Island author speaks about issues surrounding affordable heath care
The new law is more than 1,000 pages long, according to Dr. Maggie Kozel of Jamestown. Most Americans have not read the fine print, she said on Sunday, as she explained the basic changes on the way.
Kozel’s presentation at Central Baptist Church on Jan. 22 drew about 40 people, and many were nurses and doctors themselves. Most were well informed about the issues.
Kozel, who is the author of “The Color of Atmosphere: One Doctor’s Journey In and Out of Medicine,” started the discussion by showing an informational video about how reforms will impact people. The video was produced by the New York City-based Henry J. Kaiser Family Foundation, which, according to its website, provides an independent source of information about U.S. health care issues.
Overall, Kozel said during her hour talk that reform will enable more Americans to obtain coverage. By 2019, most of the people without health insurance today will be covered. The reforms will cost money, some $938 billion over the next 10 years.
“That’s 2 percent of the federal budget,” she said, putting the estimate in context.
During a spirited question-andanswer session afterwards, Kozel and the audience discussed a broad range of issues, including the cost of end-of-life care and the value of electronic health records.
Jim Traer of Jamestown questioned the high costs to care for terminally ill people over the final six to eight weeks of life.
“Part of the huge growth in medical costs has been end-of-life care,” Traer said. He personally has known of situations where the patient was terminally ill and had signed a “do not resuscitate order” and yet was resuscitated.
“You do need to have end-oflife discussions,” Kozel said.
Besides the high costs, heroic efforts at the end of life sometimes prolong the patients’ suffering, said Dr. Dannie Ritchie, a Providence family practitioner.
“That is one of the issues around highest cost and varies around geographic area,” she said. “Some regions do more, but planning for treatment or care is a better way to talk about it.”
Without that discussion, she added, family members may not understand that they’re not helping their loved one by insisting on chest compressions and intubations when the case is hopeless. These steps to prolong life can be “torturous,” she said. According to Ritchie, these people should settle these questions in advance of an emergency and name the family member who should make decisions for them about end-of-life care.
“If there are problems within the family,” she said, “it’s not a comfortable place to start to act out those issues. It’s too hard, too stressful to have a clear head.”
Kozel said the much ballyhooed “death tribunals” are not part of the new law but agreed people need to have discussions with family about end-of-life treatment.
Ritchie mentioned the high cost of care for premature babies and other ill babies that have to be treated in the neonatal intensive care units. Kozel acknowledged these treatments also are expensive, but said the issues at stake differ from end-of-life care. As a pediatrician, she’s reluctant to urge parents to stop treatment, even when the case seems hopeless.
“It is very different at the other end,” she said, when faced with parents unable to give up hope for the child.
After the discussion, Jim Keller of Jamestown said he would like to see the government compete with private insurers to help individuals obtain coverage. That isn’t part of the new law, though.
“Single payer is not being offered as an option,” Keller said. “I wish it were so the federal government could compete with private insurers.” He added that his understanding of the reforms improved after hearing Kozel’s presentation.
“She diminished or destroyed the myths – or, dare I say, lies – that are being perpetrated.”
Kozel also passed out a test, which the Kaiser Foundation created, to assess everyone’s knowledge of the new law. Most Americans (65 percent) who took the survey could answer four to six of the 10 questions.
They knew, for example, health insurance will be mandatory, and people who fail to comply will face fines.
In other key changes, children will no longer be denied coverage because of a preexisting health condition. But adults in the same predicament will not be automatically entitled. They will have a chance to obtain insurance through a high-risk pool.
It’s unclear yet if the cost would be prohibitive. The idea is, health insurance companies will have to compete for business, and the competition will make rates affordable.
“It’s all theoretical,” Kozel said. Meanwhile, health insurance companies have been raising premiums while they still can. Those hikes, though, have nothing to do with the health care reform act, according to Kozel.
Another area of concern is that some doctors are going to be paid less under health care reform. One unintended result could be a shortage of physicians, making it harder for people to gain access to care.
“Starting in 2014 there are going to be cuts to Medicare,” Kozel said. “It will still be cost-effective to treat patients but along a different model. Small group and solo medical practices will become less common.” That could signal access problems or “might be just transition where health care is changing.”
“I hate to get into doctor wars,” she said. The American Medical
Association and most professional associations do support the reforms, but many doctors have left the AMA in protest and some surgical specialties are opposing it. But according to Kozel, support for the new law is coming from the overwhelming majority of physicians.