Ramon Zayas is only one of a million Americans baffled with how health care reform has unfolded. The debate has dozens of nuances, each more complex than the next, and the nearly 2,000 page bill has drawn criticism for its intricacy.
Zayas, 54, was diagnosed with prostate cancer in 2008 and is now covered by Medicare.
By the time doctors discovered it, the cancer had already metastasized and spread into his spinal cord and bone marrow. There was little they could do, except prescribe him 22 medications including Zometa to prevent bone fractures and Lupron to suppress the release of testosterone which spurs the growth of cancer cells in the prostate.
Sitting in his home office one afternoon, surrounded by framed art and family photographs – of Mercedes, his wife, and two daughters — he said he’s only on eight medications now, yet none of them are to treat cancer. Rather they are designed to foster containment.
Groggy from the injections he receives three times per month at Florida Cancer Specialists, he shared his past life before his cancer, and stopped mid-sentence to look out the window and contemplate his future.
“Today, I came from treatment, I sit back in this long chair and snooze off after, the injection leaves you bummed out for awhile,” he said. “It (the cancer) was found too late, it already metastasized and is now in my spine and bone marrow.”
Zayas is mentally exhausted.
And it’s not only the injections that have robbed him of his lucidity. In 2005 he suffered a stroke, forcing him to leave a lucrative career in selling pharmaceuticals and medical equipment because he could no longer communicate effectively in a business that requires its salespersons to make quick, coherent pitches to doctors and companies.
Recently he grew distressed after finding a flyer near the magazines in his doctor’s waiting room entitled “Cancer Patients’ Right to Know,” released by the Community Oncology Alliance. The flyer, while seemingly innocuous, said the government was planning to make severe cuts to Medicare payments, which account for approximately 50 percent of cancer care in the United States.
It stated that clinics have already closed because of the cuts while others were forced to reduce staff or send patients to other clinics. Reading each sentence Zayas grew more angry, interpreting it as just another piece of campaign literature meant to frighten cancer patients into opposing health care reform.
“The more I started reading it, the more mad I got,” said Zayas. “What are they saying? That the politicians in Washington are going to cut my cancer treatment?”
Earlier this year the Centers for Medicare and Medicaid Services proposed a 19 percent cut in radiation oncology for 2010, yet after pressure from organizations such as the American Society for Radiation Oncology, the CMS decreased the cuts to 5 percent over four years, meaning that the decrease for 2010 is approximately 1 percent.
A letter to Zayas from Dr. Scott Tetreault, a physician at Florida Cancer Specialists, said the cuts were based on what he described as a “flawed” survey carried out by the American Medical Association. Most importantly, he said the new rates, which he alleged are to offset the costs of a government-run public insurance option, would dismantle the country’s cancer care system.
Even though Zayas didn’t take the flyer at its word, he said many patients would likely believe it and panic about how the government is trying to reform healthcare. When asked this question directly, officials from the CMS said the fee changes have no relation to a public option.
“There is absolutely no truth to the allegation that any changes to payment rates in the Medicare Physician Fee Schedule are tied to funding a public option in health care reform (or to funding any other part of health care reform),” wrote Ellen B. Griffith, with the Office of External Affairs at the Centers for Medicare and Medicaid Services.
Griffith explained that payment rates for Medicare are updated annually to adjust for changing services and inflation. She added that payments were reduced for 2010 because data indicated that CMS was overpaying for high-cost equipment over $1 million. There will be reductions in other areas over the next four years, she said, so that other physicians can receive more funding.
“The overall dollars going to physicians will not change based on this reduction,” she wrote. “It’s just that the size of the slice of the payment pie that goes to radiation oncologists will be somewhat smaller, while the slices that go to other physicians will be a little larger.”
Since the November 2008 election, health care reform has been at the forefront of American politics. Even after months of public debates, contentious town hall meetings and Washington protests, the U.S. House of Representatives passed their version of health care reform, 220-215, last Saturday.
HR 3926, the Affordable Health Care for America Act, mandates that all Americans get insurance, that employers offer insurance and a government-run public option. The last time the government considered overhauling the health care system so profoundly was in 1965 with the start of Medicare and Medicaid.
But even with today’s limited government-run insurance options, the U.S. Census Bureau estimates that 47 million people still don’t have insurance.

The need for health care reform in Lee County

Lee Memorial Health System hosted a healthcare symposium earlier this month where President Jim Nathan and other health experts discussed health care reform. Nathan said the status quo will no longer work.
“The reality is, it’s not working even for the insured because they are paying a larger and massive hidden tax,” he said.
Twenty-one percent of the population in Lee County receives its healthcare from Medicaid. People without insurance either delay doctor visits — risking their own health — or use the emergency room for primary care, and in the end, don’t pay the bill.
The revenue lost from uninsured residents who can’t pay for health care is later shouldered by patients with private insurance in the form of higher premiums — a phenomenon called the “hidden tax.” In Lee County, this “tax” decreased from 35 percent of patients paying 100 percent of profits last year to 27 percent in 2009.
Not only is Lee County struggling to pay the health care bills, but the state is already estimating a $2 billion budget shortfall for the coming year.
Over the last two years the Florida Legislature struggled with balancing the state budget and health care plays a huge role. Between October 2008 and December 2010, the state received $5.4 billion from the federal government to avoid health cuts, yet stimulus dollars are due to stop flowing in 2011.
Furthermore, local Medicaid revenue has already decreased by 13 percent.
Health reform may change the way doctors and hospitals are reimbursed by the government for Medicare and Medicaid. Doctors are currently paid according to what tests they order, rather than on patient outcomes.
“We are trying to go to a model where they pay for outcomes and quality for care,” said Dr. Ron Castellanos, a neurologist with Lee Memorial Health System who co-hosted the symposium. “Right now, doctors are paid more for the more X-rays or tests they order, not the outcomes or quality of care.”
Some states may also have some flexibility if health care reform is implemented, according to discussion at the symposium. Legislators have discussed the idea of allowing states to opt-out of a public option as long as they implement a similar program that meets federal requirements.
AARP, a non-partisan organization for people over 50, supports the bill that passed in the House. Curtis Hamilton, a Lee County advocacy organizer for AARP Florida, said the organization wouldn’t support the bill if it included dangerous cuts to health care.
“They have a great reputation for integrity and doing what is in the interest of health care and seniors,” said Hamilton. “I’m sure AARP would be glad to see some of the things improved on it, but on the whole they felt it is the best bill and one that they would choose to support.”
AARP’s main rival, the American Senior Benefits Association, recently announced its membership had increased by 100,000 people due to disenchanted seniors who left AARP because of its stand on health care reform.
“Seniors want to be part of an organization that reflects their own belief system and advocates for them on the key issues impacting their lives,” said Bill Hill, president of ASBA.

National health care reform and
the public option

Before the bill can be signed into law, the U.S. Senate must pass it and both versions must be reconciled before it reaches the White House. It is expected to stall in the Senate and may not be addressed until after the new year.
Congressman Connie Mack, R-Southwest Florida, issued a statement against the bill last weekend after the House voted.
“The American people don’t want bigger government and higher taxes. They don’t want politicians and bureaucrats to come between them and their doctors when making their health care decisions,” he said.
Mack explained that he supported a Republican alternative to health care reform that included health savings accounts, association health plans, tort reform, tax incentives for those purchasing insurance, improvements in transparency in costs and allowing individuals to purchase insurance across state lines.
U.S. Sen. Bill Nelson, D-Florida, supported an earlier version of health care reform bill but has spoken out against the bill passed in the House.
“There are many good elements to the House health care bill, but I don’t support it,” said Nelson in a statement to the Breeze. “I prefer the version the Senate Finance Committee passed earlier this fall.”
Nelson said he agrees that the current system is unfair and too costly, and that reform is needed.
“My main goal is to help pass legislation that’ll make health care more affordable for everybody,” he said.
Lines in the sand have already been drawn by both sides. In a ironic twist, the American Medical Association supported the House bill but the Florida Medical Association has come out against it.
Some are concerned about the ramifications of a public option, specifically about whether the country is moving towards a model of socialized medicine, yet experts point out that the federal government already insures a sizable chunk of Americans.
According to Dr. Paul Keckley, executive director of of the Deloitte Center for Health Solutions and key-note speaker at the healthcare symposium, one-third of the U.S. population receives healthcare from the federal government.
“The government currently insures directly, between Medicare, Medicaid, military health and federal employees, about 100 million people or one-third of the U.S. population,” said Keckley.
Disregarding most of the contentious ideology that has made up the debate, Keckley said some form of reform is needed to stop the industry’s rapid growth. Health costs are increasing 6.2 percent each year and will consume 20 percent of the country’s gross domestic product by 2019, he said. Reformers are simply trying to reduce the rate of growth from 6.2 to 4.7 percent.
“Policy and healthcare is not built by the extremes, it is somewhere in the middle, the policies aren’t about death panels or restricting access to promising technologies, and they aren’t about driving doctors out of business, they are about slowing the rate of growth without compromising care,” said Keckley.
Of course some believe that if reform is passed it will destroy the American health care system as we know by instituting rationed care, excessive wait times to see a doctor and alleged “death panels.”
The Fort Myers Veterans Clinic is open to 202,000 veterans in Southwest Florida. Military personnel and veterans receive full health benefits from the federal government. According to Shilpa Patel-Teague, spokesperson for the Bay Pines VA Healthcare System, 90 percent of all veterans are seen within seven days of a desired appointment date.
“If you are sick today, 41 percent could get it (an appointment) within the same day, with an additional 49 percent in the next seven days,” she said. “An additional 9 percent get their appointment within 14 days.”
The veterans clinic doesn’t have an emergency room, but Patel-Teague said cases are triaged and patients can be seen immediately. Like other emergency departments — including a newly renovated department at Cape Coral Hospital — the clinic follows an urgent care model to deal with an influx of patients choosing the emergency room over physician offices.
Rationing of care has also been discussed in the debate over the health reform bill.
One section titled “annual limitation” reads that “the applicable level specified in this subparagraph is $5,000 for an individual and $10,000 for a family,” yet it refers to the maximum amount of co-payments and not a cap on care.
FactCheck.org, a non-partisan “consumer advocate” project at the Annenberg Public Policy Center at the University of Pennsylvania, found that 26 of 48 claims made against the health care bill are false, including rationing of care, the issue of a government committee deciding treatments, and free healthcare to undocumented immigrants.
On the other hand, the group found that some claims were true, such as hospitals being penalized for what the government deems preventable readmissions, that individuals without insurance will be taxed 2.5 percent of their income, and that all private healthcare plans must participate in a Healthcare Exchange.
But, FactCheck.org’s analysis was released in August and based on the original bill, HR 3200. The House made some changes to that original bill, including a section on abortion, and more changes are likely to come as the legislative process continues.