Tuesday, October 13, 2009

Method in the Medical Madness?

The battle doesn’t seem to involve the “people”… just special interests. Insurance companies on one side. Hospitals over there. Doctors hidden behind bushes firing random volleys. And the biggie pharmaceutical companies over the next hill lobbing (or was that lobbying) mortar shells. Our healthcare coverage is in the middle, taking shots from every direction.

Insurance companies point to the minimal cost to individuals opting out of having medical insurance under the proposed plan, figuring that they can afford to wait until they are sick to get a policy since they cannot be turned down… hence raising the cost to everyone. Why can I see a very simple solution to that one? Hmmmm. Wonder why private insurance companies want to make sure that everyone not covered by Medicare has private insurance with no “public option” (low cost, non-profit competition provided by the government). Why would they want 46 million new customers and plant campaigns around town that as the plan is drawn now (allowing folks to opt out), premiums will skyrocket for the average American?

A report, prepared by PriceWaterhouseCoopers, released by the healthcare insurance industry, predicted steep increases in near-term insurance rates under the above scenario for most Americans – 18% higher than current expected increases according to the report. Scare tactics replies the White House. The October 12th New York Times: “Reid H. Cherlin, a White House spokesman, said: ‘This is a distorted and flawed report from the insurance industry and cannot be taken seriously. This so-called analysis appears on the eve of a vote that may eat into the insurance industry’s profits. It conveniently ignores policies that will lower costs for those who have insurance, expand coverage and provide affordable insurance options to millions of Americans.’..White House officials said the industry had ignored features of the bill that would lower costs for consumers, like subsidies for people who could not afford insurance. The report, by PricewaterhouseCoopers, acknowledges, ‘We have not estimated the impact of the new subsidies.’” Sigh… half truths… expensive lobbyists… special interests slanting the table.

Pharmaceutical companies are so rich that their lobbyists have all but killed any serious attempt to hold down the cost of meds. Every special interest in this industry has spent some serious bucks making sure their bread remained thoroughly buttered. Insurance companies don’t mind the mandatory healthcare, as long as they can pass costs on to their policy-holders, force people to buy their product and don’t have a public option (without a profit motive) as a competitor.

What seems to be happening is that we are clinging to an old system, one that doesn’t work or remotely reward efficiency. The NY Times: “‘The discussion has gone from health care reform to insurance and payment reform,’ said Toby Cosgrove, the president and chief executive of the Cleveland Clinic, which Mr. Obama visited in July and often holds up as a model of how hospitals would operate in a revamped system. ‘We’re not really reforming the system,’ Mr. Cosgrove said. ‘We are reforming how we pay for it. It’s certainly all about politics right now.’” The plan before the Senate now, according to the Congressional Budget Office, would cost $829 billion over ten years – if you believe those numbers – and that’s pretty reasonable given the time and the scope.

If there is one huge hole in our democratic system, it has to be the ability of special interests to provide so much in the way of campaign contributions, direct and indirect, and negative publicity (regardless of truth), so that they actually wind up calling the shots. We also have battles over regional issues: it costs more to live and work in New York, NY than it does in Springfield, Ill, so any attempt to impose uniformity on costs challenges the higher cost jurisdictions to fight the inequality. That’s lawmakers covering their home turf. The result of all of this bickering is hardly what will make this sector efficient and affordable.

What’s missing in all this? Rational thought. Common sense. Take a look at one of the few provisions in the proposed legislation that will have an impact on costs: “Lawmakers have said they do not want to force changes too quickly, but experts warned that in the meantime costs will continue to soar for the 250 million Americans who have insurance and who, faced with confusing and expensive legislation, are asking: ‘What’s in it for me?’

“Along with reducing the ranks of uninsured, a top goal of the legislation is to slow the steep rise in medical costs. But budget experts said there is only one big initiative in the legislation aimed at that goal — a proposed tax on high-cost insurance plans. That proposal, in the Senate bill, is fiercely opposed by many Democrats in the House.” The Times. But that sure doesn’t make stuff in the system cheaper!

In the end, failure to address the root causes of cost escalations – rewarding “volume” healthcare services (you get paid more if you order more services and meds) as opposed to better health – will simply continue these frustrating cost spirals, will add a huge new group of clients for private insurance companies, and probably add costs we never thought we’d have. Hey, let your voice be heard. The outcome in the Senate Finance Committee was never in any doubt – a clear Democratic majority easily pushed the Baucus proposal onto the Senate floor for consideration. Now the games really begin… in Senate (can the Democrats find any Republican support?) and in the echoes of loud, angry voices in the House of Representatives. Maybe surgical doctors and nurses aren’t the only ones wearing masks!

I’m Peter Dekom, and I approve this message.

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