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(HealthNewsDigest.com) – America wants health care reform. They’ve made that clear in their votes and in their letters, and it’s been revealed in poll after poll after poll. But Congress and the White House seem to be tone deaf, perhaps entirely deaf. They aren’t hearing us. Or maybe they’re just ignoring us.
Obama seemed determined not to make the mistakes the Clintons did. Rather than submitting a detailed, pre-designed plan that stole legislative initiative from Congress and left the plan open to continual carping by opponents, Obama chose to outline his broad principles and then let the Congress draft legislation, as they’re charged with doing under the Constitution.
His first ideas offered hope for a bipartisan approach: He wanted transparency, pay for performance for physicians, lower payments for high readmission hospitals, technology research to determine effectiveness, and improved access to insurance for the uninsured. Insurance companies, long seen as the enemy by some, were even prepared to go along with the attempt to ensure that all Americans had access to affordable coverage.
But somewhere along the line something went terribly wrong.
The House chose to ignore anything that resembled a bipartisan bill, running roughshod over more than 90 GOP amendments in the three committees that generated proposed legislation. Liberals, firmly in control of Congress, refused to pass any legislation that didn’t include a “public offering.”
The Senate’s two committees passed nothing prior to the August recess, if for no other reason than to at least attempt to generate a bill that would garner some Republican support so as to avoid a filibuster.
During the August recess the American public, sometimes less-than-politely, rendered up a resounding “NO!!” to the proposed offerings from the House. But rather than listening to their constituents, many chose to denigrate them instead. The push for a full-blown public option was presented, and the particulars of the offering virtually assured that within five years private plans would be driven out of the market.
The Senate Finance Committee finally came out with a bill that, while flawed, at least attempted to offer a solution without forcing a socialized solution down a non-socialized country’s throat. Liberals in the Senate immediately announced that they would attempt to add a public option to the bill on the floor of the Senate, virtually assuring a filibuster (unless Senate Majority Leader Reid attempts to bypass it via reconciliation, a.k.a. the “nuclear option.”)
47 Million Uninsured—a Misleading Number
The motivation for a “public plan” seems to be the oft-repeated factoid that “47 million Americans are without health insurance.” That very handy, scary number is misleading, however.
First, it’s a river, not a pond. The people in that uninsured group change. Daily. Past studies have shown that up to half of uninsureds are “between jobs” and are covered within less than a year.
Second, it’s not really 47 million. Within that 47 million:
Are 9 million illegal immigrants — to whom the public doesn’t want to provide free insurance.
As many as 7 million are eligible for Medicaid but haven’t yet signed up (when Massachusetts implemented “universal” coverage they found 15% fit that description).
Another 5 million, by past experience, are just plain wrong – they have coverage but have forgotten it because they don’t pay for it.
Another 10 million to 15 million are eligible for healthcare at work but don’t feel like paying the premium.
Do the math. Subtracting out those who we shouldn’t cover, those who are or could be covered, and those who “don’t feel” like paying their share of their employer’s plan, we’re left with 10 million to 16 million truly uninsured, some large fraction of which are between jobs and will be covered within months.
The Way Forward
So where do we stand today? Most would agree that:
We need to rein in health care costs.
We need to help get affordable coverage for lower-income uninsured
We need to protect the relationship between the patient and the doctor
We DON’T need to completely rebuild a system that more-than-adequately serves 285 out of 300 million Americans… destroying that which serves 98 percent of the public so as to find help for the other two percent just doesn’t make sense.
How, then, should we proceed? Here are several ideas, some from the Administration and its team, others from the private sector, and some from the GOP. Each of these things would help solve the problem without budget-busting implications.
Stop paying for medical mistakes. Medicare and some private plans are doing it, and the rest should. A provider’s mistake should be his cost, not ours.
Fund and widely publicize best-practices research showing which treatments are truly most effective. (Many say 30 percent of treatments add no medical value whatsoever — wasting the cost of those treatments.)
Reduce payments for ineffective treatment procedures.
Mandate transparency of cost and quality outcomes for doctors and hospitals. Make it readily available and easily accessible by the public. Educated consumers make wiser decisions.
Reward wise health selections. Share savings from wise provider selections with those users who choose appropriate providers (tiered networks, deductible and copayment subsidies, etc.).
To facilitate electronic medical records and claims submissions, require that doctors adopt technology. Make its adoption mandatory by a reasonable future date. Subsidize it where necessary.
Subsidize and encourage tele-medicine. For instance, Dana Farber Cancer Center in Boston provides a consulting service for cancer diagnoses, and they find that they change, negate or amend 70 percent of the diagnoses sent them!
Identify, develop and publicize “centers of excellence” for complex, infrequent or expensive procedures. Studies have found that such centers can achieve better clinical outcomes at a 40 percent lower price.
Find a way to require carriers to eliminate pre-existing condition limitations without bankrupting the insurers. Allowing someone to wait until they have cancer before they buy insurance is inappropriate at best, thievery at worst. Mandated purchase coupled with significant non-compliance penalties is one approach.
Allow cross-border purchase of insurance by individuals not insured by employer plans.
Approximately 85% of the uninsured have incomes below 300% of the poverty line. It would surely be cheaper to subsidize those people than to rebuild the entire system.
Reducing health-care costs is a problem that neither Congress, nor the President, nor the insurance companies can address alone. Only we, individually, can really do something about our own health care costs by living, eating and exercising well. Employers can help us; so can insurance companies and medical managers, but it’s eventually up to us. And when each of us does what we ought to do, health-care costs will go down, or at least moderate.
There are conditions and personal choices that influence how much medical costs an individual will likely incur. One large employer, Hannaford, a Northeast grocery chain, has identified behavioral and medical indicators predicting employees’ likelihood of claims.
Employees with five or more such indicators (smoking, overweight, obesity, depression, sedentary lifestyle, etc.) will likely experience claims more than twice as large as those with three or four indicators. And those with three or four indicators will incur claims about twice as high as those with two, one or none.
Consistent with protecting privacy, we have to allow medical managers to reach out and work closely with those in the pre-serious disease stage to rectify their conditions before they become serious.
Moreover we need to penalize those who don’t participate in their own well-being. That’s counter to the politically correct dictates of our time, but it’s the only way to solve the long-term problem of medical costs.
What’s more, it goes back to a unique idea: we should be responsible for and pay the cost of our own behaviors. What a radical concept.
Jim Edholm is president of Business Benefits Insurance (BBI), an employee benefits planning firm in Andover, Mass. For more information: www.bbibenefits.com
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