HCCD Report Tennessee 37917

Health Care Discussion, Knoxville, TN

The discussion was held on 12/23 during lunch break at the Knox County Health Department, and continued on 12/29. 19 people attended.

Compelling Personal Stories:

Crissie:
Crissie is a 51 year old accounting clerk with health insurance from her job. In 2004 she was diagnosed with lupus. She also struggles with sleep apnea and problems in both knees. She is constantly fighting with the insurance company to get coverage for the tests, equipment and care that she needs. She pays $35 co pays per visit to the rheumatologist, $35 co pay for each physical therapy appointment, $500 co pay for tests like heart CT, MRI etc. Her monthly bills for medication are $195 minimum. Crissie sold her house in 2004 knowing that she no longer had the means to pay the mortgage. In 2006 after 2 years of struggling to pay for her medical care, she had to declare bankruptcy. She now pays half of her salary to the bankruptcy settlement. That means that she has very little income to cover her continued medical expenses. She tries to limit her medical care to the most urgent, although she knows that preventive care is important. She cannot afford the care she needs. CrissieCrissie

Melissa
Melissa says: “When it comes to health insurance, my family’s story is a nightmare.”
Melissa’s relative was laid off from his job, which provided the family insurance. It took a little time for him to find another position. Five days before the insurance from his new job kicked in, a member of her relative’s familyMelissa was admitted to the hospital for an emergency appendectomy. The family had to declare bankruptcy because of the medical bills.
Melissa’s relatives include an elderly couple who have had their share of medical problems, including a brain aneurism and open-heart surgery. The bills have swallowed up the nest egg they worked so hard to build. They have had to refinance their home. Their income is $5 over the limit for medication assistance, so during the Medicare Part D donut hole, they struggle to pay for medication on top of other expenses. One prescription alone costs $300, with no generic available. If Melissa one of the couple were to die, the otherwould be destitute.
Yet another elderly relative is still working a full time job rather than retire in order to pay their $1,000 a month medication costs.

Summary of Responses from Discussion Questions:

A great deal of the discussion of the biggest problem in the health system centered on the “for profit” system of health care. High administrative costs and paperwork associated with health insurance drive up the cost of health care without adding to the quality of care. Insurance companies make decisions about medical care that should be up to the doctor and patient. Complementary therapies and alternative medicines are not covered. The current system promotes treatment rather than prevention or education. Patients receive poor quality care: doctors do not take the time to educate patients or treat the whole person. Indiscriminate use of costly testing is not in the patient’s interest. Many tests are motivated by fear of lawsuits.
The group discussed the lack of universal health care, and the financial burden this causes working people. Insurance is not transferable from job to job. With health care tied to employment, loss of a job can be a disaster for the whole family. In this group of 12 people, 2 had personal experience with bankruptcy caused by medical bills.
Public policy can promote quality health care providers by holding practitioners accountable for outcomes. Health care policies should be based on evidence and best practices. These are already available in the scientific literature. Public policy should encourage more doctors to work as general practitioners rather than specialists. We need to promote equity in the care given. Medical ethics needs to be promoted. We need to decrease conflicts of interest, for example, doctors who own stock in pharmaceutical companies that manufacture the drugs they prescribe. Mass advertising of prescription drugs should be regulated.
One attendee of our discussion group experienced personal bankruptcy as a result of medical bills, and another had an immediate family member go bankrupt. An elderly parent was $5 over the income limit for medication assistance, and was having great difficulty paying bills through the Medicare Part D donut hole. Although we all have steady jobs, we all agreed that we could lose everything in a medical emergency. Policy makers can address this problem by setting up a system of universal coverage. We would like to see a level of quality care to which all people are entitled. Policies should promote prevention, such as clean air and sidewalks. Health education promotion could help people stay healthier.
Employer based coverage is not adequate. If an employee changes jobs, then they become uninsured. They often-times have to change providers. The waiting period between leaving or losing a job and becoming eligible for COBRA could cause drastic problems. A serious illness or injury during this time can cause financial disaster for a family, forcing them into bankruptcy.
The current administration of Medicare is too complicated. The way Medicare used to be was more practical.
Every person deserves a basic system that provides health care to everyone- universal coverage. But education about what this means would have to be included in the plan. Many people are afraid because of stories they’ve heard about what has happened to people in other countries. They fear a waiting period for necessary surgery and just to see a doctor.
However, we have that problem now and people have accepted it. It is rare for one to get an appointment without having to wait weeks.
Knox County government pays about $6,000/employee for family coverage which is matched by the employee.
Employer’s role in a reformed health care system could be to pay into a global system for a collective system of care. The amount would be based on a formula considering number of employees. The management of care would not be by the employer. Policy makers should consider what an employer could do with the funds if they didn’t have to pay insurance. There should be incentives for employers to promote good health and employees to take personal responsibility for their health.
Insurance premiums should be based on income. If insurance was affordable for everyone then there wouldn’t be a dependency on the employer.
There are many reasons why heath care costs are so high. Global competition from companies has forced health care costs up. Fear of lawsuits increases unnecessary use of expensive technology.
Use social marketing and education to promote personal responsibility
Key: a universal plan may decrease access to what you “think” you need. For Profit drive is heavy in the area of pharmaceutical and technology. Lobbying is a huge problem especially with pharmaceutical, physicians and insurance.
Public policy can promote prevention by making prevention not treatment the emphasis of the health care system. People are more educated and requesting more preventative services. Some insurance providers are covering these for the most part but the referral system is a hindrance.
Lack of primary care providers is a problem which will only be increasing unless some type of policy is developed to encourage physicians to go into general practice.
Providers should be made accountable
The health care system is too complex
To promote healthier lifestyles, public policy can:
- Build an environment where people can make healthier choices.
- Subsidize healthier foods
- Decentralize farming
- Promote health education
- Regulate healthier food choices through food stamps program
- Use a big industry and media approach to educate and promote healthier choices and healthy lifestyle.