There is a Health Care Reform Plan That Doesn't Duck the Big Issues--and More Than 100 Heavyweight Stakeholders Support It!
It seems that everyday we see a new health care reform plan on the table.
So what would all of these new health reform plans do? They would pile millions of more people back onto a system whose costs are unsustainable. It would be like trying to re-board the Titanic!
As I have said before, all of these new health reform plans ignore the real issue--the cost of health care.
But there is one health care proposal that doesn't duck the tough issue.
Health care costs are the problem. The 47 million that are uninsured are just a symptom. Here's a real blast of wisdom for you--47 million people don't have health insurance because their family can't afford it, or their employer can't afford it, or their government can't afford it, or some combination.
So, why do all the health reform plans just try to pile millions of more people back on board a system we can't afford to keep afloat?
Massachusetts is struggling to launch their new health reform plan because the cost of the mandated policy is too high (recent post). In the end, all of the new health reform plans will struggle with the same cost issues if they don't face them head-on. In Massachusetts, getting their costs down to $250 per person per month (they are above that now) would develop a $9,000 mandated health insurance policy for a family of three. Over $48,000 per year (three times the poverty level), that family would have to pay the full cost of this mandated policy.
Does it sound to you like Massachusetts is going to actually launch its new universal health reform plan????
Taxpayers are going to launch the Massachusetts legislature if they try to implement that mandate.
In the past few weeks we have seen a number of key health care stakeholders come together, sometimes in surprising combinations, to support health care reform. Sometimes they've been some pretty strange bedfellows.
But none of them are dealing with that big fat elephant in the room--the cost of health care--any more than Massachusetts is.
But what if I were to tell you that more than 100 REALLY BIG and diverse stakeholders have already come together in support of a far-reaching health care reform proposal that doesn't duck any of the issues--the uninsured, cost, or quality.
The organizations and individuals are a "Who's Who" of those that use health care services, pay for it, insure it, deliver it, think about it, advocate for it, and pray on it.
Just take a look at this list:
AARP
Actors' Equity Association
AFL-CIO
Ahold U.S.A., Inc.
Alliance of Motion Picture and Television Producers
American Academy of Family Physicians
American Academy of Pediatrics
American Association of Community Colleges
American Association of State Colleges and Universities
American Cancer Society
American College of Nurse Midwives
American Council on Education
American Dental Education Association
American Federation of State, County, and Municipal Employees (AFSCME), AFL-CIO
American Federation of Television and Radio Artists
American Federation of Teachers,AFL-CIO
American Fiber & Finishing S.C., Inc.
American Water
Association of American Universities
Blue Shield of California
California Medical Association
California Public Employees' Retirement System (CalPERS)
California State Teachers' Retirement System (CalSTRS)
Catholic Charities, USA
CodeBlueNow!
Colorado Public Employee Retirement Association
Communications Workers of America
Duke Energy
Duke University Medical Center
The Episcopal Church
Exelon Corporation
General Electric
Giant Food, Inc.
Gross Electric, Inc.
Group Health Cooperative
Illinois Municipal Retirement Fund
International Brotherhood of Electrical Workers, AFL-CIO
International Brotherhood of Teamsters Union, AFL-CIO
International Federation of Professional & Technical Engineers, AFL-CIO
International Foundation for Employee Benefit Plans
Iowa Farm Bureau
Kaiser Permanente
Kellogg Company
Michigan BlueCross BlueShield
Maternity Center Association
Motion Picture Association of America
Motion Picture and Television Fund
National Association of Chain Drug Stores
National Association of Childbearing Centers
National Association of Independent Colleges and Universities
National Conference on Public Employee Retirement Systems
National Consumers League
National Coordinating Committee for Multi-Employer Plans
National Council of Churches of Christ in the U.S.A.
National Council on Teacher Retirement
National Education Association
New York State Common Retirement Fund
New York State Teachers' Retirement System
Presbyterian Church (U.S.A.)
Principal Financial Group
Public Employees Retirement System of Ohio
Qwest Communications
Religious Action Center of Reform Judaism
Salvation Army
Sheet Metal Workers International Union
Southern California Gas Company
State Teachers Retirement System of Ohio
Stop & Shop, Inc.
Union of American Hebrew Congregations
United Food and Commercial Workers International Union, AFL-CIO
UnitedHealth Group
United Methodist Church - General Board of Church and Society
United States Conference of Catholic Bishops
United Steelworkers of America, AFL-CIO
Utility Workers Union of America, AFL-CIO
Visteon Corporation
Former President George Bush
Former President Jimmy Carter
Former President Gerald R. Ford
The Honorable Frank Carlucci
Chairman Emeritus
The Carlyle Group
Former Undersecretary, HEW
Former Secretary of Defense
The Honorable Thomas Daschle
Former Majority Leader of the United States Senate
The Honorable Robert Dole
Former Majority Leader of the United States Senate
The Honorable Robert Michel
Former Minority Leader of the United States House of Representatives
The Honorable George Mitchell
Former Majority Leader of the United States Senate
The Honorable Paul H. O'Neill
Former U.S. Secretary of the Treasury
Former Chairman
ALCOA
The Honorable Louis W. Sullivan, M.D.
President
Morehouse School of Medicine
Former Secretary, HHS
The Honorable Harris Wofford
Former Senator from Pennsylvania
Henry J. Aaron, Ph.D.
Senior Scholar
The Brookings Institution
Stuart Altman, Ph.D.
Professor of National Health Policy
Heller School
Brandeis University
Former Chairman, ProPAC
Marcia Angell, M.D.
Editor-in-Chief Emeritus
The New England Journal of Medicine
Donald M. Berwick, M.D., M.P.P.
President and CEO
Institute for Healthcare Improvement
Roger J. Bulger, M.D.
President and CEO
Association of Academic Health Centers
Charles C. Edwards, M.D.
Former President
Scripps Clinic & Research Institute
Former Commissioner, FDA
Former Assistant Secretary of Health Education and Welfare
Harvey V. Fineberg, M.D., Ph.D.
President, Institute of Medicine - National Academy of Science
Former Provost, Harvard University
Former Dean, Harvard School of Public Health
Rev. Theodore M. Hesburgh, C.S.C.
President Emeritus
University of Notre Dame
Michael E. Johns, M.D.
Executive Vice President for Health Affairs
Emory University Health Care System
John D. McArthur
Dean Emeritus
Harvard Business School
John Mendelsohn, M.D.
President
Univesity of Texas, M.D. Anderson Cancer Center
James J. Mongan, M.D.
President and CEO
Partners HealthCare System, Inc.
William Novelli
CEO
AARP
Uwe E. Reinhardt, Ph.D.
James Madison Professor of Economics and Public Affairs
Princeton University
Arnold S. Relman
Editor in Chief Emeritus
New England Journal of Medicine
Professor of Medicine Emeritus
Harvard Medical School
William C. Richardson, Ph.D.
Former President and CEO
W.K. Kellogg Foundation
President Emeritus
John Hopkins University
Steven A. Schroeder, M.D.
Distinguished Professor of Health and Health Care
University of California -- San Francisco
President Emeritus
Robert Wood Johnson Foundation
Graham B. Spanier
President
The Pennsylvania State University
John Sweeney
President
AFL-CIO
Samuel Thier, M.D.
Professor of Medicine and Proffessor of
Health Care Policy
Harvard Medical School
Former CEO
Partners HealthCare System, Inc.
Former President
Institute of Medicine
(Source: NCHC website)
Each of these individuals and organizations are part of something called the National Coalition on Health Care.
The National Coalition on Health Care has been unambiguous in calling for a systematic approach to a systemic set of problems:
- Health Care Coverage for All--They call for mandatory coverage and could live with a number of ways to accomplish this including schemes that involve the use of employer and individual mandates, Medicaid and S-CHIP expansion, individual subsidies, and a number of related ideas as part of a multifaceted approach.
- Cost Management - While everyone else with these health reform plans either ignores the real problem in the U.S. health care system, or fritters around on the edges with it, these folks hit it head-on. They cover the usual list of things like better information and patient incentives, BUT MOST IMPORTANTLY, they also take things to the next step--"An independent board, chartered and overseen by Congress, should be responsible for establishing and administering...measures for calibrating rates and limitations that keep costs and premiums in alignment with defined annual targets."
- Improvement of Health Care Quality and Safety - Their federal board would lead the development of, and coordinate, a national effort to improve quality and set common treatment standards and as well as oversee protocols for patient records, prescription ordering, billing standards, and privacy standards. Finally, a referee to get us on with this.
- Equitable Financing - The plan could be funded from a wide variety of sources including general revenues, earmarked taxes and fees, employer contributions, individual contributions, and co-payments. Sliding scale assistance would be provided to lower-income citizens.
- Simplified Administration - A core benefit package would create a consistent set of ground rules for patients, payers, and providers. The creation of a national information technology structure for health care would decrease costs and errors.
The National Coalition on Health Care reform plan is very similar to many of the plans that have recently come on the scene from Massachusetts to California--with one HUGE exception. They have a cost containment plan that has teeth. Big, ugly, tough, teeth that will upset a lot of very powerful players in the health care system.
But wait! They are a lot of the big powerful players in the health care system!
The feds told us last week that we are well on the way to 20% of our GDP being wrapped up in health care in just ten years (from 16% today).
It's time--well past time actually--to have a serious national debate not just about how to get more people into the health care system but about how we do it in a way that we can afford it long-term. That means talking about big, ugly, tough ways to actually control our costs with something that has teeth.
That does not mean we should all favor a Canadian-style system. Government and the private sector can easily coexist in the health care world (and do). This group of corporations, unions, providers, politicians, and preachers have a plan that can do it. But let's quit kidding ourselves that the market is going to do it all by itself--any minute now.
For all you folks out there now screaming, "Government controls," let me ask you just one question? What do you think of Ben Bernanke and Alan Greespan? You know, the guys from that independent federal board that artificially controls the U.S. money supply? That wonderful capitalist institution of mega government managment.
If the U.S. health care system needs one thing it is the management of its money supply and the Federal Reserve, with its political independence, is a good model to follow.
Does anyone else want to join these guys on the reality side of the debate?
Health Care Policy and Marketplace Blog: http://healthpolicyandmarket.blogspot.com/
3 comments:
You analysis of the plan put forth by The National Coalition on Health Care is well thought out, therefore I wish to treat it with respect, but I would like to address a few points made in the hopes of pointing out some of the inherent flaws in your diagnosis.
You are undoubtedly correct: addressing the problem of cost is perhaps the primary issue we must face if we are ever going to reform our health care markets. However, there is an inherent contradiction in the coalitions first two points. They call for "Health Care Coverage For All" and then immediately after discusses "Cost Management." With the payment structure as it currently is, and expanded as the coalition described, costs will inevitably go up. The payment structure is designed specifically so that people are sheltered from the true costs of their medical consumption choices. Expanding Medicaid (which is already going broke) and S-CHIP (which will go broke, assuming we continue to pilfer the stabilization fund) is to put more people into a sinking ship. It is here that your Titanic analogy is truly relevant.
The only way to afford such a system would be to massively increase taxes (not just a few points) or administratively limit the services that people can choose. Which leads me to the board proposed in the plan. There is no plan possible that can allow people to consume as much medical care as they want and save money at the same time. The only way to address this is to tackle either supply or demand. Administratively, you can forbid certain people certain services, the implies a loss of choice for the individual.
However, if we allow the markets to work, to allow people to make decision for themselves, supply and demand will naturally reach an equilibrium. Sure, some people will get better care than others, but this is the case in every industry. I have a 1991 Tercel, my neighbor has a BMW. My neighbor can afford the latest diagnostic imaging, I can only afford the cheaper and outdated MRI. We both get a minimum amount of care, only in this manner nobody is dictating the terms of the decision making.
Health care costs are the problem. The 47 million that are uninsured are just a symptom.
Not quite. Healthcare costs are also a symptom. Costs are increasing across the board not because healthcare providers are charging ridiculous prices for the same old services or because managed care providers are poorly managing the individual cost of services. These costs are increasing because utilization is increasing: more people are using products services they did not use in the past. Utilization is driven by demand. And, as John so eloquently pointed out, “The payment structure is designed specifically so that people are sheltered from the true costs of their medical consumption choices.”
Cost sheltering is one of the factors driving demand, along with an aging population, better access to care, etc. The increase in demand is driving up utilization, which is driving up total costs.
An independent board, chartered and overseen by Congress, should be responsible for establishing and administering...measures for calibrating rates and limitations that keep costs and premiums in alignment with defined annual targets.
I have been around long enough to know double-talk when I hear it. A board which is responsible for “keeping costs and premiums in alignment with defined annual targets” sounds suspiciously like a board which will set upper reimbursement limits for healthcare products and services. The author made a very careful choice of words so as not to say “price controls”, but price controls is exactly what I heard.
Back to my first point: unit prices for products and services are not the problem. The problem is an explosion in utilization which is caused by many different factors, unit costs not being one of them.
Capping the reimbursement on a flu shot, a colonoscopy, or a bottle of Lipitor will neither reduce nor slow our growth in health spending. Costs will continue to increase at (at least) the current trend until someone addresses the real problem: demand.
Presidential candidates, Congressional leaders, Fortune 500 executives, Labor executives, and Special Interest executives, Republican, Democrat, Libertarian, or Independent, are not stupid, as much as some people would like you to believe. They would never have reached the level of professional achievement they did if they weren’t some of the smartest people out there.
All of the aforementioned people know the issues driving healthcare. They all know what will not solve the problem. They also know what it takes to retain their positions, whether it be dominating the next election, making their organization perform, or, in the case of executives, both.
Political leaders know what is required to ensure their own future success and the longevity of their party (which will, in turn, ensure their own future success). Republicans need the support of conservatives. They must promote ideologies such as capitalism, personal choice, and limited government to retain the support of their base. Democrats need the support of liberals. They must promote ideologies such as socialism and big government to retain the support of their base.
What’s the point, you ask? The point is that I see this “healthcare reform plan” (and others like it, such as those put forth by Clinton and Obama) as, for lack of a better phrase, a power grab. This is the “big gun” that the Democratic party needs to expand its base, thus ensuring its future success.
The Democratic party could be the dominant party for the next few decades it can sell the public on the idea that we need a government run, government controlled national health plan. …and, by the way, we also need to pay for it. Because revocation of an entitlement program is political suicide, the plan will effectively become permanent effective the day of implementation. Members of the Democratic party will then promote themselves as saviors.
And they can again promote themselves as saviors when the program becomes insolvent. The opposing party will be at fault for the poorly designed Democratic program which ignored the real issues.
I am not opposed to any of the healthcare reform plans simply because they will usher change, because they will require massive tax increases (for everyone who works for a living), because they will ensure a larger government which is more involved in our daily lives, or even because I just love the idea of a national health plan which is as well run as CMS, the IRS, the FDA, or the Department of Education. These are all issues about which we the people can have intelligent, rational debates.
I am opposed to these healthcare reform plans because they are long term political strategies under the guise of entitlement programs we the people can no longer live without.
To the Democratic lawmakers: call the proposals what they are. The dishonesty is killing me and the public is buying it hook, line, and sinker.
As Benjamin Franklin famously said, “When the people find that they can vote themselves money, that will herald the end of the republic.”
I'll say it again, health care costs are NOT the problem. Continued focus on the symtom and ignoring the root cause is flawed logic. Until we support a revolution in personal accountability including resposibility for personal health and well being, we are arguing over how to finance this mess, not unlike arguing over the color of tourniquet while the patient bleeds to death.
It's about a cultural revolution to change the way we live, better choices, healthier choices.
If you can handle the brutal truth, go to:
www.youhaveanuglybaby.com
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