Shattering the myths about health reform

In a USA Today editorial today, Steven Findlay, senior health policy analyst at Consumers Union, sheds some light on the myths about health-care reform, many of which have frightened Americans. In it he debunks the notion that our system is headed toward socialized, government-run medicine with a side of rationed care:

"Cookbook and rationed care? This fear stems from concerns that the government aims to dictate what doctors do and cut costs by limiting access to care. These notions are wrong. Rather, what [President] Obama and both Democratic and Republican leaders want to do is aggressively measure the quality of care that doctors and hospitals deliver and change the way those providers get paid so quality of care—rather than quantity—is rewarded. That's hardly a socialistic notion."

So what must be done to fix the system? Findlay urges creative thinking and proposes that the medical industry be challenged to cut costs and change its "General Motors gas-guzzler mindset" by reducing waste and inventing more efficient systems.

Consumers Union fully agrees that it will indeed take creative thinking from the government and medical industry to reform health care. In our latest report on how we’d fix the system, we examine five of the worst fears about health reform, including the myths that "comparing the relative effectiveness of treatments and drugs will lead to rationing," and "health reform means a government takeover of medicine as in England and Canada." We stand behind a public plan that covers everyone—even the sick, gives patients the freedom to choose a health plan that gives them affordable, portable, and quality coverage, and focuses on the importance of primary care—which would not only allow doctors to be doctors, but would also cut health costs by an estimated 20 to 30 percent.

—Ginger Skinner

We’d like to hear from you: What myths about health reform resonate with you? And what are your biggest fears about reform?

Comments

[Richard Corry]

I'm surprised at all the comments stating dissatisfaction with health care in other developed countries - like those in Europe. It's useful to check the record: The U.S. ranks much higher in cost of health care and lower in live births, lower in life span, and lower in many other measures of health and well being. Most European countries are democracies. If people were so unhappy about the taxes or quality of their health care, politicians would have changed it long age - because people would have elected politicians to do exactly that. Remember that Margaret Thatcher was pretty conservative, and elected as Prime Minister 3 times, and she didn't do away with National Health Care there. Most countries have had conservative governments over the course of the last 20 years, and none have chosen to introduce an American style health care system.
When you read or see documentaries about health care in other developed countries, you don't see people outraged about their health care system, or envious of ours. What you see is something like pity for Americans who have to endure a system like ours.
Richard

[Richard Corry]

I wasn't going to comment until I read some of the comments above. Overall, I agree with most of the reforms being considered in Congress and advocated by President Obama. My first preference would be for universal health care and a single payer system.
• I think it's critical to do research on all aspects of medical care and drug treatments for medical conditions to insure that doctors know best practices for care, and that the criteria for best practices has a solid basis in science and research. In my own experience, doctors have been winging it in their care for me, and that's had a bad effect on my recovery.
• I think providing end of life counseling options are very useful to patients and to families, because then everyone has a chance to talk about a very sensitive and difficult topic and learn what the patient actually wants in terms of care. I don't think most people want to be lying essentially non-functioning, kept alive with extreme measures, in a hospital icu. I think most people would prefer being at home with high quality care available at home to insure that they're comfortable, as awake and aware as possible, and as pain free as possible. Home is generally more familiar, more comfortable and more accessible to family, friends and neighbors who want to show their love and concern, while hospitals are not all that comfortable an environment and may be difficult for friends and family to get to easily on a day to day basis. Everybody dies. What we want is an honorable and respectful death where we can feel peace and connection with the people important to us in our last months, weeks or hours.
• I wish the dialog about health care were based on factual knowledge about health care in the US as compared to other developed countries, and especially based on "best practices" in various countries that could be imported and adapted to U.S. health care.
• We are unusual because our government system is divided between States and a National government, with States having specific constitutional rights. We have wealthy states like California and very poor states like Mississippi and Arkansas, and funding a bill that meets the needs of both ends is difficult. Wealthy states are often high tax states, and asking them to pay more becomes a problem. Poor states don't feel they have the income to pay more taxes. Our tax system isn't as progressive as it could be, nor does it tax business at comparable rates to average people, so the Middle Class ends up paying disproportionately for all government services. People need to understand that there is no free lunch, but they shouldn't be responsible for paying for their lunch and the corporation's lunch, dinner and entertainment as well.
• What patients need should be based on the patient and the doctor, not on government policy or religious doctrines. If a patient asks for an abortion and the doctor agrees that this is medically sound, the health care plan should pay for it and the doctor and hospital should be able to provide it. The same should apply to birth control. If people understand sex and use birth control properly, you don't need to have an abortion and in addition you can reduce a lot of sexually transmitted diseases. It helps to insure that every child born is a wanted child and that the parents can provide for the child.
• We are paying (and vastly overpaying) for medical care now, through our current system. Everyone with insurance is paying for people without insurance. Those without insurance are getting inferior care, and ironically this increases the cost of care because without insurance, conditions get worse and the person without insurance has not had preventative care. There is no real competition among insurance companies, or pharmaceutical companies. Both insurance companies and drug companies ration care based on income. Cancer (and many other) drugs can cost thousands of dollars a month - more than many insurance companies will pay. Doctors are sometimes prevented by the insurance company from even discussing a medical treatment, if the treatment is deemed too expensive. The problem isn't that government bureaucrats will be rationing care, the problem is that for millions of people, insurance companies and drug companies are rationing care now. We need a health care system that puts patients first.
Richard

[Bob]

As to creative thinking from the government on SS, historically there has has been little creative thinking. The primary direction has been to maintain the status quo. I think it is lack of creative thinking that has led to problems in SS and Medicare. Unfortunately, the emotional level created by the two topics tends to stymie any creative, rational or objective thinking and comment.

[Neil]

I can't believe that CU is endorsing this "public option". Whatever happened to an objective look at the facts about anything? The government IS trying to get us into a single payer system like Canada. I invite anyone considering this to actually check into how well that works. I saw your "tale of 2 cancers". Let me give you a third story. If the 3rd one was in Canada, they would not have spent that much out of pocket money, but they very well may be DEAD. The extremely long delays and coverage denials are very real. I ask everyone to check this out. Another point -- can anyone actually name any government program that cut costs and worked? How about social security, medicare, the post office, and VA hospitals? These are all government run programs. Look how well that works. There was also an ammendment that would have prevented the government from overriding what your doctor says would be necessary. This was taken out of the bill. This bill also does not ever address tort reform. There is much that can be done to help make the best health care system better, but not socialize it.

[tell it Tommie]

I wish C/R would do a comparison of our health care "system" vs the European plans. i would gladly pay higher taxes for the social benefits they enjoy. government paid {not "run"} health care, education, vacation time, public transportation etc: do they have cities comparable to Newark, East St Louis,Detroit, and so on. show the way of life of an inhabitant of Stockholm, Copenhagen, Berlin, etc: Compare every facet of a citizens life in Europe with the U.S. How many coast guard vessels are there in the rivers bordering Canada to stop all the Canadians from penetrating our country to avail themselves of our superior health care. a single payer system sounds like the ticket to me, but the powers that be aren't going to let that happen.even some of the people who are poor to middle class defend the status quo. like the cliche states... go figure!

[Dan Rapak]

"NOBODY has done any study which tells us just how "disruptive" it would be to simply expand Medicare to include all and get rid of the entire profit motive in funding healthcare."

I don't think expanding a government program that is going bankrupt is the answer. Also, profit is not a bad thing. Its important to remember that the "profit motive" is what has led to virtually all the major advances in medicine. Why develop that new drug if you can't make a profit for doing so? Do you think corporations would have developed the MRI or CAT scan if there were no financial incentive to do so?

"Also, as one who has resided in Canada and received care there and cared for family in that system AS WELL AS the US system, a BIG myth that resonates for me is that the US is so different than Canada"

There is one VERY important difference. Last year I spent two weeks traveling across Canada by overnight trains. This provided a lot of opportunities to speak with Canadians about their health care system. In truth, most seemed to be reasonably satisfied with the system, just as polls show that most Americans are reasonably satisfied with the system we currently have. The BIG difference is the tax rates! What the Canadians told me was that if you add up federal income tax, provincial (state) income tax, provincial sales tax and the federal sales tax (which so far we do not have in the US) the equivalent tax rate is more than 70% !!! This of course varies depending on how much purchasing you do, but overall the total Canadian tax revenues divided by the total Canadian income is more than 70%!

I for one am not prepared to hand over 70 cents out of every dollar I earn to the government. The Boston Tea Party was held, a revolutionary war was fought and a new country founded over much less.

DR

[Reed Sessions]

2 points need to be made of which the average consumer is not aware.

First, healthcare needs to move as fast and as far away from the hospitals as possible. There are countless studies demonstrating the tremendous savings that are achieved when care is provided by independent companies in our communities. I have been told by insurance representatives and hospital management personnel alike that the average reimbursement paid to a hospital for a sleep study in our area is around $2,500.00. The independent sleep lab where I work gets paid an average of $700.00. Unlike independent sleep labs, hospitals are allowed to add “facility charges” dramatically elevating the amount paid by the billed insurance company. Hospital labs are appropriate for in-patient studies or for those critically ill. Similar studies have been conducted regarding nursing care and MRIs. Insurance providers, politicians, and all of us in the general public should demand that independent providers of healthcare services, away from the hospitals, become their preference and their first line of care.

Second, physicians should not be allowed to financially gain from prescriptions that they write. The Office of the Inspector General (OIG) has already deemed such conflicts of interest illegal with regards to surgical centers and medical equipment companies along with many other areas of medicine. However, due to a loophole in the definitions pertaining to diagnostic services, medical testing remains an area of medicine where physicians may financially profit from ordered tests. Studies conducted over the last decade show a dramatic increase, often over a 200% - 300% increase each year, for diagnostic testing such as MRIs and sleep studies to diagnose sleep disorders. This confounding increase coincides with the introduction of physician owned MRI machines and sleep labs. When a physician’s bonus, house payment, or vacation budget is directly affected by the number of tests he/she orders, we have officially discovered the definition of a conflict of interest. This argument does not even need to be justified because it has already been accepted in many areas of medicine making such practices illegal. It simply needs to be applied across the board to assure that we are getting the most appropriate and unbiased healthcare possible.

By fixing these 2 areas, along with a healthy focus on preventative medicine, we will see a dramatic reduction in the consumption of healthcare resources which will positively affect us all by lowering our premiums and improving the health of our communities.

[KS]

As a healthcare worker I can tell you that one of the reasons costs are out of control is that we live in a very litigious society.
Doctors often order expensive tests justs to "CYA" because they know the one time they don't someone will try for a little easy cash. An example of this is the anxious or drug seeking person who repeatedly shows up in the ED complaining of chest pain. Previous tests have all been normal but we have to do them again because for that complaint that is the standard of care.

[Frank]

Consumers Reports does an exceptional job at reporting the quality and appropriateness of a product for individuals and families. However, it is not in your best interest to become involved with the legislative process and the current discussion of the medical and health issues at the Federal level. When you become involved with these discussions you leave yourself open to criticism that you no longer are a non-biased group looking at the consumer goods being produced for the American society. Instead you now become a lobbying group and leave yourself open to loss of being a not-for-profit non-biased agency.

[Oren R]

The myth that resonates for me at the moment is the myth that to fundamentally change healthcare in the US requires dismantling the entire system. NOBODY has done any study which tells us just how "disruptive" it would be to simply expand Medicare to include all and get rid of the entire profit motive in funding healthcare. Also, as one who has resided in Canada and received care there and cared for family in that system AS WELL AS the US system, a BIG myth that resonates for me is that the US is so different than Canada and any of the other industrialized nations.

REALITY is that when Medicare started up, it was a very unexciting and uneventful start. It started up with very few votes (people really fought it) but people INCLUDING PROVIDERS are vehement about its retention today and providers favor dealing with medicare over all other payers.

Consumer reports needs to check its own tendencies towards buying into prevailing fears and unfounded red scare tactics.

[Don Wong]

One significant wellness service omitted from Health Care reform is DENTAL CARE.

A recent Seattle Times article: "Poor dental care has been linked to everything from heart attack to stroke, not to mention the tremendous pain and suffering endured by those who can't afford proper care. The situation is a sad one. Dental insurance rarely gets the kind of press it deserves, instead taking a backseat to other healthcare issues; it's "a neglected stepchild among health priorities."

I hope Consumers Report will include Dental Care in its efforts to provide public awareness of the issue.

Thanks, Wok King

[Tony]

I also can't buy the notion that "The Public Plan would get no special favors or funding."

They don't even give you the opportunity to TRY to buy that notion. Right in the text of every proposal floated so far, they clearly and fully admit that the public plan would "set" their reimbursement rate, usually to something relative to Medicare reimbursement rates.

Neither private insurers, nor individuals, have the opportunity to "set" their reimbursement rates. Rates must be negotiated -- IE mutually agreed upon -- between private insurers and providers. If they can't reach an agreement, that provider is not a member of that insurer's network.

We know for a fact that the public plan WILL (not "might" not "will end up", not "I bet they will" -- they WILL) impose rates on providers that providers will not get to negotiate. That is in no way an equal playing field, no matter how strenuously advocates insist that it is.

[Tony]

"Rather, what [President] Obama and both Democratic and Republican leaders want to do is aggressively measure the quality of care that doctors and hospitals deliver and change the way those providers get paid so quality of care—rather than quantity—is rewarded. That's hardly a socialistic notion."

Excuse me? The idea of the government changing the way providers are paid for medical care is "hardly" a socialistic notion? It's the very definition of socialism!

[Tony]

"I find the comments describing how the government never gets anything right laughable. Roosevelt's New Deal was controversial, and opposed by the same kinds of people that are complaining about the government in their comments."

You're right, the New Deal was controversial. But it is also directly attributable for many of the country's social and economic problems today. I don't know anyone who thinks, in hindsight, that the New Deal was a good idea -- do you?

Your comparison is apt, however, because nationalized health care is the New Deal writ large. With Medicare, however, the gap between reimbursement (Medicare pays a fixed, currently below cost price for every medical service received by recipients) was able to be recouped by charging higher rates to private insurers, and higher rates still to individuals -- making Medicare a significant contributor to the high cost of health care and health insurance among those it doesn't cover.

[Lawrence Cavallo]

I wouldn't think of making a major purchase before first consulting Consumer Reports, but when it comes to Consumer's take on Health Care Reform, I have to say, I'm more than disappointed in thier fuzzy report. I hope anyone reading this IS fearful of our government taking over health care. Unless they have a crystal ball, how do they know that we will not wind up with the same disasterous systems they currently have in England, Canada and most of Europe? And who exactley will be paying for all of this? Of course the answer is the already overtaxed middle class. Maybe there's a plan to charge anyone illegally crossing our borders(who by the way already get free healthcare here) an entry fee to pick up some revenue. I agree that there must be some changes to our current health care sytem, like getting serious about insurance and Medicare fraud, but going to a proven failed system such as those in Europe is something to be very fearful of! I'm sorry to say it, but I truly believe that we are being lied to! I guess only time will tell.

[Rob]

I find the comments describing how the government never gets anything right laughable. Roosevelt's New Deal was controversial, and opposed by the same kinds of people that are complaining about the government in their comments.

If the federal government is so irresponsible, why aren't these same people clamoring for a privatized military? I'm sure they would say something like "That's different" without being able to tell us why, but they may say something like how national defense is something that's just too important and too subject to abuse and so has to be handled by publicly elected officials who are sworn to obey the constitution and act on behalf of the American people. Of course corporations have no such obligations. Their only purpose is to enrich their owners, shareholders, and executives.

We don't trust corporations to defend us from foreign powers during war, so why would we possibly assume they'd have our best interests at heart when it came to preserving our very lives? Simple: they don't.

Insurance companies add no value what-so-ever to the process. Remember they are FOR-PROFIT middle-men. They provide no healthcare, and they produce no goods or services related to healthcare. Their entire function is to skim as much as they can and pay it out in dividends and executive compensation. Where do you think that money comes from? - It comes from YOU!

I say let's end the discussion and let private companies compete with federal healthcare. Let's see which system people choose for themselves in the market place and go from there.

[Dan Rapak]

I've just read the August 2009 articles on health care. There are many good ideas there. However, there are also a few points I must question.

You state that any solution to health care must preserve "freedom, fairness and choice." Yet you state that "A fair solution would be ... a rule requiring everyone to have coverage." So much for freedom.

However, the suggestion that concerns me the most is the idea of having a Public Plan. You state it would operate with lower costs on a non-profit basis and would compete with private insurers to keep premiums low. Nice theory.

But can you give me three examples of any time in the history of our country when the Federal Government has taken over a function previously performed by the private sector and the end result has been a product that is cheaper, more efficient and better for the end user? Social Security is going bankrupt. Medicare is going bankrupt. Why in the world would anyone think that this Public Plan insurance option will be any different?

Also, I can't help but observe that this proposal makes participation in the Public Plan optional; that we could still choose a private insurer if we wanted. Isn't this model EXACTLY what was proposed for Social Security reform? Isn't this what all the opponents to privatization said would never work; that it would destroy Social Security and have all our seniors eating cat food? Why would it destroy Social Security and yet be the answer to our problems here?

But let's ignore all that. Let's assume that the operation of the Public Plan would work; that the non-profit operation would be enough to overcome government waste and inefficiency and the Public Plan as described would survive. There is still another problem that the article overlooks. If the government run Public Plan has lower premiums than the private plans, why would anyone choose a private plan?

The private insurance companies have to make a profit. They have to pay their shareholders or they go out of business. How does a private insurer compete with a government backed non-profit offering the same services? Obviously, they can't. The private insurers would soon be gone and all we would be left with would be the federal, Public Plan insurance. Again, so much for freedom.

I also can't buy the notion that "The Public Plan would get no special favors or funding." In no time at all the politicians will be giving away free insurance to curry favor and buy votes. That "free coverage" will be paid for with tax dollars. It would start with the poor, but the threshold below which people will qualify for "free coverage" will continue to rise until everyone is covered "for free" which is what the people pushing for this really want. Personally I agree with the pundit who said, "If you think health care is expensive now, wait until you see how much it costs when its free."

Finally, I would like to submit the following criteria for ANY proposed health care reform: Whatever plan the politicians come up with should include mandatory participation of the politicians themselves. The health care plan that the President and members of Congress currently enjoy must be abolished and Congress and the President must enroll in our plan with no special favors or benefits. If its good enough for us it must be good enough for the folks in Washington and for their families too.

Respectfully,
Dan Rapak
Randolph, NJ

[eric]

CU/R...you are ignoring a lot of facts that don't support the position you have taken.

What is wrong, is this: "Cookbook and rationed care? This fear stems from concerns that the government aims to dictate what doctors do and cut costs by limiting access to care. These notions are wrong."

IF there is govt program, it has been shown by many analysts that many companies, especially smaller ones, will drop their private insurance they currently carry (very expensive) or their employees. Those will then have to get on the govt teet. The more that happens, the more bankrupt that system will become - another ponzai scheme like social security. The more the funding becomes an issue, the more regulation there will be on health care, who can get it, when they get it, etc. NONE of the current socialized systems in Europe or Canada started out the way they are either. But it doesn't take long for everyone to try to get on the "free ride" - leading the govt to be in charge.

Why is it so hard for people to pick up and article or history book and learn something today?

sad.

[Mike]

My biggest fear is that, over time, the government will begin to regulate behavior to keep costs down. Everything we do has some risk associated with it. Will the government tell smokers that they'll be penalized for smoking because they are a burden on other tax payers(not an unheard of idea even now with private insurance)? But what about mountain climbing? What about driving more than average? Will we have to exercise a certain number of minutes a day? How much meat can be consumed? Will there be a weight penalty? What will they choose to monitor and penalize? Will the risk factor become a complex equation like a credit score?

I know that these questions make me sound like an Orwellian alarmist but I think that people tend to trade freedom for security (physical AND economic). So the question remains: how much of our freedom will we trade to keep universal healthcare solvent?

By the way, I'm not against universal healthcare. I just think that vigilance is very much in order.

[born in the 60s]

My only fear is that it will not go far enough. As long as Insurance Companies are skimming Billions of "Health Care Dollars" from the system and thier profitability is enhanced by denying people coverage the system will consistantly cost more and deliver less.

People scream about the government making health care decisions and claim those decisions should be made by Doctors but in practice under the current system those decisions are being made by Insurance Companies. This is WORSE.

[PsySciGuy]

"Consumers Union fully agrees that it will indeed take creative thinking from the government..."

Thant's just silly. "creative thinking from government" brought us bankrupt social security, the current economic mess (Thanks Barny for the give-a-loan-to-everyone creativity), and a congress that won't be using the health "care" system they impose on us.