Sunday, August 23, 2009

What's wrong with the Health Care proposals?

There are lots of commentaries out there regarding health care and the various proposals that are being considered in Congress. All of them have one thing in common: They are trying to be all things to all people.

Health care is a really big problem. There are issues with people being dropped from coverage, being denied covered due to pre-existing conditions, etc. A single catastrophic illness can cause serious financial problems for individuals. I have no problem with something being done to help these issues.

On the provider side there are issues with the existing Medicare program not reimbursing in a fashion that encourages physicians to choose primary care, thus causing a shortage in first line physicians. In my particular area, laboratory, Congress has time and again tried to save money on reimbursing these services. This is because we do not have a real voice and we are the most politically expedient area to cut. We're virtually invisible to patients and our services aren't publicly valued even though the laboratory provides 80% of all data needed for medical decision making.

So, why do I have a problem with what's proposed?

As I said, too much is trying to be accomplished at one time. You can't try all solutions at once. As in any scientific experiment, it is important to change one variable at a time or else you don't know what caused any changes you observe. How do we know what has worked if we change multiple things at once?

My suggestion: Make changes to the insurance regulations. One big issue is that each state monitors their own insurance programs. If the insurance issues: Not able to get, dropped from are major problems, then regulate these issues. However, you need to realize that if you require insurance companies to take these insureds then the cost will go up. However, you could but a ceiling on the costs or determine a package of benefits that must be offered for a set price, but that many other packages could also be offered with additional services if people choose to take them. I am also in favor of the individual mandate. All adults should be responsible for making sure they are not a burden to society, therefore, they should be required to obtain a minimum package of services and most particularly catastrophic insurance. Perhaps, the catastrophic first and then the minimum later. This will help drive the cost down by having a larger pool of participants absorbing the risk. Insurance companies are in it for profits, but it has to react to the marketplace. More competition is better. But NOT government competition. That isn't real competition. I am open to some non-profit firms, but these exist now (e.g. USAA).

Bottom line: Insurance reforms should be tried first before the Government jumps into the pool. In the meantime, work on Medicare reforms that makes it better and reimburses more fairly. Examine changing the system from a procedure driven reimbursement model to some other model, because reimbursing procedures has been the downfall of primary care which utilizes medical knowledge (screenings/diagnosis/treatment) more frequently than they perform procedures.

Till next time...

1 comment:

  1. Going about reform in a careful, systematic manner makes sense.