Progressive Regressive Health Care Reform
A Speech By Dr. Deborah Honeycutt at the CNP.
Government is filled with euphuisms and oxymorons these days. The former “Global War on Terror” is now the “Overseas Contingency Operation.” What about the old saying, “I’m from the Government and I’m hear to help you?” Certainly putting government and help in the same sentence is often oxymoronic. And now we come to healthcare system reform. Many think this is a euphuism for “Let’s throw a lot of money into the ailing system and hope it gets well.” I think it is an oxymoron because we don’t really have a health care system, we have a disease care system. The system is willing to pay tens of thousands of dollars to cut off a gangrenous diabetic foot. But it is unwilling to pay the couple of thousand dollars needed to educate patients on how to care for themselves so that the circumstances leading up to amputation are avoided. But, across the political spectrum many people agree that our healthcare system is dysfunctional and is dragging down our economy.
The events of this past Monday with President Obama’s announcement of Healthcare Industry Leaders pledging to cut the rate of growth of national healthcare spending by 1.5% each year from 2010 through 2019 giving an expected resultant savings of $2.3 trillion dollars over that time is admirable. I believe in miracles, but it has been a long time since anyone walked on water. If the savings do occur, patients, as consumers of healthcare, as well as the federal government which subsidizes healthcare through Medicaid and Medicare, will be benefited. President Obama noted that this voluntary growth rate cut is in addition to and separate from his plan for healthcare reform.
Recently, President Obama has said, “…Those who seek to block any reform at any cost will not prevail this time around.” On Monday, the same healthcare industry entities that have for decades blocked healthcare reform efforts became his political allies—or so it seems. But, politics being what it is (many tiny blood sucking tic vermin) the healthcare industry leaders have played a strategic hand—Pledging to do something that sounds like they are fully on the reform bandwagon. Of course, a few of us have pointed out that these healthcare industry leaders have not given any specifics as to how they will make the cost cuts, which are voluntary and at this point unenforceable. Maybe they will eliminate some of their own jobs as a start, since 1/3 of all healthcare costs are administrative—administration which adds little to the health of citizens.
“…Those who seek to block any reform at any cost will not prevail this time around.” This is all fine rhetoric, Mr. President, but even a lowly family medicine physician like me perceives that healthcare industry leaders are brown nosing. Get on your good side now so that as Congress writes your healthcare plan, the voices of the healthcare industry leaders will ring loudly in your ears from their seat at the table. But you can bet your bottom dollar that those same industry leaders will be fighting tooth and nail against a government-run, government-as-the-single-payer healthcare system.
So let me just bring you up to date on where we are with some congressional efforts to effectuate our President’s health care reform solution of “improving quality, lowering costs, honoring patient choice and holding insurance companies accountable” while expanding coverage to make our healthcare system accessible to all Americans, although I may have made a huge assumption that only our American citizens will be partaking.
Senate Finance Committee Chairman Max Baucus (D-Montana) released a comprehensive white paper in Nov, 2008 that encompasses Obama’s reform principles. This Baucus plan would establish a nationwide Health Insurance Exchange, allowing Americans to select from a menu of private plans as well as a new public plan similar to Medicare. (And we all know how well Medicare is working!) This new system would be overseen by another new government entity, the Independent Health Coverage Council, whose members would be appointed by the President and confirmed by the Senate.
Until this Exchange is established, Americans age 55 to 65 and disabled people could buy into Medicare. Once the Exchange is operational, all Americans would be mandated to obtain coverage, with subsidies available for those with lower incomes and small employers. Employers that don’t cover their employees would have to contribute to a subsidy fund. All Americans under the poverty level would join Medicaid. Laudably, his plan calls for greater focus on primary care and prevention, pays physicians for coordinating care, expands the use of medical homes and accountable care organizations. But of note is that workers receiving employer-paid healthcare benefits would have to pay income tax on that benefit. (I see this provision as another manifestation of the Robin Hood mentality—steal from those you think are rich and give it to those you deem poor.) Obama the candidate criticized this income tax on healthcare benefits idea. But Obama our president recently indicated that his administration is now open to taxing health care benefits. Adding a new tax that middle class workers will have to bear the brunt of is not my idea of change we can believe in.
There is another plan, the Healthy Americans Act that is currently being pushed in the Senate by its sponsors Sen. Ron Wyden, (D-Oregon) and Senator Bob Bennett, (R-Utah.) Though it is consistent with many of Obama’s reform principles, it does not include a new public insurance plan option. It mandates healthcare coverage, but it allows employees to cash out their employers’ health benefits and buy a different plan. It requires employers to pay into a subsidy pool, taxes employer healthcare payments and establishes a standard healthcare tax deduction for individuals and families. Americans would buy private coverage through state run Health Help Agencies. with subsidies for lower income patients. Premiums would be paid by paycheck deductions. Everyone would receive a benefit package at least equal to what federal employees receive. All applicants would have to be accepted regardless of health status and sicker people could not be charged higher premiums. The government would publish data on each plan’s quality performance (whatever that is.) States would receive incentives to adopt limits on malpractice lawsuits, including a cap on the number of suits any attorney can file.
We await with baited breath whatever plan President Obama’s staff is working on—the details of which seem to be available no where. The three Healthcare Solution bullets on his website sound good to anyone. The devil is in the details. What ever his plan is, I am sure it will take us at least a step or two closer to socialized medicine. He is very good at starting with something that sounds good but wording it in such a way that gives him leeway to do what ever he chooses.
Of course, the insurance industry strongly opposes the creation of a public insurance plan to compete with their private plans, but as part of the healthcare industry leaders, they have at least bought themselves a place at the bargaining table to discuss this and other topics important to them–like how to control costs, regulate plans, pay for coverage expansion, and set benefits, (euphuism for limit benefits.)
Given the complexity of healthcare, the competing demands of powerful interest groups, ideological differences over a bigger government role and our nation’s depressed economy, whether the extensive healthcare reforms that Obama is calling for will come to fruition is yet to be seen. Even some Democrats are expressing concerns. Sen. Chuck Schumer (D-NY) has proposed that any government run insurance plan be required to comply with the same rules imposed on private insurers with the objective of having a “level playing field for competition” between public and private insurers. Over in the house, Rep Charlie Rangel (D-NY) chairman of House Ways and Means said he will not support taxing employer provided health benefits.
As President Obama moves our country toward socialized healthcare, if you are over 60 and need elective surgery, I’d get it now. If you need a hip replacement, get it now. Because if we end up with anything like England’s socialized healthcare system, you will be left out. And let me tell you about my personal experience in Scotland. I was visiting a family medicine physician colleague as he saw patients in his office. After the patient exam, the doctor gave her refills on her routine high blood pressure medications. With the visit nearly finished, the Doc looked down at the patient’s chart and noted that she had had gallbladder pain with increasing frequency and intensity in the past. So he asked her about it. She replied, “Oh, that’s all fine now. I went to—and she named another country—and had it taken out!”
Many in our society are concerned about healthcare costs—at least the dragging down of our economy part of the problem. But unless we fix the dysfunctional part, little progress toward cost control will be made. Sure, we can make access to care insurance available to every citizen. But the decreasing number of physicians, the maldistribution of physicians across our country, our mobile society coupled with ever changing evidence based medicine demands and our system’s disease treatment nature (rather than having a prevention-support and wellness-maintenance nature) are other areas of challenge that must be addressed. But even if all of that were “fixed,” there is one part of the healthcare milieu that is not being addressed and is seldom even mentioned.
I have a euphuism for that all important but seldom mentioned aspect—singulus intus obligato—or the an acronym, SIO. Singulus intus obligato, a Latin translation roughly meaning individual within obligation, or better known to us conservatives as PERSONAL RESPONSIBILITY. How do you legislate and enforce singulus intus obligato? If having health insurance coverage is government mandated, will taking part in protecting your own health be mandated? Will citizens be jailed for missing their doctor’s appointment? Will there be a fine for forgetting to take your medicine? Will the Healthcare Enforcement Police monitor your exercise habits, your food portion size and your vitamin and herb intake? Days of Atlas Shrugged may be near! But, well documented Scandinavian studies show that even when patients are given–free of charge–all medications that the doctor has prescribed, patient compliance with taking the medications is not significantly higher than when patients have to pay for the medications themselves. “You can lead a horse to water, but you can’t make it drink.” So much for expecting that throwing a lot of money at a problem will resolve it.
Many are weighing in, but as of now there are few specifics to look at, and still no indication as to where all the money will come from to pay for healthcare reform. President Obama and his advisors, I’m sure, would love to partially fund it by putting a tax on being a conservative— as an effort to tax away our desire and ability to speak out against his socialist policies.
