For Your Health

Congress Is Fumbling Its Chances At Real Health Care Reform

Jerry Ortiz y Pino
4 min read
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The country is desperate for major reforms to our non-system of health care. Our people can no longer afford to spend twice as much per capita on health care as any other country—while receiving health outcomes that don’t even make the top 25 list from around the globe.

“Drastic action” is called for daily in the halls of Congress, where it has been more than 50 years since Medicare and Medicaid were enacted, the last serious attempt at providing significant portions of our populace with basic medical services. Fifty years of frustrating debate over the right path to reform … while trillions of dollars have been futilely expended, money that produced corporate profit but precious little health.

Now that pent-up energy for change is about to finally produce action, or so we are told. I’ve been holding my breath, afraid to put a gris-gris
on the process by speaking too optimistically. Now I must exhale. It seems clear that Congress and the administration are on the verge of fumbling away this once-in-a-lifetime opportunity, dropping the ball on the goal line itself.

The problem is that, once again—as with the Medicare Part D fiasco, the hopelessly fouled-up (and fiscally devastating) raid on the public treasury by Big Pharma—the entire den of foxes has been consulted in the design of the henhouse defense system. In other words, the insurance companies have been invited to the table to help craft the new plan.

This is a huge mistake.

Sen. Max Baucus seems to be steering the plan toward creating a new “Federal Option” (Medicare-lite) for consumers to select, while allowing the existing full smorgasbord of insurance companies and “products” to keep on filching cash from the system while contributing nothing of benefit.

I can’t go into all the issues this raises, but I’d like to point four of the biggest problems with the approach the insurance industry is selling Congress.

First, the “Federal Option” won’t save any money. It completely misses the enormous savings that could be realized by eliminating the 30 percent (some say as much as 40 percent) now wasted in health care expenditures through administrative duplication, advertising and excess profits skimmed by insurance companies.

Second, it creates a two-pronged health financing system: Sick people will migrate to the public Federal Option while private plans will cherry-pick healthy non-users of medical care. Keeping employers in the loop as the “consumers” shopping for the most affordable plan for their employees means the private plans will be guaranteed a market—they won’t be burdened with having to cover the unemployable or those with prior conditions they deem too costly to cover.

Third, there is much more wrong with our current situation than simply paying the bills in a more equitable and efficient fashion. All the incentives that push for costly procedures, duplicative testing, overspecialization and unnecessary medication will remain in place, draining our pocketbooks to no beneficial effect. We need a “reform” that will actually roll up its sleeves and grapple with the way that “insurance” (whether paid for by public or private dollars) actually incentivizes all the wrong decisions about care.

Finally, it will not deal with the crushing issue of bankruptcies due to medical bills. The latest data I’ve seen shows that 52 percent of all personal bankruptcies in the U.S. today are due to catastrophic medical bills … and that 75 percent of those catastrophic bills were for families with insurance
. Insurance policies can frequently prove to be of great comfort and security, until you actually get sick. Then the small print kicks in: the limitations, co-pays, lifetime caps, prior approval requirements and even (filthy term) “rescissions”—outright cancellations because you will cost shareholders too much.

No, the reform we need is to relegate the foxes to the sideline. Change the health care paradigm from a business, profit-driven, insurance model into one that emphasizes providing care without a middle man.

The opinions expressed are solely those of the author.

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