The politicians are not going to talk about the important issues in health care. The press does occasionally.
When, in the early 1990's, Hillary Clinton first tried to address cost containment and universal coverage in health care, she and the press chose not to address fundamental issues such as the fraud on bills -- that is billing patients for procedures that did not occur -- and the crazy charges called "cost shifting," such as $50 for a paper hospital gown. People in those years who tried to complain to the fee-for-service private insurers or Medicare about billing fraud got no response. And yet insurers took over medicine in the name of "cost containment," which they never practiced as fee-for-service insurers -- they never addressed fraudulent overcharges. The insurers have since done little to cut costs, but instead have cut services, like procedures or drugs they deny their enrollees, like the nurse to patient ratio, and they are putting the money they save in their pockets. As we head for "reform" again no one is looking at the crazy and still fraudulent bills and the history of insurers in gaming the system, nor are we confronting the following which we also failed to confront in the early 90's: there should be clinics that people can go to instead of emergency rooms which cost about 10 times as much as clinics; for most procedures Medicare pays a fraction of what private insurers pay; charges are way high if you go outside of your private insurer's network; the HMO process took away consumer choice -- choice of doctor, taking away the free market which (the free market improves quality and drives down costs); Many programs that are highly regarded like the Mayo Clinic and Kaiser and the Cleveland Clinic pay doctors by salary rather than fee for service, which saves money and removes incentives for doctors to make inappropriate choices -- too bad Congress and Obama are afraid to push the idea; Pharmacy benefits managers are middle men who squeeze kickbacks out of the drug companies on one end and the hospitals and pharmacies on the other -- they are corrupt and should be policed or better yet eliminated. For article on PBMs click here ; Congress, when writing the recent pharmaceutical bill for Medicare, forfeited the right to bargain for lower drug prices like private plans do -- Obama and Congress are not talking about changing this travesty; Insurers of the post fee-for-service era have strapped doctors with a huge paperwork burden including having to get insurers to OK medical decisions, which incurs many billions in costs as well as puts many medical decisions in the hands of office workers who should not be making such decisions; Medicare should pay for all pharmaceuticals -- we have people who have paid into the social security system all their lives but now go without medicine (the "donut hole") and eat very little or go without meds because the government is under the thumb of the drug companies. (The reason pharmaceutical companies don't want the government to pay for medicare prescriptions is -- care to guess? I mean why wouldn't they be happy to get their products paid for? -- because government covering these costs might lead to price controls. For article on unaffordable drugs in the economic downturn click here; hospitals that serve the poor have been shut down or stopped serving the poor, such as M.L. King in Los Angeles (closed in 2007). We should fix all of the above -- these are the kinds of reform we need to bring down costs and make sure the poor and retired can get medical care. A recent NYT's editorial by Bob Herbert cites government clinics that serve the medically underserved. We should back the expansion of these "Federally Qualified Health Centers" which are bucking the trend of shutting down hospitals like King in L.A. At these centers anyone can get care, and pay on a sliding scale. For article (op/ed) by Bob Herbert click here. We should also reopen centers like King which have been closed.