Most of the discussion regarding health care reform up to now has been about what the Democrats want and what the Republicans don’t want (which is basically the same thing). Now instead of just complaining about every aspect of the health care reform, the House Republicans have come up with their own health care reform plan. The leaked bill(which is a hefty 230 pages but much lighter than the Democrat bills) was drafted by House Minority Leader John Boehener of Ohio and states the following purpose:

“The purpose of this Act is to take meaningful steps to lower health care costs and increase access to health insurance coverage (especially for individuals with pre-existing conditions) without –

1) raising taxes;

2) cutting Medicare benefits for seniors;

3) adding to the national deficit

4) intervening in the doctor-patient relationship; or

5) instituting a government takeover of health care“

The bill wants to introduce a number of GOP ideas for reform such as:

-giving states subsidies for lowering health care costs and covering more people

-ban the use of federal funds for abortions except in the cases of rape, incest or harm to the mother

-exclude illegal immigrants from participation in any of the reforms

-capping mal-practice suit rewards at $250,000

-encourage individuals to use Health Savings Accounts

One of the few things that matched the House and Senate democratic bills is the extension of coverage for young adults under their parents’ plan. I think number 4 of what the bill wants to avoid is bs. The system that is being supported, which they are not proposing to change much about, does intervene in the doctor-patient relationship. It should be changed to “no additional intervention of the doctor-patient relationship, hopefully.”

The glaring problem with the Republican bill is the lack of cost containment coupled to coverage expansion. There are no subsidies for individuals or families with low income, which still makes health insurance unaffordable for many. In the case of cost, the responsibility is being transferred entirely to the states to find a method of cost containment. The bill is giving the states a task without any tools such as the ability to negotiate drug prices. And by banning illegal immigrants from participating in the high risk pools, the cost of treating them in the ER will only increase. Most importantly, the Republican bill does nothing to ensure that quality of care is maintained while addressing the issues of cost and coverage. Most likely when the debates over the Republican plan begin, the focus will solely be on the fact that their bill is not going to cost as much as the Democratic bill. And that is a formidable argument while the number 1 concern on Americans’ minds is the state of the economy.

In fact the Democratic losses in New Jersey and Virginia yesterday might be an indication of how much economic worries trump everything else. The race in virginia for the governor’s seat wasn’t even close as the Republican candidate, Bob McDonall lead by double digits over Democrat Creigh Deeds and most attribute McDonall’s success to the Democrats’ inability to solve the state’s economic problems after eight years of governorship. Republicans are taking advantage over this victory to attack Obama’s liberal policies and arguing that NJ and Virginia are the American people’s dissatisfaction with Democratic control.

This shows that the health care reform debate is subject to influence from other current political issues. Any small momentum, whether directly relevant to health care or not can push health care reform in a favorable direction for the Democrats or the Republicans. What all of this comes down to is the partisanship that has continued to develop and has come to a point where there is essentially 2 warring factions that oppose each other simply to oppose each other.

On last Sunday’s This Week with George Stephanopoulus, Valerie Jarrett, Obama’s top counselor, was interviewed and one of the main topics discussed was whether Obama has failed in his promise to reach out to Republicans and reduce partisanship. Jarrett was adamant in that fact that Obama has reached out and listened to what Republicans have to say, but that Obama will still do what he believes is the best for the country. I think that basically eliminates any possibility of bipartisan cooperation, because the Democrats and Republicans have such different views on what is best for the country. During the round table discussion, Rob Brownstein of the National Journal explained that both the Democratic and Republican bases have become more homogenous in recent years and their legislators feel more pressured to vote according to party ideology.

I think that in addition to more defined party lines, Republicans are refusing to cooperate with the Obama administration because they feel they’ve already lost too much in recent elections. The more threatened a group feels, the tighter they band together, which means they will fight harder on every legislation that comes out. That is just my take on why no moderate Republicans besides Olympia Snowe have come out to support some aspect of the health reform bill, but I am not a political psychologist and therefore cannot understand all the things that motivate politicians.

One aspect of this health care reform debate that I have wondered about recently is the role of the American citizens in how all of this will wrap up. There polls have shown that when it comes to general support of health care reform, the majority of Americans are in favor. But when specific questions are asked about the public option, individual mandate, urgency of reform, the numbers wary greatly (Gallup). Therefore the public is convinced reform is necessary, but they are unclear on what type of reform and when it should happen. I’m curious as to how much influence public opinion even has on how most legislators will vote.

When I started the health policy class almost 2 months ago, I was hoping to learn the basics of how the health care system works. I didn’t expect to be thrown into the quagmire of health care reform. But I am very glad that after this class I can make educated responses to questions regarding health care. I think one of the reasons the Gallup polls and other polls such the Kaiser Family Foundation poll show indecisiveness in support for the health care reform or parts of it is because people don’t know the whole picture. In a NBC news/WSJ poll regarding support for Obama’s plan, 15% of the people polled felt they understood the issue very well and 32 % said they somewhat understood the legislation. Only after learning about the structure, history, costs, etc of the health care system can one take a firm stand in each of the proposals or amendments of the reform.

After expecting to learn everything about health care during this class, I have realized that twenty something hours of class + some independent research has only allowed me to skim the major issue of health care. Although now I know where to turn to for even more information and my favorites include

Kaiser Family Foundation (has basically all the tools for learning about health care and health care reform)

Robert Wood Johnson Foundation

Washington Post (for general news that may pertain to health care)

My very first blog entry discussed the problem of the “young invincibles” and how recent grads like myself don’t feel as we have affordable options when it comes to health care. I guess the current proposals that extends coverage of young adults under their parents’ plans has basically solved the problem that is most important to me in this health care debate. Although this extension of coverage solves one issue, I think it is an avoidance of addressing the bigger issue, which is affordability of quality health care. If the public option does not pass, I believe that the health care will remain expensive without covering all those who need it.

As a hopeful pre-med student, learning about this (insert curse word) system has fortunately not crushed my desire to be a doctor, but I am wary of one day becoming part of and contributing to a system that I don’t believe is working in the best interest of the patients. Hopefully by the time I actually start practicing medicine, the system will be at least a tiny bit better than it is today (just being realistic – not cynical). And after witnessing the health care reform roller coaster of this year and what it might accomplish, I’m sure this is not the end of health care reform.

For additional research, I watched Sicko, a documentary by Michael Moore. In an earlier blog post, I mentioned how Michael Moore’s abrasive and opinionated style makes me uneasy in accepting what he presents in his movies, but I was surprised to find that in Sicko, one rarely hears Moore’s voice criticizing the American health care system. Instead the problems are clearly told by the heart-wrenching stories of many Americans, the experiences of patients abroad, and the tape recording of a meeting between Nixon and an advisor discussing the profit perks of managed care.

Moore romanticizes health care in France and Great Britain by not discussing the problems their governments have with spending, but it is still undeniable that for being the wealthiest country in the world, we have a shameful health care system.

Most of the data for this entry is from a report from the Common Wealth Fund.

Canada “single-payer”

A lot of attention has been paid to the Canadian-single-payer health care system over the last few months as the health care debate has heated up in the US. Compared the variety of insurance options available here, the Canadian system is simple and straightforward; there is one national health insurance program called Medicare that uses mostly tax money to pay for health care. And there is still the option of purchasing private insurance for services such as dental and vision that are not covered under Medicare.

In my research for an average cost of a hospital stay in any Province of Canada, the best I could find was a traveler’s insurance site that listed the range of costs for an ER visit, daily ward stay, and intensive care stay, which varies depending on the Province. So for a typical 24-hour hospitalization, the cost ranges from as low as $858 to $3686 (keep in mind this is in Canadian dollars). I’m assuming this does not include the cost of CAT scans and blood tests.

In Sicko, Moore makes a trip across the border to visit some relatives who have refused to visit the U.S without first purchasing insurance. They talk about how friends who have traveled in the U.S without insurance have met financial hardship after having to visit the hospital during their vacation. So not only does the U.S bankrupt its own citizens for using the health care system, it extends the courtesy to visitors as well.

But Canada currently faces several major problems with its health care system such as long wait times, too-short hospital stays, and illegal visits from U.S citizens trying to get some health care. Just kidding about the last one although I have witnessed people ordering prescription drugs from Canada.

Germany “social health care”

My family and I utilized the German health care system during the years my dad was getting his PhD there. The Social Health Insurance (SHI) system has since been remodeled and now there is an individual mandate along with a new financing structure. Even before the individual mandate, only 1% of Germans did not have health insurance. As the oldest insurance model in the world, the German system is based on employee and employer contributions to the health care fund.

Similar to the UK system, there are no monetary transactions in the hospital, except for buying some cafeteria food (according to my mom who has spent a few nights in German hospitals). Insurance cost us $99 marks per person each month and there are no copes. We were never charged for drugs, dental visits, etc. In order to get a tooth pulled, I had to visit the oral surgeon 3 times, because the stubborn tooth wouldn’t come out. We didn’t pay a single extra cent for all the trouble they went through. I may be a little biased when it comes to the German system, because my mom always praises it while complaining about the complicated and expensive US system.

The Ministry of health reports that about 80% of Germans are satisfied with the health care system. Some of the challenges the SHI now faces include spending with an aging population and monitoring the system after the implementation of the 2007 reforms.

Similar to the US, Germany also leads the world in medical technology. But “managed competition” in the health care field keeps prices in check.

Japan “tightly controlled”

Nobody has gone bankrupt in Japan because of medical bills. Although the cost of living in Japan is one of the highest in the world, health care remains affordable.

Unlike a lot the government run or socialized systems that help ensure universal access in the developed countries so far reviewed, the majority of hospitals and doctor’s offices in Japan are privately owned. But the government does step in when it comes to price controls. From the cost of stitches to how many MRI machines are allowed, the government regulates each detail to keep health care affordable, which is why a typical overnight stay in a Japanese hospital will cost you about $10. That price gives you an idea of the price range of health care services in Japan.

Japan does have health insurance, but the system is not -for-profit. When there is money unspent, it is transferred to the next year in the form of reduced premiums for patients (instead of bonus checks for CEOs). There are 3 types of insurance coverage and the type you get depends on your work status and the size of the company you work for. Employers pay most of a premium that is set as a certain percentage of your monthly salary. The employee makes up the rest, which is about $280 on average, regardless of your economic situation. The unemployed, retired, and self-employed get subsidies from the government.

What is great for Japanese patients is not so great for Japanese physicians and hospitals, which have trouble making avoiding deficits. But with health care spending at around 8% of GDP (2006), the Japanese government could probably afford to treat the doctors and nurses a bit better. The government will likely have no choice except to increase spending on health care as the population ages.

United Kingdom “National health care”

Since World War II, the UK has had a system of socialized health care. The National Health Service (NHS) began operating in 1948. Basically, there is no charge for health services at the time of service. Medical care is a public service and there is no charge for an overnight stay in the hospital. In Sicko, Michael Moore emphasizes the lack of monetary transactions in UK hospitals by asking different departments how much they are charging and patients how much they are being charged. In addition, he locates a cashier counter that actually gives patients money if they are in need of transportation reimbursements to and from the hospital.

I think the best aspect of the UK system is that people can utilize the health care system in a similar fashion to how police services and firefighting services are used. One can visit a doctor when in need and not fear rejection or a hefty bill a few days later. I can vouch for the patient-first health care system the UK has from a first-hand experience. When I was 6 years old, I spent a month in England with my parents, because my dad was doing research-related work there. During that time, I ate too many frosted flakes and had a painful toothache at one point. My mom took me to the see a dentist and my toothache went away. We didn’t pay a cent and no one cared about our status in the country.

Access and efficiency are the highlights of the UK system but the UK system is not without faults. Despite the great general care provided, there is dissatisfaction with access to specialists. Although one might have to wait longer to get a particular surgery in the UK, the easy access to general practioners ensures that one has to worry less about catching a disease in a later stage. If one can afford to see a doctor on a regular basis, then steps can be taken to address a rise in blood pressure or blood glucose before heart disease and diabetes sets in.

United States “The Money Maker”

The hardest part of this blog entry was finding cost estimates of an overnight hospital stay in the U.S. I already knew this was going to be an unpleasant task, but I didn’t fully comprehend the lack of transparency in costs until I embarked on a journey to uncover costs. There is no definitive data, because there is no set price across a county or state for a typical night stay in the hospital. What I did find on the net were personal stories about patient’s experiences of an overnight stay in the hospital (not intensive care or ER) and the shock of the bill a few weeks later. On an issue of the Dan’s Paper Inc, which is owned by Brown Publishing, an independent newsletter, the author discusses an overnight stay in the hospital that cost his insurance company $20,000. He did receive several tests such as a CAT scan and X-ray in addition to blood tests, but in the end he wasn’t even treated for anything, because the doctors couldn’t find anything conclusive.

Therefore it is completely believable that in 2007, medical bills caused 2/3 of bankruptcies. That was before the financial crisis.

I won’t go into the details of the health care system in the U.S except to say that the insurance companies set rates for treatments and tests unless it is a Medicare or Medicaid recipient. The government sets the reimbursement rates for Medicare and Medicaid recipients.

The emergency department stays busy in the US with 119.2 million visits a years according to the National Hospital Ambulatory Medical Care Survey in 2006. That number has gradually increased (in 1996 it was 90.3 million visits) as the number of uninsured has increased. 17.4 percent of the 119.2 million visits were by the uninsured. But if those on Medicare were excluded, then one would see a higher proportion of the ER visits made by those who are uninsured.

The Common Wealth Fund ranks the health care systems of Australia, New Zealand, the UK, Germany, Canada, and the US in 5 categories:

Quality

Equity

Access

Efficiency

Healthy lives

The US ranked last in every single category.

In this comparison of the different health care systems, one can see that no health care system is perfect. I think it is impossible to satisfy every single criteria (spending, quality, access, etc) to everyone’s satisfaction, but what I see in this comparison is that despite their differences in set-up and delivery, most developed countries aim for a health care system that puts patients first. Health care at the fundamental level should be about treating patients with the emphasis placed upon the doctor-patient relationship.

The sole exception is the U.S, where the set-up is doctor-insurance-patient. Other countries also have insurance companies, but their insurance companies aren’t influencing how the doctor treats a patient or whom the doctor sees. The word insurance is defined as “a means of guaranteeing protection and safety” according to the Merriam-Webster dictionary. But when health insurance is responsible for the someone’s inability to receive care, I think it’s time we call these “insurance” companies something more fitting their role like “cleverly disguised death panels” or “profit first, patient last.”

It’s ironic that the phrase “death panel” was thrown at the President’s attempt for broader coverage when there have been death panels all over the country called medical reviewers. The 1987 testimony of Linda Peeno is a perfect example. She talks about how the purpose of her job as a medical reviewer and then as a physician executive was to deny necessary procedures to patients in order to save Humana (an insurance company) money.

Additional resources (not used for this entry but interesting)

NPR’s comparison of international medical bills tool

The healthy blog

Health transparency

The first question which was from the moderator, asked the panelists what issue is the most important to address in this reform. Both of the doctors mentioned cost and access as the most important problems. I didn’t note what the senator said. It was a long answer that seemed to circle and circle around the point and never went anywhere. The Republican said that the main issue is the role of government and whether government should be a protector of our natural rights or a provider. He also said that some type of reform is necessary and that the solution is in the free market.

The second question came from the audience. The man started out stating that we do have access to health care right now and the issue is whether we should have universal coverage. His question was regarding whether health care is a right or a privilege. The attorney-doctor corrected him and said that right now people have access to emergency room care and that this type of care is inefficient and very expensive. He stated that it is generally agreed that people do have a right to basic health care. And if we have access to ER care, then people should have access to preventative care, which will keep people out of the ER. The CMA doctor asked the audience whether they think health care is a right or a privilege and the outcome was 80% -right and 20%-privilege. Doctor Mahal said that is the general way groups of physicians vote as well.

The Republican answer was that health care is not a right and that government by forcing people to have health care is violating people’s right of freedom. He added that we(Americans) have agreed to be ruled by the right of law not men. My opinion: As important as the constitution is to the establishment of this country, it is a document drawn up by a group of men several centuries ago. It is a set of principles to govern by, not a doctrine to live by without variation or expansion.

Next, a rather angry audience member asked what happened to to the single-payer plan. The attorney-doctor answered first and said that the single payer plan was not considered, because there was no way it would have passed. President Obama has stated that if health care is starting from scratch, then he would support a single-payer plan, but what is plausible right now is to work with what system is already in place. Dr. Mahal pointed to the individualistic nature of the American people which makes a single payer plan that works for Canada not possible here.

The last question I heard asked the republican guy specifically why he is against making everyone pay insurance when the government is already forcing the public to pay taxes, obey traffic laws, etc. She was basically pointing out that one more law won’t make a difference. The Republican guy answered that there is a difference between government enforcing laws for the common good and protecting our natural rights. He said that the constitution was set up to protect people from the government and that government should not interfere. He then pointed out that the free market has been tested over and over again and is the only reliable force. At this many in the audience shouted out comments about how the free market is what got us into the current financial mess.

At one point in the debate the moderator brought up the question of physician accountability. She cited the Atul Gawande New Yorker article about the two hospitals in the same state, but with very different costs. She also brought up the example of the Mayo clinic and how they have lower costs but higher quality care. The attorney doctor said that there will be something in the reform bill that will address the issue of which methods work the best. I didn’t note who, but someone from the audience or the panel mentioned the need for a more scientific basis of care delivery by physicians.

It had not occurred to me before how different the methods of different physicians are depending on where they trained, but now that I think about it, there should probably be more uniform protocols for how physicians handle different situations. Although it is necessary that such protocols are flexible enough to allow physicians to customize treatment to each patient’s needs.

In defense of physicians, Dr. Mahal pointed out that physicians only get 19% of what is charged. Most of the money goes to hospitals. Therefore, he is strongly for more preventative medicine in order to keep people out of the hospital. Primary care physicians are important in this aspect, because they are the ones that can answer a patient’s simple question when they are experiencing and ache or pain.

Summary of the health care reform forum: Nothing that was said was really anything new or surprising. No one really offered concrete ideas about exactly what should be done. The republican rep is the only one who made it very clear what he thought the solution to be. The forum gave me the impression that no one is really confident about any solution that has been offered and they also didn’t want to offer any solution themselves. Sustainability of the system seems to be the biggest concern and everybody believes change must occur. Nonetheless this forum was still really interesting to me. It was the first time I had attended any type of community event in Union City and it was nice to hear what other people who lived near me thought about health care reform. The opinions about what should be reformed and how it should be done are so diverse and it is clear that people feel passionately about this issue.

Now for some of the things that occurred in the health care reform debate this week:

Michael Moore’s views on Health care reform:

Michael Moore is outspoken and controversial for his documentaries that often show the inadequacies of government. His style has never been one that appealed to me because I don’t trust that his movies are free of bias. Tuesday night on Anderson Cooper 360, Michael Moore expressed his views regarding the public option, which he believes health care reform cannot do without, because without it there will be no change. His interview came after the Senate Finance Committee voted against the Public Option.

The big news in health care reform this week is that the public option was voted down on Tuesday in the Senate Finance Committee but there is still hope that some sort of public option will pass. As long as the house bill contains the public option amendment, there is chance that the public option will make it to the President’s desk. Even if the public option does not make it on the final bill, Democrats may use it as a bargaining tool to gain ground on other amednments.

Some of the amendments that did pass included one that would offer insurance discounts to people who either quit smoking or lose weight. In the last blog entry, I addressed the issue that in our culture today, money seems to be the biggest incentive to do anything, including taking care of your own health. Although I think that even the money saving incentive won’t be enough to stop smokers, because the tobacco tax didn’t to work very well to deter them.

One of approved amendments that may be more effective in producing change is allowing states to negotiate with insurance companies over the rates for the low-income population who will partcipate in a “state-like-public-option-exchange.” People who do not get insurance from their employer and have an income between 133% to 200% of the federal poverty level will qualify. The funding comes from government tax credits. This amendment is based on a similar program in Washington State.

The public’s view of health care reform in September is less pessimistic than it was in August according to a survey done by Kaiser Family Foundation. More people (including both Republicans and Independents) believe reform will benefit them and their families. One statistic offered that I found interesting is that 55% of seniors are reported as “confused” over what reform will do. Perhaps Obama should be getting on the air more often to lay out his plan.

The survey also took a look at which areas of health care they support reform for. (for anyone who wants to check out all the pie charts and line graphs, the link above will lead you to a hefty pdf file).

Reform people support:

1. Better health care for children

2. Ensure access to those who really need it by providing financial aid

3. Make sure medicare is healthy

Changes people oppose

1. Limiting choice of doctors

2. Doctors receiving less payments for Medicare patients, which may make them turn away Medicare patients

3. Government interference in personal health care decisions.

As someone who has planed to join the health care system in a while, it has been an unpleasant shock to realize how much of the economic side I did not know. A recent survey conducted by the University of Michigan Medical School reports that less than half of graduating med school students understand the health care system. It must be an unwelcome surprise to them when they start practicing in this convoluted system. Most pre-med students I’ve met are probably unaware that they are not only signing up to take on patients and treatments but also insurance companies.

In a commentary by a primary care physician practicing in Redding, Ca, one of the biggest problems in health care is discussed: the issue of decreasing practicing PCPs and less medical students willing to go that route. And this is at a time that PCP’s are most needed to help control health care spending. Primary care physicians are the first line of defense when it comes to treating and keeping patients healthy yet the system is pushing them out. According to Dr. Harris, he saves the system thousands of dollars via preventative medicine by telling patients what they need to do stay healthy and doing history of health exams that can better diagnose a problem than a multitude of tests.

But the facts clearly show why change is necessary:

1. 46 million Americans are not covered

2. Other first-world countries pay less for health care, cover more people and have better health stats

3. Health care costs make up 16% of the GDP and is continuing to grow. According to the Chicago Tribune, a study done by Hewitt Associates projects a 10% increase in out-of-pocket spending due to growing premiums.

If there are unquestionable major problems with our system, why are there so many who vehemently oppose change? At first I thought this is just evidence of the polarity of American politics. Republicans are opposing Obama just to oppose Obama, but after reading “The struggle for the soul of American health care,” by Deborah Stone, I am convinced that the real issue is American culture, specifically the for-profit mind-set.

I think foremost Americans value the freedom to pursue personal happiness. When happiness is closely tied to the quantity of money in the bank account, then the pursuit of happiness is essentially all about getting rich. The negative consequence of this type of culture is that we work hard and fend for ourselves and our families, but focus less on the well-being of the whole community. Stone’s essay compares the solidairity structure versus Actuarial fairness (which is what we have). Private insurance companies have convinced people that they should only be paying for their own risk. Well the whole point of insurance is to pool risk, because the future of anyone’s health is as predicable as bay area weather.

The solidairity principle is basically pooling all the risk and distributing it among everyone, which allows minimal cost and prevention of health neglect (when people opt out of health insurance but end up in the ER due to lack of preventative care). The lowering of the penalty cost to individuals who refuse to buy insurance by 50% this week in the Baucus bill is a mistake. It will tempt some to just pay the penalty fee, because it is cheaper than the insurance plan. That would not be beneficial to either the community nor the individual, because with an average lifespan of around 72 years, everyone will need some type of care at one point. An uninsured person who refuses to share the responsibility of health care costs will then push the cost of any care they recieve onto the insured.

In class, we briefly debated the issue of not penalizing people who have unhealthy habits and whether that will lead to unhealthy behaviors. Insurance companies, after the reform, may only collect minimal information about the insuree excluding long questionaires that asked about lifestyle (drinking, drug use) and health history. Some think that the incentive to be healthy will be staying out of the hospital while others believe that people need the monatary penalty threat to take care of themselves. Changing bad habits is difficult and without higher premiums to deter people, there may be some who will continue to risk their own health. This once again points to the source of the problem, which is a culture with too much green on their minds. Money should not be more important than health.

The for-profit issue is also preventing health care reform from making big enough changes, which is what the system needs. An example is the supposed victory for Obama this week when the Senate Finance Committee voted down the amendment proposed by Sneator Nelson to raise $106 billion over 10 years in order to provide discounts to medicare receipiants similar to the discounts Medicaid recepiants receive now. The amendment would have discarded the agreement made between pharmaceuticals and the president back in June. The president knows that any hope to reforming health care must be done gradually. A sudden threat to the profits of the insurance companies, drug companies, etc. would cause an uproar. It is hard enough convincing the American people that change is necessary without lobbying from billion-dollar industries. America is proud of its innovative spirit and still leads the world in technology and drugs aimed to save lives. But it should not be proud of the fact that all the innovation is only used to save the lives of those who can afford it.

The upcoming week will highlight one of the most important topics in the health care debate: the public option. President Obama pushed for the public option aggressively in the beginning, but has now backed off a bit in trying to convince legislators and the public that a public option is necessary to keep health care costs in check. Once again we see the concessions Obama is making in order to get any type of health care reform approved even though he claims in the interviews done with 5 big broadcasting stations last week that he will not sign anything that does not fit certain standards of reform. The coming Tuesday will see whether President Obama still stands by his public option plan as the Senate Finance Committee votes on it.

If the public option does not pass, then we are still faced with the issue of how to control premium rate increases and the general issue of health care costs. In a recent interview done by Kaiser Health News.org with Dr. Robert Ouelett, a former president of the Canadian Medical Association, the Dutch health care model can be something the US system can adopt. The Dutch have better coverage and better results for less spending per person than the US. In addition, the insurance is run by 6 companies half of which are for-profit while the other half is not-for-profit. Competition between these companies is managed and there are regulations in place to ensure that the companies can’t put profit before coverage like in the US. Insurance in the Netherlands is compulsory and none of the companies are allowed to refuse a someone. If they can’t afford it, then the government steps in and pays the premium. There are controls on the price of premiums. Essentially the Dutch insurance companies are free to play within certain playground rules.

In class we have discussed the health care systems of other countries but mostly focused on Canada, which many American oppose, because Canadian health care is always linked to the concept of “rationed-care.” So perhaps it is better to learn from a model of health care that is inherently closer to our system. Anything we can learn and adopt from these countries will be thoroughly Americanized before being implemented for those who worry that what works for other countries can’t work for us.

And now to end with a brilliant video that sums up our health care system:

As my fellow classmates and I approached our graduation date, the main worries included where we would live, job hunting, and graduate school. How to begin financing our own health care is not a top priority for a 22-year-old graduate. But unless one goes straight into the workforce and receives health insurance coverage from an employer, graduation also means it is time to decide what to do about your health care. Most students are covered while in school by a University health care plan or by their parents’ plan as a dependent.

There are several options graduates can choose from such as COBRA which extends your coverage as a dependent under your parents’ plan and various policies that have low monthly payments but high deductibles. The first time I took a look at the different policies available, I finally realized how much I had taken for granted when it came to health insurance.

I also underestimated how important health insurance coverage is even to people my age. An article by CNN presented the story of a recent grad who gave up a dream job offer because there was no insurance coverage. The author went on to suggest applying directly to grad school in order to extend coverage as a dependent, which only applies to full-time students. In a country all about following your dreams despite the odds against you, it amazes me that health insurance can play such a big role in someone’s pursuit of their dream job.

In general, people between the ages of 19-29 do not see health insurance as important as the general population does. A recent article by Time Magazine titled “Young, Invincible – and the key to health care reform,” states that 1 in 3 Americans between the ages of 19-29 do not have insurance. They are called the “young invincibles.” The main concern for someone my age when it comes to health care is the risk of a catastrophic event such as a major car accident that can potentially bankrupt you and put financial strain on your family. But asking a job-hunting 22 year old without major health concerns to pay for one of the plans out there now that offer bare minimum coverage is not going work.

It is important that health care reform addresses the issue of these young invincibles, because they need young people to help pay for the higher costs of care the elderly generally need. The Baucus bill proposed mandatory insurance for everyone. I think mandatory coverage is a good idea. Everybody contributes a little and everyone will benefit from being protected from catastrophic events. But at the same time, it is important that a better plan will be offered to young people. The finance committee’s draft of a bill has addressed this issue by proposing a new category of health insurance for those under the age of 25. These catastrophic policies will have low premiums and high deductibles, and will cover preventive care.

What the finance committee is proposing does not sound very different from what is already out there except for the coverage of preventive care. I did a quick comparison of the plans offered to me on ehealthinsurance.com and found that most of the plans do not cover any services until a certain amount has been paid out-of-pocket. There are also a lot of different proposals coming out that describe conditions that qualify people for federal or state aid. Qualification is based on income. Some of the bills have several different categories for different poverty levels.

I understand that there are numerous problems with American health care at the moment, but for me as a recent college grad with only a part-time job, the problem I want addressed in this health care reform is how people in situations similar to mine can avoid the problem of financing their health care when they can’t even afford to live alone! It is bad enough to be pushed into the real world with an uncertain future without having to worry about bankruptcy if you happen to need emergency services.

Although I must admit that figuring out all this health insurance stuff is in a way a good introduction to the real world. It forces you to take responsibility of your own care and finances. I also better understand the politics surrounding health care reform and why health care is always a big issue during campaigns. If you had asked me what were the republican’s versus democrat’s main stand on health care a few weeks ago, I wouldn’t have been able to answer.

Putting aside the educational benefits of facing no health insurance after graduation, there is still the big problem of how recent grads can be expected to have insurance when they don’t even have a proper job. With the state of the economy being so unfriendly towards recent grads, one can expect more and more young people going without insurance. It is absolutely contradictory that Americans must have health care or be at risk and yet the system makes it impossible for people in certain situations to afford this necessity.