This morning driving to work I listened to a story on NPR Morning Edition. It described the effort to build Charles Babbage’s Difference Engine – a mechanical predecessor to today’s computer. Babbage died before he could ever complete his machine but modern engineers have recreated it.
The analogy with health care struck me. Congress is building a Babbage machine in an era of super computers.
And we dare to call it progress?
December 5th, 2009
In a recent report on National Public Radio (NPR) about a gang rape in Rcihmond, CA, one person asked the question. “Where has all the humanity gone?”
The same question can be asked in the current debate on national health care reform.
Where has all the humanity gone?
We are talking about Americans here
The politicians are wiling to deny undocumented immigrants access to the proposed Health Insurance Exchange. But that is not enough for some. They are afraid that hospitals will use federal funds to treat undocumented immigrants in the emergency rooms.
Aren’t some of these very same conservatives, also Christians? Aren’t they familiar with the story of the Good Samaritan? In case they forget, the moral of that story is doing good to your enemies. Oh that’s right, Christian values don’t apply to government, because government funds are involved. Unless, of course, its abortion. Then then “Christian” values apply because government funds are involved.
By the way, since most countries in the world have some form of national health insurance, what about sending the bill for undocumented immigrants back to the country of origin?
It is easy to pick on immigrants, because most of us don’t know immigrants, But there are lots of people that will be affected by health reform that we do know.
November 28th, 2009
When a 2,000 page piece of legislation traverses the legislative sausage making process, it is a large target for those who want to take pot shots.
When you are trying to fix a system that is broken in lots of places, it is not an easy process.
Let’s remember what we are trying to fix.
The system does not cover everybody. Estimates on the number of uninsured range from 30 million to 70 million depending on whom and how you are counting.
It’s expensive. Our economy already sets aside more resources per person than any other country on the planet. We pay more in taxes for health care than any other country on the planet.
We are not a healthy country. Relative to other industrial countries, we don’t live long. Our babies die before they reach their first birthday. Our pregnant mothers die in child birth.
That’s a lot of fixes.
In fact, the 2,000 pages is a pretty mediocre start. If either the House or the Senate version survives intact, it still will not cover everybody. It still will be expensive. And there isn’t much reason to believe that we will be any healthier as a result.
But it is a start.
And let’s not forget that simple in the form of single payer (HR 676) was taken off the table very early in the process.
February 28th, 2009
A letter to Senator Thomas McLain (Mac) Middleton
Chairman, Senate Finance Committee
Maryland State Senate
In one way or another I have been associated with labor management benefit funds throughout my working career. For years, the multiemployer funds were my model of how a health care system based on employment could work.
But I have become convinced that the health care system is broken at its core.
I understand that the Maryland State Senate will be considering SB 881 in committee hearings on Wednesday, March 4th. I am asking you to join the effort to lead Maryland to a single payer solution to health care in Maryland and the nation.
Who should the system serve?
First, I ask you to pay attention to who is complaining the loudest that the current system is broken. It is patients and doctors. If all of the other stakeholders aren’t facilitating patient access to care and physician delivery of care, then their role in the process needs to be reexamined. A single payer approach begins a fundamental realignment of those roles. It does not need to eliminate their roles. It needs to make them secondary.
Why is there not more support for an expanded employer role in providing health insurance to all Americans? I sense a certain exhaustion among decision makers and employee benefit professionals as they grapple with costs that just defy control. I notice at professional conferences an increasing openness to the single payer model.
We have seen one cost control fad after another. More and more employers are dropping health benefits in order to stay afloat. In this game of Old Maid, those employers who do provide benefits struggle to maintain their social compact with their employees without footing the bill for the rest of the world.
The rest of the world? How does that occur? In a number of ways.
I have often made the point that a major flaw in the health care status quo – I balk at using the word “system” – is that no single entity accepts full responsibility. With very few exceptions, everyone is trying to find someone else to pay the bill or the rest of the bill.
And too often the consumer is the rope in this tug of war.
With the election of Barack Obama, there is a lot of hope and optimism about the potential for health care reform.
There is also some nervousness.
The nervousness originates from those who think that the current economic crises will inhibit reform efforts. That somehow the price tag of reform will scare people away from health care reform. I am encouraged by an insightful article by Ezra Klein on Obama’s choice of Director of the Office of Management and Budget.
According to Klein, Peter Orszag believes that health care reform is the key to the fiscal future. Since it his office that will pin the price tag on any health care proposal, his biases matter.
Others are worried that Obama might be soft on insurance companies.
I am not a great friend of the insurance companies. I deal with them every day. But neither am I a knee-jerk opponent of insurance companies.
Insurance companies reflect the markets they operate in. And health insurance companies function in a market that brings out their worst qualites.
Unlike home insurance, or auto insurance, there is no legal or market mandate to have health insurance. This allows health insurance companies to avoid insuring the very people that need it the most – high risk (read sick) individuals.
Outside of the Medicare supplemental insurance market, there are very few limitations on what should be covered or not covered in a health insurance plan. This gives insurance companies the license to put restrictions and exclusions in their policies as they, or their customers, see fit.
Three reports this week about the costs of health care and health care reform caught my attention. One said that health care reform will be a sure fire economic stimulus because it will replace jobs lost from the current recession. Another suggests that a modest upfront investment will produce $530 billion in savings. The third moans that without a commitment to hard choices, we are doomed to health care spending profligacy.
John Nichols in The Nation describes a report and follow-on campaign by the National Nurses Organizing Committee/California Nurses Association (NNOC/CAN) that attempts to bolster the argument for a Single Payer health care system by describing its impact on jobs and the economy.
Lastly, Robert Samuelson in the Washington Post reports on findings of a report by the McKinsey Global Institute that provides valuable insights into why US health care costs so much more than it does elsewhere in the world. Unfortunately, it was short on constructive “shovel ready” policies.
So how does one react to such disparate perspectives. Clearly, each study support a specific ideological slant and approach to fixing our admittedly broken system.
Just about every health care reform proposal includes payment reform as an important part of its platform. Most of the proposals come from organizations representing providers. Not much is heard form the other side of the exchange.
Two stories recently highlight the need for payment reform from the consumer point of view.
Number one. My son recently visited friends in New York City. An unfortunate accident landed him in the New York University hospital for two days. He is 23 years old and has his own very good insurance.
Several weeks after he returned home, he received a bill from one of the doctors that treated him in the hospital. Apparently the insurance only paid him a bit more than $200 of the $800 bill. Because he was an out of network doctor, he could and did bill for the balance.
Number two. A Participant called our plan recently. His daughter was travelling with her mother to visit her grandmother in a southern state. She too wound up in the hospital. The family belongs to an HMO and so the HMO paid the Emergency Room bills and the follow on hospital stay. But they are having difficulty with the follow up care. HMOs routinely do not pay for services provided by out of network providers.
These examples represent the most frequent type of complaints that we hear from members and why payment reform should matter to consumers.
Before I explore these two stories more detail, I wanted to outline why providers, academics and some large purchasers are advocating for payment reform.
The blogosphere is buzzing with discussions about the promise of health care reform. For a weekly poster like me, it is impossible to keep up. As 2009 approaches, and more importantly, as 1.20.09 approaches, I thought I would offer my insights into the topic from the perspective of the administrator of an employer and union sponsored health benefit plan
If there is one thing that unites the comments it is their oppositional posture. Insurance companies are the most common enemy, but hardly anyone escapes.
So I would like to go on the offensive and tick off a few positives that I would like to see in health care reform. Please indulge my autocratic use of the term “will”.
1. Every individual will be required to have health insurance.
2.There will be a defined set of benefit plans.
3. There will be a uniform drug formulary.
4. There will be payment reform.
5. Medical education reform will include major financial support by the federal government. 6. There will be a system for a fair redress of medical errors.
7. Cost to the individual will be based on ability to pay.8. There will be delivery system reform
9. There will be room for experimentation.
10. Above all, there will be recognition that the health of the nation is not dependent solely on its health care system. It depends on good nutrition, opportunities for exercise and outdoor recreation, on the education of its citizenry, on safe working environments, on safe drinking water and sanitation systems, and on clean air.
Over time I will take the opportunity to expand on these topics. Some may notice that I offer no silver bullets: fix this one thing and all will be right. It took this country a long time to get into this mess. Fixing it will take time, leadership, and concerted effort.