reform will send government reps knocking on the doors of senior citizens to make them decide how they want to die? So, what’ll it be? Asphyxiation? Strangulation? Blunt force trauma?

C’mon folks. It makes sense to document while you are conscious if and under what conditions you want to be kept alive by artificial means.

Some say the government will pick our doctors and take over our medical decisions. The keyword in public option is option. You can stick with your insurance company. But, with reform, you would no longer have to worry about losing your job, becoming seriously ill or having a pre-existing condition.

Government takeover? Please! Regretfully, we still seem generations away from true reform to a single-payer system. All one need do is utter the s-word, socialism, which is selectively used to describe health care but not public schools, roads and other government services we all use and appreciate.

The insurance industry spends $1.3 million a day on lobbying and the Republican National Committee has spent $9 million in TV ads to scare people about reform. Wouldn’t we be better off if we put the bogeyman in the closet and turned our attention to solving real problems?

Does anyone doubt that insurance premiums will continue to escalate? That many employers will be forced to drop coverage for workers? That we all pay the cost of care for the uninsured? That a country as wealthy as ours cannot tolerate, without a terrible cost to our economy and our humanity, leaving 45 million people uninsured.

Now that’s scary.

Sharon Campbell
Chapel Hill

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Professor Donald Taylor’s Opinion page article in the July 31 News & Observer and the letter from Sen. Richard Burr the previous day give an idea of the disparity in the thinking processes of our academic and medical community vs our political establishment.

The Taylor article gives factual information as to the cost of our health care and the sad state of the general quality of health of our citizens compared with other developed countries. We are not getting our money’s worth for the amount we spend.

However, Burr’s letter gives the general impression, without giving specifics, that “government-run,” “socialized systems” come at a cost to the taxpayers. He also makes a blanket statement that “Government-run health care has produced negative results across the globe.” This is a patent lie!

I am a semi-retired internist/geriatrician and state categorically that, both as a Medicare provider and as a recipient of Medicare, it is one of the better systems of health care insurance, better than any other entity. I have more freedom to make medical treatment decisions with Medicare than with Blue Cross, Aetna, United Health, Cigna or any other private insurers. So, when the Republicans are screaming that they do not want the government between the patient and the doctor, it is really very far from the truth.

Most physicians would rather deal with one entity, government or other, than the multiple insurance companies with hundreds of different plans in each of them.

I recommend that Burr read the article in the Annals of Internal Medicine, April 21, 2009, which describes a study of improvement in health care between 1999 and 2006. The conclusion was that during the past decade, the improvements in measured quality parameters for cardiovascular disease and diabetes were substantial. But the disparity of health by race, ethnicity and education, were the greatest in the population below age 64 and these differences were nonexistent for the Medicare population.

This clearly shows that universal, affordable health care insurance in the senior population has given us a quality health system. Burr cannot argue that a government-run plan has produced negative results across the globe, unless he thinks that the U.S. is not part of the globe!

Raghu Ballal
Chapel Hill

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In all the debate on health care cost containment on Capitol Hill and in the media, I’m baffled by the complete absence of mention of the potential savings to taxpayer/consumers and employers if insurance premiums shrink as a result of reforms.

The right is scaring voters silly with talk of “inevitable” tax increases to pay for any “government-mandated” changes — yet not a word is said about how much less those same citizens could well pay for coverage after such reforms.

Here’s an example, admittedly hypothetical, but based in real probabilities from everything I’ve read: If a family now pays $2,000 a year for coverage, and a more efficient plan (private or public) were to cost that family 25 percent less, or $1,500 a year, for the same or better coverage, would that family still be so easy to frighten by mentioning a 1, 2 or even 5 percent tax hike?   

Again, business interests complain, often with reason, that they can’t afford to pay more toward employee coverage. There’s one reason business finds that coverage less and less feasible to offer: the rapid, alarming climb in premium costs — sometimes double-digit hikes from one year to the next — that we’ve all put up with for decades. Halt that rise in costs, and employers could stop fleeing the sinking ship of offering worker coverage.   

To gray heads like me who’ve been hoping for 60 years for real health care reform, the current pulling and hauling is excruciating — especially if, as many would, we’d prefer the relative simplicity and efficiency of a single-payer system, knowing through friends and family abroad how well such systems can work.

But never mind. Some improvement is better than none.

All I ask right now is that on our mental balance sheets, and Congress’ too, potential savings to insured citizens (and their employers) on the private side be entered and balanced against any potential costs on the public side.  

Ann Thackrey Berry
Raleigh

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Improving our current health care system is important, timely and requires that the public receive the best information. Unfortunately, much misinformation is currently being spread by multiple sources, including the N.C. Medical Society (NCMS). They oppose a “public” option, stating it would restrict physician choice. The current public program, Medicare, does not restrict physician choice. Private insurance, through preferred provider organizations, does.

Their own board of directors just two months ago adopted a resolution endorsing coverage through an affordable mix of public and private payer systems. NCMS also expressed “grave concerns” about “denial of care or rationing” in the proposed plans. No such proposal is on the table; the NCMS is spreading misinformation. What is occurring right now is daily denial of care when one out of five North Carolinians are uninsured.

NCMS also expressed grave concerns that government “guidelines” would not have physician involvement. No guidelines are proposed in the current legislation, but the bills do propose more research to determine the best treatments for patients. Knowing more about what works in medicine can only help physicians and the public. On a modest scale, such comparative effectiveness research is currently conducted at UNC, Duke and RTI, always with physician involvement in all stages of the work, and future work will be similar.

Current proposals are still a work in progress; informed input to our legislators is critical. Concerns over proposals are appropriate, but they should be based on evidence, not misinformation.

Tim Carey, M.D.
Chapel Hill

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For decades now we have heard from the economic libertarians in the Republican Party that the government can’t do anything right, and that the for-profit private sector can always outperform and underprice public programs. It has even been suggested that to think otherwise is socialism.
But now in the health care reform debate the prospect has arisen of a public option, allowing people under 65 to choose a program like Medicare if they want it. Suddenly, the very same defenders of free enterprise have reversed themselves, claiming that private insurance companies need protection from government competition. Talk about waffling!

Has the Postal Service put UPS or FedEx out of business? Do public schools make it impossible to have private schools as well? Of course not! Yet we are hearing the possibility of a public option described as a Washington takeover of health care, which is an outright lie.

We need health care reform legislation from Congress before the end of this year, and it ought to include a public option.

James Coley
Chapel Hill

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I read Senator Burr’s reply to the Sunday Forum letter about international comparisons in health care outcomes quite closely. The senator’s points were:

1) Japan has the second-highest publicly held debt in the world. It also has a government-run health care program. I guess I am supposed to conclude that the former is a result of the latter.

According to statistics about national debt as a percentage of GDP reported on the CIA’s World Factbook Web site, Japan does indeed have the second highest rate of debt in the world at 170% of GDP. However, I noted that the national debts of several countries, including Austria (56.8% GDP), Switzerland (44% GDP), the Netherlands (43% of GDP), Spain (37.5% GDP) and Sweden (36.5% GDP) all are much less than Japan’s, while they also have health systems that are either government-run or heavily regulated to provide universal care. And each one of these countries with socialized health care have lower national debt as a percentage of GDP than the US, which comes in at 60.8% of GDP — just ahead of Morocco which, in an interesting aside, has a payroll-based health insurance system and, just like we are in the US, is debating national policy about expanded health care coverage. [Health Affairs 26(4): 1009-1016 (July 2007.)] So should we deduce that our ability to afford health care is comparable to Morocco’s since our national debts as percentages of GDP are similar?

2) Canadian citizens have one of the highest rates of high-risk pregnancies in the world despite their universal access to primary care. It would be nice if Burr cited his sources. I spent 45 minutes searching Medline for an article that supported this. I couldn’t find one on point.

Part of the problem is that a high-risk pregnancy is not an outcome; it’s a set of descriptive characteristics. Any woman who is obese or undernourished, younger than 15 or older than 35, less than 5 feet tall, or with history of complications during previous pregnancies, or more than five previous pregnancies, or with abnormalities of the reproductive tract such as a history of uterine fibroids, or with a history of hypertension, Rh incompatibility, gestational diabetes, infections of the vagina and/or cervix, kidney infection, fever, an acute surgical emergency (e.g.: appendicitis, gallbladder disease, bowel obstruction), post-term pregnancy; a pre-existing chronic illness (such as asthma, autoimmune disease, cancer, sickle cell anemia, tuberculosis, herpes, AIDS, heart disease, kidney disease, Crohn’s disease, ulcerative colitis, or Type I or Type II diabetes mellitus may be considered to have a high-risk pregnancy.

Does Canada have a high rate of high-risk pregnancies because Canadian mothers are less healthy? Or do they have a high rate because they have a national health system that collects better data than other countries? Hard to say. However, as far as real outcomes, Canada doesn’t do too badly when it comes to keeping its babies alive. The infant mortality rate in Canada, according to statistics on the CIA World Factbook Web site, is 5.04 per thousand live births. Interestingly, the US rate is 6.26 — right behind Cuba, which has an infant mortality rate of 5.82 per thousand live births.

It seems like, despite the considerable amount of study Burr has applied to this question, he has arrived at some strange conclusions. However, we can be reassured that he and Sen. Tom Coburn have now sponsored a bill that would give me a $5,700 tax credit to help pay for the approximately $15,000 health insurance premium bill covered by myself and my employer. As I understand it (and, admittedly, I may not fully understand it, because the plan as reported is somewhat less than straightforward), their plan also mandates that employer-covered premiums be taxed as income. At my current tax rate, the $5,700 tax credit is just about equal to the extra amount of tax I’ll have to pay on the extra income Ill have to report under the Republican plan, so it will pretty much be a wash for me. However, for those without an employer-sponsored plan who are expecting to purchase decent family coverage with their $5,700, good luck.

Lying with statistics is an old habit among politicians of both parties. I just wish that the Republican senator from my state didn’t do it with such alacrity. Is Burr really OK with the fact that Cuba, of all places, has a lower infant mortality rate than the U.S.? I don’t know if the Democratic Party’s health care reform plan is going to make our health care better or not. However, I am pretty sure that the partisan obstructionism and misrepresentation of the facts by Burr and others in his party is almost certain to make matters worse.

Ross Goldbaum
Hillsborough

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Let’s start with the urgency to reform health care. A 2006 ABC News-Kaiser Family Foundation-USA Today survey found that 89% of Americans were satisfied with the quality of their own health care.
Now for Medicare, which was cited by President Barack Obama as an example of  a well-liked government program. In 1968 total federal government spending was $178.1 billion and in 2007 was $2,728.9 billion, for a 15.3 times increase. Medicare rose from $5.1billion  to $436 billion, an astounding increase of 85.5 times over the same 40 year period. Defense outlays increased only 6.7 times.

And how about government estimates of future spending. In the mid-1960s, the government projected outlays for Medicare 25 years later to be $10 billion. Instead, in 1990 the outlays were $107 billion. Government estimates were off by a whopping factor of over 10 times!

If you believe that the federal government can increase coverage for health care and reduce cost without rationing of medical services, I have a bridge over the Neuse River that I’ll sell to you for great price.

And remember, H.L. Mencken once said “The urge to save the world is always a false front for the urge to rule it.”

Lawrence Whitley Gould
Raleigh

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It may be that most North Carolinians oppose the type of health care reform under consideration in Congress (“Critics call reform ‘the fight of our lives’”, July 30), not because Congress has gone too far, but because Congress hasn’t gone far enough.

In the year 2000 the Carolina Poll found that 83% of potential voters agreed that the state legislature should make a plan so that all North Carolina residents can get decent health care on a regular basis. In February 2007 Public Policy Reporting said the percentages of Democrats, Republicans and Others in N.C.  who would prefer a universal Medicare-like system covering everyone were 69, 33 and 49%, respectively. These numbers suggest that the majority of North Carolinians want health care for themselves that is as good as Medicare for our seniors.
 

Only government can guarantee affordable health care that is there when you need it, not our current insurance-based system which systematically denies care (as per Wendell Potter on Bill Moyers Journal, July 9, 2009) and has an administrative overhead of 31%! Medicare for all (HR 676) is the only health care reform that offers both universal coverage and cost savings.

Jonathan Kotch, M.D.
President, Health Care for All NC
Durham

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President Obama is misleading when he says that people that are happy with their insurance can keep it. What he doesn t say is what is contained in Section 102. PROTECTING THE CHOICE TO KEEP CURRENT COVERAGE, which is on page 16 of one bill in Congress.

An individual will not be able to change plans or obtain a new plan. Insurance companies will no longer be allowed to enroll individuals. In other words, those who currently have private individual coverage won’t be able to change it. Nor will those who leave a company to work for themselves be free to buy individual plans from private carriers. Individuals with current coverage will, however, be able to add dependents.

An individual will be able to keep their current coverage as long as the issuer does not change any of its terms or conditions, including benefits and cost-sharing, from those in effect as of the day before the first day of the year in which the bill is enacted.
This provision will lead to the goal of President Obama and Congress to have a single-payer health care system.

Lynn Lowry
Raleigh

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Sen. Richard Burr’s letter of July 30, “What doesn’t work,” makes for interesting reading and seems to miss the entire point of health care reform.  Burr was quick to point out the “trade-offs” of Japan and Canada’s government-run health care systems, but made no mention of the U.S. government-run system in which he and his colleagues participate. Since the U.S. system was not lambasted, perhaps he should spend time studying this system as a possible model that can be put forward in the debate as an alternative to the ideas and suggestions (or lack thereof) currently circulating the country by proponents and oppositionists alike.

The Coburn-Burr Patients Choice Act as a solution for the health care crisis might be a sensible approach in an environment of full-employment (when all things are equal) and a system not driven primarily by special-interest groups; i.e., the insurance industry and others opposed to true health reform.

It is time for Burr, Sen. Kay Hagan and colleagues to stand up for the American people and do the right thing. Oh, how we long for the era when true statesmen/women were elected to represent our interest and not those of lobbyists.

W. R. Morris
Raleigh

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My question is simple. If President Obama’s proposed healthcare reform bill is so great, then why would the Congress exempt itself from it?

Randy Currin
Lillington