Healthcare Reform: Obama verses McCain
I have just read both versions of Healthcare Reform as presented by the Republicans and the Democrats. How either is considered reform escapes me. Reform implies a great change intended to improve the quality or performance of an item. Few of the current healthcare deficiencies would be improved by these proposals. The problems with the current system that must be addressed include too many people with insufficient or no coverage, too high a cost for the products (drugs, procedures, etc.), too much manipulation of patient care by the insurers, too many healthcare dollars being divided up in board rooms and on Wall Street, and no way to track and control abuse by providers, suppliers, institutions, and especially of the health insurance industry itself. If these problems were corrected, it would still be only one half of the reform we need.
The other half of the needed reform is in the financial aspects. Our economy is hurting and most people already feel the crunch. As reported by Ross Perot at http://perotcharts.com/, 53% of our current Federal spending is non-discretionary. In other words, we have no choice but to spend that percentage just to get by. That leaves approximately 37% to spend on everything else (defense, roads, etc) including healthcare reform. It is clear that what ever we do with healthcare has to be fundable. That does not mean we can just dump it on the taxpayers. We need to look at what we have in place, both in structure of the current system and how we fund the current system, and keep as much as is reasonable,to save money, then to reform the rest. It is the only way we can get a non-watered down version of Healthcare Reform that we can fund for years to come.
It is clear that a free market system only works if the product can be taken or left behind. Healthcare cannot adhere to that constraint. When you need it, you have little choice. The system we have in place is based in the free market and it clearly does not, and cannot, work. Now, what is offered by our “reform candidates”?
John McCain’s plan is simply more of the same. He wants to expand insurance in the private sector, often at taxpayer expense. This also means further profits for those insurance companies who participate. Aren’t they already bleeding us dry while restricting care in order to do so? His plan would deregulate the insurance market in a way that would allow a person to buy health insurance across state lines. The downside is that the current regulations are the only reasons some companies cover patients as thoroughly as they do. Removing these regulations may free them of that requirement. He also wants to move away from fee-for-service opting for a bundled payment approach. There is no surer way to get providers to work less hours and to see fewer patients. How many cars would be assembled on a line if a workers pay was bundled into one lump payment, giving them little or no incentive to work harder. Lastly, by making the cost of care visible to the patient, McCain feels they would shop for cheaper products and insurance. What a misperception. This is such a complicated business and the products and insurance plans are so confusing and incomprehensible that the average person will not be able to barter their cost downwward by any amount.
The Obama plan at least makes a gesture in the right direction, but still relies heavily on the private insurance companies. He would set up a government backed public health insurance plan, somewhat on the Medicare system, and would let people with expensive coverage or no coverage to pick between the private or the public sectors. This would potentially expand the number of persons covered, but would be terribly expensive to the taxpayer. By allowing this voluntary shift, the healthy, low cost patient could stay in the private sector (with his premium profit margin going into the afore mentioned board rooms) while the high cost patient would wind up in the public sector where his premium deficit could be shouldered by the taxpayers. Further, people choosing not to participate in any plan would still wind up costing the taxpayers anytime they were sick and needed care. There are no funds of these folks anywhere. Obama is counting on letting the Bush tax breaks expire as partial financing for this plan, but with our current national economy and deficit, how much tax money can we really afford to commit?
I am very disappointed in each of these proposals. They seem to represent a gross misunderstanding of what is needed and/or of mindlessly compromising with those persons and industries that are opposed to healthcare reform. There are other plans available. Some can be instituted in the upper and lower age groups now, and then scaled to include all age groups as funding and infrastructure improve. This is a major reform for us, and knowing how slow congress is to repair its mistakes; I would rather get it right the first time.
Mark Green MD