On Friday, I received an e-mail from someone who had just visited with several Capitol Hill staffers on health care reform. He was discouraged with the general response that health care reform was done – there was no room for new ideas.
He was promoting EMBRACE, the plan offered by the Healthcare Professionals for Healthcare Reform
Even more discouraging was the perception that Congress had a busy agenda and they were just eager to get this issue behind them. In addition, he was disheartened by the lack of provider unity on this topic.
He made the comment in his e-mail, “This isn’t health care reform, it’s insurance reform.”
I beg to differ. It is not insurance reform; it is an insurance industry bailout. It is a status quo bailout.
I have to admit that the report recently released by the Senate Finance Committee, chaired by Senator Max Baucus, (D, MT) Call to Action Health Reform 2009 touches all the right buttons.
He talks about access.
The U.S. is the only developed country that does not guarantee health coverage for all its citizens.
He talks about costs.
American families are struggling to keep up with out-of-pocket costs for health care. American businesses are straining to absorb rising health care costs while staying competitive at home and around the world.
He talks about the value we get for our health care dollars.
Despite high levels of spending on health care, the U.S. ranks last out of 19 industrialized countries in unnecessary deaths. America ranks 29th out of 37 countries for infant mortality — tied with Slovakia and Poland, and below Cuba and Hungary. The United States has almost double the infant mortality rate of France or Germany. A recent study by the Institute of Medicine concluded that the current health care system is not progress toward improving quality or containing costs for patients or providers.
But the solution is woefully inadequate.
And it stems from a fundamental reluctance to come to terms with the source of our problems – a fragmented patient delivery system.
We parcel patients into various patient delivery silos based on income, age, employment status and various other categories. Each of these patient delivery silos comes with its own bureaucracy that specifies the rules for entry. None of these patient delivery silos accepts full financial responsibility for the patients assigned to it. Instead, another set of elaborate rules allows cost shifting back and forth among silos in a complex shell game of shifting financial responsibility.
I have written often enough about the federal government’s proclivity toward small solutions. Small solutions engender large sets of rules to keep their solution small. Mr. Buacus has proposed a plethora of small solutions.
How does Senator Baucus propose to cut through the current maze of health care rules and bureaucracies?
More rules and bureaucracies.
We will have the Health Insurance Exchange.
We will have the Health Coverage Council.
We could have a Health Court.
We will still have Medicare Advantage plans.
We will have changes to the current relatively simple (emphasis on relative) rules on the tax exemption of health care benefits.
I see little in this package that will reverse the very evils that the report claims to decry. The only possible exceptions are some positive approaches to malpractice reform.
What is “Health Insurance Reform”?
To qualify as real health insurance reform it needs to expand risk pools, not shrink them. It needs to go much further to improve communications about health insurance by simplifying plans. It needs to eliminate medical underwriting. It leaves insurance company regulation in the hands of the individual states.
What about delivery system reform?
Again, Mr. Baucus pays lip service to issues raised by the provider community.
He speaks of:
Strengthening the role of primary care and chronic care management.
Refocusing payment incentives toward quality
Promoting provider collaboration and accountability.
But until the patient delivery systems are reformed, those efforts will be a continuing uphill battle.
I am only aware of two plans that recognize that, both are put forward by provider organizations. The Physicians for a National Health Program advocate a single payer system.
Healthcare Professionals for Healthcare Reform mentioned earlier advocate a concept they have titled EMBRACE. They are allied with the American College of Physicians. Their program combines some of the principles of a single payer system, but concedes a greater role for insurance companies.
I am not a highly paid political consultant. But I predict that if the Baucus plan is implemented it will be a debacle for the Democrats. It will do little to improve access, cost or quality, while adding substantially to the bureaucracies that are the current health care maze and the current problem.