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Eshoo plans in-person town hall on health care

Original post made on Aug 26, 2009

Rep. Anna Eshoo, D-Menlo Park, says she will hold a face-to-face "town hall" meeting on health care issues on Wednesday, Sept. 2, at Gunn High School in Palo Alto.
[Web Link ■ ==B Rep. Eshoo message on high-speed rail, health meetings. ==]
■ [Web Link Highlights of Eshoo's responses on health care reform]


Read the full story here Web Link posted Tuesday, August 25, 2009, 5:41 PM

Comments (20)

Posted by Not dead yet, a resident of Woodside: other
on Aug 26, 2009 at 4:37 pm

"Rationally-based health care". Watch out. You might not be worth saving.


Posted by Steve, a resident of Menlo Park: Downtown
on Aug 26, 2009 at 5:21 pm

Not dead yet must be a republican, still does have the facts or willing to check out the actual facts. Oh well.......


Posted by Not dead yet, a resident of Woodside: other
on Aug 26, 2009 at 5:37 pm

Steve of Menlo Park -- what, specifically, do you think "rationally-based health care" means?


Posted by N.O. Thanks, a resident of Portola Valley: other
on Aug 26, 2009 at 9:55 pm

Steve, let's check out this fact at Eshoo's next town hall meeting: is she willing to switch her own health plan as a member of Congress to the plan she has in mind for the rest of us?


Posted by think, why don't you, a resident of Menlo Park: Allied Arts/Stanford Park
on Aug 26, 2009 at 10:06 pm

It's interesting that opponents of health care reform immediately jump to the conclusion that "rationally based health care" means that Eshoo is advocating rationing health care. Does it occur to you that she might mean "rational"? As in "logical"? As in governed by logic rather than politics, greed and/or stupidity?


Posted by Concerned Parent, a resident of Menlo Park: The Willows
on Aug 27, 2009 at 11:12 am

Not Dead:

Despite everyone's concerns about any potential for rationing, I wouldn't take rationally based care to mean rationing. I suspect it refers to what would be medical guidelines based on comparative effectiveness research. If done well, this can answer some questions about best clinical practice, but it's rarely black and white. While it has the potential to provide the basis for limiting some care, if done well it should only be care that is not effective. The reality is that we are going to need some limits on what we spend on health care. The fact that there are so many opinions and lots of engagement tells me it's a tough problem.


Posted by Tuoemy Salud, a resident of Menlo Park: Allied Arts/Stanford Park
on Aug 27, 2009 at 11:31 am

Aren't there any elements of health care reform people can agree on? How about banning the practice of excluding people for having pre-existing conditions? How about banning health insurance companies from "recisions" -- dropping people after they get sick, in order to save money?


Posted by Concerned Parent, a resident of Menlo Park: The Willows
on Aug 27, 2009 at 12:20 pm

Tuoemy:

From looking at these boards a fair amount, I would guess the following:

1) No longer allowing exclusions based on pre-existing conditions appears popular
2) This should go along with banning recission.

3) most people seem to agree with the principle of increasing competition though there is fierce disagreement about how to do it.

a)allow sales of insurance across state lines
b) "public" option
c) co-ops
4) Most people (I think) seem to like the idea of decoupling health insurance from employment which again could happen in a variety of ways.

The challenge is that if you were to pass a bill covering 1 and 2 above, the left wing of the Demos will tell you it isn't real reform and not worth doing.
Once you come up with an answer to competition you appear to lose either the Repubs (b or c) or Demos (a and some b and c).
I would personally love to see tort reform up there as well but the Demos haven't even mentioned it.


Posted by Not Dead Yet, a resident of Woodside: other
on Aug 27, 2009 at 12:40 pm

Hello "Think Why Don't You" and "Concerned Parent":
"Comparative Effectiveness Research" means evaluting effectiveness in terms of cost. That is the basis of rationing, and as I said before, some people might not be deemed to be "worth" treating. Hence the outcry at town hall meetings about rationing of treatment and death panels. These would be the direct outcome of rationing. Maybe you don't like the short-hand terms bandied around by conservatives, but that's what it all comes down to. "Rationally based health care" might sound prettier, but when you get down to it, it means the government deciding what's best for you based on criteri the government chooses to use.


Posted by N.O. Socialism, a resident of Menlo Park: other
on Aug 27, 2009 at 12:42 pm

Amen, Not Dead Yet! The Government taking over health care and making health decisions for you is Socialism, pure and simple.


Posted by Seymour Sense, a resident of Atherton: Lloyden Park
on Aug 27, 2009 at 1:47 pm

Yeah! Goverment out of my Medicare!


Posted by Al E. Gator, a resident of Menlo Park: other
on Aug 27, 2009 at 4:12 pm

Nice one, Seymour!


Posted by Concerned Parent, a resident of Menlo Park: The Willows
on Aug 27, 2009 at 4:57 pm

Not Dead:
I would argue that cost is one component of Comparative Effectiveness Research. While if abused (and I think this is what leads to the concern), cost can outweigh other components, ideally such analysis would allow reasonable decisions. Let's take an example of someone with back pain with the following treatment options (these numbers are made up:
1)An operation has a 15% chance of returning function to normal if successful, will take two weeks with recovery and costs $100,000
2)It may get better with time but it will take 3 months and will get you to 95% normal function (10% chance in 3 months)
3)It may feel better with pain meds at a cost of $500 and possibility of some side effects (likley to get you 95% normal function in three months with better pain relief).
4) Physical therapy/massage therapy at a cost of $1000, likley to get 95%recovery of function after 3 months, improvement in pain relief.

If you look at this only from the cost perspective, you might opt for getting better with time as the cost is nothing.

Comparative effective analysis might say that the operation has the best chance, albeit 15%, of 100% return of function but at a cost markedly above the others. If it turns out that 95% function is essentially the same for the person's life, it may be that pain pills or massage therapy are just as effective in terms of short term pain relief, avoid the complications of surgery, and are much cheaper.

Most medical interventions have some point at which there are diminishing returns and whether we like it or not, there is a limited amount of money we can spend on health care. Theoretically this might provide a framework for prioritization. With that said, in the example above, in theory it should be possible for a physician to argue on medical grounds for each of the above options if there is some justification for it. At present, we have a system where patients seem to think that more is better, doctors are incented to err on the side of treatment if there is a question, and often no good studies to guide them. IF done right, this could provide good information for MDs, however, I think there is also a component of trust that it will be done right. The lack of trust (not helped by the comments of the left) makes it hard to even initiate a discussion about these topics.
If done incorrectly, the results of these studies become government mandates and eventually medicine becomes a cookbook with no appreciation of the art side of medicine. At that point, you may as well have computers running algorithms to dictate care. That possibility, and the rush to do something rather than give people time to digest a plan, is why people are concerned.


Posted by Bill, a resident of Atherton: West Atherton
on Aug 28, 2009 at 12:23 am

Agree completely with Not Dead Yet.

Just follow the logic - - same number of doctors - - add 40 million new patients - - mix in the words ¡§free healthcare¡¨ and I smell rationing. Don¡¦t you??

I mean really ¡V forget all the talking points on both sides and just think this to its logical conclusion.

We have a ¡§large¡¨ pizza every Thursday night. If suddenly all the neighbors are invited over to eat - - for free - - I¡¦m almost certain we¡¦ll have to ration what we have to offer¡K

The current purposed healthcare bill will do exactly that on a scale that most people cannot even conceptualize. Can you imagine going to your favorite clinic and having to circle the parking lot like it was two days before Xmas at the Stanford Mall?? And that¡¦s before you even get into the waiting room¡K

And how exactly are you going to feel if you¡¦re told that you must wait behind 75 other people that were in the waiting room hours before you got there??

Canada and Europe are great examples of what we DON¡¦T want to become regarding Gov¡¦t Healthcare. Why would you think we could do so much better than their best efforts?? Why do you think they come here to pay for procedures - - outta their own pocket??

Want to save $$ and reduce overall costs ¡V then start talking up tort reform. Our family Dr. pays well into 6 figures / per year for liability insurance to protect his good name from jackpot lawyers that seek out any trivial claim they can find. There are great lawyers out there ¡V but the ones that exploit this kind of opportunistic injustice need to be put into check.

Healthcare Reform = YES
Gov¡¦t controlled, Single Payer, Higher Taxes Healthcare = NO

Reform should include:
„h No exclusions based on pre-existing conditions.
„h Coverage that is portable from state to state (and even job to job).
„h Tax credits designed to encourage higher deductibles.
„h Elective procedures strictly paid for by the individual (I don¡¦t want my premiums (or taxes) to pay for somebody¡¦s spider-vein removal).
„h Co-ops that group smaller companies and individuals together for discount pricing.
„h Don¡¦t forget ¡§tort reform.¡¨


Posted by Ss, a resident of Menlo Park: other
on Aug 28, 2009 at 9:05 am

I'm very concerned over the lack of acknowledgement from our elected officials regarding the issue of rationing. We are repeatedly told that this proposed sweeping change to the US health care system would either have minimum impact on individuals or that we already have forms of rationing.

I'm sorry, but both of those responses are just lame attempts at public pacification. If you add roughly the entire population of California Web Link to the health care equation, then patients can expect longer waits and reduced services. It's simple cause and effect.


Posted by Concerned Parent, a resident of Menlo Park: The Willows
on Aug 28, 2009 at 9:18 am

Bill (and Not Dead):

I'll agree that nobody wants rationing, myself included. The question for people in that camp is what is a solution that will manage the unsustainable present system.
For those defenders of the UK, if you want a horror story about rationing, look at what happens for people with visual loss due to macular degeneration. Basically there are procedures and potentially treatments, however they don't get high enough on the priority list until someone has "enough" loss of vision at which point one eye is covered.
I agree with many of the points of the preceding poster but..
Yes there may be the same number of doctors, but it may be that effective use of nurse practitioners can extend the care of those doctors. For the number of patients not covered right now, I would have to believe that being seen by an NP would be better than nothing. It might mean that some people who are used to instant access to their MDs might have to wait. Will that adversely impact their outcomes? It probably depends.
Why we don't change tort reform (something that comes up in all analyses of other health care systems) is completely beyond me and I have to say that for all the passion the Demos show on the need to cover everyone, I'd find them a lot more credible if they had the same commitment to tort reform.
Portability, selling insurance across state lines to generate real competition, getting rid of pre-existing exclusions and recissions all seem to be obvious and even people arguing about single payer and those aginast a public option seem to agree on the pre-existing conditions, recision, and portability issues. It would be sad to see nothing or a highly partisan bill that at best a bare majority supports but a significant group strongly opposes.


Posted by Concerned Parent, a resident of Menlo Park: The Willows
on Aug 28, 2009 at 9:23 am

Ss:

I agree that what is really missing from the politicians is an honest acknowledgement of what this will take. It may be we need to do it anyway, but I feel like we get a bait and switch. So despite the fact that there are some loonies at the town halls, there are a significant number of reasonably well informed individuals with reasonable questions who are being lumped together and dismissed. This from a president who on the surface claims to say that people can handle complex issues. Hmmm....


Posted by Bill, a resident of Atherton: West Atherton
on Aug 28, 2009 at 1:00 pm


I think the suggestion that "effective use of nurse practitioners can extend the care of those doctors" is a great idea. I've even had an appointment with my NP instead of the Dr. for a minor health issue.

But here's the flaw I see. With such a great idea, why hasn't Canada or Europe employed it. They gotta be at least as smart as us. Yet their healthcare system continues to suffer.

I believe the perception to the average American is that Govt. controlled and sponsored healthcare is somehow "free." That is the way the media seems to label it. I think that creates a "dinner buffet" mentality. (Read: I am going to eat as much as possible).

Now, I really believe most folks in the mid peninsula are very intelligent and reasonable. But our demographic represents only a fraction of the millions that would take advantage of the system. Ultimately America would end up with very crowded facilities and very over-worked Dr.'s. I would even submit that many Dr.'s might exit the profession as a result. And certainly new Dr.'s in training would reconsider their professional choices.

Nobody wants to see that happen.

I am much more interested in saving $$$, which I believe translates to all sorts of positive benefits for "ALL" Americans. And I do mean "ALL."

As mentioned earlier. "Tax credits for higher deductibles."

If true healthcare reform means reducing costs while protecting Americans from catastrophic illness, then might we consider a tax deduction for higher insurance deductibles? I have a rather high deductible for my car insurance that reduces my overall rate.

My current health insurance requires me to pay $20 per visit and $10 per prescription. If I decided I could afford $75 per visit and $25 per prescription and knew that I would get a yearly tax deduction for it, that would sound very reasonable. I would only go to the Dr. when I really needed to. My health, my decision.

Now multiply that over millions of people and you can quickly see a vast amount of savings.

The scale of tax credit vs. deductible could graduate depending upon the actual health and income of the individual or family. Healthy young people would probable want a higher deductible along with bigger tax credits. Those that are older and maybe in need of more care would gladly pay for lower deductible and hence more office visits, which would result in a smaller tax credit to the IRS.

I believe that combining "Tax credits for higher deductibles" with vigorous "tort reform" would result in literally billions of $$ in savings to the American Healthcare System.

The benefits to Americans (it's about "our" health, not the administration's, isn't it?) would be broad and deep.
-More choices for patients.
-Reduced taxes.
-Dr.'s engaged in their work rather than overworked.
-Continued medical innovation in techniques, equipment and medicines.

With this concept, the only losers I can see are the jackpot lawyers that pray on tort cases and the ever growing and seemingly power hungry, power grabbing Federal Govt.

Tell me I'm wrong?


Posted by Concerned Parent, a resident of Menlo Park: The Willows
on Aug 28, 2009 at 4:12 pm

Bill:

I tend to agree with your ideas. I'm not sure why the UK or Canada don't use NPs more. I like the idea of tax credits and tort reform. In addition I'd want the following addressed:
1) a means to increase competition
(I'd prefer allowing of selling insurance across state lines, others have proposed co-ops and others demand a government option)
2) A means to separate insurance from employment. The current set up tends to take one event (unemployment) and amplify the badness by adding on health insurance woes.
3)Better portability. The challenge is we can eliminate exclusions for pre-existing conditions, however, we also need to assure that rates are affordable, and at the same time not have the situation where people don't get "insurance" until they are sick.

It's a challenge and I'd prefer Obama came clean and said what is pretty obvious, we can't afford to cover everyone with gold-plated plans. There is not enough "waste" in the system nor enough still "rich" to pay for what this will cost. So tell the truth, this will result in general tax increases for everyone, and have the courage of his convictions to say it's worth it.


Posted by ruth, a resident of another community
on Sep 1, 2009 at 3:49 pm

President Obama's campaign promise was that all Americans would have the same health coverage that Congress has.

If he followed through on that promise, there would be no protest.

Question: Would he and Congress give up their plan to share the health plan they propose?

Question: why is it that a Congressperson has lifetime health coverage after serving only one term?

None of them will respond to these questions, why?


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