Since November 4th, interest in health reform proposals has understandably intensified. I like to flatter myself that this blog might make a small contribution. But I do have a day job and so the horn I blow here only has one note; if we simplify the system we can find the money we need to cover the people without health insurance and increase product satisfaction among all stakeholders.
I am not a policy wonk who views the health care system wonderfully distilled through the glorious abstraction of statistics; nor am I encumbered by practical politics. I view the system from the bottom looking up. I have a stake in the present system, but that stake is poorly represented in these musings. I am a gatekeeper to the health care maze. In my ideal world there would be far less need for the work I am doing.
I know from daily encounters just how daunting that maze is for people needing care. I tend to demonize piece rate physicians who are too quick to deny care rather than trust the maze.
So when I read others who write about health care reform I look for my theme. On Sunday, November 23, 2008, the Washington Post published an opinion piece by Shannon Brownlee and Ezekiel Emanuel, 5 Myths About Our Ailing Health-Care System. The authors are right on target with four of the five myths that they debunk. They drive home the point that we are paying a lot of money for our health care, that we are paying a lot of money for not particularly good health care, that we really are paying the price through premiums, taxes, and lost wages, and that Americans are ready for a change.
I support a simpler health care system. That is my number one priority. Thus I am unimpressed with the health care reform platform of our newly elected president. I do share the hope and optimism of many that meaningful change can and will happen.
But getting a simpler health care system means that some of the stakeholders need to be cut lose from the system. That is a politically daunting task. It is why most health care reform proposals try to add more patches to what is already a shabby patchwork quilt of private and public programs.
One effort does try to simplify a small part of our current system. At least 30 states have mandated that insured health care plans cover all children until they reach a certain age. Yet as simple as this concept is, it comes with more variations than states that have adopted it.
What are we trying to simplify?
Most health plans offer parents with dependent children in college the opportunity to continue coverage for their child if they provide evidence that the child is enrolled in a qualified post secondary education program.
This is a holdover from the days when children entered the job market after high school and those jobs provided health insurance. Today, it is more likely that neither half of that statement is true. It is an obvious adaption to changing times. It is a relatively easy way to expand coverage to a vulnerable population. Young adults are healthier than the general population and therefore not an expensive expansion. Of course, that doesn’t prevent this trend’s detractors from referring to it as the “slacker mandate”.
Amazing seems a most appropriate word to describe the financing and delivery of health care services in the United States of America.
According to Merriam-Webster’s Collegiate Dictionary, 9th Edition (OK, I have an old dictionary) amazing is derived from a French word meaning “to confuse”. Obsolete meanings include consternation, bewilderment and perplexing.
Yes, health care in the US is truly amazing. Rube Goldberg could not have invented a more illogical maze of non-systems. Lewis Carroll’s might have added an additional chapter on Alice’s efforts to get those pills that made her big and small. Kafka might imagine a special Penal Colony for those responsible for this maze.
I should be careful on this last point, since I am part of that system. I administer the benefit plan for approximately 25,000 participants. I like to think that we do our best to help our members navigate what is all to often a daunting and perplexing maze.