Wednesday, July 29, 2009

The Health Care Overhaul

Dear Readers,

With the whole country focused on the health care crisis and what to do about it, many who profit under the present system are trying to confuse the issues and delay progress in the hope that the movement will lose momentum.

In a recent comment to one of my posts, Sue made the following remarks, which she has since expanded upon at my request. They represent such a clear, rational summary of the main points we need to keep in mind, that I they are well worth repeating here:

Changes need to be made in the American health-care system. First, it is unconscionable in today's world that health care is dependent on employment. That made some sense in the era when people (meaning men) went to work for a company right out of school, spent their entire careers there, and retired a few years before their probable deaths from old age (at between 65 and 72). There was an unwritten contract that employees would be loyal and that employers would take care of their workers. This generally included health coverage for spouses and children. Now, of course, neither employers nor employees expect a lifelong employment relationship. In fact, many former employers now contract for temporary workers and workers may hold several jobs simultaneously. In this environment, employer paid or employer sponsored health coverage just doesn't make sense--much less work. And, for this reason, any health care coverage needs to be for everyone, not just for those who currently lack coverage. In other words, we need to disconnect the employment--health insurance connection.

Second, premiums range from outrageously expensive to totally unaffordable: both for individuals and for employers (especially the small businesses that make up the bulk of the employers in this country). The small company where I work is being hit with a 26% increase for the coming year, which is typical. Individuals and families will easily pay two or three times as much as individuals as they would as members of even a small group. And yet, if we were a larger company, our premiums would be lower and our coverage better.

Third, medical providers tend to be paid on a "per service" basis, which encourages them to order expensive tests and treatments and to see more patients than they can easily accommodate. Paying medical providers salaries rather than on a service basis could go a long way towards controlling costs.

Fourth, (and this goes right along with point three) we need a good peer review system to assure that the tests and treatments ordered are consistent. This doesn't mean that research facilities would be precluded from developing new approaches or pharmaceutical companies new medications, but it would assure some level of consistency.

Fifth, health care needs to be structured to emphasize preventative care. HMOs have received a bad reputation, due in part to the poor business practices of a few, but there are good ones. Kaiser Permanente and Group Health Northwest manage to take good care of their patients/clients while controlling costs and providing a high level of service. They could be excellent models for programs throughout the country. Also in this area, any program needs to include dental, vision, and prescription coverage to address all areas of preventative health care.

Finally, health care doesn't need to be a "single" provider to be reasonably cost effective. Choice is a good thing, but the choices should be realistic. We can't afford to have people running from doctor to doctor to find an agreeable diagnosis/treatment. Sure, this means a few people will be unhappy, but the vast majority will find their options more than adequate. Medicare and good HMOs are a good example of this: you can choose your doctor/facility within pretty broad parameters.

The Preamble to the Constitution includes as its raison d'etre "esablish[ing] justice" and "promot[ing] the general welfare"--two things that a reasonably thought-out health care plan would accomplish.

As to cost: if the money now being invested in employee health care by governments and corporations were pooled into a national program, I think we might find that we could cover all the people in the country for very little more than is now being spent on health care. Seems like we should give it a try.

While we may never agree on every point, this issue--unlike the economy--is one on which every one of us has some expertise. Almost all of us have fears, risks, and limitations associated our lack of adequate coverage or the costs of insurance. It doesn't take an economist to know that the public system, if it's not fixed, will soon be bankrupt. We really have no alternative but to get on with it.


Idna said...

Sue makes some very good points in her post. And as we wait (or shudder)to see what the DC politicians will force on us we should really examine what the real problems are with health care today. What is currently working and what isn't.

There is a whole list of things that drive the price of medical care up: Medicare and Medicaid, great new technologies, government regulations, malpractice suits, overuse of medical care and fraud, not to mention the freebie ER room treatments given to everyone who shows up (whether they could pay but choose not to or are illegally in this country.)

There is a fabulous article from the New Yorker Magazine that I ran across. It addresses many issues in a non-political way. Shows what IS working and what isn't, and why. It is a really long article, but I would highly recommend it to anyone who is truly interested in understanding more about the health care discussion.

Here's the link:

Anonymous said...

I'd like our legislators to look into this idea of medical co-ops, before they get the government involved. I believe that the public, the doctors, and the insurance companies can work this out. The government's role is simply to say, "Do it -- or else."

The insurance companies understand now that they are under the gun and have already begun to come up with solutions such as figuring out ways to cover those with pre-existing conditions.

Maybe we could form up non-employment-related co-ops. Each co-op takes a certain percentage of those with pre-existing conditions or those who can only afford minimum premiums. If we allow these co-ops to make a profit, they will compete for business and the consumer will be able to choose which co-ops program meets his/her needs. The coverage is portable, so if you move from coast-to-coast, your coverage goes with you, just the way your Medicare coverage is good wherever you are.

Every government program I know of is in financial trouble -- Medicare; Medicaid; the VA system; Walter Reed Hospital. We have no evidence that the govt. can successfully run a cost-effective national health care program. They have a history of reducing reimbursements, limiting coverage, and closing hospitals, none of which help the person who needs medical help.

Barney Frank says straight out that getting the "public plan" into the current legislation is the first step in getting a "single payer program."

If you want to severely clog up a system, make it free or nearly free one for at least part of the population. That segment will come fogging in. After all, who among us doesn’t like to get something for nothing.

Also, since the govt. will set the regulations for the reformed health care, I don't think they should be involved as one of the regulated parties. It just doesn’t make sense to have them on both sides. Just monitoring all the transactions and telling us all what we can and can't do will require a HUGE bureaucracy, most of whom will be completely unqualified to make medical decisions. They will sit in offices and look at their actuarial tables and decide whether it’s cost-effective to let you have a treatment.

Finally, let’s not confuse coverage with care. Although the number of uninsured has jumped from an estimated 26 million to 50 million during the discussions of the last month (!), many of the uninsured receive care through the process of cost shifting, i.e., those of us with insurance pay higher premiums and higher costs at the doctor/ER and in so doing provide coverage for the uninsured. That might still be cheapest option.

Citizen Jane said...

Hello, A,

First, the current system is WAY broken. Changes need to happen, and very soon. I think everyone agrees on that. I don't think insurance companies--which for decades, like all good companies, have been raking in dough and reducing their output as much as possible--would be the least bit interested in making changes if it weren't for the fact that the government has weighed in.

That said, everyone who is seriously trying to solve problems in good faith wants cooperation and compromise; that's the best way to get things done. (We both know there are plenty of legislators who lack that "good faith," although we may disagree about who they are.)

I don't think any of the government programs you mentioned are evidence that the government "can't successfully run a cost-effective national health care program." In many ways, those programs have all done the job for many years--although we all agree that the "cost-effective part" needs work. However, the programs--and Walter Reed Hospital--are obsolete and need to be revamped or reinvented. That will happen if most of our collective energy is focused on solving the problems rather than demonizing those who are sincerely working toward positive change.

Thanks for your thoughtful comments! I think these kinds of discussions can move us all along toward mutual understanding and, ultimately, constructive change.