Guest Authors

As requested by Dr. Jecklin...

Our guest authors include Matthew (patient), Brittany (worker), Scott (student) and Coach Showen (worker). Coach Showen's opinion can be viewed in various "comments" sections throughout our blog.

Thank you.

Medicaid & Access to Dental Services

The U.S. healthcare system is the most costly compared to any other developed country and yet statistics describing our infant mortality rates, rates of disease and length of life are rather grim. Americans are receiving average to poor health care outcomes while paying twice as much as others living in the developed world.

As a BadgerCare Plus Outreach Specialist, I witness firsthand how healthcare reform could greatly benefit members I work with everyday. Imagine telling a single working mother that the only way she is able to obtain regular dental care is by driving over two hours one way to receive care, or listening to a member describe how his oral health pain became so severe that he extracted his own tooth with everyday tools laying around his house, all without anesthesia. While the Medicaid program in Wisconsin has been touted as one of the best, there are also many gaps, sadly due to financial issues. Members of BadgerCare Plus receive two cards once they have been enrolled in the program: one is their HMO card stating which HMO they are a part of and the other is the ForwardHealth card which is what members use for prescriptions, chiropractic care and dental services. However, when BadgerCare Plus members call the long list of dentists in their community, they hear a repetition of “no, we do not accept the ForwardHealth card,” leaving many Medicaid members without regular dental care for extended periods of time until emergency services are demanded due to pain, infections and reduced quality of life. Oral health care is extremely important for children, pregnant women and adults alike, all across the life span for many reasons. According to the National Maternal and Child Oral Health Resource Center, individuals from low income families face a twelve times higher rate of missing school or work due to dental problems compared to those from families with higher incomes. Early tooth loss caused by tooth decay may result in impaired speech development, absence from and difficulty concentrating in school, and decreased mental and social well being at school all of which in turn negatively affects the child’s self esteem and success later in life. In addition, a child who is experiencing dental pain or missing teeth may have to limit their food choices due to chewing problems which can result in nutritionally inadequate diets. It is also extremely necessary for pregnant women to receive regular dental care as pregnant women experience increased hormone levels making them more susceptible to oral infections which may result in pregnancy complications. There are several dental issues that pregnant women are more prone to develop including periodontal disease, pregnancy tumors, and pregnancy gingivitis.

The goal of BadgerCare Plus was to guarantee 98% of Wisconsin children health insurance, however if the oral healthcare needs are being unmet by a large number of Medicaid members, has the state of Wisconsin really fulfilled that need? Serious healthcare reform must take place in order to solve this dental access issue for BadgerCare Plus members. While it is true that some communities have attempted to combat the issue by establishing free or reduced price dental clinics, those clinics are forced to install parameters stating they will see only children under the age of 12 or emergency dental issues only otherwise the clinics would be flooded with individuals. One solution to the problem would be to increase the Medicaid payout to dentists. Currently the Medicaid rate for dental health care is 34 cents to the dollar, the reason dentists refuse Medicaid patients. Dentists do not want to perform a service for which they are underpaid compared to commercial HMO members. However, with the state of Wisconsin’s budget, finding extra money to dole over is not a very likely happenstance. Another solution would be for the state to mandate that every practicing dentist in the state has to see at least 10 Medicaid patients – that would greatly help to solve the problem.

The need for oral health care is the most prevalent unmet need among children and adolescents. A state Medicaid program targeting children and their caregivers that cannot guarantee dental services provides grossly inadequate services to its members.

Let's Minimize the Profit in Healthcare

Since the early 1990's, when the brave but naive Clintons dared to suggest health care reform, the idea that access to affordable health care in the United States should be a right and no longer a privilege has gained some traction. Perhaps the financial crisis that accelerated this past fall will convince more Americans that economic behavior in pursuit of mindless profit harms far more people than it helps.

On the other side, however, are the right-wing zealots who scare citizens into believing that any government-initiated remedy to our broken, needlessly expensive, and anti-democratic health care system would mean less access, less choice, and a lower standard of care.

Apparently, many people trust that their insurance company, the faceless financial behemoth that collects the premium money from them and their employers, will take better care of them than their government will.

Given the deregulation of the corporate and financial world over the past 30 years and the booms and busts that have left a wake of economic decay and demoralization for the majority of Americans, I don't think it's wise to entrust life and death decisions of health care to corporate boardrooms and Wall Street traders.  For example, when I learn from 60 minutes that health corporations grant bonuses for denials of service to patients who pay their hefty premiums on time, that is the clearest evidence that this system is beyond reform.  Such appalling corporate conduct is the best argument for removing private insurance companies from health care.

As deregulation has made the insurance giants indistinguishable from investment banks, is it no wonder that many have lost confidence in what was their core mission: provide the stability that individuals and families need in a complex financial world.  In the case of health insurance companies, of course, that has long included only those without 'preexisting conditions'.  This, in effect, excludes those who present a large financial burden to the industry, to be certain.  These are also the people who need the most help.

One of my good friends from high school was a star runner, captain of the school hockey team, and the smartest one of our crowd.  Fortunately for him, his employer, from whom he receives his health insurance, has stuck with him throughout a devastating bout of multiple sclerosis.  I witnessed his decline as a runner, when he couldn't explain why his times kept slipping compared to his training partner.  By the time of his wedding, he needed a cane to get down the aisle.  Shortly after, he accepted that he would need a wheel chair for independence, a larger computer monitor to make out text on the screen, and a more accessible place to live.

I wonder where Dan would be today if he had been dropped by his insurer.

Certainly he wouldn't have adopted two boys from Guatemala, wouldn't continue to serve the patients at UW Sports Medicine, and he wouldn't have won the Mike McKinney award for community service, all the while dealing with decreased function and, no doubt, the pain that comes with the loss of the life he had once imagined.

For most Americans, a devastating diagnosis of this magnitude quite often leads to the bankruptcy that results from the mounting debt of medical expenses and, for some, job loss.

So, first, get the profits of insurance companies, who add no value to medical services, out of health care.

Second, we need a national health plan to make sure that all Americans have affordable access to health care services and to those treatments that doctors deem necessary.  One of the causes of the spiraling cost of treating patients is the cost of pharmacuticals.  And yet, we have no regulation of prices and a shoddy FDA, which is not immune to the lobbying pressure from drug manufacturers.  Otherwise, how can we explain how a drug like Viiox was released to the public?The federal government could both negotiate better terms for consumers, or, better yet, place price controls on the amount of profit companies can make prolonging the life of those who face difficult decisions on whether or not to fill and consume their prescriptions.

A third rememdy I would offer is to change the salary structure of what specialists, such as surgeons make, compared to what their colleagues make in primary care and family medicine.  Unfortunately, the present billing structure of most health organizations rewards the work of specialists far more than it does those on the front lines of medical care.  What happened to the old addage, "An ounce of prevention is worth a pound of cure?"  In the model of most HMO's, however, the pound of cure, a procedure, is billed at an astronomically high rate.  But where does that leave those practicioners who are charged with keeping patients health enough to avoid expensive testing and costly surgery?  Perhaps in our question we see the answer: it is in the interest of HMO's to guide patients towards expensive procedures, where services are the most profitable.

It's obvious that the Obama administration and the Nation has its work cut out for it.

Reform Proposal 4

Reform Proposal 4-Quality

Molly Teska-Maroon Group-Finance

For the most part, Americans receive high quality health care services everyday, but there is always that risk that someone will not receive the best quality in their healthcare services (medical errors, patients receive care that they don’t need; patients receive wrong type of care). The truth is Quality of healthcare services depends on where you live, who you are, and how much is known about treating your condition. Some believe that we as Americans are not receiving the quality we should be for as much as we are paying. The U.S. spends more than twice as much on each person compared with most other industrialized nations; we're in last place when it comes to preventing deaths through appropriate medical care. Although there are many people without access to healthcare, for the ones who are able to access healthcare cost and quality varies dramatically. The US spends more of our healthcare dollars on administrative costs, or about 7.5 percent, than other countries, Germany and Switzerland, for example, spend five percent. The Obama-Biden Administration has many plans for the improvement of the cost, quality, and care of the US healthcare system. For one, Under the Obama-Biden Administration there would be improvement in the infrastructure of the existing health care system to reduce inefficiency and waste and improve health care quality using current providers, doctors, and plans. Under four elements: electronic health records, disease prevention and management, increased competition, and catastrophic illness costs, the plan would lower costs in the health care system. For electronic health records the plan would be to computerize the process of creating and maintaining medical records to allow nationalization of information so that records follow patients. Under disease prevention more than 75 percent of health care funding is spent on patients with one or more chronic conditions, such as diabetes, heart disease or high blood pressure. Obama-Biden will require all providers who are participating in the plan to follow proven disease management programs. It would also require that providers deliver quality care by promoting patient safety and reducing disparity in health care, reforming medical malpractice while preserving patient rights and requiring full transparency regarding quality and costs. For increased competition Obama-Biden plan to increase competition in the insurance and drug markets. The plan would force insurers to pay out a reasonable share of their premiums for patient care instead of keeping excessive amounts for profits and administration. This would also allow consumers to import safe drugs from other countries and help prevent drug companies from blocking generic drugs from consumers. Under catastrophic illness costs the plan is reimbursing employer health plans for a portion of the catastrophic costs they incur, making health care more affordable for employers and workers and helping them reduce premiums and avoid bankruptcy. American people are too often offered two extremes: government-run health care with higher taxes or letting the insurance companies operate without rules. Obama-Biden believe both of these extremes are wrong, and that’s why they’ve proposed a plan that strengthens employer coverage, makes insurance companies accountable and ensures patient choice of doctor and care without government interference. The Obama-Biden plan provides affordable, accessible health care for all Americans, builds on the existing health care system, and uses existing providers, doctors, and plans. Also, under the Obama-Biden plan, patients will be able to make health care decisions with their doctors, instead of being blocked by insurance company bureaucrats. Some of the above listed are just some of the plans under the Obama-Biden Administration that hopes to lead towards not only better access of healthcare but overall quality of the US healthcare system.

http://www.ahrq.gov/

http://www.fiercehealthcare.com/story/study-quality-u-s-healthcare-lags-despite-high-spending/2008-09-19

http://www.wsbtv.com/health/18991527/detail.html

http://www.whitehouse.gov/search/?keywords=health%20care%20quality