Monday, March 2, 2009

Health Care Reform: Some Consumer Advocates Criticize Kennedy's Private Meetings With Industry Lobbyists

Recently, the New York Times reported that since last year Senator Kennedy has conducted invitation-only private meetings with lobbyists and representatives of insurance and pharmaceutical companies, businesses, labor, and retirees in order to strike a consensus on health care reform. According to the New York Times:

The 20 people who regularly attend the meetings on Capitol Hill include lobbyists for AARP, Aetna, the A.F.L.-C.I.O., the American Cancer Society, the American Medical Association, America’s Health Insurance Plans, the Business Roundtable, Easter Seals, the National Federation of Independent Business, the Pharmaceutical Research and Manufacturers of America, and the United States Chamber of Commerce.
Because Kennedy chairs the Senate Committee on Health, Education, Labor and Pensions, he will have a significant voice in health care reform.

All of the Democratic presidential candidates pledged to deliver health care reform, and President Obama's proposed budget commits $634 billion to this purpose. Obama, however, promised to host public and transparent meetings (potentially aired by C-SPAN), and he has strongly condemned the influence of lobbyists in Washington. Despite Obama's critical stances toward lobbyists, Kennedy's "workhorse group" could potentially reach a consensus that ultimately shapes the content health care reform.

Some Care Providers and Consumer Groups Cry "Foul"
The consumer advocacy group Public Citizen has criticized the secret meetings for lacking inclusiveness. Particular, the group argues that advocates of a "single-payer" system have not been invited to the discussions. A joint statement prepared by Sydney Wolfe and James Floyd, two medical doctors who are researchers for the group, urges President Obama to consider input from advocates of a single-payer system:

The president wants this process to be open and transparent, with the goal of achieving universal coverage. However, groups representing physicians, nurses, and consumers who advocate for a single-payer system of national health insurance have thus far been excluded from the summit.

Under a single-payer system, doctors, hospitals and other health care providers are paid from a single fund administered by the government. The system would eliminate the wasteful spending and high administrative costs of private insurance, saving almost $400 billion annually. This savings is enough to provide every American with the same high-quality care, including those who currently have insurance but still cannot afford medications and treatment.
Floyd also wrote a column on the subject for the Huffington Post. In that article, Floyd observes that representatives from organizations such as "Physicians for a National Health Program, the California Nurses Association, Healthcare-Now," and other groups that favor a single-payer system are "notably absent" from the list of attendees at Kennedy's private meetings.

My Take
Advocates for a single-payer system believe that the nation can only afford universal coverage by eliminating the costs associated with privately run insurance companies. Clearly this idea will provoke very heated debates, because it basically threatens to eliminate insurance companies. I cannot see this idea gaining traction because Obama himself has not advocated the position and because insurance companies have a powerful lobby. But the idea is extraordinarily similar to Obama's assertion that the government should eliminate private companies that administer government-backed student loans.

All relevant parties should negotiate and study a matter as significant and expensive as health care reform. In order to reach an appropriate outcome, all voices must have a seat at the table (to borrow from Obama's own words). Instead, it appears that all voices except for single-payer advocates (and those who do not want reform at all) are present at the moment.

Of course, things are in a preliminary stage, but budget talks will soon commence, and the issue of health care reform will take center stage following the allocation of funds. In order to ensure the best outcome, the process should include additional voices and become open and transparent; otherwise, the process will give legitimacy to critics who fear that a "backdoor deal" among powerful interests will decide the issue.


FLRN said...
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FLRN said...

Darren -
Thank you for the information! ~ Health care in its current form is indeed broken not just as a result of the millions of uninsured or the under insured but primarily because American's are paying more and more billions of dollars for less and less quality healthcare.
While I applaud Ted Kennedy's interest in seeing the system reformed, I have to strongly agree with you that the participants at the table are without a doubt lacking a powerful voice advocating changes - that of nursing. I have long asserted that the current DRG system that is blind to patient acuity levels and fails to incorporate federally mandated nurse to patient care ratios in the acute care setting in indeed doomed to continue to fail. Likewise the insurance companies that dictate length of stay and reimbursement dollars without having to participate in the liability consequences of sending a patient home too soon or having poor care delivery because a nurse care giver has an unrealistic patient care load will only continue to foster the break and drive health care costs through the glass ceiling. Unfortunately, unless you have been a patient or a family member of an acutely ill patient you may not understand what I am really talking about.
Senator Kennedy himself has suffered lately from poor health however I suspect given his wealth and background I do not believe he was transitioned from the acute care setting to his home until he said he was ready to go - I'll also go out on a limb and suggest that he probably had one-on-one care with strong family support - the best money can buy. I don't begrudge him this service (RHIP). I merely point it out because this is a level of care not achieved or delivered in any way shape or form to the average patient receiving acute care under our current health care system. This phenomenon is poorly understood by anyone (patients, businesses, accountants, lawmakers) except front line care givers and the recipient of that care who may quite often be too ill or too uneducated to properly assess the risks and care deficiency that exist in the day to day operations of a health care facility. The widespread national nursing shortage (at critical mass here in Florida) is the clearest evidence I offer of this breakdown. This is why nurses are voting with their feet and leaving an industry that does not understand the role or task before care givers. I have seen care delivery in action and have faith that the only solution is a collaborative one with a multidisciplinary approach from all stakeholders!
While I do not know what health care reform will look like (I suspect it will resemble VHA), I do know that it will remain significantly incomplete until everyone hears voice of the care givers - the nurses and primary care providers - those that participate in care delivery and are there for held to the greatest risk in the liability should health care delivery break down during a care event. These voices carry a powerful message, and should have a seat at the decision making table probably on the right and left hand side of the host. Nurses especially are well trusted by the public and will continue to serve as an ad hoc patient advocates at a time when people are at their most vulnerable. More importantly nurses do not financially benefit from the decision making process, making them a valuable unbiased voice for reform and change. It is important to recognize that insurance companies do not participate in the liability responsibility found in the corners they box us into with the current DRG reimbursement system. It cannot simply be the special interest groups and third party payer sources - you must hear from the care givers themselves - ignore this group and as we say in the industry it will be the similar to the difference between choosing to call the doctor before the code or during the code or after the code is over - If you are the patient there is a significant difference!

Darren Lenard Hutchinson said...

I completely agree! I looked at the entire list of participants again, and I do not see caregivers. There are union representatives, but I am not sure they represent nurses. I imagine they are "general" labor representatives because labor unions have an interest in this issue (it will save a lot of companies from this expense). Even if they represent nurses, nurses have their own "labor" issues that are both related to and distinct from the delivery of care. So I am upset that at this early stage, providers are not at the table.

Anonymous said...

Would my consumer rights be violated when being operated on at a hospital and not given a choice to pick my anesthesioligist? I was told I do not have that choice after I was billed and told it is staffed by the hospital.My insurance company accepted the group with the 1st surgery and 7 months later stated they did not and renigged on the 1st surgery dicount. Are there any legal statues, laws, anything on this? Should I have known upfront? I would love to here some response Becaused I am getting shafted by the hospital for not giving me a choice, shafted by the insurance company by renigging on the discount and now the anesthesiologist has sent this to collections? WHAT ARE MY RIGHTS

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