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President Obama and his plan for health care reform
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Fast-forward to 2009. Fifteen years have passed since the Clintons were unable to usher through comprehensive health care reform. Health care costs are still hugely unaffordable for many. Parts of the provider community are eagerly hoping for change. Hospitals carry immense patient loads for which care is uncompensated. Physicians face seemingly insurmountable challenges with medical malpractice. Community health centers attempt to fill the gap in medical coverage by providing basic routine care to the uninsured even as their funding dwindles.
Americans see large amounts of their “disposable” income being drained by the costs they pay for their coverage and care. The number of uninsured remains in the millions (though we learned during the last debate that this cannot be taken on its face; while there are too many legitimately uninsured individuals, there are also a great many people who choose to not spend a portion—albeit a potentially huge portion—of their income on insurance, be it because they are healthy or would rather spend their dollars otherwise.) Oh, the list goes on and on.
Administrative costs must be lowered. A report released last year by the research group the Commonwealth Fund showed that, “administrative costs of the medical insurance system [in the U.S.] consume much more of the current health care dollar, about 7.5 percent, than in other countries.” http://allcountries.org/health/usa_health_care_2008_nyt.html This is important for both public and private health insurance offerings.
Another criticism levied about past reform efforts is that recovery of dollars lost through fraud and waste has not gotten serious enough consideration. While not easy, it would seem like an unquestionably necessary exercise. I applaud the President for forming a new task force to look at this issue. http://www.washingtonpost.com/wp-dyn/content/article/2009/05/20/AR2009052001782.html This is especially critical for public programs, such as Medicare and Medicaid, where fraud and waste run rampant.
Efforts such as this, if they yield effective results, coupled with efforts such as medical malpractice reform, could pay for a good deal of expansion and improvement to the existing system. For example, “doctors complain that ‘defensive medicine’ — ordering tests and procedures out of fear of being sued — drives up health costs.” http://www.nytimes.com/2009/06/15/health/policy/15health.html?_r=1&partner=rss&emc=rss&pagewanted=all
Another point of cost-savings could be to ensure that the appropriate care is delivered in the appropriate setting. According to a June 29th story on National Public Radio by Julie Rovner, Elliott Fisher, who is the lead investigator for the Dartmouth Atlas of Health Care, states that in parts of the country which spend fewer dollars overall on health care, “more care tends to be provided by primary care physicians, and patients in those areas are much less likely to spend time in the hospital for care that could be provided elsewhere.” http://www.npr.org/templates/story/story.php?storyId=106028653
Each and every person must be actively involved in their own medical care. Providers should be viewed as partners, not dictators, in our care. As a patient—or an individual seeking to not be a patient through preventative care—we bear the responsibility of asking the questions, and working to understand the answers. Health care should not be a luxury; it is a necessity. We all must play our part. Health care should not be treated as OPM (other people’s money)—we all pay, through increased costs and decreased access to care.
Uncompensated care simply drives up the cost for everyone who with health insurance. For example, allowing individuals to repeatedly utilize the Emergency Departments of hospitals as if they were walk-in clinics is unacceptable. Continued efforts to educate the population who abuse the system—whether knowingly or unaware of the correct way to proceed—must be done. Simply refusing care to these people is not the answer; nor is allowing this pattern of behavior to continue.
Programs such as “Kentucky Homeplace,” could help. http://www.economist.com/world/unitedstates/displaystory.cfm?story_id=13832443 As described in this story that ran in the June 11, 2009 issue of The Economist magazine, Homeplace essentially serves as an advocacy system, “employs about 40 “lay navigators” who work in the poorest parts of Kentucky helping people figure out what they need and how to get it.” Run by the University of Kentucky, Homecare’s employees act as patients’ ombudsmen, and help people negotiate the complicated web that is the health care system.
It is my hope that the debate will not devolve into the posturing seen a decade and a half ago. “Harry and Louise” did little to advance the substance of debate in the 1990s. http://www.economist.com/research/articlesBySubject/displayStory.cfm?story_id=13414128&subjectID=348960&fsrc=nwl
This time around, the President himself is functioning as the principal spokesman for “change” of the current system; Mr. Obama has taken much more personal, high-profile ownership of a health care reform bill—yet this may backfire. The President needs to maintain the high ground, ensuring that he can step in to negotiate a final law which does the most it can, and still be agreeable to the majority of players on the field. He needs to be inclusive, keeping all of the players at the table. His recent public scoff directed at the insurance industry will do nothing to bridge chasms. "If private insurers say that the marketplace provides the best quality health care ... then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business?" http://www.msnbc.msn.com/id/31502468/ns/politics-white_house/
He also needs to avoid the major misstep—on this issue, as well as all others—of making promises that are not within his power to fulfill. For example, on May 13, 2009 he sent an e-mail message to subscribers of White House e-mail updates which promised passage of a comprehensive health care reform bill by July 31st based on a conversation with (exclusively) Democratic leaders of the House of Representatives. We’ll see if the House sneaks something through in the next month; the Senate, because of its rules of procedure, it almost certain to not take definitive action during the next four weeks. His remarks in a press release issued that same day were less committal. http://www.whitehouse.gov/the_press_office/Statement-by-the-President-after-meeting-with-House-Democratic-leadership/
Industry-sponsored advertising campaigns against the proposals which have been introduced have started. For all of the general support they have proffered, the specific proposals on the table thus far have not involved the industries extensively in discussions, and they are chaffing at that. It must be said: having the players becoming entrenched in extreme positions that are at opposite ends of the spectrum does no good. Consensus building—involving all players, both public and private programs, and ensuring bi-partisan buy-in (everyone getting some of what they want, everyone having to give up something that they had hoped to see)—moves the ball forward. http://www.latimes.com/features/health/medicine/la-ed-health27-2009mar27,0,6849200.story
Undeniably, something needs to be done. (In 2000, the last time the World Health Organization [WHO] ranked health systems across the world, the United States was number 37, based on criteria including factors such as portion of gross domestic product spent on health care.) http://www.photius.com/rankings/healthranks.html “WHO Director-General Dr Gro Harlem Brundtland said: ‘The main message from this report is that the health and well-being of people around the world depend critically on the performance of the health systems that serve them. Yet there is wide variation in performance, even among countries with similar levels of income and health expenditure. It is essential for decision-makers to understand the underlying reasons so that system performance, and hence the health of populations, can be improved.’”
There are many, many facets of this debate to consider. The problems are not ones which can be solved easily nor quickly; the President is unlikely to see his legislative desire fulfilled in short order. The President is also at a distinct disadvantage; while this is really his first go-around, many of the other players involved are veterans of the health care reform wars.
The discussion has been on-going for years—literally—and history shows that the passage of health care reforms has had its best luck incrementally. There must be a unified, bi-partisan approach to solving the problems in the health care system. While the need for change is urgent, no change will certainly be worse than step-by-step change.
We all agree that serious problems exist. Improving the health care system and the medical safety net strung under all of us is not a liberal issue. It is not a conservative issue. It is a human issue. Yet, thus far, after decades of debate during which the problem has grown, an elegant solution remains elusive.
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