Healthcare –and healthcare reform—is complicated, in part because so much of what we think we know about American medicine turns out to be untrue. For instance, one would assume that more expensive care would be better. But the Dartmouth research has taught us that isn’t the case. Most people also assume that for-profit insurers are making a fat profit; after all, look at how high insurance premiums are! 

But as Rick Newman points out in the most recent issue of U.S. News & World Report , “blaming insurance firms for runaway healthcare costs is a weak argument, because the insurance industry isn't all that profitable to start with."

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I still recall Ted Kennedy’s speech at the 1980 Democratic convention. It remains the finest, most inspiring political oration that I have ever heard. This is in part because Kennedy was speaking from a position of defeat. He had just lost the Democratic nomination to Jimmy Carter. And yet this was a full-hearted, rousing speech delivered by a man who realized that in the battle ahead, the issues at stake were far, far more important than his own loss. Intuitively, he knew that the country had reached a turning point.

Many people are talking about that speech today. Instead of substituting my prose for Kennedy’s, I have decided to quote high points from that speech for the many readers who either didn’t hear it– or don’t remember it in all of its richness. This was a speech written long before slippery political strategists had learned to “frame” ideas as bumper-stickers. In its eloquence, it shows great respect for the English language, for ideas, and for its audience. And, I think, it reminds health care reformers that this is not a time to “yield.”

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It’s bad enough that Conservatives like Sarah Palin and Betsy McCaughey are spewing wild charges that the House health reform bill will lead to “death panels” and the premature demise of grandma. But what really gets me about these lies—so clearly aimed at frightening seniors and blocking all action on reform—is that they are being advanced in the supposed interest of protecting patients.

In McCaughey’s now legendary battle with Jon Stewart on the Daily Show she identified herself as a “patient advocate” (although most of us know her as a former Lieutenant Governor of New York, vociferous opponent of Clinton’s health care plan and a newly-resigned director of a medical device manufacturer.)

First a little background: I have been a journalist for over 20 years but recently returned to school to pursue a Master’s degree in Health Advocacy at Sarah Lawrence College. Graduates of this program go on to take a wide range of jobs; a sizable portion end up as patient advocates in hospitals, nursing homes and hospice organizations. These trained professionals value autonomy and respect for all patients first and foremost—rejecting the older, paternalistic model of medicine where the doctor always knows best.

In fact, a basic tenet of patient advocacy is making sure all patients have so-called advance directives—living wills, durable power of attorney, health proxies, and orders for life-sustaining treatment—to help guide their care. These advance directives, which are dynamic and can be amended as a patient’s condition changes, allow patients—or if they become incompetent, a designated loved one—to make meaningful choices about what kinds of care they receive.

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Below, a guest-post by HealthBeat reader Pat S.

Medicare is the second largest health care payer in America, trailing only Medicaid.  The program is very popular with its enrollees, with polls showing a higher level of satisfaction than with private insurance. 
Medicare is less popular with hospitals.

Opponents of health care reform in general and of a strong public option in particular often cite hospital dissatisfaction with Medicare as a reason why the reform programs won’t work.  They report that evidence suggests that overall Medicare pays hospitals less than what it costs them to provide care. Private insurers pay more, and by “cost-shifting,” hospitals use these payments to make up the losses on Medicare.  Opponents worry that if a public option linked to or modeled on Medicare becomes the dominant payer for people under 65, hospitals will go broke without the “subsidy” from private insurers, and the health system will be destroyed. Data collected by hospital groups and the insurance industry suggests that this is unlikely to happen.

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Too often, those who oppose health care reform say that while there may well be waste in our health care system, it’s hard to say where it is. One man’s waste is another man’s effective treatment. Many tests and surgeries may be controversial, but who is to say for sure what is unnecessary?

The truth is that we have stacks of medical evidence showing that many procedures and products are of little or no value to many patients who receive them.  These treatments may be useful to patients who fit a particular medical profile: women between the ages of 50 and 70, for instance, or patients suffering from left main coronary artery disease. In these cases, health care reformers agree: patients should receive the treatment. 

But typically a much larger group of patients are subjected to a procedure that provides no benefit. Thus, they are subjected to risk without gain. Keep in mind that one hundred thousand people die each year from complications of surgery—far more than die in car crashes. And some of those surgeries were unnecessary.

In a recent post on The Health Care Blog (THCB) (www.healthcareblog.com)  Dr. George Lundberg, former editor-in-chief of the Journal of the American Medical Association,  wrote about seven areas where we have enough comparative effectiveness research to know that a great many patients are being over-treated. Lundberg, who is now president and chair of The Lundberg Institute suggests that we could begin to rein in health care spending NOW –if doctors  take “a good hard look” at the evidence (and “in the mirror”), and share medical evidence with patients about benefits and risks when discussing options for treatment. (For more on “Shared Decision-Making” see this Health Beat post)

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Health Wonk Review, a round-up of some of the best posts in the Healthcare blogosphere over the last two weeks, is now up on Health Business Blog, hosted by David Williams here:.
http://www.healthbusinessblog.com/?p=2556
http://www.healthbusinessblog.com/

Just a few highlights:

The Robert Wood Johnson Foundation presents a users’ guide to health reform. Key assertion: if we improve efficiency in health care we can avoid cost/coverage tradeoffs

Managed Care Matters offers the top ten misconceptions about health reform. Reason #2: “A public plan would crush private insurers and we’d all end up covered by the public plan,:

Heath Care Renewal thinks hospital Group Purchasing Organizations (GPOs) are acting more like Group Kickback Organizations. As Williams points out, Roy Poses, the editor of Health Care Renewal has  written about this problem “as far back as 2005, but now investigators are taking an interest”  This is very good news.

To find links to these, and other top posts, go to
http://www.healthbusinessblog.com/?p=2556
http://www.healthbusinessblog.com/

Below, a response to novelist Jane Smiley that I am publishing on the Huffington Post tomorrow.  Earlier this week, Smiley posted on Huffington expressing her dismay that President Obama seems to be folding on health-care reform. I don’t blame her for coming to the conclusion: this is what the mainstream media has been telling her. My response begins:

An Open Letter to Jane Smiley: Please Don’t Believe Everything You Read

            (The Media Is Not Always a Reliable Narrator )

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The pharmaceutical industry has been settling into its “good guy” role in recent days; first committing to $80 billion in cost savings over ten years to help defray the cost of health reform and then forking over $150 million to finance an ad campaign championing the administration’s plan. (Of course there was that slight fall from grace when it looked as if, in exchange, PhRMA had secured guarantees that Medicare would not be able to negotiate drug prices…click here for Maggie’s take on that.)

But what else can the industry do to help burnish its image with the American people? How about finally consenting to some common-sense limits on the barrage of prescription drug ads confronting consumers every time they turn on the TV or open a magazine? While a complete ban is probably not possible (in part because such a ban might violate the First Amendment) how about making prescription drug ads a lot more educational and a lot less like a hard sell for a new BMW?

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Media Matter has done a nice job of rounding up and debunking 14 of the most common myths about healthcare reform here.  You may find it useful when talking to friends and relatives.

I doubt it.  Progressives are in the middle of a long negotiation with conservatives that will end in  conference committee late this fall, where politicians will merge the Senate and House versions of the bills, hammering out the differences. We know that the House bill contains a strong public sector plan. It seems likely that the Senate plan will offer, at best, a weak public sector alternative. What will happen then? 

No one knows. But as I have suggested in the past, conference is what matters. Whatever compromises Senator Max Baucus does or doesn’t make in the Senate Finance Committee’s version of the bill may not, in the end, be that important. 

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