Costs of Health Care Will Go Up

One of the big justifications for the Health Care Reform Bill being rushed through was because it was intended to bring some financial stability as the nation is dealing with recession. According to this report from the American Spectator (which has also been covered via other venues), health care costs will actually go up. This particular excerpt is short enough to quote in full.

The economic report released last week by Health and Human Services, which indicated that President Barack Obama's health care "reform" law would actually increase the cost of health care and impose higher costs on consumers, had been submitted to the office of HHS Secretary Kathleen Sebelius more than a week before the Congressional votes on the bill, according to career HHS sources, who added that Sebelius's staff refused to review the document before the vote was taken.
"The reason we were given was that they did not want to influence the vote," says an HHS source. "Which is actually the point of having a review like this, you would think."
The analysis, performed by Medicare's Office of the Actuary, which in the past has been identified as a "nonpolitical" office, set off alarm bells when submitted. "We know a copy was sent to the White House via their legislative affairs staff," says the HHS staffer, "and there were a number of meetings here almost right after the analysis was submitted to the secretary's office. Everyone went into lockdown, and people here were too scared to go public with the report."
In the end, the report was released several weeks after the vote -- the review by the secretary's office reportedly took less than three days -- and bore a note that the analysis was not the official position of the Obama administration.

Note that the report was suppressed even though it was received before the vote on the health care bill.

Oral Health as a Model

One last big-picture, foundational post, then I'm going to try to initiate some dialogue on some of the finer points of the Health Care Bill (as I understand it).

In oral health, the majority of disease boils down to caries (the disease of cavities) and periodontal disease. The outcome of caries could be as minor as a need for sealants or a filling. Or the extent of disease in a given tooth could require a crown or a root canal. Or it can result in an infection (accompanied by tooth pain - excruciating, from what I hear), requiring extraction as the worst case scenario. Actually, an even worse case-scenario of dental infection would be the case of Deamonte Driver, who suffered a brain infection and died. Less dramatic outcomes of extraction could involve bridges or implants or partial dentures or complete dentures. So you see, a lot of the dental profession deals with the outcome of caries. The potential outcomes of periodontal disease are gingivitis, gingival recession, bone loss, gum infections, tooth mobility, tooth loss.... These are almost certain, unless managed with proper brushing and flossing and routine visits to the dentist/hygienist or periodontist (gum disease specialist).

Both diseases - caries and periodontal disease - are actually infectious diseases. When we are young, our mouths are colonized with different strains of bacteria, usually transmitted by mother or other primary caregiver. Some of these bacteria are more effective at causing decay. Some are more effective at causing gum disease. I'm more familiar with the problem of dental caries, being a specialist in pediatric dentistry, so I'll spend more time writing about that.

The way we get cavities is that these strains of bacteria that cause cavities basically consume the sugar we eat. Then they produce acid, which breaks down the mineral in our tooth, resulting over time in a cavity. There are certain things that promote cavity formation - eating lots of sugar and not brushing or flossing away the sugar or the bacteria that are rapidly multiplying because they get lots of sugar. There are certain things that prevent cavity formation - not eating lots of sugar and brushing and flossing.... you get the idea. Now granted, there are some preventive factors that are completely out of our control, like immune response, quantity and quality of saliva...

Here's what I'm trying to get at. It's something one of my colleagues calls the "biobehavioral" model for oral health. There is certainly an aspect of oral health that is completely out of our control. It's just the biology we're dealt. But there's another aspect of health that is dependent on behavior - adding in healthy behaviors and avoiding unhealthy behaviors. So in pediatric dentistry, we counsel parents to decrease on-demand bottle or breast-feeding by the time a child is 12-18 months. We advise parents not to let children go to sleep with a bottle. We recommend avoiding juices and sodas until the child is of school age (and certainly not in the bottle). Not easy, huh? How about brushing a kid's teeth two times a day and/or flossing for them until they're able to do it themselves. These things to avoid and things to add have been shown to be associated with a reduced rate of dental caries.

But what if a parent of a child determined to be at high-risk for dental caries decides to ignore our advice? Is it the insurance company's responsibility? Is it the dentist's fault? We've seen it happen in our clinics. Families who bring child after child in to treat dental disease that is so severe that the kids have to be put to sleep in order to take care of all the cavities. We remind them of the behaviors that promote cavities and right after the dental procedure...here's your Big Gulp, baby...and two years later...here's our next kid, doc. Obviously, that doesn't happen all the time. There are certainly families who work with us to prevent disease, but still...

Overall health is like this also. There are some diseases we just can't prevent. But there are diseases that are worsened or even activated by our own choices. Diabetes and poor diet control. High blood pressure and diet control. Pulmonary diseases and smoking. Cervical cancer or STDs from early sexual activity or multiple partners. HIV...

One of my big-picture problems with the Health Care Bill was that the underlying philosophy seemed to remove responsibility from the individual and place it with government or employer. So if someone else is paying for treatment, why do the hard work to change unhealthy behaviors? If someone else makes global treatment decisions, why do the hard work of thinking through treatment options?

The problem is that we DO have a great deal of control over our health. So I feel we should also have a great deal of control over the means by which health care is compensated.

Your thoughts?

"That's what insurance is for"

I hear it quite often. In my dental practice and in the clinics where I teach, we usually write up a treatment plan (an estimate of the procedures needed), along with an estimate of the fees, broken down into patient portion and insurance portion.

Sometimes, I show the fee estimate to the parent of a child and the parent will look at the 20% they are responsible for rather than the 80% the insurance company is covering. And the parents sometimes protest, "Why do I have to pay?" "I'm sorry," I sometimes reply, "I didn't put the cavities there. I'm just trying to fix them." "Oh, not you", they return, "shouldn't insurance cover that? That's what insurance is for."

Sometimes, I make a treatment decision for a procedure that isn't covered by insurance. Most often, it's a small child who won't be able to sit for a filling done to the standard of care. Rather than torturing the child with a perfect filling, I'll opt for a temporary solution that will just buy time until the kid is old enough for a real filling. I don't know why the insurance companies don't cover them. Maybe because they don't last as long as definitive fillings. But we don't expect them to. We just need to buy time. I can see the insurance company's point. Sometimes they last only 6 months. Sometimes they last 6 years. They only cost about 1/3 of the cost of the final filling. But quite often, parents get upset. "Why won't the insurance company cover that procedure. That's what insurance is for."

Sometimes, I go a little above and beyond the first time I see a patient for a checkup. I ask what insurance they have and I explain that even though the American Academy of Pediatric Dentistry recommends two checkups a year, some insurance companies only cover one (because that's what's acceptable for adult care). The family is then responsible to cover the cost of the second exam. I don't mention that as long as their kids don't have cavities, the $66 for the second checkup may be the only cost to the family the entire year. I do mention that if the family does not want to pay the $66 for the second checkup, they are welcome to schedule a cleaning for their child (which is covered) and remind me not to come in the room for the checkup. Quite often they get a bit peeved, sometimes at me because I've insinuated something about their willingness to pay, and more often at the insurance companies. "That's what insurance is for," they often protest. Only sometimes do I explain that it may not be the insurance company that made that decision. It may have been the employer who chose to make the specific insurance plan available to the insured individual. Some families come in with insurance that covers both recommended examinations.

I think we need figure out what insurance is for. Is it supposed be similar to auto insurance, where coverage extends only to accidents and catastrophe and big ticket expenses that we didn't expect, and not to routine maintenance (like the oil change we don't expect our insurance companies to pay for). Or should it be extended to cover prevention, in which case it would have to cost more, like the additional sum I paid for the maintenance plan on my VW. I mean we can't expect to pay a little to receive a lot, can we? To pay for one thing and get another more expensive thing,right?

The reservation I have about the current movement is that insurance companies seem to be operating from the assumption that their purpose is to help us cover the costs of major unexpected events. But what I hear from the biggest advocates of the current health care bill, is that the purpose of insurance should include regular maintenance. But I don't hear much acknowledgement that the costs of such an increase in services will raise premiums. My impression of the supporters of the health care bill is that there really is an expectation that it will be possible to try to pay very little to receive a lot. And I don't think that's financially feasible.

Context

It's been one year since either Ian or I have posted on this blog. One year of sitting back and reading the writings of others and learning and absorbing and contemplating. But now I'm itching to comment again. And it's the new health care bill that has prompted my return to the blogging world.

I've actually been wanting to express my observations for a number of months, but...quite honestly...have been a little afraid to. I have dear friends who completely disagree with my political views. As long as we stay away from politics, things can stay happy. I guess, ultimately, there are more important things to agree on that we don't have to worry about political views. And I'm also afraid because I am an academic. We professors are supposed to be evidence-based in our pronouncements. And I just don't have the time or energy to do as complete a review of the evidence as I would prefer before publishing my opinions.

But the passage of this health care bill has become so important to me. It has stirred together my interest in politics with my work world. So the focus of my new hobby has impacted my workplace.

At any rate, for the few people who indicated they might be interested in my opinions on the health care process, I figured I should start with context. That way anything I write can be interpreted and applied more appropriately based on my perspective.

My political context:
-Born to immigrant parents who started out poor and voted Democrat. Said immigrant parents experienced the American dream, achieving financial success and switched to Republican. Said upper middle class parents started thinking about the influence of society on personal values (and vice versa) and became social conservatives.
-Raised in Orange County, the anomalous center of Republican activity in Blue state California. Influenced heavily by an incredibly diverse (ethnically and socioeconomically) pool of friends in college. Developed a concern for the poor. Started eschewing my knee-jerk, raised-to-be-Republican ways.
-Went to dental school in Boston. Harvard, no less. 'Nuff said. Heard only the New England context during the Clarence Thomas confirmation hearings. Started thinking that Republicans were nasty people. Increased the concern for the poor to a commitment to care for and live among the poor. Started preferring Democrat policies regarding the poor. Might have voted Democrat if the election cycles had worked out differently.
-Returned to LA politically confused and therefore, apathetic.
-Finished professional training and got a job. Tripled income in one year. Enlisted the services of an accountant. Started wondering where my income was going and whether it was being used effectively.
-Woke up on 9/11. Started wondering what on earth could make people in other nations want to hurt us. Was not convinced that it was because we are an imperialist nation. Developed an opinion that it was/is more about fundamental Islamic terror than American arrogance. Became very patriotic.
-Started teaching dental students. Started encountering some entitled, lazy dental students. Started wondering what they were learning in college and in life that made them express such entitlement. Became slightly disenchanted with the liberal (lefist?) mindset that seems to pervade the University.
-Started encountering international dental students - those who are already dentists in other countries who want US degrees to practice in the US. Heard story after story of struggle and hard work and persecution and perseverance...all accompanied by an incredible admiration for the American dream, the American promise, the American way. Freedom, liberty, opportunity, democracy..... Started loving this incredibly flawed, but amazing country.
-Started realizing that 90% of work and social environment was Democrat. Started listening to conservative talk radio and reading conservative blogs to learn. Ooops. Revealed my hand.
-Yep. I am a conservative. I don't like to call myself Republican, because, quite frankly, the politicians with that affiliation don't always perform that admirably. I've run the gamut and am now conservative because I think that it is people, not government, who have the greatest potential to perform acts of beauty, creativity, and intelligence. I think government sometimes gets in the way of people.

My healthcare context:
-Dual-trained as a Pediatric Dentist and an Orthodontist
-Spent most of professional training mainly treating low income individuals (who else goes to a dental school for 3 hour appointments?)
-Practiced in a huge HMO type practice
-Did not purchase my own health insurance (I thought I was healthy). Paid for all medical expenses out of pocket.
-Joined faculty at dental school. Received a great benefits package including health insurance.
-Enrolled in an HMO for my own insurance
-Switched to a PPO
-Decided on a health care plan with a Health Care Savings Account to take more responsibility for my own health care decisions.
-Started practicing in a fee-for-service, indemnity, high-end practice with a highly educated patient population.
-Started teaching in a low income, self-pay, and publicly assisted clinic with a minimally educated patient population.
-Worked for and with people who create public policy in oral health and focus on access to care.
-Stopped preferring Democrat policies regarding the poor.
-I've run the gamut in my experience as a patient and a provider and am not convinced that government options are the best by any stretch.

In a nutshell, I prefer conservative solutions. I think health care needs reforming, but not this way. I do see a role for government, but not as far-reaching as this bill seems to indicate.

So that's my context. Hopefully it helps as a framework for posts to come.

Hope for the future

Sometimes I wonder what on earth is going to happen to American politics in the future. The University has been incredibly successful in advancing a leftist/liberal agenda. There is no balance to the political perspective our young people are exposed to in college.

Then I hear someone like this 14 year old. And I have hope that the ideas of conservatism might not lose out to the ideas of the left.



I hope he doesn't lose it when he hits college.

Clarice

Practicing Islam in America's Public Schools?

Read this special report especially if you have children in the 7th grade in public schools. The textbooks used to teach about Islam offer revisionist history (actually propaganda) and are being used to indoctrinate the next generation into accepting Islam and shariah law.

Sounds alarmist and ridiculous, but the report is well documented. Read your child's 7th grade history textbook to see if the mistreatment of women and violent history of Islam has been whitewashed. It seems that many of the textbook publishers have been pressured by the Council on Islamic Education to tell half truths and outright lies; claiming Islamic beliefs to be facts.

Islam's intent is jihad; stealthy and "peaceful" as long as Muslims are in the minority, violent and aggressive once they out-reproduce the majority and take over; as they did in Lebanon, a country that used to be majority Christian.

Ian

I just don't get it

I just don't get why he cares so much about abortion.



Clarice