Health Care Becoming the Prime Issue?

Reuters is reporting that Medicare was listed first among issues concerning American voters, even before Romney named Paul Ryan as his running mate (http://www.reuters.com/article/2012/08/16/usa-campaign-medicare-idUSL2E8...). Excerpts:

Medicare has become a top healthcare issue in the U.S. presidential election, surpassing the controversy over President Barack Obama's healthcare law, according to a poll conducted just as Republican Mitt Romney pushed the issue to the forefront of the campaign with his choice of running mate.

On Saturday, Romney announced he had picked Congressman Paul Ryan, a lawmaker whose plan to cut billions of dollars from the U.S. deficit included transforming the costly, but popular, healthcare program for the elderly.

The nonprofit Kaiser Family Foundation said on Thursday that 73 percent of respondents polled in the days around the announcement described Medicare as "very important" or "extremely important" to their votes. That included large majorities of Democrats, independents and Republicans.

The Kaiser foundation said a separate survey conducted a week earlier found that 58 percent of adults - including 55 percent of Republicans - favored keeping Medicare as it is today with all seniors receiving the same insurance benefits.

Only 36 percent of adults - and 39 percent of Republicans - said they favored a plan along the lines proposed by Ryan, according to the July 25-Aug. 5 poll conducted by Kaiser and the Washington Post. That data had a margin of error of 2 percentage points.

In an intensifying war of words, Democrats are attacking the Ryan plan with the claim that it would "end Medicare as we know it." Meanwhile, Republicans accuse the Obama administration of cutting $716 billion from Medicare to pay for "Obamacare," which is unpopular with many voters.

Meanwhile, back in Utah, the Legislative health reform task force has chosen a basic benefits package in compliance with the requirements of ObamaCare, according to Kirsten Stewart reporting in the Salt Lake Tribune (http://www.sltrib.com/sltrib/news/54710635-78/health-plan-utah-care.html...). Excerpts:

Come 2014 virtually all Utahns must have health insurance. But what will it cover, and how much will it cost?

Utah is a step closer to answering those questions — the Legislative Health Reform Task Force decided unanimously Thursday to choose as a benchmark one of the high deductible plans available to public employees.

Lawmakers picked the Public Employee Health Plan’s (PEHP) "Basic Plus" policy over the protests of low-income and mental health advocates who worry it sets the bar too low.

But task force Chairman Rep. Jim Dunnigan, R-Taylorsville, stressed, "This is the absolute bare minimum that must be offered. Insurers can, and certainly will, offer more."

Defining an "essential benefits" package is a requirement of federal health reform. It applies only to policies sold to individuals and small businesses, not large employer plans.

tah had to base its benchmark on top-selling policies on the market, including federal, public and small business plans.

At minimum, it must cover emergency services; hospitalization; maternity, newborn and pediatric care, including dental and vision services; mental health and substance-abuse treatment; prescription drugs; rehabilitative and similar services; medical devices; lab tests; prevention and wellness; and chronic disease management.

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PEHP’s "Basic Plus" covers the bases, but the devil is in the details.

It doesn’t, for example, specifically guarantee coverage of autism therapy or substance abuse treatment. Dental and vision coverage is limited to two check-ups a year for kids ages 3 to 18 and one eye exam for kids 5 to 18.

Also not covered: eyeglasses, hearing aids, orthotics and prosthetics, other than for the eye and breast reconstruction following surgery for cancer. Therapies for the disabled don’t include residential group home treatment. And coverage for prescription drugs is limited to a formulary of mostly generics.

My comment:

I hope that it is the case that Americans engage more in the debate about health system reform. But that will require getting past the talking points currently surfacing from the presidential campaign and really digging into the facts. Medicare is an efficient payer for health services, with an overhead far less than the private health insurance business model. However, Medicare pays for medically unnecessary goods and services, just as does private health insurance. So improvements can be made. And ObamaCare is not driving the discussion into better methods of paying for health care, just barer methods. Rather than selecting a health plan according to business priorities, wouldn't it be better if we were to organize a benefit package according to what clinical science finds to be effective? If we were to stop paying for inappropriate care while at the same time improving patient safety and increasing the efficiency of health care financing, we would find ourselves able to pay for universal health care services while spending $1 trillion less per year. Who is willing to look hard at these details?

Dr. Joe Jarvis