The State of NC Healthcare

Jim Buie’s comments on healthcare reform

Posted in Reform-in-progress by writemyline on 12 January 2009

Jim Buie (The Buie Knife) posted the following comment on writemyline in response to an earlier post that first appeared on this blog and entitled “Bits and pieces” of healthcare reform . I think Jim is right on target and that his thoughts deserve consideration, especially his idea of healthcare being similar to a public utility.

Jim Buie: 
It will be very important for those of us concerned about health care reform to put the heat on the new administration. Sens. Kennedy and Baucus will take a leading role in proposals, I’m reading. What passes will largely be determined by COST, given the huge bailout package. The argument that will be most persuasive is that health care reform, in the long run, SAVES money. We in the U.S. need to face the fact that other countries manage to INSURE EVERYONE and provide, overall, better care for far less cost than we do. We need to learn from studies of comparative health care internationally and implement recommendations.

– by insuring the uninsured, we move them away from the most expensive care, in emergency rooms, and eliminate cost-shifting.

– by allowing the gov’t to purchase generic phamaceuticals in bulk, we reduce price gouging by pharmaceutical companies.

– we should reduce the “for profit” nature of private health care, with exorbitant salaries for executives. Cap their salaries and eliminate bonuses. Start thinking of health care as a public utility.

– reduce the number and wasteful purchase of expensive machines, such as CT scans (utilization in the u.s. is far greater than in other countries).

– merge small insurance groups into much larger pools to reduce adverse selection, ban cherry-picking of healthy (and most profitable) patients, and reduce the overall risk of health care plans — that should reduce monthly premiums because risk is shared more widely.

– maybe open up Medicare to younger people, and the federal health insurance programs to people who aren’t federal employees. If people could get into these plans, they’d pay far less than they do for private health care plans.

(I currently pay $300+ a month as a self-employed person for health care for myself, my wife, and son, but there’s a $10,000 a year deductible. This is not really health insurance, it’s simply insurance against the loss of our home in the event of major illness.)

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“Bits and pieces” of healthcare reform?

Posted in Reform-in-progress by writemyline on 16 November 2008

From Can Obama Truly Deliver?   “On October 31, Obama told CNN that he would set five immediate priorities: “stabilize” the financial system, move toward energy independence, enact some form of healthcare reform, grant middle-class tax cuts, and strengthen the education system. But he made clear that the nation has entered an era of limits because the economy is in such bad shape.”

But will Election Day exit polls further influence President-elect Obama’s “todo” list? 

According to Kenneth T. Walsh of US News and World Report(USN&WR), “about 62 percent of voters said the economy was their biggest concern–far and away the most important issue. About 19 percent listed Iraq or terrorism, and 9 percent said healthcare.”  USN&WR did not report the numbers for voters mostly concerned with energy independence, education, and other issues. If exit polls determine Obama’s response to American voters and the order in which he addresses the country’s most significant concerns, then healthcare reform is not so high on the list. With the overwhelming majority of voters depending on deliverance from the current global financial crisis, Obama’s promise of healthcare reform is likely to fade in the background.

USN&WR says that Obama’s aides “expect him to compromise in his own particular way.” They say that the President-elect will likely “scale back each of his priorities.” An unidentified, but “prominent Democrat who knows him well” says Obama will do “bits and pieces” rather than abandoning or down-sizing the issues he promised to work on. 

As far as Obama’s healthcare reform plan, it is probably safe to assume that it won’t be as aggressive as promised throughout his campaign and could settle on “insuring everyone under 18 years old so no child would be without health insurance”–not exactly the universal care that appealed to voters most concerned about healthcare. While insuring those 18 and under is, indeed, a worthy accomplishment, whether it can boost the movement toward overall reform is questionable. 

One wonders if some or a little change is better than no change at all, particularly when the larger issues continue to burden the whole system of healthcare providers and institutions as well as the entire profile of the population they must serve. Can a government-initiated healthcare reform project set out on the path of least resistance and get anywhere, especially when politically motivated? Is it likely to make a lasting impact?

It will be necessary for President-elect Obama to continuously re-evaluate his priorities; still, the American people depend on progress or at least the hope of it. In regards to healthcare reform, it is critical that leadership fuel the momentum with the knowledge that lasting and positive change is a long-term goal, that results are often slow to come into focus, and that the final page will most likely be written by future leaders and subsequent administrations. With that said, perhaps President-elect Obama will be the one who truly initiates change–not necessarily the one who signs final legislation.

President-elect Obama has a difficult task ahead because not all voters are going to be satisfied with just “bits and pieces” of the expectations they cast along in the ballot box. As one of those voters, I am more hopeful that our President will initiate and engage in an effective healthcare reform process in which there is no turning back–one that, perhaps, may not come to an end under his tenure, but surely would not have started without vision and leadership.

Speaking of experience…How do the candidates measure up to healthcare reform?

Posted in Reform-in-progress by writemyline on 30 August 2008

John McCain

Barack Obama

On healthcare:

On healthcare:

Harness market competition for comprehensive reform. (Feb 2008): Preserve quality of health care by individual responsibility. (Dec 2007): Give individuals $2500 refundable tax credits for healthcare. (Oct 2007): Control health costs so manufacturers stay competitive. (Oct 2007); No mandated universal system; no mandated insurance coverage. (Jun 2006);We should be able to re-import drugs from Canada. (Jan 2006); Include a health savings account in healthcare reform. (Jan 2006);The problem with health care in America is inflation. (Jan 2006); Supports tax-free medical savings accounts & tax credits. (Nov 2004); 1989: No mandatory catastrophic Medicare coverage. (Jan 2004); 1993:To socialize healthcare would be to ruin it. (Jan 2004); Greater consumer access to generic drugs. (May 2002); Higher taxes on cigarettes. (Jan 2000); Matching funds for seniors citizens’ prescription drugs. (Dec 1999); Expand health insurance to 11 million uninsured children. (Dec 1999); Keep health care promises to aging veterans. (Nov 1999); Address powerlessness when faced with health care crises. (Jul 1999); “Patient rights” means value human life over dollars. (Jul 1999); Expand medical savings; community health; & tax deductions. (Jul 1999); Patient Rights: access; MDs over HMOs; grievance process. (Jul 1999); Allow paying extra for choice of doctors & care. (Jul 1999) Full doctor-patient discussion even when it costs HMO. (Jul 1999); Supports patient rights; regulate nicotine as a drug. (Jul 1998); More tax-deductible health costs; limits on malpractice. (Jul 1998)

End-of-life self-medication ok; euthanasia by others not ok. (Apr 2008); Hillary’s plan must either be enforced, or leave out people. (Feb 2008); The problem with health care is about affordability. (Jan 2008); Subsidies to people who can’t afford care–not single payer. (Jan 2008); Bring GOP & Dems together to make healthcare affordable. (Jan 2008); FactCheck: Reducing obesity would save $18B, not $1T. (Dec 2007); Reforms in prevention and drug price negotiation save money. (Dec 2007); Tackle insurance companies on reimbursement system. (Oct 2007); Help young people deal with the cost of medical education. (Oct 2007); Morally wrong that terminally ill must consider money. (Sep 2007); FactCheck: Correct that insurance lobbying cost $1B. (Sep 2007); National smoking bans only after trying local bans. (Sep 2007); Reform failed in ’90s because of drug company lobbying. (Jul 2007); Take on insurance companies; drive down health care costs. (Jun 2007); Address minority health needs by more coverage & targeting. (Mar 2007); Health care tied to balancing costs and taxes nation wide. (Jun 2006); Allowing seniors to bulk purchase will save taxpayers’ money. (Oct 2004); Allow prescription drug re-importation. (May 2004)



Voting Record

Voting Record

-Allow appealing HMO decisions externally & in court. (Jul 1999)

-Voted NO on expanding enrollment period for Medicare Part D. (Feb 2006)

-Voted YES on increasing Medicaid rebate for producing generics. (Nov 2005)

-Voted YES on negotiating bulk purchases for Medicare prescription drug. (Mar 2005)

-Voted NO on $40 billion per year for limited Medicare prescription drug benefit. (Jun 2003)

-Voted YES on allowing reimportation of Rx drugs from Canada. (Jul 2002)

-Voted YES on allowing patients to sue HMOs & collect punitive damages. (Jun 2001)

-Voted YES on funding GOP version of Medicare prescription drug benefit. (Apr 2001)

-Voted NO on including prescription drugs under Medicare. (Jun 2000)

-Voted YES on limiting self-employment health deduction. (Jul 1999)

-Voted YES on increasing tobacco restrictions. (Jun 1998)

-Voted NO on Medicare means-testing. (Jun 1997)

-Voted NO on blocking medical savings accounts. (Apr 1996)

-Tax credits for those without employee health insurance. (May 2002)

-Tax deduction for long-term care insurance. (May 2002)

-Support telemedicine for underserved areas. (May 2002)

-$350 billion for prescriptions for poor seniors. (May 2002)

-Rated 25% by APHA, indicating a anti-public health voting record. (Dec 2003)


-No need to mandate coverage; just let people afford it. (Jul 2007)

-Voted NO on means-testing to determine Medicare Part D premium. (Mar 2008)

Voted YES on requiring negotiated Rx prices for Medicare part D. (Apr 2007)

-Voted YES on expanding enrollment period for Medicare Part D. (Feb 2006)

-Voted YES on increasing Medicaid rebate for producing generics. (Nov 2005)

-Voted YES on negotiating bulk purchases for Medicare prescription drug. (Mar 2005)

-Increase funding for AIDS treatment & prevention. (Jan 2001)

-More funding for Rx benefits, community health, CHIPs. (Jan 2001)

-Improve services for people with autism & their families. (Apr 2007)

-Preserve access to Medicaid & SCHIP during economic downturn. (Apr 2008)

















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UNC’s Jonathan Oberlander assesses McCain and Obama’s healthcare reform.

Posted in NC Healthpress by writemyline on 23 August 2008

Jonathan Oberlander, UNC associate professor of social medicine and health policy and administration, has published an article in the August 21 issue of the New England Journal of Medicine that outlines and discusses key elements of John McCain’s and Barak Obama’s plan for healthcare reform. [Read the full article here.]

According to Oberlander, “McCain’s plan embraces market forces and promotes individually purchased insurance. Its centerpiece is a change in the tax treatment of health insurance,” while Obama’s plan “relies on an employer mandate, new public and private insurance programs, and insurance-market regulation.”

Oberlander sums up his dual assessment by stating:
“The McCain and Obama health plans are best viewed as sketches rather than finished portraits, with many important details yet to be revealed. Still, the 2008 presidential election clearly offers voters dramatically different alternatives. The candidates’ opposing visions of health care reform reflect fundamentally different assumptions about the virtues and vices of markets and government. With the debate over how to reform U.S. health care far from settled, whoever wins the presidency can expect fierce opposition to any attempt at comprehensive reform.

Key Elements for Health Care Reform1

Barack Obama’s Plan

John McCain’s Plan


“Play or pay” employer mandate requiring businesses either to offer workers insurance or to pay a tax (very small businesses would be exempt)


Creation of a new national health plan (similar to Medicare) for the uninsured and small businesses


Establishment of new national health insurance exchange that would offer choice of private insurance options for the uninsured and small businesses


Mandate that all children must have coverage


Subsidies for lower-income Americans to help them afford coverage


Expanded coverage financed through the payroll tax, letting tax cuts for families making over $250,000 expire, and savings from electronic medical records,

disease management, and other system reforms


Regulation of all private insurance plans to end risk rating based on health status


Establishment of federal reinsurance program to insure businesses against the costs of workers’ expensive medical episodes


Other proposed measures to control costs and improve quality:

Reduction in the administrative costs of private insurance

Accelerated adoption of electronic medical records

Promotion of disease management

Emphasis on prevention and public health

Payment of providers on the basis of performance and outcomes

Reduction in excessive payments to private plans contracting with Medicare

Allowing Medicare to negotiate with drug companies

Establishment of a comparative-effectiveness research institute



Elimination of current tax exclusion for employer-paid health insurance premiums


Using revenues generated from eliminating tax exclusion, provision of refundable tax credits ($2500 for individuals, $5000 for families) for all persons obtaining private health insurance; if insurance costs less than the value of the credit, the remaining funds can be deposited into health savings accounts


Creation of guaranteed access plan to provide insurance pool for persons who are medically uninsurable on the individual market


Promotion of individually purchased insurance and less comprehensive insurance policies


Deregulation of insurance markets


Reform of Medicare to make bundled payments for episodes of care and to pay on the basis of outcomes


Other proposed measures to control costs and improve quality:

Enhanced competition

Faster introduction of generic drugs

Emphasis on prevention and better management of chronic conditions

Greater use of health information technology

Medical malpractice reform

1. Oberlander J. The partisan divide—the McCain and Obama plans for U.S. health care reform.  New England Journal of Medicine, August 21, 2008; Volume 359:781-784.

2. Morrissey S. Curfman G. Drazen J.  Health of the Nation — Coverage for All Americans.  New England Journal of Medicine, August 21, 2008; Volume 359:781-784.