As we continue the rush toward health care “reform” – a misnomer in the making, perhaps it is time to recap where we have been. Frankly, I am a bit confused myself. After reading so many versions of this concept, participating in numerous conference calls and meetings and speaking with the staff of a dozen members of Congress, I can’t remember who told me what, but I do remember they told me conflicting “facts” and they were all Democrats.
Yes I remember now, they all told me they were going to save the Country from certain crisis if health care costs were not controlled, but they were unclear as to who was going to benefit. On the other hand, I have been hearing that same song since 1978 or so and I am still waiting for that universal health care ID card that Bill Clinton held up in his first State of the Union speech. However, I must admit that when GM lamented over the $700 per car that represented their health care costs back in the 1970s they were on to something, but they too failed to do anything to correct the problem and you know who ended up paying for that. One has to wonder if nobody can fix a problem, is there a problem to fix? Perhaps Americans like paying a lot for what they believe is good health care.
From the start, the health care debate has been more about expanding coverage to the uninsured than truly reforming the health care system. In fact, along the way, the debate became reforming health insurance and as I write this, the insurance companies have managed to make themselves the villains again drawing the rath of the White House before providing Pelosi and friends more fuel to push a public option.
Competition among who, could it be among health care providers? Nah, that would be too logical
When there is talk of saving money is it about the federal budget, when there is talk about making something affordable it is about subsidizing premiums to lower the cost to the individual or expanding Medicaid. Even when there is talk of changing the system, such as comparative effectiveness studies it is in the context of Medicare. The Senate Finance Committee bill calls for a new Medicare panel to manage costs without lowering benefits or cutting payments. Translate that to some form of rationing as that is the only option left.
If you among the people who believe that we can have all what we want, when we want it and that any expense can be justified in some manner, I ask you to simply take a look at the federal and state budgets, the deficits and the collective taxes you pay. If you like what you see…stop reading Quinnscommentary.com
Members of Congress and large segments of the population see insurance premiums as the cost of health care and the cause of our woes. In fact, premiums reflect true costs not the other way around. Large emploeyrs, including state govenrments are seeing double digit incrases in their health care costs for 2010 and they don’t even use isnruance companiens…how can that be, no CEO pay to blame and costs still out of control? Ask Nancy.
When there is talk about the need for a public option, the failures of Medicare are ignored. In fact, one commentator recently noted that Medicare “our most successful public option, is going broke”. GM was successful too, until it went broke. Again, we define success in health care reform as coverage for more and more people. I am not sure that is all we are looking for.
My point is that we are missing the point. We should be talking about the ills of fee for service medicine, the incentives to render more rather than the most efficient (or best) care, and the lack of clear definitions and application of quality health care. We should be curtailing the advertising in health care services that misinform and encourage utilization, the practice of defensive medicine and many of other real issues largely ignored by Congress in large part because they fear losing political contributions.
My wife recently had an ear infection, as part of the treatment she had a drain placed in here ear as they do for small children. The procedure took ten minutes in an outpatient center owned in part by the surgeon. The total cost for the ear infection was $18,300, including one office visit that was $2,000 because some hearing tests were done. When we confronted the doctor about this total cost, his response was essentially that the fees were in line with what others are charging and the insurance companies allow. How helpful! This is an example what needs reform because that is what affects the premiums we pay.
In addition, the rate of future increases will continue as they are and perhaps accelerate as we increase demand for services. Nothing in any of the proposed legislation will change that, especially for the next ten years at least.
Finally, many of the assumptions used in determining the cost of reform are either outright flawed or very poor guesses and the track record for staying within costs or even projecting them accurately is poor, especially over ten years when each succeeding Congress will do its own thing to tweak whatever is passed in 2009. Mirror, mirror on the wall who is the slickest one of all?
In short, this mess will accomplish one goal only. More people will be able receive medical care with someone else paying the bill and because that is true the demand for services will grow. Because providers will be paid less under Medicare and a public option, there will be additional incentives to provide more care to make up for the lost revenue. Because there is no reform of in the area of malpractice, the incentive to practice defensive medicine will continue.
I have spent 48 years managing health benefits, working with employees on claims problems, serving on HMO boards of directors, writing about health benefits, negotiating with providers and serving on a state health benefits commission. I wish I were wrong in this somewhat negative assessment of the current state of affairs, but my experience, history and even a touch of common sense tell me otherwise.
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Posted in Healthcare Tagged: comparative effectiveness, debt, health care rationing, insurance companies, Medicare, Medicare Advantage Plans, Medicare reimbursement rates, public option, Senate Finance Committee, UK health care
