dcj,
I suppose it's all dependent on your point of view. While I was never a huge fan of GWB, he did make a number of health care initiatives. So your comment about being unwilling to do anything is just not borne out by the facts.
1. He made a huge push to combat AIDS, malaria and TB worldwide.
2. He pushed through a very expensive Medicare prescription drug program that while it had some flaws reduced the number of of senior citizens without drugs from 33 to 8 percent.
3. He granted the state of MA a waiver to start their universal health plan coverage. Yes, that was GWB who did that.
4. He doubled funding for community health care centers.
These were all solid accomplishments that get brushed under the rug by critics and haters of GWB.
As far as your opinion that the Republicans refusing to work with Obama I'd strongly disagree as well.
There were many times where Republican calls for Tort reform and inter-state competition were dismissed out of hand. There were numerous Republican and more importantly conservative plans that just were flat out ignored. But please don't take my word for this, please visit...
http://www.heritage.org/Initiatives/Health-Care
Welcome aboard, by the way!
.
Hi everyone and thanks for the welcome. I agree with you on some of the points. GWB2 did do a TON for HIV, TB, and Malaria worldwide. Those are truly noble causes, but they do not have a lot of bearing on US healthcare, at least not directly.
I will address medicare part D below.
I am not totally aware of the situation in Mass, but I know he did increase funding for community health centers. Those are both great things that Bush did. Absolutely.
I also agree that the Republicans wanted to open inter-state markets, which makes sense to me as well. I know that some democrats backed that idea as well, and something similar is being implemented in the form of the insurance exchanges, but I believe (although far from certain) those are going to be open only to people on government run plans. This is far from ideal, but a step in the right direction, which was apparently begun by republicans.
I will acknowledge that saying the Republicans have done nothing was too harsh, and I apologize. However, I still feel that many members of the party were putting party ahead of country because they were trying to make healthcare Obama's "waterloo" in an effort to regain control. Some might argue that the dems forced the bill into law to score a victory for the party, possibly at the expense of the country. I couldn't really argue against that, but I don't entirely agree. I think they were acting with the best of intentions, and dems, and Obama in particular (for obvious political reasons), wanted more bipartisan support. I believe for some republicans their opposition was more political posturing than true opposition, but that is just a gut feeling. To be honest, I have not been able to follow things as closely this past year as I would have liked because my study schedule has been pretty intense.
As for Medicare Part D it is the bane of the pharmacist. This is a program that exemplifies whats wrong with government run programs. Best of intentions, completely confusing, and ultimately ineffective. The plan was to cover prescription benefits for seniors, and it does. Where the problem went awry was that they put in a doughnut hole. The doughnut hole basically occurs when a senior spends X-dollars on prescription drugs, at which point they have to start paying out of pocket, until they reach Y-amount, at which point the government resumes paying. The problem is that seniors (or really most patients) have NO IDEA how much things actually cost. So what happens is seniors get their meds, brand drugs and all, and then suddenly in September, October, or whenever, they hit the doughnut hole and are suddenly slammed with the full brunt of their medication cost. Yet their friends & neighbors never reached the doughnut hole so they see the system as unequal. The way the program is designed it can be very difficult for someone not in the know (aka seniors) to determine when or if a person will reach the doughnut hole, and what their costs may be on a monthly basis at that point.
The doughnut hole was instituted with good intentions. Studies have found that
if a medication is provided at no charge, it is perceived to have no value. By sharing the cost of the medication, it was supposed to be deemed more valuable (which increases adherence) and encourage a person to work to reduce their costs. Unfortunately, the hole was designed to only affect 20% of people on medicare, and the implementation meant that in many cases the end of the year was insight, so patients would forgo their meds until the new year, when the slate was wiped clean.
IMO, pharmacists should sit down with patients at the beginning of the year with a list of their meds, and say "in X-month you will reach the doughnut hole. Currently, we can switch drugs A and B to generics, and drug C to another drug in the same therapeutic class that is on formulary, thereby reducing your monthly costs, which will push your entry into the doughnut hole back to Y (or avoid it all together)". The problem is no one will pay for this. Not the government or private insurance. This is a really easy way to reduce costs, but pharmacists can't do it for free because the reimbursement on a prescription is tiny, so they have to push prescriptions out just to get by. If the payers (be they government or insurance) would get creative and utilize things like pharmacists doing medication analysis and review, then healthcare costs could plummet. I am sure there are many things doctors and nurses could do as well, but I am less familiar with them.
All of this is moot because the doughnut hole was removed in the new law, but it illustrates a point. The law was well intentioned, but poorly implemented because it was perceived as unfair and did not achieve the goals (reduce costs & improve outcomes) it was designed for. A better system, IMO, would be to have everyone pay a set percentage for their drugs (possibly with a cap on monthly expenses), but shrink the formularies to help reduce costs.
IMO, the keys to making health care reform work are transparency for all parties involved on things like cost and alternative options, implementing creative ways to reduce cost, and increasing patient involvement in their health care decision. Currently, none of the providers, private or government, do this. There is plenty of blame for all parties involved.
I believe in government
assistance, but not in the government providing
everything. Personally, I feel we can offer a very basic level of service to all of our citizens, but if you want better it should be up to you to obtain it. To make a car analogy, everyone can get a Kia Rio, but if you want an accord, NSX, or 911, then its up to you to make up the difference.
