The Reston, VA, Town Meeting

I have just watched the town meeting at Reston, VA, held by Congressman Jim Moran, with Gov. Howard Dean, MD (Vermont) fielding audience questions. All things considered, it went rather well, although there was a lot of orchestrated shouting in the beginning, until one of the political activists in the crowd was invited to submit his question and speak to it for five minutes only, or leave. He left, rather than speak under the rules of courtesy.
The subject was, of course, House Bill 3200, Health Reform. Mr. Moran spent most of the first hour explaining the bill's provisions and dispelling ten of the most widespread misconceptions making the rounds ("Grandma's going die", "The government will assign you a doctor", etc.), and then Dr. Dean, himself a physician as well as an ex-governor, explained the major points as well as what was left out of the bill and why.
I am pleased that the bill preserves personal choice of each person's choice of insurance carrier and choice of doctor, and is designed to have everyone medically insured. I would be more optimistic about the plan for handling the cost if the bill had not left out two of the biggest ways of lowering health care costs.
Tort reform will not be in this bill. Dr. Dean explained that including it would mean submitting it to the House Judiciary Committee which is strongly opposed to tort reform, and would not have allowed it to come out of committee for a vote on the floor. But by capping the non-medical, non-economic costs some lawyers seek, tort reform would reduce those tests and treatments of little benefit to the patient, done only to prevent a trial lawyer from accusing the doctor of negligence. Dean did predict that continuing progress toward nationally recognized standards of medical care will eventually solve the problem. (Adhering to standard of care is a strong defense against claim of negligence.)
Bidding down the price of medicine for Medicare and Medicaid will not be allowed, in exchange for a 50% reduction in the "donut hole" where seniors pay the full price of medicine out of pocket. This was an agreement between the President and the pharmaceutical companies. I think the President would have found bidding a much bigger way of cutting costs of medical care (Dr. Dean said the VA bidding system cuts the cost of their medicines to between one-fourth and one=half of what the other programs pay.)
But politics is recognizing what will pass Congress and what will not, and doing the possible. The final bill must pass the Senate, too. Mr. Obama may yet give all citizens a way of paying their medical bills without going bankrupt. I hope so.

Dealing With Our Fear of the Future

"How can we possibly pay for medical care for forty-five million more people who have no insurance?" The answer is, you are already paying for it, and at more than three times the amount it should cost.
These uninsured are not millions of newcomers to America. They are already here in the system, our fellow citizens with low-paying jobs or no jobs at all. Doctors who are willing to accept some non-paying patients already see them every day of the week.
Every time any of those forty-five million gets sick or injured but can't get in to see a doctor, they go to the hospital emergency room, the only place that by law must accept and examine them, and give them emergency care. Usually the ER doctor on duty has not seen that person before and must do a reasonably complete exam and lab tests to know what's going on. The charge for an emergency room visit, as many readers know all too well, averages over $1,000, compared with an average for an office visit or urgent care center of $150.*
Every time an uninsured patient, who can't pay for his care out of pocket, gets medical care at an Emergency Room, you, and all of us, are paying the cost of his care out of our present taxes or the increased rate a hospital must charge to make up for what they can't collect from the non-payer. These 45,000,000 are already in the system, and we are already paying their costs. It makes sense to get their colds and minor injuries out of the ER and into the doctor's office, at less than one-fifth the cost we are paying now. That alone would save about half the alleged trillion dollars of new insurance premiums.
In addition, instead of getting medical care after his condition has reached crisis proportions, the newly insured can get preventive care or early care, reducing chances of his needing hospitalization later on (where the cost of care is even higher than the ER.)
It's true that when the presently uninsured get insurance, they will use doctors more often, but the increased need for doctors will not be like all the newly insured are just getting off the boat and entering the country. They are already here. When doctors know that insurance will pay something for every patient, you will see more men and women entering medicine as a career.

*The reader can find many sources for cost information by Googling Consumer Health Ratings, Emergency Room, typical average cost.
I surveyed reports from Florida, Minnesota, and Vermont, plus an additional survey by G.M.P. Employers Retiree Trust.