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Health Care Reform — Can We Talk?

August 20, 2009
by Rich Temple
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I am watching the health care reform debate swirling around our country with a substantial degree of horror. This has got to be one of the most profound debates our country has had in decades, with legitimate concerns and opportunities offered by both sides, but yet as we learn about about the evolving “discussion” in the mass media, there is pretty much zero analyses of the facts and implications of the various options being considered. Emphasis is on pithy, frankly nonsensical slogans like “death panels”, “socialism”, “Nazi tactics”, and other types of phrases that have no place in this discussion.

I am going to try to be as apolitical and non-partisan as I possibly can as I write this. As I see it, the health care reform initiative(s) being considered by Congress strive to accomplish the following goals:

· Offer an opportunity for the 46 million uninsured Americans to obtain insurance and reduce their families’ vulnerability to potentially devastating illness

· Remove the cruel and exploitative (sorry, lost the non-partisan thing there for a moment) use of denying claims for “pre-existing conditions
  • Cease the use of “lifetime caps” in reimbursement that can mean that even relatively well-insured families could get wiped out by a significant medical event

· Reduce the rates for everybody by mandating inclusion of all people (including healthy ones, who will benefit in their later years from this when they are not quite so healthy) in the general insurance pool

· No dropping of coverage by insurance companies for patients who are seriously ill

I am not entirely sure what is not to like about the goals described above, though clearly some of the approaches being proposed to accomplish these goals have touched nerves on all sides of the political spectrum. Perhaps we could take it as a given that these are laudable goals to aim to accomplish and agree on that and move from there.

The ‘Public Option” – you would think that there was absolutely nothing more to this bill than the fact that there might be a new government insurance program being introduced. Now, certainly there are pros and cons to a public option, I freely concede that, but let’s TALK about those. The sole role of the public plan in this whole health care reform deal is to kind of force insurance companies to be reasonable in pricing insurance for those who are not or otherwise could not be insured by introducing some vigorous competition into the selection process. Let’s ask the question if the legislation is giving the government health plan an unfair advantage in the marketplace inherently by its apparent unlimited access to capital and its lack of need to make a profit. And, If those present an unfair advantage, is that necessarily a bad thing?

It is also worth pointing out that we already have a national public plan. It is called Medicare. It is a fact that Medicare has been a far more efficient insurer than any of the commercial insurers out there in terms of its overhead and in terms of its efforts at health care cost containment. It is also a fact that many hospitals lose money on treating Medicare (and, even more so, Medicaid) patients and the Public Option could exacerbate the financial hardships that hospitals are. Let’s inquire as to whether outcomes are better for Medicare patients. Let’s debate about whether the Canadian system has better outcomes and lower mortality rates than the US system (it does), even while spending 60 cents on the dollar compared to what the US spends. Sure, there are problems with that system; getting elective surgery, for instance, can be a challenging proposition in Canada. But when massive media attention is given to an individual who disrupts a health care reform town meeting screaming “get your government hands off my Medicare”, I feel our media and our society has totally lost its bearings.

The concept of “health care co-ops” is a notion that is meant to address some of the same issues that the Public Plan does, but without direct government involvement. Let’s dive into how the current “health care pilot” co-ops are working and how they might work if greatly expanded on to a national stage. Can insurance be offered across state lines? How would those co-ops be funded?

Socialism” - every other developed country in the world has a government-centric or single payor model (i.e., “socialist”) for health care reimbursement – including pretty much every country we look at as fellow democracies. Does our American genetic wiring necessitate that we offer different packages of insurance options, perhaps mostly from the private sector? Should capitalistic competition not have to stop at the door of the health care industry? The buzzword is “choice” – but do we really have choice of doctor and free rein to get whatever health care we think we need in our current private managed-care environment today? Would a government-run program provide more choice (think Medicare)? These are all important and valid questions and our society should be debating them in a non-vitriolic, constructive way.

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I also hate having to be non-political, I guess it's part of the PC ethos. It seems to me a few points have been overlooked in the reform discussion, most notably, where's the message, but let's not waste anyone's time going there.

Most extremists in the reform discussion will agree that the idea of everyone have access is good, independent of how it's funded or implemented.

That being the case, can't a reasoned argument be made to meet the needs of the uninsured and the underinsured without having to toss out what works? Can a business case be made to somehow cover those people in a program similar to Medicaid/Medicare, or to even include them in the existing programs?

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Rich Temple

Chief Information and Business Intelligence Officer, AristaCare Health Services

Rich Temple is the Chief Information and Business Intelligence Officer for AristaCare Health...