Successful Health Care Reform
2012
We seem to be consumed by the debate on the proper role of government in the economy. We have recently seen an unprecedented intrusion by government into the private sector. The budget deficit for this fiscal year is projected to be $1.7 trillion, and large banks have almost been driven to the point of nationalization. General Motors is very nearly on the verge of becoming Government Motors.
Major discussions in Congress have been held that indicate there will be a significant expansion of the role of government in healthcare. The debate between the function of government in healthcare goes way back to the time of the presidential candidacy of William Jennings Bryan and remains as controversial today as it was then
Today, our position in the world economy requires us to have a healthcare system that is as efficient and effective as possible. It should be built on the strengths of both the private and public sectors. We should, however recognize the significant distance we have already come on the road to a government dominated healthcare system. The Government already pays nearly 50% of all healthcare expenses. The new Medicare drug plan, and the Children’s Health Insurance Plan (CHIP) are major new government programs that have recently been implemented and are examples of the accelerating growth of the government in healthcare. It is striking to note that even with the implementation of these various programs and efforts to improve the system significant problems still remain.
A recent survey indicated 59% of the population has access problems, and 50% reported that they are dissatisfied with the present system. The fringe benefit tax deduction unfairly favors those with employer sponsored health insurance. Those with minimal insurance or none at all often are forced to delay healthcare services. The cost of healthcare is overbearing as healthcare currently consumes over 16% of the GNP compared to 7% in 1970. Employer health insurance premiums rose at a rate of 9.8% annually since 2000, almost twice as much as the CPI. Primary care manpower in key areas is in short supply. The cost of mal-practice related expense is out of control as most lawyers want citizen juries and providers favor specialized Medicare Liability Courts. Also, the reimbursement system for the treatment of those with chronic disease has incentives that reward quantity of services rather than treating the chronic condition. Over 95% of healthcare expenses are spent treating problems after they occur.
Under the present administration solutions to these challenging and lingering problems are most likely to be addressed by a larger role for government. Many proposals have been presented for review and discussion. The biggest issue that all agree on is that there is no way we can continue to provide healthcare services at the present rate and remain financially sound as a country.
The foundation upon which reform can be built has a wide array of approaches that span the entire spectrum from a minimal role for government that emphasizes the private sector all the way to a government run universal plan. However, there is a lot of agreement on the pillars that successful reform must address. Some of these major pillars are listed below.
Health insurance and services must be affordable
Health information technology should be utilized to produce computerized and transferable medical records.
Mass consumer health information including price and quality transparency must become available in a basic and understandable format.
The low income must be provided proper financial assistance.
Changes in the Tort system must bring a solution to our current malpractice problem.
More provider incentives to better treat the increasing number of the chronically ill must be developed.
Reimbursement systems should be changed so that they do not promote inappropriate, unsafe, or wasted health care services
Improve end of life care with the ethical use of effectiveness studies.
Have realistic expectations of what our health care system can do.
Emphasize and provide incentives for wellness and prevention.
Increase incentives for the consumer to take responsibility for their health. and provide incentives to control risk factors such as obesity.
Move the emphasis of the healthcare system toward primary care.
The following elements of a plan for reform would hopefully lead to all being covered with some type of insurance. This plan contains some of the more popular proposals that have been presented.
The federal government provides catastrophic insurance for all.
Require all citizens to have insurance, remove pre-existing conditions, and require community rating of insurance policies.
Establish a comprehensive set of required benefits for insurance policies which have a basic range of services as an option. Allow the purchase of insurance across state lines.
Government insures a level playing field for private insurance competition.
Require the availability of basic price and quality information that promotes incentives for a competitive environment in primary care.
Remove the tax deductibility of health care benefits provided by employers.
Allow for a Roth type HSA available to all. This would be in conjunction with a high deductible health insurance plan.
Provide vouchers for health insurance to the low income.
These are just a few of the elements that could make-up a reform proposal. Our history of muddling through has almost always worked in implementing reform. It will be of great interest to see the actual reform that healthcare that will take.