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Tuesday, October 13, 2009

Senate finance bill 10/13/09

A bill has passed the senate finance committee, with "bipartisan support", which means one Republican voted for it. The bill is only a tiny part of a health care reform package that will eventually by voted on in the house and the senate.

This tiny piece provides for more affordable universal health insurance, which is good, and will make those of us who have to negotiate for health insurance breathe a little easier. It would put an end to really heinous insurance company antics, such as canceling policies because people are sick. It allows for competition across state lines, stand alone dental insurance, expansion of medicaid and funding help for consumer driven health insurance options.

So it is good. It is not exactly what we need, but it does address some of the issues.

What we really need is still a radical reduction in costs. Although, as a health care consumer, I welcome anything that will bring some relief to those of us who suffer through having to pay for health insurance, I also recognize that those costs are almost completely driven by the cost of the product that is being paid for.

We focus on health insurance costs because, for those of us who are insured but rarely use medical services, that is what hurts most. And it is true that health insurance companies make obscene profits. Nevertheless, even the obscene profits are a drop in the bucket of what we pay for medical care overall. If we are relieved by improvements in the way insurance is administered and paid for, that relief will only be temporary, because the actual costs will continue to be too high. Costs need to come down.

As we breathe a sigh of relief that not all of our income will be used to pay for insurance, we need to stay focused on the work of rethinking what we want from medical care.

Presently, the culture of medicine, despite improvements in communication between doctors and patients over the years, remains hierarchical. Patients are expected to defer to doctors' opinions, and rely on the idea that doctors will truly know what is best for them. And doctors are still trained to think of the cost of care as being irrelevant. We have been trained in medical school to search for truth, find the diagnosis, even if it may have no important influence on outcomes, and damn the cost. Patients, through long association with their doctors, have come to accept this approach as only right and proper. There has been movement in the direction of providing appropriate and cost effective medicine, but it is by no means the rule.

The rethinking of our medical culture is going to take work, and time, and a willingness to change. As much as I would like to believe that legislation can make it happen, that would probably be unwieldy and heavy handed. Other than substantial federal malpractice reform, changes that need to happen need to happen at the level of health care providers and their patients, agreeing to do things differently, in a way that benefits their well being and remains financially sustainable.

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