Healthcare system: the next financial meltdown?

When Tommy Thompson scans the horizon, here's what he sees. "The next catastrophe." Thompson is former secretary of Health and Human Services under President George W. Bush, former governor of Wisconsin, and former Republican presidential candidate. He held a conference call with Kenneth Thorpe, former deputy assistant secretary of policy at HHS under President Bill Clinton and now executive director of the Partnership to Fight Chronic Disease. "Healthcare has the potential of being the next calamity," Thompson said.

They're looking for bipartisan solutions to the healthcare mess, the main solution being to prevent chronic diseases such as diabetes, heart disease and obesity in a U.S. population that is seeing epidemics in all three.

Those conditions stay with a person for a long time -- or until death -- once they hit, and chronic diseases eat up 75% of all healthcare costs. That's three-quarters of the total $2.2 trillion spent on healthcare in the United States. That comes to $1.65 trillion, if my online calculator serves me correctly.

That's more than two Wall Street bailouts.

America can't wait for another segment of the economy to collapse before doing something about it, they said. "There's some concern that given the current state of the economy, taking on healthcare might be too much, too big," said Thorpe. "I would argue the opposite. Failure to act on the issue of making healthcare more affordable is a recipe for disaster. This issue is too important to ignore. As wages slow down and the deficits rise, we've got to find places in the public budgets and in the private sector to make healthcare affordable for families and businesses."

They suggest some major redesigns of the system, including the efficiency of electronic medical records (which Thompson says should be government funded to speed up their implementation) and a team approach, using nurses, nurse practitioners and physician assistants, to prevent and control chronic illnesses.

It's too big an issue, they said, to be anything but bipartisan.

-- Susan Brink

To understand Obama, McCain health plans, watch TV

A new documentary on the PBS show P.O.V., "Critical Condition," will take a personal look at America's healthcare crisis on Tuesday, Sept. 30, at 9 p.m. PDT. With real-life stories of four people who lost their jobs, their health insurance, their homes, their savings -- even, in two cases, their lives -- Roger Weisberg's documentary lays out the human cost of America's expensive and often inaccessible system of health insurance and healthcare.

Though the film likely will get you wringing your hands with woe at the tragedies that befall people who find themselves uninsured, a follow-up discussion -- at 10:30 p.m. PDT Tuesday -- might give you some clues about which candidate you think has the most workable way out of the healthcare mess.

Susan Dentzer, editor of the journal Health Affairs and a former correspondent for PBS' "The News Hour," will host a panel discussion after the film. Neera Tanden, domestic policy adviser for Sen. Barack Obama's campaign, will be there to explain Obama's healthcare proposal. Douglas Holtz-Eakin, senior policy adviser to Sen. John McCain's plan, will present McCain's plan.

Also on the panel: Uwe Reinhardt, health economist at Princeton University; and Stuart Butler, vice president of domestic and economic policy at the Heritage Foundation.

If you listen to the discussion after watching the documentary, it might help you decide which candidate might better help people like Joe Stornaiuolo, Karen Dove, Hector Cardenas, and Carlos Benitez -- all of whom appear in the film.

Stornaiuolo, a doorman for 15 years, lost his job when he lost a finger. And with his job went his health insurance. He also had chronic liver disease, and could no longer afford the medications or the care he needed. He thought getting Social Security disability would rescue him, but he fell through a loophole. He and his wife made too much money to qualify for Medicaid, the federal program for the poor. And to qualify for Medicare, the program for the elderly and disabled, there was a two-year waiting requirement. He didn't live to qualify. He died last Christmas, leaving his widow with $60,000 in unpaid medical bills.

Cardenas, a diabetic patient, lost his foot to the disease, and then lost his job as a warehouse manager. He fell into a Catch-22 cycle: he needs a prosthesis to find a job so he can have health insurance, but cannot afford the prosthesis that he needs in order to find a job.

Dove had to leave her job as an apartment manager because of deteriorating health. When she felt stomach pains, she had trouble finding a doctor who will see her without insurance, and by the time she did, a year had gone by, and her ovarian cancer was at Stage III. Her chemotherapy and surgery put her family deeply in debt. Dove died in March 2008.

Benitez had a severe back deformity that caused him severe pain for 15 years, and cost him 7 inches in height. As a chef, he had no health insurance. He went to Mexico, looking for less costly care, but even that was more than he could afford. Then, a rare thing happened. He ran into Dr. Patrick Dowling, chief of the Department of Family Medicine at UCLA, at a health fair. Dowling arranged for free care -- surgery and follow-up care worth $300,000. But, he says in the film, "We can't do endless surgery on uninsured patients; it begs a national solution."

There are 45 million more stories of uninsured people in the U.S., some no doubt as dramatic, some not. And there are an additional 25 million people who are underinsured, according to research reported by the Commonwealth Fund, which is helping to sponsor the panel discussion. In other words, they have health insurance, but it does not adequately cover their medical needs.

-- Susan Brink

Health sector lobbyists shovel big $ to McCain, Obama

In an article in today's New England Journal of Medicine, journal correspondent Dr. Robert Steinbrook analyzes the millions of dollars making their way to the campaign coffers of both parties and both presidential candidates.

As of July 2008, health lobby contributions added up to a paltry 3% of all presidential campaign contributions. Still, $29 million is nothing to sneeze at. And this election cycle, the health sector, represented by health professionals, hospitals and nursing homes, and pharmaceutical and health products industries, reversed a long-standing trend by giving more money to Democratic presidential candidates ($17.7 million) than to Republican candidates ($11.2 million) from January 2007 to July 2008. That's according to the Center for Responsive Politics and reported by Steinbrook.

Of that haul, Sen. Barack Obama received $8.8 million and Sen. John McCain received $4.7 million. The last time the Democrats got more money from health interests than Republicans was 1992, when Bill Clinton was running for his first term.

But those millions are just presidential campaign contributions. Since 2006, the health sector has spent more money on lobbying the federal government than any other sector of the economy. In 2007 alone, interest groups representing healthcare spent $450.7 million in lobbying efforts -- some $35 million more than the financial sector shelled out.

A lot of donors cover themselves by contributing to both parties. But here's what Steinbrook says about why the Democrats might be raking in more this election cycle:

"Like other groups, healthcare interests seek access to and influence with candidates and elected officials. The Democrats' fundraising advantage probably reflects the likelihood that they will continue to control Congress, regardless of who becomes president. However, it may also reflect other factors, such as a perception that healthcare is a more important issue for Democrats than Republicans, the realization that Obama's proposals are more likely to increase federal funding for healthcare and to expand federal regulation of health insurance than McCain's, and the greater potential for new legislation affecting the sector if Obama is elected and the Democrats extend their control of Congress."

The two candidates' plans for healthcare reform are vastly different, Steinbrook writes.

Another article in the Aug. 21 New England Journal of Medicine summarizes the differences. "The candidates' opposing views of healthcare reform reflect fundamentally different assumptions about the virtues and vices of markets and government," writes Jonathan Oberlander, professor of health policy and administration at the University of North Carolina at Chapel Hill and author of the article.

The centerpiece of the McCain plan, Oberlander writes, is a change in the tax treatment of the employee health insurance benefit. Now, employees don't pay taxes on that benefit. Under McCain's plan, they would be taxed on their insurance benefit, and the revenue from those taxes would fund tax credits ($2,500 for individuals; $5,000 for families) to obtain private insurance. There would be an insurance pool to guarantee coverage for those with pre-existing conditions or who are otherwise uninsurable. His plan also calls for deregulation of the insurance markets, as well as Medicare reform, enhanced competition, faster introduction of generic drugs, emphasis on preventive care, greater use of information technology in healthcare, and malpractice reform.

Obama's plan, Oberlander summarizes, includes a "play or pay" employer mandate requiring businesses to offer health insurance or pay a tax, creation of a new national health plan, like Medicare, for the uninsured and small businesses, a mandate that all children be covered, subsidies for low-income Americans, and increased regulation of private insurance plans to end risk-rating based on health status. His plan also includes accelerated adoption of electronic medical records, emphasis on disease prevention, provider payment based on performance and outcomes, allowing Medicare to negotiate prices with the drug industry and the establishment of an institute, akin to the National Institutes of Health, to research the effectiveness of treatments and medical care.

Whoever wins, the health sector is putting up its money. Steinbrook writes: "Regardless of whether Barack Obama or John McCain becomes the next president of the United States, there is no shortage of healthcare money seeking to influence what happens after the votes are counted."

--Susan Brink

Photo credit: Randall Enos / For The Times