Dean's health care via E-Mail?

[lurk_no_more]

From a recent E-Mail

Like most health care promises, no one reads the fine print, or past the positive sinps of a positive spin and you would think that a positive health care record of past would be one without the need for spin or the need for telling less than all there is, however dean's Vermont healthcare plan while on the face of it, appears to be a model for the future, (or to here dean say it, his model for the future) it is proclaimed a wonderful thing by omission of all that is not.

Dean claims to have a health plan that will guarantee insurance for all Americans modeled on the system he set up in Vermont. In reality, according to his own Web site, his plan would leave at least 10 million Americans uninsured. And that is only if he actually implements his plan-he is determined that "nothing will happen on health care until he works out a plan to balance the budget." If he does model the national health care system on Vermont's system, it won't be pretty.

Vermont actually doesn't have universal health care. It is true that almost all children under the age of 18 are covered, but U.S. Census Bureau figures show that 10-12 percent of Vermonters remain uninsured. This is only a little better than the national average of nearly 15 percent uninsured.

For those Vermonters who are insured under Dean's plan, their access is extremely limited. Dean's plan requires families to pay monthly premiums for government-subsidized health care. Because services are provided through private insurers, however, premiums have been steadily increasing while care has been steadily deteriorating. Over the past 10 years, employee health insurance costs have increased by 400 percent.

Dean has also cut basic services from the health plan such as X-rays, dental services, physical therapy, psychological care and cheap prescription drugs. As Dean explained to the Rutland Herald in 1991, one of the main assets of his health care plan is that "it definitely keeps people out of the emergency room."

It seems his main concern was not so much universal coverage as cost-cutting. In his first State of the State address he moaned: We spend too much money in this country and in this state for unnecessary
medical procedures. We must reduce the combined pressures of professional liability, consumer demand and reimbursement mechanisms which encourage providers to administer more care and to order more tests.

In other words, health care under Dr. Dean means paying more for less.

I personally found the cuts in X-rays, dental services, physical therapy, psychological care and cheap prescription drugs more than a bit disturbing, especially for a doctor.


” JAFO”

[brainshrub]

1. Two quick points:

1. Deans plan for Health-care reform can actually pass Congress. A single-payer system would be better, but there is no way in hell the insurance lobby would allow it.
Dean admits his plan isn't perfect...but it's a start. He isn't hiding anything.

2. This is only a little better than the national average of nearly 15 percent uninsured.

I don't have the exact numbers onhand...but the number of uninsured Americans is much higher than 15%. (Anyone on DU have a source for the info?)

[madfloridian]

2. I heard 47% without insurance.

I heard, but have not seen the figure. Will search.

Dean makes it clear in every speech that it is just a beginning to help as many as possible get into the system. He makes that very clear.

[sandnsea]

3. 15% is about right

That figure may actually be a teeny bit high. At least 40% of people are insured through Medicaid/Medicare alone.

[TLM]

4. SOmebody did not read the fine print... that 10 million...

that is the number of folks they expect will elect to opt out of the system.

Since the system is not mandatory, many will decide to go with their own private insurance providers or to just not take part in this program, and that's where the 10 million figure comes from.

And isn't there a DU rule against simply reposting talking point chain mails?

"Vermont actually doesn't have universal health care. It is true that almost all children under the age of 18 are covered, but U.S. Census Bureau figures show that 10-12 percent of Vermonters remain uninsured. This is only a little better than the national average of nearly 15 percent uninsured."


First off I think the national numbers for uninsured are higher than 15%... do you have a source on that?

Second, not only are kids covered in VT but also anybody under 125% of poverty.

"For those Vermonters who are insured under Dean's plan, their access is extremely limited. Dean's plan requires families to pay monthly premiums for government-subsidized health care."


Only if the family income is over a certain level. This is very misleading and makes it sound as if everybody has to pay a monthly.


"Because services are provided through private insurers, however, premiums have been steadily increasing while care has been steadily deteriorating. Over the past 10 years, employee health insurance costs have increased by 400 percent."

Got a source to support that claim?


"Dean has also cut basic services from the health plan such as X-rays, dental services, physical therapy, psychological care and cheap prescription drugs."

Again very misleading... as Dean has also instituted programs that cover several of tease areas.

Dean's VT record on prescription drugs...

Drug Patent Reform Governor Dean was founder of Business for Affordable Medicine (BAM), a coalition of governors, business and organized labor with one objective - closing loopholes used by brand name drug manufacturers to prevent or delay lower-priced generic drugs from reaching the marketplace when patents expired. Governor Dean created and coordinated unanimous passage of NGA policy on the need to reform the Hatch-Waxman Act. Thanks to his leadership with other governors, the U.S. Senate and House have included provisions that would close some loopholes in the currently pending Medicare prescription drug bill.

Preferred Drug Lists and Supplemental Rebates Under Governor Dean, Vermont has been a leader in lowering drug costs in the Medicaid program.

Dean wants to expand these measures nationally:

Preferred Drug Lists (PDLs) to ensure that doctors and patients use less expensive medications where clinically possible. Vermont started with one class of drugs - Gastric acid reducers which includes the highly-advertised drugs Prilosec and Nexium, and put a less expensive therapeutically equivalent alternative drug on the preferred list. The results have been remarkable: Vermont’s Medicaid expenditure on gastric acid reducers has been slashed by 43%.

Forcing Pharmacy Benefits Managers (PBMs) to have transparent contracts with the manufacturers to disclose any financial incentives they might receive from drug manufacturers. Vermont was one of the first states to implement such an agreement, and this is another step that Governor Dean wants to take nationally.

Finally, Vermont last summer expanded the PDL and began to negotiate supplemental rebates with drug companies, in addition to those the companies provide in accordance with federal Medicaid law.

The Pharmaceutical Research and Manufacturers of America, a trade group known as PhRMA filed suit against the U.S. Department of Health and Human Services, questioning HHS’ authority to grant states the ability to use PDL’s. Governor Dean organized 22 other Governors who sent a letter of support to Secretary Tommy Thompson on August 12, 2002. In addition, Governor Dean organized a press conference on this suit with other Governors at the National Governors Association summer meeting.

Disclosure of Gifts to Doctors Last June, Governor Dean signed a bill into law which, among other things, made Vermont the first state in the nation to require pharmaceutical manufacturers to disclose the value, nature, and purpose of any gift, fee, subsidy, or other economic benefit provided to any physician, hospital, nursing home, pharmacist or health benefit plan administrator in Vermont.

Re-importation for personal use Governor Dean has endorsed the strategy of United Health Alliance’s Medicine Assist program, enabling U.S. citizens to obtain prescription drugs from Canada via fax. Canadian drug prices are, on average, half those in the United States. Governor Dean has held numerous press conferences encouraging people to take advantage of the plan to make their prescription drug costs more affordable.


Dean's VT record on mental health....



Insurance Parity — Governor Dean signed insurance parity legislation in 1997, ending discrimination against individuals with mental illness in private health care. In Vermont, insurance companies cannot charge higher fees or provide fewer benefits for mental health care than for physical health care.

Improved Accountability — Governor Dean consolidated fiscal responsibility for publicly funded in-patient psychiatric care, improving accountability and coordination of clinical care.

High-Quality Providers — The Dean Administration raised the salaries and benefits for community mental health care workers to attract and retain the best providers.


Children’s Mental Health — The Children’s Upstream Services program is the first statewide early childhood mental health program for children up to six years old.

“Success Beyond Six” — The Success Beyond Six program puts mental health workers in every school district to assist teachers and provide services to children in need.

Rural Mental Health Care — The Pediatrician Pilot program puts mental health workers in rural medical offices to assist children who need mental health care.

Community-oriented Care — Vermont is a leader in developing integrated community care and flexible funding programs that encourage comprehensive mental health services for adults, including supported housing, employment and peer-run recovery services.

Improved Care for Older Vermonters — Vermont’s elder care initiative assigns mental health workers with geriatric expertise to local aging programs to help identify and improve care for older citizens with mental illness.

Support for Substance Abusers — Vermont’s assertive community treatment teams pair mental health and drug treatment professionals with probation and parole officers to provide outreach services to people who have a major mental illness and serious substance abuse disorder who are in the custody of Corrections.


Reduced Imprisonment — Implementation of Vermont’s mental health crisis response system for children and youth helped significantly reduce the number of youth going into state custody.

Increased Employment Opportunity — Vermont’s employment rate for people with mental illness is twice the national average.

Low Homelessness Rate — Vermont’s rate of homelessness for people with mental illness is far lower than the national average.


Dean’s VT record on the elderly...


Prescription Drugs — Governor Dean understands the importance of access to prescription drugs in preserving health and avoiding unnecessary institutional care of our seniors and people with disabilities. While in office Governor Dean expanded pharmaceutical assistance to these Vermonters. Vermont has three pharmacy assistance programs with the level of benefits for each program indexed to household income. Seniors and people with disabilities can have incomes up to 225% of the federal poverty line and receive assistance with their prescriptions.

Nursing Homes — Governor Dean decreased the state’s reliance on nursing homes by mandating that funds be shifted from nursing homes to other services, such as home health care where people can live with independence and dignity. Over $30 million dollars has been shifted from paying for nursing homes to paying for in-home and community based services.

(This one is one that spinners like to use... they scream Dean cut money for services to the blind and the elderly. Yet they never mention that he shifted those funds to in-home care programs so that Vermont’s elderly and disabled could live with dignity and independence in their own homes instead of being locked up and drugged out in some nursing home. It really shows the sick lengths that some dishonest folks will go to attack Dean.)

Home Health Care — Between 1996 and 2000, there was a 161.3% increase in individuals receiving a home-based waiver and services, while there was a decrease of 13.5% in individuals living in nursing homes.



"As Dean explained to the Rutland Herald in 1991, one of the main assets of his health care plan is that "it definitely keeps people out of the emergency room."

Yeah, because when folks have no coverage, they go to the emergency rooms for basic care, or wait so long that a minor conditions turns to a much more serious one, and both of these things drive up healthcare cost immensely. Having even a basic level of coverage allows folks to get PREVENTITIVE care and care outside the ER. ER care is the most expensive kind and is a huge drain on the insurance and healthcare providers.

Trying to spin that as some nefarious comment is dishonest and desperate.

[askew]

5. The 10MM are the individuals who opt out of insurance coverage.

Dean's plan will cover everyone, but like VT's plan some people will opt to go without coverage completely.

Dean's plan is a combination of:

1. providing better coverage under Medicare/Medicaid and making that coverage available to more Americans.

2. allowing any American to buy into the current plan available to Congress and Gov't workers (considered the best healthcare plan around).

3. providing incentives to small businesses and other companies to continue to provide coverage for their employees.

This is better than a single-payer plan, because it will pass Congress, it does not force everyone to go to one plan, it won't phase out private insurance companies (who employee lots of Americans) and it will cost less.

[MercutioATC]

6. Some missed points, as others have stated, and one HUGE omission:

Dean's plan would end the exclusion for pre-existing medical conditions. Currently, even if a displaced worker finds new employment, most medical conditions that they had been treated for previously are excluded from coverage under their "new" health plan. By expanding Medicare and FEHBP, Dean's plan eliminates this problem which is an incredibly huge deal for many families.

I'm a member of FEHBP, subscribing to an AETNA HMO. In addition to no exclusion for pre-existing conditions, I have:

$20 office visits
$25 office visits to specialists
$20 prescription drug benefits

...and AETNA is hardly the best carrier in FEHBP...I stick with them because they have my son's primary care physician and allergist in-system (oh, my son has allergy shots every 3 weeks and I pay only $25 per year).

DON'T think of FEHBP (which also offers PPV plans) as some cut-rate HMO system. I get beater medical benefits that most people I know and I pay very little. The best way I can think of to explain it is if you have ever worried about your coverage or how you were going to pay for it, Dean's plan is for you.