Newt Gingrich on Health Care in Real Change

I read the material about health care in Newt Gingrich's 2008 book, Real Change.  I have four items.

1.  One topic that Newt addresses in Real Change that I did not see in Saving Lives & Saving Money is doctors and dentists who defraud Medicare and Medicaid----by overbilling the government or by requesting reimbursement for services that they did not perform.  Newt believes that this problem costs the health care system money, and he attributes it (at least in part) to bureaucratic incompetence.  After all, he says, while federal bureaucrats go home at 5, defrauders work long hours to figure out ways to cheat the system!

2. On page 227, Newt states that "Allowing individuals to pass their health costs onto others reinforces the attitude that their health is not their problem and adds to the irresponsible, unhealthy behaviors that bankrupt the current system."

I don't think this is entirely fair.  For one, a lot of individuals do not solely pass their health costs onto others in America's health care system.  Even many who have health insurance have high premiums and copays, plus their insurance company may choose not to pay for certain treatments.  Second, it's the current health care system that discourages preventative care, by making people reluctant and afraid to see a doctor on account of high medical costs.

To his credit, Newt is a strong advocate for preventative care.  He wants for the government to lead by example by incentivizing that, and he presumes that private health insurance companies would then follow its lead.  I hope so!  You'd think that private health insurance companies would support preventative care, since that costs them less than catastrophic care, leaving a larger profit for them.  At least that's my opinion about how it would work, and I could be mistaken.

3. On page 235, Newt favorably quotes Franklin Roosevelt, who stated: "The success or failure of any government in the final analysis must be measured by the well-being of its citizens.  Nothing can be more important to a state than its public health; the state's paramount concern should be the health of its people."

I think that this sentiment is biblical (if that matters to you), for Ezekiel 34:2, 4 criticizes the rulers for not curing the ill or binding the broken.  Moreover, the U.S. Constitution talks about promoting the general welfare.  The government is supposed to be concerned about the health and well-being of the country's citizens.

Unfortunately, when I hear many conservatives and libertarians talk, the vibe that I get is that they don't think the government should be concerned about health care.  For them, the government should keep out of it, and people should be responsible for their own health----for good or for ill.  I respect conservatives and libertarians who talk about ways to bring down the cost of health care, but I do not care for the callous approach that some of them appear to convey when discussing what the government's role should be (or should not be).

4.  Did Newt Gingrich support a health insurance mandate, which now is a significant part of President Obama's health care plan (though I am writing this post on April 7, before the Supreme Court has decided on whether or not the mandate will remain a part of the health care law)?  I did not see that in Saving Lives & Saving Money (which was published in 2003), for, while Newt highlighted the importance of universal coverage, he focused on how to make it cheaper for people to purchase health insurance, without mentioning a mandate.  In Real Change, however, he appears to support a mandate.  On page 276, Newt states: "...we should insist that everyone above a certain level buy coverage (or, if they are opposed to insurance, post a bond)."

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I finished Newt Gingrich's Saving Lives & Saving Money: Transforming Health and Healthcare.  In this post, I'll highlight something from my latest reading, then I'll briefly state my impressions of the book as a whole.

At the end of his book, Newt talks about the prospect of a biochemical attack on the U.S.  Remember that this book was published in 2003.  I'm not sure if people are still fearing that nuclear or bio-chemical weapons could fall into the wrong hands, but that was a great fear in the early 2000's.  It was one reason that we went to war against Iraq, and the Democrats accused the Republicans of not doing enough about nuclear proliferation.

Newt hopes that America's health care system will be efficient in case a bio-chemical attack occurs.  Newt believes that the FDA "must fast-track and accelerate approval processes with priority reviews for emergency-use licensure" (page 291).  For Newt, risks should be managed and benefits should be analyzed, and "animal efficacy data" must be used instead of "human efficacy trials".  But Newt thinks that there should be tort reform that acknowledges and understands "the need for risk and benefit" (page 291).  I am not sure what Newt means here.  If the FDA approves of something that harms someone (even if it did not harm an animal who was part of a test), does Newt believe the person's right to sue for damages should be limited, since there is some risk when scientists try to come up with treatments that can help people?

In terms of my overall impressions of the book, it was all right.  Parts of it, I expected.  Newt is big on preventative care and computerization, so it did not surprise me that these issues were significant topics in his book.  I thought that he made sense on those issues.  Newt also touted some of the typical conservative proposals for health care reform, such as Health Savings Accounts and tort reform.  I think that Newt made a good case for the necessity for tort reform and the need to come up with a system that protects patients without lining the pockets of trial lawyers and driving up the cost of health care.  But I do not believe that Health Savings Accounts are much of a solution for the rising costs of health care, since health care can easily become so expensive as to wipe those accounts out.  I was expecting for Newt to write more about how special interests profit from the current system, since he mentioned that topic in debates, but he did not go into this in as much detail as I hoped.

Next, I'll read the sections on health care in Newt Gingrich's Real Change.

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In my latest reading of Saving Lives & Saving Money: Transforming Health and Healthcare, Newt Gingrich praises a Computerized Patient Record System that the Veterans Administration plans to use:

"The provider 'view,' Computerized Patient Record System, organizes and presents all relevant patient data in a way that directly supports clinical decision making.  The comprehensive cover sheet displays timely, patient-centric information, including active problems, allergies, current medications, recent laboratory results, vital signs, hospitalization, and outpatient clinic history.  This information is displayed immediately when a patient is selected and provides an accurate overview of the patient's current status before any clinical interventions are ordered."

This makes sense.  It's better than what happens a lot of times now, when doctors ask patients the same questions over and over (i.e., Have you ever been hospitalized?  Do you use medications?, etc.), or the right hand may not know what the left hand is doing.

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I'm in the section of the book Saving Lives & Saving Money: Transforming Health and Healthcare in which Newt Gingrich praises companies and hospitals for taking steps to transform the United States' health care system.  One company that Newt praises is Pfizer, a pharmaceutical company.  The reason that Newt likes Pfizer is that, in Florida, it is cooperating with the state to help Medicaid recipients with preventative care, which keeps them out of the emergency rooms and thus saves the health care system money.  This partnership also taps into the knowledge and experience of doctors across the state, which Newt likes.

I was wondering where I heard the name "Pfizer" in the news.  I knew it wasn't in a positive context.  When I read the wikipedia article and did a google search on Pfizer, I saw some things that rang a bell, and more.  Pfizer was the company that tried to take advantage of eminent domain, resulting in the 2005 Supreme Court Kelo case, which allowed local governments to take private property for economic development.  In 2012, there was controversy about whether or not Newt acted as a lobbyist for Pfizer.  And, on wikipedia, I see discussion about Pfizer damaging the environment, lobbying against the prescription drug benefit and the entrance of generic drugs into U.S. markets, and supporting a ban on lawsuits against those who manufacture body implant parts.  The last item made its way into proposed tort reform legislation in the U.S. Congress.

These things concern me, and they tell me that Pfizer may be part of the problem, not just part of the solution.  Still, if Pfizer is working with the Florida government to promote preventative care, that's a good thing.  And, while I think that tort reform can go too far, I agree with Newt that some form of tort reform is necessary, for the fear of being sued inhibits doctors from acknowledging and correcting mistakes, as well as imposes a monetary cost on them.

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In my latest reading of Saving Lives & Saving Money: Transforming Health and Healthcare, Newt Gingrich talks about the living arrangements of people with disabilities.  On page 198, he states:

"...most families want to do as much as humanly and financially possible to enable their family members with a disability to live in their own home and participate in the community.  And, from the perspective of public policy, it will be extremely difficult, if not impossible, for our country to continue providing costly institutional care for people with disabilities as the number of people needing these services grows."

On pages 198-199, Newt quotes Carol Hughes-Novak, who was the chairperson of the Disabilities Task Force in Newt's district and whose son has cerebral palsy.  Carol believes in promoting "implementation of President Bush's Olmstead Executive Order that requires state Medicaid programs to provide long-term-care services in the community whenever appropriate for the individual."  (See here for information about the Olmstead Executive Order.)  Carol supports reversing the bias in Medicaid towards institutional care, as disabled people under Medicaid are entitled to placement in an institution, while those who prefer "Medicaid Home and Community based long-term care services that are more humane and almost always less costly" must wait for years.

This discussion stood out to me because of posts that I read on the blog, Whose Planet Is It Anyway, during the 2008 Presidential election.  According to those posts, John McCain supported institutional care for the disabled rather than integrating the disabled into their communities because he thought that the latter was too expensive, when (as the blog, Newt, and Carol point out) it is actually institutional care that is more expensive.  Those posts made me question that Republicans were truly on the side of fiscal responsibility.  It turns out, though, that people in both parties think that we should move away from institutional care and towards helping the disabled to integrate into their communities.  See here and here.

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In my latest reading of Saving Lives & Saving Money: Transforming Health and Healthcare, Newt talks about the importance of increased government spending on scientific research.  In some cases, this would be to combat diseases, such as Diabetes and Alzheimer's.  In some cases, it would be to promote national pride, as the space program does.  While Newt acknowledges that he wants for the country to spend more money on scientific research, he believes that doing so will save the country money in the long run, since Diabetes takes a toll on America's health care system.  I'm cool with this argument, but I wonder how America could do this and cut taxes at the same time, which I say in light of Newt's tax cut proposals.

I liked what Newt said on page 182 about education:

"...we teach these subjects as facts to be memorized rather than a great adventure of discovery to be pursued.  Teaching, memorizing, and testing are all familiar words.  But we must return the words wonder, adventure, and discovery to our schools.  We should not center on education, but on learning.  We should go beyond force-feeding numbers and theories to a level of true discovery where a child wonders what the answers are and goes in search of them for the pure excitement of it."

I was one time working with a program that tutored at-risk youth, and I remarked that I could understand why the youths were so bored with what they were learning in school, for I was bored with that stuff and was happy to be in college where I could pursue my interests and take the courses that I wanted.  My supervisor responded that my opportunities to do so in college were my reward for doing well in the boring subjects in junior high and high school.  I think that it's important for students to learn subjects that may not necessarily interest them.  At the same time, I believe that schools should encourage students to pursue their interests, and that opportunities to do so should not be limited to the gifted and talented or to those who go on to college.

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For my write-up today on Newt Gingrich's Saving Lives & Saving Money: Transforming Health and Healthcare, I want to highlight what Newt says on pages 145-146:

"The current system dictates a focus on reactive acute care and does not incentivize prevention.  Coverage for prescription medications is a paramount example...Medicare will cover the visit to the doctor to discuss the numbness in the foot, but it will not pay for the insulin to relieve, and stop, the problem.  Medicare will pay for visits to the emergency room when a beneficiary has a heart attack, but it fails to pay for the cholesterol medication that may have prevented the incident all together.  Medicare's end-stage renal-disease program (offers kidney dialysis when the kidneys no longer function) is one of the highest cost programs in Medicare, yet it will not pay for the insulin that could prevent many of those individuals from needing it in the first place."

Newt wrote this before the Medicare prescription drug entitlement was passed into law.  And what Newt said makes sense, for you would expect for prevention to save money by reducing the number of people who end up in emergency rooms.  But did the prescription drug benefit save Medicare money?  As far I as know, Medicare spending has continued to increase since that benefit was passed.  Why?  Is it because the donut hole requires some people to still pay for their prescription drugs, thereby hindering them from a health-plan of prevention?  Is Medicare Advantage part of the problem, as I have read that it entails the government giving money to insurance companies, plus there are questions about the quality of Medicare Advantage plans?  Is the sheer cost of prescription drugs part of the problem?

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For my write-up today on Saving Lives & Saving Money: Transforming Health and Healthcare, I'll highlight what Newt Gingrich says on pages 110-111:

"In a world where we have the ability to do our own trading on the stock market, it should be unacceptable that we are still at the mercy of an insurance company to understand care options, provider choices, and costs.  The role of a patient has evolved into a dependency relationship in the healthcare delivery system rather than the driver of the system.  Access to information and knowledge about healthcare will empower individuals, as consumers, to make the best healthcare choices in deciding which procedures, treatments, and preventive care will meet their mental, emotional, and physical needs.  We want to know that the physician performing our hip and knee replacement has done the procedure enough times to be proficient at it.  We want to know that if we have type 2 diabetes, our doctor has a high percentage of success in treating patients with that condition."

But what if you do an online search and find a doctor you like, and the insurance company doesn't cover a visit to that particular doctor?  Knowledge is not necessarily power, especially in a system where one is dependent on the insurance company.  I wonder how Canada would handle this: Can Canadians visit any doctor in the country, and the government pays for it?

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In my last reading of Saving Lives & Saving Money: Transforming Health and Healthcare, Newt Gingrich talks about offering incentives for healthy living.  I enjoyed his anecdote on page 101:

"The amount of hours we worked and the time my staff and I spent in the Speaker's office made it very easy to make poor dietary choices and not exercise.  Leftover cookies and appetizers from meetings and receptions, fast food, and tuna melts from the grill led to almost everyone in the office gaining weight over the first year.  Someone in the office started a weight contest, who could lose 8% of their body weight in eight weeks.  Everyone who wanted to participate put in $20 and weighed in with the weight keeper.  It became a team approach to healthy behavior.  After eight weeks, two of the staff had achieved their goal, winning about $150 each, and quite a few others were close behind.  This is not a revolutionary idea but the kind of healthy, team-building activity that could be replicated in any workplace.  It just takes leadership."

I appreciate this anecdote because it gives me a glimpse into what life in Washington is like and also shows that Newt and his staff were pretty cool----in that they had the camaraderie to hold a weight-loss contest.

In terms of the incentives that society can offer for healthy living, Newt on pages 101-102 suggests "lower co-pays for patients who are compliant with their health-management requirements."  I wonder how that compliance would be measured.  Would it be through such things as weight-loss and low cholesterol?

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I have two items for my write-up today on Newt Gingrich's Saving Lives & Saving Money: Transforming Health and Healthcare.

1.  On pages 73-74, Newt talks about childhood nutrition.  He laments that "School lunches...contribute to instilling unhealthy eating habits in children" because they "are high in carbohydrates and fail to offer a variety of healthy alternatives such as soymilk", when "Foods containing soy protein are effective in reducing cholesterol, treating kidney disease, and may cause calcium to be better utilized, helping to ward off osteoporosis."  Newt states that the dairy industry is being put ahead of children's nutritional needs.  Newt then discusses a school district in California that has banned sodas on campuses, replacing them with milk, "beverages with at least 50% fruit juice, and sports drinks with less than 42 grams of sugar per 20-ounce serving".  Newt says that childhood obesity is a growing problem.

Newt goes on to say that he's not in favor of banning soft drinks and whole milk, but that people should learn about balance.  But Newt may support the school's ban on soft drinks, for he says that "The soft drink companies should be challenged to expect to produce healthy alternatives or to expect to have reduced access to young people as a market."

What Newt said in this 2003 book intrigued me, in light of conservative snark about Michelle Obama's anti-obesity campaign (see here).  I wonder what the difference is between Newt's approach to this issue and that of Michelle Obama.

In any case, as much as I like soda, I think that schools should promote healthier dietary habits.  Many conservatives decry Michelle Obama's anti-obesity program as characteristic of a big government nanny state, and some of them defiantly affirm that they have a right to eat whatever they want, even if it's unhealthy.  But eating in an unhealthy manner doesn't just affect the person eating in an unhealthy manner.  It produces health problems that impact everyone else----in terms of higher health care costs and insurance premiums. 
 
I wouldn't go so far as to say that the government should ban junk food.  I seriously doubt that Michelle Obama goes that far, either.  But schools and school lunches should be stocked with healthy food and drinks.  Michelle Obama does well to work with restaurants to encourage them to have healthy items on menus.  A health care program that encourages preventative care----which entails doctors coaching patients to eat right----can benefit individuals and society as a whole.

2.  Newt once again expresses disapproval of third-party payers for health care.  Newt supports health savings accounts----tax-free accounts of employees to which employers will contribute.  But Newt's proposals do not get rid of insurance altogether.  Newt believes that health-savings accounts will reduce premiums because people would have money in their account for medical needs, and thus could have a higher deductible in their health insurance.  Newt also wants to move America away from employer-based health insurance, yet he recognizes that it's more expensive for individuals to purchase health insurance.  As a solution, he proposes a tax credit for the individual purchase of health insurance, and also that groups (i.e., of small businesses, organizations, etc.) be able to purchase health insurance.

I think that these ideas are a step in the right direction, but I doubt that they're adequate for everybody.  Would a tax credit help individuals who don't make enough to pay much in taxes to begin with?  Would health-savings accounts provide enough money for costly operations?  Moreover, while Newt's proposal that small businesses come together to purchase health insurance may have merit, I question whether Republicans have the will to push for this.  I remember George W. Bush supporting this idea when he debated John Kerry.  Then Bush won, and I didn't hear about the idea again.  (But maybe Bush did mention it, since he supported some proposal regarding health insurance, which was rejected by the Democrats.)

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I have three items for my write-up today on Newt Gingrich's Saving Lives & Saving Money: Transforming Health and Healthcare.

1.  On page 55, Newt states: "In the airline industry, we insist on safety first and profits second.  In providing care we should insist on value for the patient before the provider or insurer can try to make a profit.  Any other focus risks lives and is inherently immoral."

This should be obvious.  Unfortunately, as Newt notes and as many of us have experienced, our health care system does not run that way.

2. On page 63, Newt states: "We should incentivize providers to achieve certain outcomes.  For example, the national rate for hospital-induced illnesses is about 4%.  If Medicare had an incentive program in which hospitals reporting an error rate under 1% received a substantial bonus (say one-half the amount they saved Medicare by creating fewer hospital-induced illnesses), we would begin to see dramatic decreases in hospital-induced illness."

Although Newt is talking specifically here about hospital-induced illness, what he says reminds me of something in Michael Moore's Sicko.  Michael Moore was interviewing a physician in the United Kingdom (if I'm not mistaken), and the physician was telling Michael Moore that the government gives him a bonus when his patients are healthy.  Suppose that Medicare did that here in the U.S.: it gave hospitals or doctors incentives if most of their patients were healthy, thereby saving Medicare money.  That could encourage preventative care.  At the same time, a potential problem could be that doctors would not see the very sick, for the doctors would want for most of their patients to be healthy so they could collect that bonus, and thus they'd cherry-pick.  Hospitals, of course, have to see everyone, but, if I'm not mistaken (and I welcome tactful correction), doctors can limit the patients they see.

3.  On page 64, Newt states: "...if Congress adds a prescription drug benefit to Medicare that is similar to the House bill passed in 2002, the cost of the drug benefit over 75 years will equal the current national debt.  To pay for those kinds of programs we must transform the system."

I remember Newt saying in one of the debates that the prescription drug benefit was good policy because it saved money.  In a sense, it's preventative care: it costs less to pay for prescriptions that alleviate illnesses than it does to allow those illnesses to become an emergency.  In the passage I just quoted, however, Newt acknowledges that the benefit could get costly, and he appears to think that it could function best within a profound transformation of the health care system, not the status quo.

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What I liked in my latest reading of Newt Gingrich's Saving Lives & Saving Money: Transforming Health and Healthcare is that it differed from some of the usual conservative talking-points that I hear.

Many conservatives love to argue that there are long waiting-periods in Canada and other countries that have single-payer national health insurance, but Newt (although he does not favor single-payer national health insurance) points out that there are long waiting periods in the United States to see a doctor, in a number of cases. Many conservatives hold that the number of uninsured people in America is far less than 42 million, but Newt sticks with the 41.2 million figure, which is based on Census Bureau numbers. Many conservatives have maintained that the vast majority of Americans are satisfied with their health insurance and the U.S. health care system in general, but Newt highlights increasing dissatisfaction, and he contends that the quality of U.S. health care could be better. Some conservatives have said that health insurance should only be catastrophic and that its coverage of other things is what contributes to high premiums, but Newt acknowledges the importance of preventative care, in terms of both health and also the cost of health care.

Newt is still a conservative, for he criticizes the large role that the government plays in the U.S. health care system. Overall, Newt would like for the system to focus on the doctor and the patient, and he does not care for third-parties paying for health care. The result of third-party payers, as he notes, is that you have the insurance companies and the government, which want to control the amount of money that they spend on health care. In the case of the insurance companies, this is to maximize profits for the companies and the shareholders; in the case of the government, it may be to keep government spending for health care under control to prevent deficits or to allow money to be spent on other things. You have the doctors, who want to make more money. As Newt notes, if the government or the insurance company pays less per visit by patients, then the doctors will simply find ways to schedule more visits! And then you have the patients, who are dissatisfied with the care that they are getting.

I think that third-party payers are a problem, but I cannot think of any alternative, for the reason that these payers exist in the first place is that health care is expensive. I tend to trust the government more than private insurance companies seeking to maximize their profits, however, for I recall Howard Dean saying that, when he was a doctor, dealing with the government was much easier than dealing with private insurance companies, in terms of getting his patients the care that they needed. Perhaps there's more to the issue than this, though.

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I started Newt Gingrich's Saving Lives & Saving Money: Transforming Health and Health Care. Actually, Newt wrote this book with other people, but I'll only refer to "Newt" when discussing what the author of the book says.

My impression has been that this book in particular is an important book to Newt, for Newt referred specifically to it at least two times in his campaign. I first heard of it when I watched Newt Gingrich's debate with Herman Cain, and I decided to buy it so that I could learn more about what Newt thought was wrong with America's health care system, and how he believed the system could be fixed.

At the outset, let me say that one thing that I admire about Newt is that he at least acknowledges that the American health care system is broken. When I hear many other conservatives talk about health care, I wish that I observed in their comments that same sensitivity. Instead, what I hear are goofy arguments. "Oh, the American health care system is the best in the world! Everyone has to be treated in emergency rooms in the United States of America!" Yeah, and that drives up the cost of health care, which is why Obama and Romney have supported an insurance mandate. Plus, I have heard that those without health insurance don't get as good of care in emergency rooms as people with insurance.

In my last reading of this book by Newt, I encountered one idea that was vintage Newt: that we could reduce bureaucracy and paperwork in the health care system by making more things computerized, thereby saving money. Moreover, like many conservatives, Newt also talks about how trial lawyers contribute to the increasing cost of health care. According to Newt, the litigious culture discourages people from becoming nurses, which is why there is such a shortage of nurses. Plus, because doctors are afraid of being sued, they are reluctant to admit mistakes, which hinders those mistakes from being corrected.

Newt believes that another problem is that there is a third party involved in paying for health care, namely, insurance companies and the government. I doubt that he wants to remove completely any third parties, for he has stated that he supports allowing the elderly to stay in Medicare if that is what they want. But, while third parties may contribute in some manner to the rising costs of health care, I doubt that health care would be cheap were they to leave the picture. Newt himself acknowledges that one reason that the cost of health care has increased is because of the advancements that have been made in health care.

Another point that Newt makes is that Medicaid eats up a lot of states' budgets, hindering them from spending money on things that they need (i.e., roads). So does Newt support reducing money that is spent on government health care programs? This could be problematic, for, on pages 27-28, he states:

"Because the government accounts for 45% of all healthcare spending, their tactics to control costs have hit the system like an atomic bomb. Decreased reimbursement rates from the government are hurting the bottom line. Doctors and other care providers are forced to see more patients for less time in order to maintain their standard of living. Some doctors are now even charging a 'membership fee' of $1,500 to reduce the number of patients they treat."

Government attempts to control costs have negatively impacted supply-and-demand. But perhaps Newt is saying here that the problem is that the government is too heavily involved in health care at the outset. Because people depend so heavily on the government, what the government does has quite an impact. But suppose people were not as dependent on the government? I myself think that health care would still be expensive.

One final point for this post: On page 17, Newt has a chart, and he's drawing from information here about insurance premiums. Essentially, the figures show that the annual increase in employer-based insurance premiums was declining until 1996, when it started to increase. A conservative friend of mine once told me that I should thank Bill Clinton for my high premiums (which are actually not employer-based), but I forget what his reasoning was.