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(HealthNewsDigest.com) – When it comes to the emotional healthcare debate raging across the country, there is one central point on which most Americans agree: we need to reform our healthcare system. Whether there is any one issue that resonates more than another is somewhat irrelevant if you focus on the healthcare problem in its most global form. The other point to consider is whether or not we as a society are prepared to make the choices that are required and commit to getting something done. This is going to be a long process and it will not be solved all at once.
First, too many people in this country do not have access to affordable, quality healthcare because they are uninsured. Secondly, and equally as important, for all those people who say they have insurance and like it the way it is; be aware. It takes one catastrophic illness for someone to realize they are vulnerable in our current system with uncovered services, high deductibles, lifetime caps on coverage or even worse, getting dropped from insurance. It is important to understand that if you are not covered by Medicare, the system for those over 65, you would have some level of risk if something goes wrong with your health. A recent Newsweek study showed over 50% of all bankruptcies are caused by healthcare related issue. Given the mortgage crisis, it is all the more shocking to see healthcare top the list. It is for this reason, the system needs to change.
Whether we have the public plan or we leave it to the private insurance industry with heavy government regulation is a debate for which there is no one right answer — each side, including all the various interest groups, can effectively argue the pros and cons of each plan. It is for this reason the reform process should start slowly, without making radical moves so we can figure out what is going to work well without destroying what good there is in the system today (yes, there are good aspects of our healthcare delivery system). So what does that mean in terms of a governmental plan vs. leaving the government option out? It means we can try both. Either way, the health insurance markets need to be regulated. While we have allowed them to function as they do today for a long time using our capitalists principles, the industry can no longer function under the current model. The public has decided it is time to regulate the sector, albeit leaving some capitalist principles intact. On the government plan, it would not hurt to try it out in a region somewhere in the US on a limited basis.
Massachusetts has been touted as a real life test case whereby a single state reduced its uninsured population without over extending the state budget (which is now subject to debate), however, it important to remember 3 key points. First, the percentage of uninsured in the state was already lower than the national average. Second, Massachusetts previously spent more money on healthcare for the indigent (charity care) than many other states, and finally, there are many studies that claim it is a failure. Certainly, their approach to managing the costs of the program should be incorporated into any health insurance reform package. Fundamentally, testing the government plan in a larger and more diverse region will allow America to see what happens to small and big business, individuals, doctors, and hospitals along with helping to understand the true costs implications. It would either prove or disprove the theories of whether self insured companies (big business) would drop employee coverage and move to the government plan. And finally, perhaps most importantly, it would show if physicians would accept the insurance (and the fees paid) and see all the patients that are newly insured. If it does not work, it’s localized and can be ended without disrupting the overall healthcare delivery model.
Any way you look at it, healthcare reform is going to be expensive — there are really a limited number of options: raise taxes, cut spending or combinations of both. Most people are against raising taxes, especially in a recession. On the flip side, people do not want limits on their medical coverage. There are countless other mechanisms to raise funds — whether one calls them taxes or not is important. They cost taxpayers more. The second would be to cut the waste that is in the system today. Rest assured; there is a tremendous amount of waste. Society needs to come to terms with the difficult choices that need to be made today. Whether it is limiting benefits on extremely expensive drugs (a drug that only extends life for 60 days) or expensive equipment that only marginally improves the diagnostic testing capability currently available are fair questions that can and should be asked. Collectively, we can develop the answers and improve the system although no outcome will be perfect.
There can be new payment mechanisms to reward hospitals and doctors for keeping people healthy and not by paying per test but transitioning to this model takes time since doctors and hospitals have fixed and recurring costs that are encumbered under the current system. We can reform the malpractice system so physicians are not forced to practice defensive medicine which is extremely costly because of the need to order excessive tests and pay for high jury awards. These questions all require honest discussion, real answers and careful planning — switching overnight to a new system can be irresponsible and dangerous. On the other hand, to ignore the problems and leave the status quo is far worse. Congress needs to be careful and methodical in listening to the experts and move cautiously. That will be the only way to accomplish reform we need and can afford.
What cannot wait much longer is the need to tackle insuring all Americans. The key will be to figure out the right level of coverage. Congress is planning a hybrid approach whereby certain minimum levels of coverage would have to be offered and the rest would be designed by the private sector. In truth, with a government plan establishing minimum coverage standards and designing modified benefit packages, along with setting the prices, the private sector will have no choice to offer the same coverage at the same prices. If that results in lower reimbursement to the physicians and hospitals, we could be in a situation where there would not be enough providers to see the patients (and accept the insurance). A fine line will have to be drawn here — again, another reason to go slowly.
To keep the cost of reform manageable for the taxpayers, we are going to have to ensure that while all Americans carry insurance, we may not be able to afford providing comprehensive coverage to everyone right away. Specifically, a comprehensive benefit plan with low deductibles/co-payments/coinsurance levels will cost the government much more than a more limited plan that protects the insured with modest benefits and prevents catastrophic losses. Those who cannot afford to pay for insurance should have financial assistance. The assistance will depend on the cost of the plan which is why less may be more in this case. In other words, some coverage is better than no coverage.
I believe most Americans will support legislation that protects people from going broke or saddled with insurmountable debt when confronted with a personal health crisis. There is still much more detail to be addressed in Congress. Only then will Americans be able to evaluate the options. Right now, there is not enough information. Congress and the President need to explain more of the detail if there is going to be meaningful discussion on reform. In the absence of meaningful information, the public, relying on others to interpret what is going to happen, can be mislead very easily. That is the most dangerous part of healthcare reform. Bad information will lead to bad decisions and no reform.
The rhetoric on both sides of the aisle regarding health care has reached epic proportions. The general public is still in the dark about what the health care debate will mean to them. People are really nervous. Confusion prevails. What is need are straight forward facts and useful explanations.
Andrew Rubin is a hospital administrator and Vice President Clinical Affairs at NYU Langone Medical Center and host of Health Care Connect on Sirius/XM.
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