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Where I stand on health care reformThe Easy Reader
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September 11, 2009 |
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I never thought I’d say it, but America’s health care system is a disgrace. I come from a family of doctors. My father treated three generations of patients in West Los Angeles at a practice he built from the ground up. My brother is an oncologist. I am proud that they spent their careers committed to providing affordable, accessible and high-quality care to those in need. Health care professionals deserve praise for their hard work, but their efforts increasingly go to waste. It’s not their fault; they work in a system that has become bloated and inefficient, with profit taking precedence over people’s lives. The status quo is indefensible. As a member of the House Energy & Commerce Committee (and its Health Subcommittee), I am working closely with the Chairman – fellow Californian and our congressional neighbor to the north Henry Waxman – to reform our country’s broken health care system. Since the 2008 election put health care on the front burner, people in this Congressional district have weighed in via every medium imaginable, from Venice to Wilmington. And the “Medicine Cabinet,” a group of South Bay medical professionals that I established early in my career, has helped me evaluate various prospects. Many have underscored the irony—and embarrassment—of last month’s free, eight-day Remote Area Medical Corps (RAM) clinic staged in the parking lot of the Forum in Inglewood. 12,000 Angelenos overwhelmed a space that usually hosts concerts and sporting events. The organization sponsoring the clinic was founded to provide healthcare to people in underserved rural areas where doctors are few and far between—not in the heart of a major metropolis. And yet the RAM event painfully demonstrated how underserved parts of Los Angeles are. These days access to a doctor is more about insurance than geography, and in Los Angeles County 22 percent of adults between the ages of 18 and 64 don’t have insurance. Our 27-year-old son, Dan, is one of the statistics. Following surgery for a torn ear drum, his insurance company paid the bill and then dropped him. Such behavior by insurance companies is beyond cynical and, ultimately, will prove counterproductive. Judging by the number of people it treated, the RAM clinic was a success. But the care stopped there, with bittersweet results. One visit was enough for the mother who brought her children in for vision exams. Her kids got glasses and she’s glad they’ll be able to see the blackboard—and perhaps get better grades in school. But for many others, a single visit is just the beginning: I heard about several women whose pap smears returned serious results. Since they don’t have insurance, where will they receive the follow-up treatment they need? A more sustainable service is offered by the Little Company of Mary Hospital van, a mobile clinic that serves 2,000 school children who don’t have health insurance. This is a valuable service, but it’s a band-aid on a gaping wound. My visits last week to South Bay hospitals and conversations with doctors, clinic leaders and constituents have persuaded me to focus on several key priorities in the ongoing debate: • Creating a medical “home” where real doctors coordinate individual patient care. • More effort to curb prescription drug prices. • Supporting a robust public option that fosters genuine competition to the private insurers who maintain a stranglehold on America’s health care system. Access to quality care Having health insurance doesn’t necessarily mean you can see a doctor when you need to. The ideal ratio of primary doctors to patients is 1:2000. In the South Bay, that ratio is 1:7000. Even when you see a doctor, that doctor may take no initiative to follow up. We need more doctors and we need to give them incentives to take a more holistic approach to their patients. While visiting San Pedro’s inspiring Little Company of Mary Hospital, I met a ventilator-dependent former gang member who used an amazing computer system talk to me. His insurance coverage falls far short of the $900 per day needed to maintain him in some measure of dignity and comfort. Remarkably, the hospital covers whatever he and has family cannot – and squeezes its budget to provide for an adequate number of doctors. For 19 years, the hospital has also provided an essential, and little appreciated service: it serves as a central hub to coordinate the man’s care. That’s something that all patients should have, a single doctor to help manage all aspects of a patient’s healthcare. Your “home” doctor can help guarantee that tests are not redundant and that treatment prescribed by specialists makes sense given your medical history. Some doctors do this already, but because they’re not reimbursed for such oversight, they have little incentive to. A health reform bill should fix this, paying “home” doctors for coordinating patients’ care. It should also increase the number of doctors who can do so by establishing loans and incentives that encourage medical students to choose primary care as their specialty. Curbing Drug Costs Lowering the cost of medicine is the health-related reform with the biggest impact on the most Americans. Congress had an opportunity five years ago to do something about it, but we punted. In a middle-of-the-night vote in November 2003, the House voted 220 to 215 to ban the Secretary of Health and Human Services from directly negotiating lower drug prices for Medicare recipients. It was a lowlight of my House career, a cruel example of how back-room deals had left Congress incapable of taking meaningful action. Since then, prescription drug costs are one of the fastest growing areas of health care spending. Many Americans face a life-threatening choice between buying medicine and paying the bills. Here in the South Bay, one elderly widow with diabetes chose to pay her rent rather than buy her insulin. Not long after, she arrived in the ER dehydrated and comatose with a blood sugar level over 800. The pharmaceutical industry is one of the most profitable in the world. Drug companies can continue to prosper without pushing American consumers to the brink of financial disaster. To begin with, the federal government must be able to negotiate for lower prices for Medicare recipients. I was one of a handful of Democrats on the Energy & Commerce Committee who persuaded the Committee to pass a bloc of amendments that would do just that. Chairman Waxman has said that the House is not bound to President Obama’s deal with the drug companies to limit their reform concessions to $80 billion over 10 years. I wholeheartedly support Waxman’s view. Congress should explore all reasonable options. These include creating a safe, legal way for Americans to purchase medications from other countries; allowing doctors to post prescriptions online, where pharmacists can bid to fill them at the lowest price; and securing drug rebates for so-called “dual eligibles” – individuals entitled to both Medicare and Medicaid benefits. A Robust Public Option At Harbor/UCLA’s remarkable Family Medicine department, young doctors told me about a 50 year-old chef who, despite using his entire life savings to pay his health insurance premiums and purchase drugs to manage a congenital heart condition, still ran out of money and medications six months ago. This is an outrage. Why does health insurance cost so much? Because a lack of competition in insurance markets allows insurers to keep rates unnecessarily high. This doesn’t only affect individuals trying to buy or keep their own coverage; it affects businesses that help employees pay those premiums. Small businesses struggle to provide health benefits while big corporations struggle to compete against international firms that don’t face the same costs. The public option is misunderstood. It is not a government takeover, and it would not put private insurers out of business. With start-up funds from the government, but sustained by premiums paid by its subscribers, it could compete with private plans, ensuring that patients have real choice. The private insurance market has become non-competitive, with 94 percent of U.S. markets dominated by a single insurer. A public option will help the market deliver all the benefits of competition, including lower prices, improved efficiency, and better products. Now What? Sadly, the debate over healthcare has increasingly deteriorated into shoutfests and distortions of fact. Such behavior is not constructive and has not been limited to either political party. One thing we can all agree on is that our healthcare system is broken and we must find a way to pay to fix it. As Congress resumes its work on health care reform, both parties owe it to the American people to support a calm, serious debate about the best way forward. This problem is more important than partisanship. ### |
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