Shaheen, Working on Health Care Reform, Sees Challenges Aheadd
Health care reform
New Hampshire Union Leader
Aoife Connors
Boston University Washington News Service
April 22, 2009
WASHINGTON – Melinda Haney, a 46-year-old mother of two from Rochester, N.H., says she is the perfect poster person for the importance of Medicaid. “If I didn’t have Medicaid, I would be dead.” Haney said.
Medicaid is a system of health care provided for low-income families and people with disabilities. Before she became a Medicaid patient in March 2006, Haney said she could not afford to take all of her prescribed medications, which cost more than $1,000 a month.
Haney, who has recovered from three bouts of cancer, said, “I wouldn’t be here for my kids if it wasn’t for health insurance.” Insulin medication, to regulate diabetic blood sugar levels, costs her $800 a month. “Even if I was working 60 hours a week, I could never afford my Medicaid bills,” Haney said.
Unable to work because of her illnesses, the former nurse assistant said she takes 14 pills in the morning, 3 in the afternoon and 12 at night, for other medical conditions.
Acknowledging that she is one of the lucky ones, Haney said, “many patients are really sick and dying because they can’t afford their medication.” Many people do not qualify for Medicaid because of their incomes, but still do not make enough to pay for expensive prescriptions.
President Barack Obama and Democratic congressional leaders have said implementing comprehensive, affordable health care reform before the end of 2009 is a top priority. According to the Department of Health and Human Services 46 million Americans have no health insurance and 25 million are underinsured. And those are numbers that almost certainly have grown during the current steep recession.
Proposals on how to reform the system are contained in a 98-page report by Sen. Max Baucus (D-Mont.), chairman of the Senate Finance Committee. The Baucus proposals include reducing the cost of Medicare by rearranging private plan options, expanding Medicaid coverage to everyone living below the poverty level, increasing competition in the prescription drug industry and focusing on preventive rather than acute hospital care.
Baucus and Sen. Edward Kennedy (D-Mass.), chairman of the Senate Committee on Health, Education, Labor and Pensions, are leading a series of hearings and roundtable discussions to consider the proposals under consideration. The White House Office of Health Care Reform, meanwhile, has published similar proposals as part of President Obama’s health reform plan.
Baucus and Kennedy say they hope to have a bill before Congress by June and Obama said he wants reform legislation passed by the fall. James Gelfand, a health policy analyst with the U.S. Chamber of Commerce, said, “Sen. Kennedy will be the leader on the issue; he is playing the role of master convenor, bringing everyone together.”
The creation of a national insurance exchange that acts as a marketplace for Americans to compare competitive company plans and choose the one that best suits their needs is also proposed in the Baucus plan. Sen. Jeanne Shaheen (D-N.H) said the insurance exchange could be “a critical component” of reform and “is certainly something I would support.”
There is ongoing debate about whether a single-payer (government) system or a competitive market-based system (private companies or employer-based) offering health insurance plans is better.
Sen. Judd Gregg (R-N.H.), one of the Republican senators chosen to lead the GOP’s health reform proposals in Congress, said, “One part of the answer to solving the health care crisis lies in a consumer-based, private market approach, which helps drive innovation and reduce costs.” Gregg warned, “We do not want to go down the path of a nationalized, single-payer health care system run by the federal government. This would lead to rationing and a reduction in quality of the care available to all Americans.”
Richard Kirsch, national campaign manager for Health Care for America Now, a national group lobbying for affordable health care, said, “A public insurance plan, with the option of private insurance, has a much better record of controlling costs than private health insurance.”
Dr. Terry M. Bennett, a primary-care physician in Rochester, N.H., said regulating the private insurance industry is essential because right now, “the private health insurance industry’s purpose in life is to make money; they’re an industry, so they’re concerned with the health of their bottom line, not the people they serve.”
He compared reforming the health care system to “breaking all of the old chinaware and buying a new dining set, table and silverware.”
One of the main obstacles to achieving health care reform is how it would be paid for. Reforming the system is estimated to cost $50 billion to $65 billion a year, according to Obama. A portion of the revenue to finance the reform would come from a $630 billion reserve fund, included in the President’s fiscal year 2010 budget, to be created over 10 years.
The United States spends $2.4 trillion each year on health care, and the rising costs are threatening the country’s long-term fiscal security, according to the Baucus report. The Congressional Budget Office says that almost one-third of health care spending – $700 billion – does not improve patient health outcomes.
Gregg said that with 17 percent of the gross domestic product being spent on health care, “there is a significant amount of money already in the system that if allocated in a more efficient way, would go a long way towards achieving comprehensive health care reform.”
Shaheen said that reforming the Medicare and Medicaid systems and instituting cost savings in those systems will be essential to the success of any comprehensive health care reform plan.
She singled out Medicare Advantage Plans as a system that needs to cut costs, It lets people 65 and older choose between the basic Medicare plan and a private plan that provides extra benefits but sometimes costs participants more.
“The government right now pays 114 percent for a Medicare Advantage Plan of what it would pay for someone in a traditional Medicare plan,” Shaheen said. “That doesn’t make sense to be paying more.”
Obama has called for eliminating excessive subsidies paid through a Medicare Advantage Plan and instead paying what it costs to treat patients under traditional Medicare.
Shaheen said lowering the cost of prescription drugs is also an important part of health care reform.
Shaheen is proposing that re-importation of generic drugs from other countries be allowed. “So for example, in New Hampshire, I can go to Canada, right over the border, and purchase most drugs for much less cost than I can purchase them in New Hampshire, and right now you’re not supposed to do that,” Shaheen said,. “We need to change the law, to allow the re-importation of safe drugs from Canada and other countries, if they pass the Food and Drug Administration requirements.”
She added that generic drugs need to come on the market more quickly. “Right now our patent laws have prevented a lot of generic drugs from competing with those brand-name drugs and I think we’ve got to make changes in our patent laws so that they are able to compete and get into the market place faster,” she said.
Generic drugs cost 20 to 30 percent less than brand-name products. But, a patented drug allows the drug company to set the price for the duration of the patent, without any government control.
The Obama plan states that prevention of chronic illness and disease must become a cornerstone of a reformed system. Shaheen said, “Right now we have a system that’s based on acute care, on hospitalization, but we need a system that promotes wellness and preventive care.”
To achieve this, Shaheen said, the incentives have to change. The Baucus plan proposes focusing on prevention of chronic diseases like heart disease, obesity, diabetes and cancer.
The key element of health care reform in 2009 is about “creating a system where our health, both our personal health, our family’s health and our country’s financial health, comes first,” said Kirsch of Health Care for America Now, “and I think we’re going to do that, because we can’t sustain the current system any longer; it really is bankrupting families and our nation.”
Shaheen agrees. “We cannot wait,” she said.
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