Thursday, Dec. 17, 2009

Will health care reform stop the bleeding?

As South Carolinians hunker down for another winter of double-digit unemployment and slow economic recovery, President Barrack Obama is pushing Congress to pass a massive, 2,000-page healthcare reform bill that would overhaul the nation's struggling health care system. Two pieces of legislation are making their way to the President's desk to be signed into law: The Affordable Health Choice Act passed in the U.S. House of Representatives in November, and the Patient Protection and Affordable Care Act, under consideration in the Senate. The proposed bills would impose strict regulations on a health insurance industry that critics say has run amok, in the hopes of providing those insured with security and stability in the face of skyrocketing healthcare costs. The White House is pressuring Congress to pass the legislation before Christmas and this could be a make-or-break week.

For the more than 30 million uninsured Americans, the health care bill promises free and/or low-cost preventative medicine, while promising to make better care and less costly health insurance available to individuals and small businesses. The proposed plan carries a hefty price tag of nearly $1 trillion dollars, and has divided Democrats and Republicans for the past year, as advocates, experts and lobbyists weigh in on the issue.

Politics aside, the truth is South Carolina is hurting. The United Health Foundation, in a 2008 ranking of healthiest states, ranked the Palmetto State the 48th least healthy out of the 50 states. Conversely, our state ranks higher than the national average in amount of residents who are uninsured - 19.4 percent of South Carolinians are uninsured, compared to the national average of 15.2 percent.

Along the Grand Strand in particular, the multitude of service industry, retail and hospitality jobs offering low wages and no benefits leaves workers to fend for themselves when it comes to protecting their health. From paying for health insurance, to the cost of office visits, to treatments and hospital stays and medication, the soaring cost of healthcare is draining our wallets and contributing to poor health and high rates of otherwise treatable diseases and conditions. In a tragic waste of life, and despite our advanced technology within the fields of medicine and science, people in this country are dying for lack of medical care.

From paycheck to paycheck

Charles "Chaz" Stubbs, 42, worked for four years at Pizza Hut on 76^th Avenue North in Myrtle Beach. Stubbs was offered a management position several times through the years, a position that would have come with insurance coverage. He passed on the opportunity, confident he could make more in tips than what a restaurant manger's pay would be. He lived the way many hospitality workers live - paycheck to paycheck.

Despite a family history of heart disease, Stubbs rarely saw a doctor. In December of 2008, Stubbs went to the emergency room at Grand Strand Regional Hospital with a nasty case of the flu. While he was there, the attending physician informed him he had high blood pressure - extremely high blood pressure. The doctor advised him to follow up with his family physician, and discharged him.

Stubbs had no family doctor, and no foreseeable way to pay for one with his fluctuating earnings as a server. Nor could he afford the screenings, tests and medications a doctor would likely prescribe. In early October, Stubbs began complaining to friends of pain in his back that radiated around to his left arm, a pain that he thought was a pinched nerve. In the early morning hours of Oct. 25, Stubbs woke up with severe chest pains and was rushed to the emergency room. He was stunned by what the doctor told him - one of the major arteries of his heart had separated - an aortic aneurism. As the doctors prepped him for emergency heart surgery, they gave him no false hopes - he was in serious condition, and he might not make it. The surgery ended up a success, the tear was mended, and though he was in a medically-induced coma and on life support, there was hope Stubbs would eventually recover.

As the days wore on, it became apparent that the damage to his major internal organs was irreversible. On Nov. 4, after nine days in the hospital hooked to tubes and monitors, Stubbs was taken off life support. Alicia Piner was a friend of Stubbs, and was there when he died. "I miss him every day," she says sadly. The owner of Moozies Closet, a resale boutique at 27^th Avenue North and U.S. 17 in Myrtle Beach, Piner says she misses seeing Stubbs when he would drop by the store. "He'd come into the shop, and it was like sunshine on a cloudy day." For his friends and family, it makes it even harder to know his death could have been prevented, had he been able to afford to get treatment for his heart disease, in its early stages. In Stubbs obituary, his family requested that in lieu of flowers, donations be made to a trust fund they established, to offset the costs of those nine days on life support. (Charles Stubbs, Jr Memorial Fund, c/o Marsha Harris, 9409 Harris Rd., Oakboro, N.C. 28129.) As it is, the estimated costs for Stubbs' end of life care will total close to half a million dollars.

According to the Centers for Disease Control (CDC) in Atlanta, more than 133 million people suffer with chronic diseases such as cancer, diabetes and heart disease. One in two adults have some sort of chronic condition, and chronic diseases account for 7 out of 10 U.S. deaths each year. According to the CDC, in South Carolina the three most common causes of death are heart disease, cancer and stroke. Care for people with chronic conditions accounts for three quarters of U.S. healthcare spending, with diabetes alone costing more than $174 billion annually.

Treatment for chronic conditions means care among a multitude of prescribers - primary care physicians, specialists, therapists, technicians - and in our current health care system where patients often seek to cut costs by skipping tests or not taking some prescribed medications, coordinating such care is difficult, if not impossible at times. New technology, combined with the latest pharmaceuticals and advanced procedures and treatments, has the power to save money and lives in the long run when used appropriately, ideally to catch a condition in the early stages when it is most treatable.

The proposed health care reforms intend to slow spending on chronic disease by investing in prevention. The health care legislation would require insurers to cover, with no co-payments, a range of preventive services from blood pressure and cholesterol testing to cancer screening, and invest money to increase public health efforts to reduce smoking, obesity and other behaviors that stand in the way of good health. The goal is to reduce the prevalence of preventable diseases such as heart disease and stroke, while catching and treating diseases such as cancer and leukemia in the early stages. According to the consumer Web site healthinsurance.org, an estimated 137,000 Americans died in 2008 due to a lack of health insurance. They either receive too little care, or received care too late. Through prevention and coordination of services, the catastrophic costs associated with chronic disease in advanced stages - of heart surgery or chemotherapy or even life support - could be averted.

Against the odds

Even with the best-laid plans, accidents happen. Joy Bowden, 45, is the petite and gregarious owner of I Love Joy's Bar, 300 Seventh Ave. North, Myrtle Beach, a popular watering hole known for its karaoke. Although she was in good health, she worried about not having health insurance for herself, and regretted not being able to provide it for her employees, but with the demise of the Myrtle Beach Spring Bike Rally this year inside the city limits, her three-year-old, once-thriving bar business struggled just to stay afloat.

On the night of Oct. 6, Bowden talked with her teenage son as he made French fries in the kitchen of their Myrtle Beach home. He was heating oil in a large skillet on the stove when the oil got too hot and caught fire. Bowden reached for the closest thing she could find, a sweatshirt that had been hanging over a chair, and she threw it on top of the frying pan in an attempt to smother the grease fire. While the body of the shirt largely contained the fire, one of the shirtsleeves hung down from the stove, and Bowden watched as fire quickly engulfed it. As she attempted to gather up the grease soaked sweatshirt with the intent of throwing it in the sink, the frying pan tipped over. Instinctively, she put her hands over her face as scalding hot grease splattered over her. Bowden sustained first degree burns on her face, second degree burns on her hands and arms, and third degree burns on her thighs, ankles and feet, which took the brunt of it when the grease hit the floor where she was standing.

Her son rushed her to Grand Strand Hospital, who contacted the burn center at Doctors Hospital in Augusta, Ga. Bowden was taken there by ambulance, where she received skin grafts on her thighs, ankles and feet. She visited the burn unit in Augusta twice before beginning treatment at Trident Medical College in Charleston. She started going to Charleston weekly for checkups, to receive medicine and have her bandages changed and her wounds cleaned. As she improved, her checkups were cut back to every two weeks, and now, eight weeks after the accident, she goes every three weeks.

She was otherwise healthy at the time of the accident, and the doctors who have treated her are surprised at the speed in which she is recovering. With her feet so badly burned, Bowden is only allowed to stand for five minutes at a time. "I have to keep off my feet as much as possible. It slows down the healing process, and I have blisters." she says. Easier said then done for a single mom who has raised four children and spent her life entertaining people. She was optimistic when she opened her bar three years ago, but now she is not sure how long she can keep the business going, however members of her staff have put together a weekend of benefits at the bar to help. Her top concern right now is her health. "I want to be OK, I want to walk again, I want to sing," Bowden says.

The bills for her treatments have begun to crowd her mailbox, and the bill from her first emergency trip to Augusta alone is close to $80,000. By the time her treatment is done, her medical bills will total close to a quarter million dollars. Without insurance, she has no idea how she will pay the huge tab and no illusions about why she has received the treatment she has. Citing the public policy of hospital ERs to treat people in an emergency situation regardless of their ability to pay, she says, "The only reason they are treating me is because they have to," says Bowden.

Without proper medical care for her blisters and healing skin grafts, Bowden could develop potentially lethal infections, as well as risking additional surgeries and the possibility of losing her leg.

Who pays the bill?

In 2008, uninsured citizens of the U.S. received more than $116 billion in treatment from doctors, hospitals, EMTs and other providers. More than one third of that amount the uninsured paid out of pocket, with another 26 percent covered by government programs and charities. The remaining balance, $42.7 billion in 2008, falls under the category of uncompensated care. Someone has to pay the bill, and the price of uncompensated care is passed on to the insured in the form of higher premiums. Under the new plan proposed by the president, millions of Americans would be covered through an insurance "Exchange," a virtual marketplace where individuals as well as small business owners could shop and compare different insurance policies and buy insurance at more competitive prices than the current market. The exchange hopes to provide low-cost, high-quality health care to millions of Americans, with tax breaks to help subsidize the costs. For those who still could not afford insurance, eligibility for Medicaid - the state/federal program for the poor and disabled - would be expanded. Under the house bill, families with incomes at 150 percent of the poverty line (a little more than $30,000 a year for a family of four) would be eligible to receive assistance.

As the amount of uncompensated care decreases, doctors and hospitals would no longer have a need to charge higher fees to those with insurance, again resulting in lower premiums. For people with health insurance coverage, the health care reform bill would prohibit insurance companies from increasing the cost of health insurance based on age or sex, and from refusing coverage to people with pre-existing conditions. New regulations would prevent insurers from dropping clients when they get sick and need insurance the most, and would cap out-of-pocket expenses and eliminate co-pays and deductibles for preventative care like flu shots, cancer screenings and diabetes testing. Under the proposed health care reform, insurers would be required to spend a specified amount of each dollar collected in premiums on actual heath services, as opposed to keeping the money as profits or spending on overhead, advertising and marketing. Blue Cross/Blue Shield, in a public statement issued Sept. 9, acknowledges the need for reform but asserts, "For healthcare reform to work, it must include more than insurance reform. Reform must also improve quality, rein in rising costs, and ensure everyone has coverage."

The cost of the health care reform plan is estimated at $894 billion over 10 years. The plan would be supplemented with $318 billion in new taxes on wealthy filers, individuals making $500,000 or more and joint returns showing $1 million or more in income, as well as savings from cleaning up waste and fraud in existing systems such as Medicare and Medicaid. The non-partisan Congressional Budget Office (CBO), which keeps track of the cost of Congressional acts, says that changes to the Medicaid Medicare system are worth billions of dollars in savings, estimating the savings would reduce the federal deficit by $104 billion during the next decade.

Despite the heated exchanges sparked by proposed cuts to Medicare in town hall meetings this summer, the American Association of Retired Persons (AARP) has come out in favor of the health care reform package. Backed by 40 million members, the AARP supports proposed reform based in part on insurance reforms that prevent discrimination based on age or health, as well as a plan to lower drug costs for Medicare beneficiaries through eliminating a gap in coverage known as "the doughnut hole." Once a Medicare recipient has spent $2,700 on prescription drugs - drugs to control heart disease, arthritis and a host of other infirmities that inevitably come with old age - they are forced to pay 100 percent of the cost of their medications out-of-pocket.

About 3.4 million older Americans fell into the doughnut hole in 2007. The goal of the new health legislation is to not only lower costs, but to actually strengthen Medicare at the same time. The latest amendments to the bill extend Medicare coverage to all Americans age 55 and older. In addition to the AARP, the house legislation has been endorsed by a number of public and private groups and organizations, including the American Medical Association, Consumers Union, and the American College of Physicians. But this week, U.S. Senator Joe Lieberman, an Independent from Connecticut, is making the rounds and putting a potential wrench in the president's plan, saying that he can't support the legislation if folks as young as 55 become eligible for Medicare.

Legislative reform aims to reign in excess health spending by implementing a number of changes in how healthcare is delivered. Dr. Tracy Nelson is a practicing Obstetrician with Magnolia OB/GYN in Myrtle Beach, and she is a member of Doctors 4 America, a grassroots group of more than 15,000 physicians. "We have more money than any other industrial country, yet we rank poorly on healthcare," she says. Committed to passing meaningful healthcare reform legislation, Doctors 4 America met with President Obama recently, bringing physicians from all 50 states to act as a voice for people in their home state, with Nelson representing South Carolina. Nelson says the problem isn't health care itself. "Since 1975, more Nobel prizes in Medicine and Physiology have been awarded to Americans than all other countries combined," she says. "We have the best health care in the world, so much research and innovation," says Nelson. "The problem is in the delivery of services." Nelson believes health care reform can and must happen. "The United States is the only developed country that relies on profit-making insurance companies to pay for both essential and elective healthcare," she says. "If we can eliminate partisanship and really focus on caring for patients, we can heal our system."

Citing cuts to Medicare, costs approaching ten figures and a host of other concerns, Senate Republicans have been vocal in their opposition to the proposed plan. If the Republican party has become the party of no, then South Carolina is holy ground - U.S. Senator Lindsey Graham (R-South Carolina) has been a vocal and virulent opponent of the Obama health care proposal, our U.S. State Representative Joe Wilson broke with civility when he called President Obama a liar on national TV during health debates, and Governor Mark Sanford urged the South Carolina congressional delegation to oppose a proposed public health option to the reform package, which many in the Republican party feel is an attempted government takeover of healthcare. (In the early part of 2009, Sanford had generated buzz within the Republican Party that he might be a worthy opponent against Obama in 2012 - before his rendezvous in Argentina dashed his career, as well as his marriage.)

The proposed public health option was hotly debated before being shelved, and the Republican Party is now speaking out against proposed mandates in the bill that would require all Americans to carry insurance. Beginning in 2013 or 2014, most Americans would be required to carry health insurance, much as drivers are required to have car insurance. Families with low incomes would be exempt. While most Republicans are vehemently opposed to the requirement, Congressional Democrats are pushing for the mandate, saying it would reduce the cost of health care by reducing uncompensated care, which is passed along in higher premiums.

On the home front

While the debate on health care continues in Washington, along the Grand Strand the desperate need for affordable, quality healthcare continues to grow. Danielle Johnson is a 43-year-old Socastee woman who struggles with a condition called Sciatica, which she was diagnosed with seven years ago. Sciatica affects the main nerve in the back, and when that main nerve becomes inflamed, it sends excruciating pain throughout the legs, hips and lower back, making it impossible to walk or even stand. Danielle Johnson and her husband, Douglas Johnson, had been doing well for themselves up until two years ago, when he was laid-off from his construction job. After an extensive job search that turned up nothing, Douglas Johnson took a part-time job working at Wal-Mart.

Without health insurance, Danielle Johnson tries to catch flare ups with her sciatica in the early stages. If she catches it early enough, she can treat the inflammation with over-the-counter anti-inflammatory such as Naproxen Sodium or Ibuprofen. "When you have no insurance and can't go to the doctor, you have to pay attention to your body's signals," she says. "Before making that doctor appointment or going to the hospital, you have to ask yourself if it's worth it, to spend that money." During severe flare-ups, Danielle Johnson receives a steroid shot and prescription medicine from her doctor. The steroid shot alone costs about $150. Her doctor would like to run tests to determine if she is a candidate for surgery, or if her chronic condition is just something she has to live with. Without insurance, the high cost of the tests was out of the question for the Johnson family. "I called around, pricing for MRIs and X-rays, but nobody will touch you without a down payment." An MRI, or magnetic resonance imaging, uses a magnetic field and radio waves to create images of parts of the body, specifically the brain, neck and spinal cord. Costs range from slightly more than $1,000 if performed in a doctor's office, to up to $3,000 if the procedure is done in the hospital. The down payment for such a procedure is usually a percentage of the total cost, and a down payment for an MRI could cost as much as $500.

In addition to sciatica, Danielle Johnson suffers from diabetes. As part of her treatment, Danielle Johnson's doctor recommended she test her blood sugar levels six times a day, which would cost around $200 month for test strips. As a result, Johnson hasn't regularly tested in more than four years. Despite her own health, Danielle Johnson worries about her husband. "He has asthma, and hasn't been to the doctor for 15 years," she says. "I tell him to go, but he's more concerned with me, that I get to my treatments." She shopped around for an individual health insurance policy, but the least expensive rates were still too high for their budget. "Just for basic insurance, the cost with Blue Cross/Blue Shield would be over $500 month," she says. Online, the Personal Blue Basic Family policy from Blue Cross/Blue Shield, for two people, with a $3,000 deductible and $15 basic office visit co-pay, runs $475.88. "We just can't afford that."

Within the past week, Douglas Johnson came home with a surprise - he was offered insurance through his part time employment with Wal-Mart. The amount the Johnsons would have to pay for the group coverage? Still more than $500 month, and that's with Wal-Mart paying part of the plan. When it comes to healthcare reform, Danielle Johnson is very clear about what she would like to see. "The government has to go after the insurance companies and say 'this is what you're going to offer, and this is what it is going to cost.'" She hopes tighter regulation of the insurance industry would help, saying, "The big thing is - is it going to be affordable? $500 a month just isn't affordable."

In the meantime, as Danielle Johnson struggles with her health problems and paying for her care, she is disgusted both by what she sees and by what she experienced first-hand. "Rushed treatments, patients not getting full diagnosis, cutting corners - people in this country are not getting the treatments they need or deserve. People are really suffering out here."