Saturday, February 6, 2010

Do-or-Die - Five Reasons Obamacare Tanked

"I mean, to be fair, the status quo is working for the insurance industry, but it's not working for the American people."

President Barack Obama

“The nature of health care is very complex, and sometimes the nature of politics is very simple."

Angela Braly, CEO of WellPoint, America’s largest health insurer, in “A Wasted Opportunity,” Wall Street Journal, February 5, 2010

As everybody knows, life and health care aren't fair. Nice people get bad diseases, health care doesn’t cover them all, and costs keep rising – from 16.0 % of GDP to 17.3% last year.

So what do you if you’re the President of the United States, and the core objectives of your health plan proposal was to bring down costs while covering more people – and both objectives are failing?

You blame somebody – somebody big, somebody obvious. The most obvious industry, the most obvious political foil, is the health care industry. It covers 200 million people, and its costs are rising, projected at over 10% in 2010. And it often doesn’t cover those with pre-existing illnesses.

You neglect to mention that if you confiscated the profits of the entire industry, you would only pay for days of U.S. health care. And you don’t go into other little details , that one-fifth of the budget of WellPoint is devoted to managing Medicare’s fee-for-service clients. Or that to cover those with pre-existing conditions would force health plans to triple their premiums to break even. Or that the fastest growing cost sector is Medicare and Medicaid, not private health plans.

You are not interested in details. You are preoccupied with the big political picture, and you need someone big to demonize.

Also you fail to explain other reasons why the costs continue to rise.

One, health care, though nearly 50% government subsidized, is a cottage industry. Absent private market competition, and consolidation of health care in major cities and regions, hospitals and doctors have little incentive to cut costs. And hospitals and doctors have a lot of negotiating clout when it comes to insurers.

Two, Americans want choice , flexibility and cutting edge technologies to save their lives and preserve their life styles. These things cost money, and Americans are not about to give them up. After all, these things are about “my life,” not some government abstraction to save money.

Three, cutting costs is a state by state problem. Each state has its own insurance regulations, its own set of mandatory benefits, its own premium levels, its own malpractice costs, its own Medicaid budget problems, and its own level of uninsured.

Four, cutting costs is difficult because health care involves deeply personal, complex, and emotional matter, and patients, hospitals, and doctors alike distrust intrusion by government into their private worlds by Internet systems which they fear will put them into some sort of electronic prison monitoring their behavior and limiting their options.

Five, at the core of their culture and their historical traditions, some founded in the Constitution, Americans believe in a weak central , checks and balance, conservative government .

As I said in the start, life and health care aren't fair. This applies to politicians, as well as citizens, who want to change government’s role.

1 comment:

Richard L. Reece, MD said...

Sorry, I do not read Chinese. Give it to me in English, and I shall comment.