Tuesday, September 8, 2009

Matheson Tele-Townhall

Matheson (opening statements): Healthcare is a dominant part of the news. Incredibly important and incredibly complicated issue. A lot of misinformation in the media. We continue to move ahead in the worst recession since WWII. Number of indicators of progress. Personal savings rate. Growth. In Utah we're fortunate that unemployment is lower... health care is a factor in how our economy works. Cutting a deal for importation of radioactive waste is a bad idea, bad policy. Validates the need for federal legislation.

Questions:

Gary, SLC: Physician here in town. Heard you talk about the fiscal concern of health care reform, but haven't heard you talk about the moral case for reform. Would you support a revenue neutral plan?
Matheson: Cost issue, and access issue are both on the table for discussion. I'd throw on a third: quality. The concern I have is that a lot of people don't think we need reform. If costs keep going up at a greater rate than inflation, we're not even going to keep what we've got. It's not a sustainable path. I don't think the current house bill meets all fronts. It does nothing to address out of control costs.

Andy, SLC: Does the federal gov intend to create a nationalized medical records database?
Matheson: No plan to make a national records database. In Utah, IHC is one of the leaders in the country in electronic records.

Judy, SLC: Have you read the Baucus Bill, and is it giving you more confidence in the process (would you vote for it?)?
Matheson: Draft framework was introduced. Haven't read it yet, but have a copy. It's a product of a bipartisan effort in the Senate, so I'm hopeful it's another positive step. Again, health care is a complex issue. It only contributes in a positive way.

David, Murray: What about utilization and cost control?
Matheson: We have over-utilization of our health care system. A few: doctors are concerned about liability and being sued. Defensive medicine. Met with radiologists two weeks ago who estimate 30% of their procedures are just defensive procedures. Utah is one of the best states in being efficient. Would be helpful if we could apply Utah practices in other parts of country. For cost control, address liability and administrative costs.

Janet, SLC: Why not a public option to reduce huge profits in private insurance plans? Public plans are much lower in administrative costs. Why the reluctance?
Matheson: Term "public option" thrown around without much definition. What folks are looking for is competition to private health insurance. Another object that hasn't been discussed: no viable alternative for individuals to get insurance. No true "risk pooling" ops. Not so great for small businesses either. Pooling has value, and choices create competition. Co-opts exist already in other states. Another way to achieve these same alternatives, pooling mechanism, but not a government run program at all. Worthy of consideration.

Don, SLC: I support your concerns about costs, but I believe it's important to show we are serious about reform, create insurance companies rather than financial companies. Costs can be worked going forward. Can you support something to show we are serious?
Matheson: Broad consensus about guaranteed issue. Any reform package will most likely include that type of provision. I conquer, better to move something sooner than later. I hope it happens.

Amber, SLC: How do you feel about increasing competition by allowing purchase across state lines?
Matheson: Something to look at. Gets complicated. Denying that opportunity doesn't make much sense to me. Two extreme examples, Utah, and Florida. Very different set of individuals. Have to be careful how it's structured.

Lynn, SLC: Seems wrong drug company reps would be schmoozing doctors. What's wrong with cheaper generics?
Matheson: Get good info into the hands of consumers. Challenge today, who analyzes these things? Do drug companies do it? They have certain motivations that may conflict with the best treatment. Expand "comparative effectiveness" research. Manufacturers DO respond to new data too.

Jennifer, SLC: I encourage you to join with fellow Democrats when it comes time to vote. CBO chronically underestimates savings in health care reform because it's so hard to get comparisons. Urge you to take CBO with a grain of salt. Food and lifestyle also an issue. Have you been working on Child Nutrition Act?
Matheson: You're right. Any estimate of cost impacts on something this complicated should be taken with a grain of salt. CBO discounts potential savings of better coverage. 3/4's of what we spend on health care are on chronic conditions: cancer, heart disease, and diabetes. All three are preventable based on lifestyle. Stop smoking, eat better, reduce frequency. There is a reason other countries have longer life expectancy... there a lot of reasons, but one reason is lifestyle. Baltimore school system is a good example of improvements without needing more money.

Carolyn, SLC: Cost we also deal with is uninsured in the emergency room. Since you haven't supported a public option to reduce this expense, how would you reduce this expense? If we wait for co-opts, it could be a long time.
Matheson: Cost of uninsured is borne by everyone. I take issue with public plan being the way to get access issue accomplished. Public plan or not, if folks can't afford insurance, they're going to be uninsured. The way to deal with the uninsured is to address economic reasons they are uninsured. I don't think public option is the discussion to have to address the issue.

David, Murray: How will Medicare fair under health care reform?
Matheson: Not clear payments for covering uninsured will come out of Medicare. Costs grow more than inflation, we can't sustain that. It's what's blowing up the federal budget. Access will help in some ways. To ensure long term integrity of any health care options that exist, we have to control expensive growth going forward. There is a lot of inefficiency in Medicare today. About 1 in 5 Medicare recipients are re-hospitalized. We don't pay doctors to do follow up care before circumstances deteriorate and become more costly. We don't want to cut services from Medicare, but there is over-utilization we need to get a handle on.

Liz, SLC: Senator Matheson (yes, she said Senator). As a physician, I think the number one reason for the cost for medicine in the US is the threat of malpractice suits. What about tort reform?
Matheson: I agree it's an important part of cost control. In the polarized world of DC, one political party wants to talk about it, the other doesn't, and I think that's unfortunate. It's a piece of the puzzle. Lower premium costs. Medical decisions shouldn't be driven by other agendas.

Greg, SLC: You talked about IHC success with electronic record keeping. Can you cite an example inside the VA or military hospitals?
Matheson: VA system has led the way on electronic medical systems. Interestingly enough, since the VA is a public entity, it's software is available to anyone. Rate of change is challenging, but creates opportunity.

Fred, SLC: My concern is that... why do we have to have a national re-write of the entire medical system that the CBO projects will cost $1 Trillion plus?
Matheson: I'll repeat what I said earlier. A number of different pieces of legislation introduced. Agenda items: How do you go about covering the uninsured, how do you control excessive growth of costs. Talk to any business man, they'll verify how much these costs are growing. Fastest growing part of the federal budget, and the budgets of all 50 states. Efforts at the federal level we're going to have to look at to create a stable future.

Lori, SLC: What, realistically, are the outlooks for something substantial happening this year?
Matheson: Good question without a good answer. When it comes to cable channels and internet, there has been a lot of misinformation and demagoguery. I don't think we can sustain the path we're on right now over time. This isn't liberal, conservative, Democrat or Republican. Just go talk to real people. I'm rambling because there is no specific answer, but there is a concerted effort. The two parties should be working together more than they are.

JoAnne, Murray: Concerned Obama wants to hurry and "get it through"? I'm a registered nurse and I don't even know what's in the bill.
Matheson: Deliberative process important. Large group, including me, opposed having it ready before August recess. Two edged sword. Study it forever, and nothing happens, but too much urgency, mistakes get made. Hoping for sweet spot.

(Moderator: Out of time...)

Matheson: These townhalls are open to any issue, but ironically we talked about health care the whole time. Take the time to learn as much as you can about this issue. The dialog on the internet and the cable channels isn't productive in my opinion. I want to hear from you. Google the House of Reps, contact me through email or phone. Specific link for HCR comments.

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