John C Kim and International Adoption Video

Sunday, December 28, 2008

At House Party on Health Care, the Diagnosis Is It’s Broken

 At House Party on Health Care, the Diagnosis Is It's Broken 

  At House Party on Health Care, the Diagnosis Is It's Broken

Brendan Smialowski for The New York Times

 Karima Hijane, flanked by her husband, Theodore A. Kolovos, and Li Yang, needed a year to get correct diagnoses of illnesses. "Instead of being able to focus on my health, I focused on insurance to cover the tests and treatments."

Published: December 22, 2008

VIENNA, Va. — When a dozen consumers gathered over the weekend to discuss health care at the behest of President-elect Barack Obama, they quickly agreed on one point: they despise health insurance companies.

They also agreed that health care was a right; that insurance should cover "everything," not just some services; and that coverage should be readily available from the government, as well as from employers.

Those were the conclusions of a house party held here in Northern Virginia at the home of Karima Hijane and Theodore A. Kolovos, information technology consultants who have been married for seven years. It was one of more than 4,200 such events being held around the country from Dec. 15 to 31, as part of an experiment in grass-roots politics and policy-making, to provide recommendations to the president-elect.

"We have to keep the momentum going," said Ms. Hijane, 34, who was a volunteer in the Obama campaign and is active in women's health advocacy. "We are not lobbyists. We are simple citizens. We want to make sure that our voices are heard and that health care is reformed."

One of the people seated around Ms. Hijane's dining room table, Bruce D. Chatman, worked for I.B.M. for 29 years. Corporations, he said, have too much influence in the legislative process and the health care system. He wants to counterbalance their power with the energy and passion of citizens lobbying for themselves.

Mr. Chatman, a Chicago native who lives in Fort Washington, Md., said he had been inspired by Mr. Obama's book "The Audacity of Hope" and started working for his campaign as a volunteer in April 2007.

"I don't believe health care should depend on people making money," Mr. Chatman said. "The profit motive has to be tempered, especially on the administrative side of the health care business."

Shiva S. Makki, an economist, complained that in many cases, insurers did not cover the costs of screening procedures and preventive care.

Dr. Lawrence M. Nelson, a scientist at the National Institutes of Health who emphasized that he was speaking as a private citizen, said: "The incentives in the current health insurance system are upside down. The less care you provide, the bigger your profits."

Dr. Nelson said he liked Mr. Obama's proposal to create a new public plan, similar to Medicare, that would compete with private insurance companies.

Alex R. Lawson, a volunteer in the Obama campaign now trying to build public support for Mr. Obama's agenda, said a public plan would give people a choice they do not have.

"A public insurance plan would not take anything away," Mr. Lawson said. "It just adds another option."

After one speaker expressed a mild concern about too much involvement by the government, Mr. Kolovos said: "Everyone is afraid of government bureaucracy. But what we have now, with the filing and adjudication of insurance claims, is also bureaucratic."

Several people at the health care forum said they were frustrated by the current arrangement under which health insurance is tied closely to the workplace.

Hamudi Almasri, a 35-year-old information technology consultant at a small company that does work for the Labor Department, said that when he changed jobs, he had to change health plans and doctors.

"If I change employers, why should it be such a hassle?" Mr. Almasri asked.

His wife, Li Yang, said: "When I move from one doctor to another, my information is lost. In many cases, the doctors don't talk to each other. In a country where information technology is so advanced, there's no system linking all these doctors together. It's a hindrance to treatment."

Ms. Li said she and her husband "had a few surprises" when they started shopping for a better health insurance policy on their own.

"If we wanted a baby," Ms. Li said, "insurers would not cover the maternity care if conception occurred within six months after we purchased the insurance. We were shocked."

In many cases, the standard individual insurance policy does not cover maternity care, though such coverage can be bought for an additional premium. Even then, some insurers stipulate that maternity benefits will be available only if a woman waits for a certain amount of time before becoming pregnant.

The Obama transition team asked for "particularly poignant stories to highlight the need for health care reform," and such stories were abundant at the round table here.

Mr. Almasri said that when his infant daughter had severe eczema, she had to wait several months to see a dermatologist in their H.M.O. network. By then, he said, "the symptoms were all cleared up."

Ms. Hijane said she had gone from doctor to doctor for more than a year before she got correct diagnoses for premature ovarian failure and celiac disease, a digestive disorder.

"Instead of being able to focus on my health," Ms. Hijane said, "I focused on insurance to cover the tests and treatments. Everything we did was designed to find a job with good health insurance."

The Obama transition team did not ask people how a new health care system should be financed, but several people here said that individuals and businesses should have to pay a small health care tax — some preferred to call it a "contribution" — so that everyone could be covered.

Mr. Chatman said he expected insurance companies and others in the health care industry to resist many of Mr. Obama's proposals.

"This is warfare for the health care of our country," Mr. Chatman said. "The question is, Will money win, or will the people win? If we lose, we'll be a second-class country."


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Personal Web site for John C Kim: KIDDOC.ORG

I am a pediatrician specializing in General Pediatrics, International Adoption Medicine, and in the diagnosis and coaching of families pursuing joy.