Here are the questions and comments, submitted via laptops at each table, from the LaCrosse, Wisc. community leaders who attended the Leadership Luncheon on Health Care Reform on Monday, Apr. 28. Please feel free to add your input and contribute to the discussion in the comments below:
Questions and Comments
LaCrosse Leadership Luncheon, April 28, 2008
Dr. Cortese asked us whether we would want to be a patient tomorrow or go to a hospital, and we all answered no. This is because we see receiving medical care as being a negative thing. We only seek medical care when we are sick. However, if the healthcare system put as much emphasis on proactive, preventive, wellness-based care, I would be happy to go to a hospital tomorrow and be their patient in an effort to live a healthier life.
How can a new system integrate a wellness, prevention component and still meet the public’s healthcare needs?
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I’ve read that commercialization (markets, investors, profits, etc.) of medicine is driving the problem with health care. Please comment.
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How do we deal with people not wanting to get preventative care because of the costs associated with copays, coinsurance, and deductibles?
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Can you describe how this model will impact schools and local governments, that have good health care benefits for employees, but face increased costs each year that far outpace the ability of these organizations to pay?
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What are the suggestions that will reduce paperwork (insurance, federal program related, etc)
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Why are reimbursement rates lower in the Midwest?
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What can be done to reduce prescription costs in this country? Why do Canadians pay so much less than we do?
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The discussion and model focuses on reforming health care delivery. How do we move the value proposition to focus on improving health, as opposed to the delivery of medical care?
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The majority of us either started with, or will aquire a disability. Please describe the policy direction we should take regarding disabilities as we work towards health care reform.
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Will caps on medical care measures be applied to all care measures to control costs?
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It seems Mayo has identified Information Technology as a key component to health care reform. When HIPAA was enacted several years ago I seem to recall that one of the “benefits” of the initiative was to enable sharing of information. Is this (HIPAA) an avenue of shared information? It seems the HIPAA initiative has only resulted in emphasis on confidentiality/privacy.
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In an individual owning insurance environment, how does an individual of one determine value of one’s care?
What is your vision of the entity that will provide the care coordination activity?
In 1948 the United Nations, including the United States signed the Declaration of Human rights. Article 26 declares that all have the right to healthcare. All other industrial nations have universal health care for all. The US currently has made healthcare a privilege for those who can afford. It would seem that the country needs to address this issue prior to entering into ideological discussions over economic considerations.
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If our system here in the Upper Mid-West works so well (as you all seem to agree) why can’t it be duplicated and exported elsewhere?
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How does the current physician salary/payment model (RVU’s) reconcile itself against paying for value versus volume, particularly in light of the concerns that a physician may have relative to failing to order sufficient tests (oftentimes redundant) to avoid potential litigation?
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How do you envision enforcing mandated insurance? My understanding is that many young people voluntarily forego insurance and in most cases they will win that bet? This is particularly true of healthy males.
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Where does “access to healthcare” fit into your idea of measuring value? Universal insurance could lead to extended waiting times for the patient.
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Please comment on the national movement to bring mental health benefits to parity with other illnesses across the treatment spectrum.
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Part of the budget discussion in Madison is a 1% tax on hospital revenue. Is throwing more money at the problem, part of the solution for Wisconsin’s health care?
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How do we convince the rest of the country to adopt a value-based health care system, particularly if it means lower reimbursement for providers in those areas?
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We hear from Health insurance representatives that the “new system” would put health insurance companies out of business.
Since the Health Insurance business spends the 2nd largest amount of lobby dollars in Washington DC (second to the drug companies) – how can we get past the barriers both the insurance industry and the drug companies will set down if they fear a threat to their business income??
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If we pay for good performance/outcomes, won’t providers be leery about taking the most serious, complicated cases where success is less likely?
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what can providers and consumers do to get drug manufacuters and insurance companies to stop influencing the political process and candidates? Increasingly they are making political contributions that have to influence the likelihood that their profits will be affected or reduced.
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How have you addressed pay for performance on care for persons with more critical prognosis who will not be fiscally attractive to providers?
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How have your discussions addressed the unique needs of persons with mental illness who may not be able to adequately contribute to their own care (i.e. smoking, weight reduction, etc.)?
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No one trusts Congress, lowest confidence rate in history… no one trusts the drug companies…no one trusts the insurance companies…most, if not all in this room are covered. What can the average person, not here,…one of the 47 million uninsured, retirees who are going broke because of this broken system, families…what can they do? How are you going to reach them? What will you do for their frustration now, since nothing has been done for the past 20 years.
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Medical Research and Medical Education are two fundamental underpinnings of our current system…and judging by where we are they obviously need to be looked to usher in change. Does the panel have thoughts on improving the medical education of our physicians, or in enhancing research to be more focus on causes of diseases rather than symptoms (many times driven by the pharmaceutical industry)?
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Where do the Health insurance companies fit into this equation or vision? We sometimes hear of patients being restricted because of the insurance limitations. Also we hear of the aggressive lobbyists in Washington serving the interests of the health insurance companies.
Who do you see leading and developing the timeline for this project and keeping it on track? Hospital leaders? Washington?
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Do the equations change at all when we talk about comprehensive health care – not just acute and primary but mental health, dental, eye care, etc.
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How does your proposal address the issues of custodial care (example: long term care) Would this type of care be included in the coverage?
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Are there any short term initiatives? Baby steps to impact change?
One Comment
I think you have the cart before the horse. The subject of universal health care was barely mentioned in Dr. Cortese’s presentation. What I hear him saying would happen after universal health care is established. We first need to change the mind set of the people in this country from thinking that health care is for those who can afford health insurance to health care is a right for every citizen and we are a very long way from that.