HCCD Report Iowa 52060

Summary

A group of 10 individuals gathered on Saturday, December 27^th at Osterhaus Pharmacy in Maquoketa, Iowa.  The group consisted of roughly equal numbers of women and men.  Three pharmacists, three registered nurses a CPA for a provider group, a state senator and a retired insurance executive were represented.  The group met for approximately 90 minutes. 

The main thrust of our conversation was the cost of healthcare in the U.S. for the value that is received.  From that central theme we discussed the possibility or feasibility of a single payer system in our country, current disparities among different employment-backed health care plans, uninsured individuals, poor reimbursement and improving education and prevention efforts. 

It was obvious that all who were present believed that the current system is flawed, and a great deal of improvement is necessary in order for citizens to achieve and maintain good health, and for current spending to actually effect changes and healthy citizens.

Some of the biggest concerns for those attending were:

1)      Cost – plain and simple in every area too much is being spent for outcomes that aren’t satisfactory

2)      under and un-insured people, and people who don’t pay their co-pays and deductibles

3)      lack of awareness – people don’t understand what their insurance covers, what their options are, what is covered what is not

4)      unlimited spending cradle to grave doesn’t work

5)      fear – [elderly] people are afraid that things will change, this medication or procedure won’t be covered,

6)      inconsistencies amongst insurance plans, reimbursement

7)      too much spent on administrative costs and redundancies.

8)      Poor reimbursement for providers

Suggestions for improvement included:

1)      A regional healthcare ‘czar’ who would oversee an area’s health care resources, how they are utilized, if there is waste or inconsistencies in health care delivery.  Improvement of prevention and education.

2)      A single payer system so that at minimum there would be consistency and everyone would have the same prices for their coverage, and providers would be reimbursed in a consistent way across the country – no matter where the care is provided. 

3)      Having the government cover catastrophic medical insurance/benefits only, perhaps inducing insurance companies to be held accountable for their costs. Why can’t a veteran have an insurance card  so as to receive care at a location convenient for the veteran from providers who  know him or her rather have to go to certain facilities or  receive sub standard care (mail order drugs etc)

4)      Force people into prevention.  Force people to make lifestyle changes and spend money on preventative measures.   Make it tied into renewing health care policies.   Improving health at this level could help with a lot of the problems we have in our society.

5)      Rewarding physicians financially for how healthy their patients are, not for how many tests they run or how many patients they see.  In Britain, a doctor is paid more if his/her patients are healthy.

Personal Stories

Several of those attending offered personal anecdotes about a health care situation:

• One woman described her husband’s month-long hospital stay with ‘good insurance’.  After he was discharged, she received 16 different bills for his care.  There was no way she could pay all of them at once, yet they all wanted their money immediately after her husband was discharged. 
  • A mother of a child who has had a liver transplant described an insurance plan that would cover the transplant fully only at two sites in the country: Alabama and California.  The family chose to stay closer to home, with doctors they knew, and insurance paid only 80% of the procedure. 
  • A Senior Health Insurance Program (SHIP) volunteer described a Medicare information meeting where a gentleman said – “I learned more from you in 10 minutes than I ever understood with all of the information that was sent to me”. 

Parting Commernts

• Late 50s female, health care consumer:
  • We are paying for universal health care, we just don’t get it.
  • No one should lose their house because they can’t pay their medical bills
  • I think we should just do away with insurance companies.  Every provider is paying people to bill the insurance and code the insurance, and those costs are passed on to the consumer – and at the end of it all, the insurance company denies payment.  We pay all of this and then we’re not covered.
•  CPA and financial manager for physician’s group:
  • Re-running tests should be reported – if a specialist at a hospital isn’t satisfied with an MRI done by another facility, then that facility should be reported.  There’s no need to re-do tests all the time.
  • Resources need to be closely looked at.  There has to be a balance of what a facility really needs for the population it is serving.  Specifically, if a facility only does 10 surgeries a year, does it truly need a full time CRNA and Anesthesiologist on staff all year long??
• Retired insurance executive:
  • Bundling and repricing are problems.  There’s too much brokering and not enough direct contact between insurance and their customers.
  • Cradle to grave coverage without constraints is an unrealistic expectation.  It just can’t work that way.
  • Do we have enough doctors? There seem to be a lot of specialists, but are there enough doctors that are providing the basic health care that we require so we are all healthier
• Retired RN and hospital board member, SHIP (Senior Health Insurance Plan) volunteer:
  • I don’t think that a single payer plan would be a good idea.   I think some standardization is necessary, but I worry that a single payer plan would eliminate competition.”
  • I think some of the American public doesn’t realize what they can do to help themselves
• Practicing community pharmacist:
  • “I think, starting right off, with the issue of cost is VALUE.  The system needs to pay for the value that is provided to the system.  If something of value gets put into a system and if there is true value coming out of that, things work.  But when providers are being paid a great deal, and the value of what they’re doing is quite low … that’s got to stop.
  • “This year, we’re seeing more of people just not filling their prescriptions.”
• RN, manager of Hospital-based Skilled Nursing Facility:
  • There has to be some form of care for these people who have to have care, we cannot turn them away, they need care.  What can be done about that?
  • “Insurance companies with prescription drug plans – there is no consistency.  There is no way we need 48 prescription drug plans for 2009”
• Retired community pharmacist, former state representative
  • Patient-centered health care.   When they are the center, a patient may take more of an interest in taking care of themselves. 
  • Lack of reality in the pricing.  If my hospital stay results in billing of $30,000 and Medicare paid $1500, where is the sense of that?   Why is there such a disparity in what the price was versus this percent discount?
  • Why do veterans have to be seen only at certain facilities?  If they have an ID card that says they’re a veteran, they ought to be able to be seen where it is most convenient for them.
• Early 40s, Health care consumer
  • I don’t think health insurance should be tied to employment.  There are plenty of people who aren’t working [for various reasons] and yet everyone needs healthcare.   I think employers are hobbled by the requirement to offer health benefits.   They could offer higher wages if they didn’t have to offer health benefits – and then people could use that extra money to purchase their own plans.