Carole L. Milligan: Rethinking health care reform


— As a physician, I think health care reform is essential:

First, I think strongly that we need health insurance reform. We have to be concerned about the health of our communities. We need universal coverage for all Americans regardless of pre-existing conditions, employment, residence or where medical care is received. In order for this to work, those who are healthy need to participate in the system just as those who are ill. I also think that we need a mechanism for increasing competition within the insurance market, and so far the public option seems like the best mechanism, either through private enrollment in Medicare and/or Medicaid or a separate plan.

How can we afford to cover those 46 million uninsured people?

This is what health care reform is really about - the changes we can make in delivery to improve care while putting the lid on the runaway costs that are escalating at an unsustainable rate of more than 9 percent per year.

Why change?

Our system of health care is actually an inefficient health care system, despite the fact that we spend more on medical care per person than any other country. We deliver very good, high-intensity acute medical care when people get into serious trouble, but we neglect much of the inexpensive and more cost-effective care.

How can we move our spending to more effective care?

One, we need to make sure that children and young mothers have good preventive care. If young mothers get preventive care at all economic levels, infant mortality and morbidity, which is very costly in both the short and long term, will improve.

Two, because our biggest health issues are chronic diseases, we need screening and earlier interventions, and we need far better chronic disease management within the health care system.

Three, our system is fragmented both in information sharing and in service coordination. The result is that many parts of the medical system do not operate in the best interests of patients. Doctors order too many tests, too many marginally effective treatments and drugs, and recommend too much surgery. We need incentives and systems to provide more coordinated care that doesn't lead to duplication.

Any changes we implement now will certainly not be perfect and will need continuing adjustments, but by emphasizing early preventive care, chronic disease management and patient-centered care, we can create a framework that will provide improvements in health care before we are all dragged under by the system.

Carole Milligan is the medical director of Hospice of Northwest Colorado, chairwoman of the Ethics Committee at Yampa Valley Medical Center and a retired radiation oncologist.


seeuski 7 years, 7 months ago

I want my country back, I want my country back. Does that make you two wacks feel better? And if it weren't for FOX news Obama's much sought after green czar would still be receiving tax payer money and planning the "pipeline of funds" for incarcerated blacks. And not to mention his commy claims that whites were poisoning inner city blacks and immigrant farm workers. Yea, this President is bringing us together alright but on to this sad article by Miss Milligan. Where does one start? The majority of Americans disagree with the biased assessment put forth here and the polls bare that out. The majority are matching up there personal experiences of a lifelong relationship with our existing system and are realizing we are being lied to by those protecting the Obama legacy. I have 10 years of experience with care at YVMC and if what Miss Milligan says is true "Our system of health care is actually an inefficient health care system, despite the fact that we spend more on medical care per person than any other country." Then where were her columns warning us the last 8 years? Why does she not mention the promise of medical services to everyone regardless of ability to pay at the admittance desk in the main lobby? Why does she not mention TORT reform when she says, " Doctors order too many tests, too many marginally effective treatments and drugs, and recommend too much surgery. We need incentives and systems to provide more coordinated care that doesn't lead to duplication." Claiming that her fellow Physicians order too many surgeries is right from Obama's own mouth and is just ridiculous and quite frankly, disturbing. Why would a medical practitioner ignore proven successes in dealing with insurance accessibility as she claims,"I also think that we need a mechanism for increasing competition within the insurance market, and so far the public option seems like the best mechanism, either through private enrollment in Medicare and/or Medicaid or a separate plan." Here is a better idea Miss Milligan,"Interstate Competition in the Individual Health Insurance Marketplace"

Maybe read what facts are available from non partisans rather than those with Obama bumper stickers still on their cars.



seeuski 7 years, 7 months ago

This debate should not be about name calling or partisan politics but true cures for real problems and most of those problems are Government caused like the restrictions on interstate competition among insurance companies and tort reform and the existing failures of Medicare and Medicaid which is supplemented by private insurance now. Have a nice day my name calling friends.


Troutguy 7 years, 7 months ago

seeuski, if this is not to be about name calling, why do you feel the need to call the first two people who responded to this commentary "wacks"?
Thank you Carole for adding some helpful dialog to the health care debate.


Fred Duckels 7 years, 7 months ago

Fox news has asked questions that you O supporters need to answer. 1 Why in 1100 pages of this bill is tort reform not mentioned? 2 Why isn't competition across state lines mentioned? It wouldn't take long at all for a compromise, if politicians put the welfare of health care ahead of their own reelections. End of discussion! For those of you that allow Fox to get under your skin, should we eliminate alternative viewpoints, or should we be satisfied with the emporers viewpoint? What a great country, although I know a lot of you would change that if you could.


seeuski 7 years, 7 months ago

Troutguy, I should have held my tongue but if you read their posts you can see that those of us in the opposition to a public option in this health care debate are immediately referred to as nutters and FOX news disciples to name a few and there is a subtle reference to racism in one comment, "They will do what ever it takes to bring failure to this president, attacking anything be it health care or responsible stewardship of the planet. They are looking for the juggler vein. It does not matter what the issue is they just want to bring this president down." So my response in my opinion is quite tame in comparison and the sad part of this debate is that I just don't want the Government to further damage a system that is already in a mess because of Government intervention. And I don't care what letter is next to the Presidents name or the color of his skin because 4 years down the road it will be someone else but the same Government will still be misappropriating 1/6th more of the economy. I don't want 50% of GNP to be nationalized, do you?

So had those two gentlemen kept their comments to the subject and not directed their ire at the opposition well maybe a reasonable discussion could be had. I would just say that turning the other cheek in the face of such hateful inflections is not always possible. One other thing Troutguy, click on LTFO's handle and read some of this persons comments and you will see a continuous pattern of attack rather than reasoned argument.


Troutguy 7 years, 7 months ago

The reason tort reform and competition across state lines aren't talked about is because big business, in this case pharm, insurance, trial lawyers, are in the governments pockets. It's the same when the Bush administration basically let the oil companies write our energy policy. It doesn't matter which party is in power. They are beholden to their biggest campaign contributors. You can't tell me if someone gave you money, and a whole lot of it at that, you wouldn't feel you had the obligation to do something in return. It's disgusting. Then, when we finally vote them out of office, they go to work for their buddies in the business. Can anyone say William Jefferson and his freezer full of money? Jack Abramoff? How many lobbyists and politicians have served time in jail in the last 20 years? This is why we won't have any meaningful health care reform. Or serious financial industry reform. Our government is available to the highest bidder.


Jeff_Kibler 7 years, 7 months ago

Troutguy, "I feel your pain." Public servants, they are not. We, the public, are subservient via taxation and regulation. What to do? How do we find some consensus to vote them out? Lately, it's been refreshing to have conversations with folks from the left and the right. Many from both sides are plainly fed up. Third party? My ingrained cynicism thinks it ain't gonna happen. We'll meander on, "We the people" as the real public servants.


seeuski 7 years, 7 months ago

We do need to work together for the good of the country and I do believe the tea party movement is comprised of people from all voting blocks who are fed up with the system of big Government but for me it's also big Unions that are a real threat to our freedoms. The lawyers unions and SEIU are the forces behind many of the big bills along with the Alliance Group which encompasses the desire to control all phases of our lives. Many of the CZARS in the current Administration are involved with the Alliance Group including recently fired Van Jones. We can make a difference at the voting booth this coming 2010 election and vote for Constitutionally sound candidates who truly represent the people that elect them.


ybul 7 years, 7 months ago

I wonder, if the writer ever stopped to think that early detection of the chronic, largely treatable diseases would be better treated through education about nutrition. This coupled with the elimination of govt subsidies to grow grains which through conventional systems use 18% of the energy in this country, cause massive environmental problems in the Gulf of Mexico from fertilizer based algae blooms, health care woes via skewed/poor nutrition because the least expensive food is not healthy because of how it is raised.

On and on, the system is jacked up and simply trying to cover everyone is not going to solve the problem. People need to take responsibility for there lives and be rewarded for maintaining good health as opposed to the current system of runny nose insurance programs which encourage people to visit the doctor more frequently than necessary.


canyonwind 7 years, 7 months ago

LTFO and snowbow, I did not think people like you were for real. Just what is wrong with FOX news? All they do is tell the truth, their NEWS division is middle of the road. Even their Commentary is not all GOP, Sean Hannity is the only GOP member, Glen Beck would not give Bush a break the last few years. So whats the problem???

I did not vote for McCain or Obama I though they were just too simple and not up to the job. Sara Palin and Hillary Clinton would have been a better match up but we saw what the media did to those two. I would like to see Jon Huntsman Utah's GOV run in 2012 his state is not in the hole plus he is from this part of the country, Utah has more in common with Colorado than Illinois, Texas or Connecticut.

This health care debate is going to end up like it did in 1993 unless they start using some commen sense. For one lets start with the basics first like Tort reform, that right there could cut over 20% to medical cost plus if I want to get medical insurance I can not get it in Idaho or Oregon I have to buy it here, all medical cost should be 100% tax deductable regardless of income. And lets get Big Pharma, SEIU, ACORN and the millionair lawyers and unions out of the process. And why is Henrey Waxman and Nancy Polosi doing most of the bill writing? We all know how broke California is and these two bone heads were in Sacramento in the past and help write laws that ran that state into the ground. Get them outa there !!!! Lets get a real Doctor in there to write the bill, Senator DR John Barrasso of Casper WY should be writing the bill along with any other doctors in the House


StopTheBrutalChemtrails 7 years, 7 months ago

Page 22 of the HC Bill: Mandates that the Govt will audit books of all employers that self insure!!

Page 29 lines 4-16 in the HC bill: YOUR HEALTH CARE IS RATIONED!!!

Page 30 Sec 123 of HC bill THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get.

Page 42 of HC Bill: The Health Choices Commissioner will choose your HC Benefits for you. You have no choice!

Page 50 Section 152 in HC bill: HC will be provided to ALL non US citizens, illegal or otherwise

Page 58 HC Bill: Govt will have real-time access to individuals finances & a National ID Health card will be issued!

Page 59 HC Bill lines 21-24: Govt will have direct access to your banks accounts for elective funds transfer.

Page 65 Sec 164: is a payoff subsidized plan for retirees and their families in Unions & community organizations: (ACORN).

Page 84 Sec 203 HC bill: Govt mandates ALL benefit packages for private HC plans in the Exchange.

Page 85 Line 7 HC Bill: Specifications for of Benefit Levels for Plans = The Govt will ration your Healthcare!

Page 91 Lines 4-7 HC Bill: Govt mandates linguistic appropriate services. Example Translation: illegal aliens.

Page 95 HC Bill Lines 8-18: The Govt will use groups i.e., ACORN & AmeriCorps to sign up individuals for Govt HC plan.

Page 102 Lines 12-18 HC Bill: Medicaid Eligible Individuals will be automatically enrolled in Medicaid.. No choice.

Page 124 lines 24-25 HC: No company can sue GOVT on price fixing. No judicial review against Govt Monopoly.

Page 127 Lines 1-16 HC Bill: Doctors/ American Medical Association The Govt will tell YOU what you can make! (Salary)

Page 145 Line 15-17: An Employer MUST auto enroll employees into public option plan. NO CHOICE!

Page 126 Lines 22-25: Employers MUST pay for HC for part time employees AND their families.

Page 149 Lines 16-24: ANY Employer with payroll 401k & above who does not provide public option pays 8% tax on all payrolls.

Page 150 Lines 9-13: Businesss with payroll btw 251k & 401k who doesnt provide public option pays 2-6% tax on all payroll.

Page 167 Lines 18-23: ANY individual who doesnt have acceptable HC according to Govt will be taxed 2.5% of income.

Page 170 Lines 1-3 HC Bill: Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay)

Page 195 HC Bill: Officers & employees of HC Admin (GOVT) will have access to ALL Americans finances /personal records.

Page 203 Line 14-15 HC: The tax imposed under this section shall not be treated as tax Yes, it says that!

Page 239 Line 14-24 HC Bill: Govt will reduce physician services for Medicaid Seniors, low income and poor are affected.

Page 241 Line 6-8 HC Bill: Doctors, doesnt matter what specialty you have, youll all be paid the same!


JLM 7 years, 7 months ago

@ JK ---

Wow, that's a sobering commentary. A no baloney, well-informed and perfectly logical commentary supported by specific examples.




seeuski 7 years, 7 months ago

This guy can't stop campaigning and fibbing. He is a Union man and is why I don't want the Gov anywhere near my health care. 95% of Americans did not get a tax reduction. The stimulus is not working as unemployment is at 10% the highest in 26 years. And everyone knows the stimulus package was all pork just ask IG Gerald Walpin who was fired for uncovering an $800,000 payoff to Obama's buddy Kevin Johnson. Fibs.


WesternRabbit 7 years, 7 months ago

So sorry, but health care reform somehow got changed to health care insurance. Health care has to become more affordable for the common man without insurance! The last thing a patient and a doctor needs is a third party who thinks he knows more about treatment for an individual. Let us throw out both the baby and the bathwater. Drive the cost down and there is no problem. Just my 2 cents.


Reader 7 years, 7 months ago

I hope we see a government option because only the government is in a position to offer any competition to the insurance companies who are in the "business" of healthcare to make a profit. When people say they don't want the government involved at all it seems to me they are saying they'd rather have health care managed/rationed by a corporation.

I hope we see a government option because, having had cancer despite my healthy lifestyle, I doubt I will ever be able to qualify for insurance again until I'm 65. Going without health insurance is frightening. Medical expense is the largest cause of personal bankruptcy in this country.

I hope this country can see the benefit of investing in basic healthcare and better education instead of clinging to the idea of "free market capitalism" where those with the most money make the rules that keep them rich and able to operate at an advantage over the less rich.


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