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Stones & Bones / health care / volume 12 number 1, January 2010 DOSE OF REALITY A significant political achievement of the year 2009 in the health care arena is that for the first time,health care reform bills have actually gotten to the House and Senate floors—and been passed. All that remains now is to reconcile those bills and have President Obama sign the final outcome. If you want to see what is in the House and Senate bills as passed in late December, a great resource is a comparison of them published by the Kaiser Family Foundation, available at www.kff.org/healthreform/upload/healthreform_tri_full.pdf. This article is twenty-four pages long, and takes about an hour to read, maybe more if you really try to understand all it says. One nice thing about this document is that it is both factual and unbiased. That is far more than can be said about much of what one reads in the press or on blogs about health care reform. These sources are full of half-truths by omission and outright inflammatory fabrications, such as Sarah Palin’s “death panel” charges. Still it may not be worth the time to read the Kaiser report unless you are interested in comparing the bills just for the fun of it. Any input you might want make to Congress at this stage of the game is not likely to have much effect. A possible exception is commentary on the public health care plan option contained in the House bill but not in the Senate’s. If you favor that option, you might indicate so to Senator Mark Begich. No need to waste your time similarly contacting Senator Lisa Murkowski. She will ignore you. She and her fellow Republican are displaying shameful disregard for the desires and needs of the American public by giving priority to scoring political victories over the president and to protecting corporate interests. They do not hesitate to employ specious arguments and outright lies to do it. Reading through the Kaiser report the main impression I got was that neither the House nor Senate bills do much if anything to reduce the incredible complexity and cost of the American health care payment system. This complexity adds much to the system’s dysfunctional nature and allows uncontrolled escalation of costs. We hear various proposals to reduce health care costs, and typically each is touted as the end-all answer to the problem. Among them are the need for tort reform, curtailing the fattening of America, the need for greater personal choice( whatever that means), and the need for greater freedom for insurance companies to sell health insurance across state lines. These really are peripheral issues with variable if any merit, but at best they are not the key ones we should be considering if we want Americans to have high- quality health care at reasonable cost. The truly important change needed to improve health care and cut health care costs is to simplify the system. The best way to do this is to institute single-payer or all-payer health care because that form of health insurance permits proper regulation of the overall health care enterprise. Regulation is a word that raises the hackles on all proponents of unfettered free market enterprise, but it is precisely what is needed because health care is not a suitable commodity for the unregulated marketplace that these people promote so vociferously. The very nature of health care is that it either must be provided by government or be carefully regulated by government if it is to be provided by nonprofit or for-profit private enterprises. Each of these methods works just fine—as the health systems in all other modern countries demonstrate. Some governments provide health care directly (United Kingdom), some funnel health care payments through for-profit or nonprofits (e.g. France), and some (like Canada) rely primarily on private industry, but they all have the common thread of being properly regulated. These countries regulate drug prices and health care provider payments. (Not so in the United States; drug companies and health care providers can charge anything their little hearts desire, and the mostly complacent public pays the price.) Sadly, I don’t see much regulation in the House and Senate bills, but there is some, and that little bit justifies the passage of a final bill that incorporates them. One proposed regulation in both bills is actually to require that the insurance companies spend most of their premium income on paying for health care. Right now, the average payout (the so-called loss ratio) is about 72 percent of premium income for group policies and as low as 45 percent for individual policies. The two bills call for raising the ante to 80 and 85 percent, but stay tuned to see if the insurance companies will allow the resulting cut in their profits. That’s not likely, so we probably will see this provision fall by the wayside during the bill reconciliation process. Both bills call for regulation of discriminatory insurance company policies now in effect. A key phase in both bills is “Require guarantee issue and renewability,” which means that insurance companies can no longer refuse coverage to people with pre-existing conditions or cancel the policies of customers who get sick, the ploy known as rescinding. Also, the bills call for eliminating annual and lifetime limits on payouts. Well-known medical writer Dr. Atul Gawande in an article in the December 14, 2009, issue of The New Yorker notes that the bills call for instigating many pilot projects. He suggests that this is good because that methodology reformed American agriculture from an inefficient costly hodgepodge of small farmers into the highly productive enterprise it is today. The same thing could work for reforming health care, Gawande suggests. Could be, but I doubt it. Those farmers struggling to improve their productivity were not thwarted by big businesses whose profitability was being threatened by agricultural reform. In fact it was just the opposite: business profits of related big businesses—for example, fertilizer, feed, seed and equipment suppliers—were enhanced by the agricultural reforms. Neil Davis is a retired geophysicist and author of several fiction and nonfiction books. His most recent book is Mired in the Health Care Morass. More on health care issues can be found at his blog, http://healthcaremorass.blogspot.com. Neil can be contacted at neildavs@mosquitonet.com. | ||
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