HCCD Report Florida 33611

Community Health Care Discussion Group Submission

General Questions

• How many people attended your health care community discussion?
  
  Three plus moderator (14 people were invited). Our discussion was held in Tampa, FL on December 19^th. It took 3 ½ hours for our group to get through the full agenda.
  
• Please summarize compelling personal stories from attendees about the need for health care reform in our country and provide their contact information.
  
  Several participants feel that alternative medicine is more effective and less costly than mainstream medicine for many routine health problems. They expressed little confidence in the mainstream healthcare system and are very suspicious of the profit motive that drives much of the system. One participant was hospitalized for cancer; even though she had health insurance, her bills were so high that she ended up paying her share of the hospital bill in monthly installments over the next five years.

Summary of Responses from Discussion Questions:

• What does the group perceive as the biggest problem in the health system?
  The group identified four major problems with the health care system ranked here in order of importance:

1. 1. Big business, for-profit orientation.
   2. Disease-based, interventional focus instead on emphasizing prevention of disease.
   3. Doesn’t empower people to take responsibility for their own health and health care through information and education
   4. Dominance of the “allopathic” model of health care effectively precludes consideration and potential contributions of alternative therapies like naturopathy and Eastern medicine.
      
      Although not one of the biggest problems in the health care system, one participant who volunteers at a VA hospital noted the significant emerging phenomenon of injured military personnel returning from the Iraq war with catastrophic injuries. These personnel have much more extensive and disabling conditions than we have seen in other conflicts and will require a greater focus on long term comprehensive medical, behavioral and social care than our military health system has been able to provide in the past. The health reform debate needs to consider the impact of these disabled service men and women on long term funding and personnel resources in the military and civilian sectors of our health care system.

• How do attendees choose a doctor or hospital? Where do attendees get information in making that decision? How should public policy promote quality health care providers?
  
  Attendees said they have chosen health providers based on recommendations from friends or doctors, reputation in the community, inclusion in a health plan’s provider network; or in one case, by soonest availability of the next appointment. Information sources were the Internet, yellow pages and community classes, in addition to the sources noted above. Public policy could help promote quality by a) including both process and outcome measures in evaluating provider quality and b) by expanding the scope of medical training to include more emphasis on alternative health approaches and interpersonal patient skills.

• Have attendees or their family members experienced difficulty paying medical bills? How can policy makers address this problem?
  
  Two participants reported difficulty in paying bills. One participant was hospitalized for cancer and had health insurance at the time. Even with the insurance, though, the bill was so high that she ended up paying her share of the hospital bill in monthly installments over the next five years. Another participant related a similar situation while covered by insurance. Even with 80% coverage by insurance, it took a good while to pay his 20% share of cost. The group consensus was that policy makers could address these issues by moving in the direction of universal coverage and a single payer system and by studying the approaches used in other countries.

• In addition to employer-based coverage, would the group like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare?
  
  Participants felt that both options would be beneficial in improving the general availability of health care coverage.

• Did attendees know how much they or their employer pays for health insurance? What should employer’s role be in a reformed health care system?
  
  One participant pays $387 per month for single tier COBRA coverage. Another has employer-based family coverage for which the employer portion is about $800 per month. Another has no insurance and pays out of pocket for alternative medicine providers. In a reformed system, employers could either continue to provide coverage or pay into a national coverage fund in lieu of providing coverage directly.

• Were attendees familiar with the types of preventive services Americans should receive? Had attendees gotten the recommended prevention? If not, how can public policy help?
  
  Participants were familiar with recommendations but not all had pursued them. Two had their cholesterol levels checked recently. Several do not get immunizations as a rule due to concerns about effectiveness, safety and side effects. One participant was aware of guidelines but seeks care only when needed. The group felt that public policy cam promote prevention by requiring coverage of alternative testing modalities, promoting more health information to encourage personal responsibility for health; and mandating coverage of a standard set of preventive services with no cost sharing.

• How can public policy promote healthier lifestyles?
  • Ban smoking and tobacco subsidies.
  • Reform food processing to restrict use of chemicals and food additives, including drugs and hormones in livestock feed.
  • Ensure better nutrition in schools, both prepared and vending machine foods.
  • Promote more comprehensive health education and availability of healthy information beginning at an earlier age.
  • Programs to promote local food and agricultural sources and supply.
  • Require health system training for members of Congress.
  • Standardize a standard national set of vaccines for children across all jurisdictions but allow parental opt-out.