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Health Care Reform: Reform or Politics?
By Dr. James DoveHealth care reform is moving forward at a fast-pace, albeit not as fast as the President would like. As I write this, the House and Senate committees are debating legislative language. These initial ideas are far more reaching than just providing access to care for the uninsured. There are programs and subsidies that are very generous and costly. Reform or politics? Let me make it absolutely clear that I am a strong advocate for health care reform but not reform based on political expediency.
The rhetoric and partisanship have intensified. Both parties and the President are at fault for these antics. The debate on health care reform should be about improving health care quality and access while reducing the unsustainable growth in cost. Also, we need policies that promote patient compliance and address managing the ever-increasing chronic disease burden.
We have the best health care system in the world if you have access to it. The World Health Organization (WHO) rankings have little to do with the care you receive daily. These rankings have much more to do with tax-supported health care and equal access to care. In fact, a country with national health insurance of poor quality scores well by this measure. These are important societal issues but they are not the quality of care they have been portrayed to represent. There are reasons why many internationals flock to the United States for health care. Longevity in the United States is the best in the world if you subtract the deaths from auto accidents and homicides. These deaths are not because of poor medical care. The survival rates for cancer in the United States are the best in the world for 13/16 common causes of cancer. Rhetoric about the WHO Report has been propagandized as part of a political agenda. The American people want straight talk. They are not getting it. Both political parties and the President are at fault on this issue.
You’ve heard the rhetoric about how much preventive service will save in health care cost. The truth is that 80% of those preventive services cost more than they save. Make no mistake about it, they are the right thing to do; but don’t count on the cost savings that are being proclaimed.
Remember, one of the driving principles behind health care reform was to cover the uninsured. So far, the bills presented and evaluated by the Congressional Budget Office (CBO), have fallen far short of covering most of the uninsured. The benefit plans and subsidies are best characterized as politicians going to the candy store. Insurance premium subsidies have been proposed for families at 500% of the federal poverty level. That equates to premium subsidies for a family of four with $110,000 a year income. If you are in that category, you might say, great. Remember the adage, “There is no free lunch.” These benefits are unsustainable, and the CBO has so informed Congress. The insurance reform measures proposed, such as fair play rules for commercial insurance, Health Advisory Council to decide on a package of basic benefits, and an insurance exchange system to simplify comparison shopping among various plans, are good.
Changes in the delivery of health care are an important goal in improving quality and efficiency. Accountable care organizations (networks of providers and hospitals) are ways to improve coordination of care, efficiency, and quality. Currently, 85% of the health care delivered in the United States is outside of integrated systems. The sheer magnitude of this change in health care delivery will require pilots to evaluate the best structures. Until now, our government has prevented these systems from developing among individual practices because of antitrust laws. Amazing, isn’t it – government policy interfering with quality health system development? Call me when you hear any admission of guilt from the Federal Trade Commission. Promises have been made that this will change.
There are other legislative proposals that are ill defined about community health teams, community living assistance, preventive medical services, and support of workforce development to promote primary care and nursing education. What is glaringly absent in all of this legislation is any discussion about our out of control legal system. This is driving defensive medicine at a cost reported by PricewaterhouseCoopers to be $210 billion a year. The CBO report did not identify defensive medicine as a huge cost issue. Talk to any physician and you will know that the CBO report is not correct. Correcting our dysfunctional legal system will more than save enough to cover the generous benefits that Congress has proposed. The will to do so is not there because of intense lobbying efforts. There are solutions that are workable and that protect the injured. The Health Care Reform discussion, that is going to affect every aspect of our health care system, has not addressed tort reform. It must be part of any reform package.
Now is the time to contact your Congressional representatives and tell them that you want health care reform based on these principles:
1) Universal coverage and access to care
2) A mix of private/public insurance plans with fair play rules
3) High quality, patient centered care
4) Insist that patients, physicians, and the medical team are at the center of crafting the new health care design.
5) A basic health care benefit package determined by an inde pendent body
6) Insist that the leakage of health care dollars from the system caused by excessive insurance company administrative costs and profits, excessive pharmaceutical costs, and an out of control legal system are part of the solution.
Patients, physicians, and other medical personnel need to be back at the table in designing this system that builds on the quality that is already there while improving access and coordination of care. This system should not be designed by the bureaucrats.
Nobel Laureate Economist Milton Friedman said:
“We have government of the people run by bureaucracy for the bureaucracy.”
ealth care reform should be developed by the people who use it and deliver it – not behind closed doors by people who have a poor understanding of the intricacies of health care. Where is the transparency that we were promised?
