By K Richard Berlet: Whether it is “insurance” or “health-care” reform that is the objective, these proposals fail to focus attention on the most egregious and costly deficiencies in our current system.
Congress is back in session after this Labor Day weekend and legislators are ready to settle in for round two of the health-insurance (nee health-care) reform debate.
Though woefully lacking, or only obliquely mentioning, many crucial details, the current proposals are likely to be the basis of this debate. And that is just terribly wrong. Whether it is "insurance" or "health-care" reform that is the objective, these proposals fail to focus attention on the most egregious and costly deficiencies in our current system:
1) No mention of any reform to the tort statutes for malpractice is made, yet these are unarguably major contributors to the cost escalation in health care in a direct manner, raising premiums for hospitals' and doctors' malpractice insurance, and indirectly through the outrageous overuse of some diagnostic procedures — clearly preventative medicine for the insureds.
2) There are no incentive mechanisms proposed to encourage people to use health-care services intelligently and parsimoniously, and there are no incentives to live healthy lifestyles. Both of these concepts have been employed with significant cost-reduction impact in the private sector.
3) Only the bare bones of a concept to measure and reward value delivered, rather than volume, is incorporated in the proposals (the so-called "quality councils"). However, this concept is at the core of the problem. Until patients, doctors and hospitals know what quality care is, and what the associated costs are, it is impossible to do anything but take flailing, regulatory stabs at reducing costs (primarily through limiting access to treatments and tests).
On the other hand, if true value is known (a simple formula of quality divided by cost), then doctors and patients can be allowed to make their own decisions, without regulatory intervention, and this part of the cost problem will take care of itself. But, with that said, the definition of quality (diagnosis by diagnosis) is still elusive, and there is very little emphasis in the current dialog on funding the development of this data base.
4) Not even the slightest nod is given to the possibility of allowing insurance companies to compete across state lines. There is such a fixation on the public option as the only way to put "a shark in the tank" of the insurance companies, that this most obvious — and less invasive — move toward increased competition is ignored.
The proposals on the table are truly disingenuous; they offer a logic that swings daily to the direction of the wind. One day, the premise is competition, but that argument springs a leak when it is pointed out that there is plenty of opportunity to enhance competition on a level playing field by allowing interstate competition among the insurers. The next day, universal coverage is the banner that swings in the breeze, but digging into the real numbers exposes this as a red herring, since 50 percent of the 45 million to 47 million uninsured are that way by election (they opted out of coverage), another 10 percent to 15 percent are foreigners (many illegal) for whom our government really is not responsible, and the balance could be folded easily into any one of six currently existing government insurance plans.
Finally, there is the cost-containment premise, but the Congressional Budget Office popped that balloon early on, and the "c" word has been way too easily associated with the dreaded "r" word — rationing. The only conclusion one can reach is that Congress really doesn't know what they are trying to accomplish, and that is a real shame!
Nobody believes that reform is not necessary. It is the total void of any real, impactful ideas that is frustrating the electorate. Unfortunately, this reform campaign begins to look a whole lot like the stimulus package, which was sold as a do-or-die measure to stem the rising tide of unemployment, but which, so far, has been ineffectively administered and, apparently, not stimulative at all.
K. Richard Berlet is a management consultant specializing in incentive plan design. He has lived in the Valley for seven years.