Sunday, October 31, 2010

Moving from “No” to “Yes” on Health Reform

Until now, Democrats have successfully labeled Republicans as the party of “No” on health reform. Republicans, on their part, have succeeded in convincing the public the health reform law is bad, with 56% opposing and 40% “strongly opposed.”

The case against the reform law is clear enough:

“The law will spend a trillion dollars over the next decade and increase taxes by half a trillion; create a massive new entitlement on top of those that are already threatening to bankrupt the government; impose a vast array of new rules and mandates on providers, insurers, employers, and consumers; insert the government in countless new ways between doctors and patients; increase the burden of Medicaid costs for the states; and cause millions of middle class families to lose the employer-based insurance they have today and pay even higher premiums.”(“Repeal – Now More Than Ever,” The Weekly Standard, October 30, 2010).

So is the case for reform- extending care to 34 million uninsured, reining in health insurance abuses, protecting those with pre-existing illness, covering young people up to 26 under their parents plans, making health care affordable, saving Medicare, guaranteeing quality, and forth.

What Now?

With the mid-terms now 2 days away, it is all over but the shouting. Barring a Halloween surprise, Republicans will retake the House and narrowly Miss Senate control.

Is this the beginning of the end of Obama care, or is it the end of the beginning? Can we go from “No, you can’t” to “Yes? We can”? The battle between the can’ts and cans. will be bitterly fought over the next ten years and where it ends nobody knows.

The Beginning of the Middle

To me, the battle is the beginning of the middle. It is the end of overreaching federal spending, taxing, and regulating. But it is the middle of the health reform debate. We cannot repeal the law and start all over. Too many bureaucratic forces are already in motion. And President Obama will veto any move to repeal and replace.

But we can slow its momentum. We can step back. We can decide where we to go from here. We can begin to go from “No” on both sides of the aisle, to “Yes,” this is what we can do. Everyone agrees, after all, that reforms are necessary to rein in costs and to expand coverage.

Adopt the Good, Examine the Bad

We can adopt changes in the law – coverage for pre-existing illness, young adults up to 26 under their parents’ plan, rescission of life-time pay limits, closure of donut hole, coverage of 34 million uninsured – we agree upon.
We can agree that some the law’s consequences - bankruptcy of state budgets because of the new Medicaid costs, the effect of state health exchanges effectively eliminating health care brokers and agents, new health plan regulations and restrictions increasing premium costs, increased expenses on businesses and insurers causing them to drop coverage, and public fears of rationing - were not carefully thought through in the rush of passage.

Acknowledging the Doctor Shortage, Moving to Correct It

And we can agree a doctor shortage of accelerating magnitude – 50,000 now, 70,000 by 2015 exists. What good is increased coverage without doctors to care for them? Yes, there are stopgap measures – more nurse practitioners, more physician assistants, more nurse “doctors,” more foreign-trained physicians, more government-subsidized community clinics, more “efficiencies” through accountable care organizations – but these measures are not likely to satisfy mainstream Americans who seek access to individual doctors.

We can agree that doctors ought to be paid a reasonable wage based on their skills, prolonged educational process, long workweeks, and unreasonable malpractice premium expenses. We can take seriously a Medical Group Management survey indicating 67% of practices will limit or stop accepting new Medicare patients if scheduled cuts – 23.6% on Dec. 1 and another 6.5% on Jan. 1—go through. Correcting the archaic SGR (Sustainable Growth Rate) formula is a must if seniors are to have access to care.

Accepting Political Reality

Finally, based on the coming electoral results on Tuesday, we have to accept the notion that American is basically a conservative nation that resists sweeping change. It is not realistic to try to govern America, which is based on limited government, individualism, and free enterprise, from the left. America, above all, is a center-right nation.

Our health system, the so-called medical industrial complex, consumes 17% of GDP and employs 14 million. It is a massive enterprise, is central to our economy, and is subject to powerful market forces. Despite its patchy and costly features, it has produced the most sophisticated medical technology in the world. Americans do not want it to be rationed.

We can, therefore, conclude in a capitalistic free enterprise nation, the health system will always be a mix of government and the market, protecting the uninsured and underinsured but offering choice and access.

Giving the Market a Chance

It is time, I believe, to give market forces or reasonable try at incremental reforms, which the current health bill denies or ignores. These reforms might include shopping for health plans across state lines; adoption of a model like the Federal Employment Benefits Plan which relies on competition and choice across the nation; tax parity between individuals, small, large employers; the expansion of health savings accounts; variable and practical health plans designed for age, sex, and need rather than comprehensive federal plans where one-size-supposedly-fits all; the removal of hundreds of mandates for optional and alternative care; and sensible malpractice reform that avoids the current casino environment inviting high rolling malpractice attorneys.


Tad Mayfield said...

Overutilization of the health care system created by employer provided health insurance is one of the major causes of the high cost of health care in the U.S. Others include government mandated coverages, Medicare, and Medicaid. All of these problems are government created. More government regulation will only make matters worse. Wake up America. Placing the responsibility for ones health and health expenditures back in the hands of the individual is the only way to reverse the damage the government has caused.

Richard L. Reece, MD said...

I agree with your closing sentence. Only patients, spending a portion of the bill and taking personal responsibility for their own health, will turn the tide on costs. Regulating doctors, hospitals, and health plans is not the answer. That will only raise costs, as it is doing now. Let the market, ie. patients spending or saving their own money, decide. The most promising route to containing costs is health savings accounts.