Health-Care: Think You're Unhappy Now?
by Bill Bruning
As an attorney, I’ve learned the best compromise is one that leaves all parties equally unhappy. The same approach is our best hope for reforming American health care. There should be no clear winners (except our grandchildren), and no one should expect to be “happy.”
Following are the sorts of nuanced give-and-take that must occur if balanced reform is to succeed:
• Americans: Our health care system is not actually “broken,” but it is unsustainable in its current form. You should be mandated to have insurance; and you must take personal responsibility for your own health. But calm down, the consequences of change won’t be nearly as revolutionary as the heated debate suggests.
• The cost? Oh man, is this going to cost! If we’re very lucky, the overall costs, including offsets for improved outcomes and value, should eventually settle out closer to the underlying rate of inflation.
• The Uninsured: Don’t get too excited—having insurance will not guarantee access to care. You’ll be paying even more of your limited income for coverage and still figuring out how to overcome all the problems like transportation, time management, and communication that complicate your lives.
• Democrats: You tried in 1993 and over-reached. This is your last chance; don’t blow it now by trying to restructure one-sixth of the GDP by yourself in four months. Don’t load health care reform with lots of ideology. Concentrate on basic, incremental changes that will keep the system afloat, while cooler heads assess the hotter issues and unintended consequences of this first round of reform.
• Republicans: You had the same opportunity to reform the system according to your own ideological lines, and you ducked it. Now, it’s irresponsible to play the Party of No—you must collaborate in this process.
• Larger Employers: You’re accountable for the health care of half of all Americans. You will never get out of “paying” for it, so you might as well choose to “play”—that is, be sure your benefits are targeted to the health risks of your particular work force.
• Smaller Employers: If you have fewer than 25 employees, you should be free to make coverage decisions yourself without a mandate.
• Primary Care Physicians: We can’t balance the budget on your backs. We need to restructure reimbursements to focus on “episodes of care” and pay you to think, not just do procedures. However, reform should eliminate your entrepreneurial opportunities to prescribe procedures in which you have an economic interest.
• Specialist Physicians: Your days of pre-eminence on the reimbursement pyramid are waning, along with operating highly profitable, cherry-picking clinics.
• Health Plans: You’re right: a single-payer system will force triaging of care that Americans simply won’t tolerate; and if plans have to accept all applicants, then coverage should be mandated. However, you need to trim your administrative costs significantly, and it may take comparative exchanges or a competing government plan or cooperatives (on a level playing field) for that to happen.
• Hospitals: Community hospitals are fundamental to all American cities—we can’t exist without you. However, you can’t keep building costly new facilities without accountability. And, “never events” must disappear—people should never get sicker because of a hospital stay.
• Pharmaceutical Companies: It isn’t fair that Americans alone fund your research while everyone else in the world limits the prices of pharmaceuticals; and reimportation of Canadian drugs isn’t the answer. Congress should pass a “most favored nation” clause forcing Canadians to pay their fair share. But also, you should negotiate with Medicare for the prices of the drugs it buys.
• Plaintiff’s Lawyers: You keep the system honest, but we need to cap medical malpractice recoveries and establish “near-miss” registries like the airline industry uses to learn from its errors. Physicians, however, need to recognize these lawsuits are a relatively minor component of health care costs and clean up their own back yard—addressing the small percentage of physicians who account for the vast majority of lawsuits.
Now, if all readers are equally unhappy, this just might be an effective outline for health care reform.
Return to Ingram's September 2009
Bill Bruning is President and CEO of the Mid-America Coalition on Health Care, but the thoughts he expresses here are his personal beliefs, and do not reflect the views of the coalition or its board of directors.
P | 816.753.0654
E | bbruning@machc.org