Monday, January 15, 2007
Attached an article from todays Miami Herald and a response in the form of a Letter to the Editor.
Monday, January 15, 2007
Letter To The Editor
The interview with Brian Keeley, CEO of Baptist Health South, revealed a common misperception about how to solve America’s healthcare crisis. Locked into an ideological feud Democrats and Republicans either tout the benefits of a government-controlled system (Medicare For All) or the advantages of a free market system. Both sides are wrong.
Currently, local, state and federal government entities control 45% of all health care dollars spent and the number of uninsured is still rising, approaching almost one-third of all citizens in South Florida.
The so-called “free enterprise system” is riddled with mandates and regulations preventing an individual to obtain affordable insurance coverage and excluding those who suffer from even minor ailments.
A desired universal healthcare coverage should be based on the following:
1) Complete transparency and proper financial management of America’s domestic healthcare programs with full accountability of every tax-dollar spent;
2) Emphasis on prevention, individual choices and access to affordable medications;
3) Deregulation of the health insurance industry, removing insurance mandates and creation of an open national insurance market;
4) Comprehensive malpractice reform by establishing a medical court system and mandatory medical error reporting mechanisms, thereby guaranteeing the rights of patients and protecting the economic viability of the medical practitioner;
5) Creation of regional and national information sharing mechanism that allow for the immediate access to protected and safe guarded patient information, which will reduce the duplication of medical tests and avoid fatal medication errors.
America health care system is indeed in a deadly death spiral. We don’t need a Democratic or Republican solution. We need an American solution to provide health care for all.
Vice-President, Dade County Medical Association
16899 NE 15th Avenue
Phone: (305) 940-8717
Posted on Mon, Jan. 15, 2007
Reversing U.S. healthcare's 'death spiral'
Brian Keeley, head of South Florida's largest healthcare company, discusses what to do about the nation's health problems and his own firm's role.
BY JOHN DORSCHNER
Brian Keeley is a mix of big-time business executive, philosopher and social innovator.
As chief executive of Baptist Health South Florida, he has created over the past 20 years a strong nonprofit system of five hospitals in affluent southern Miami-Dade County and the Keys at a time when many stand-alone facilities were going under or being sold to for-profit chains.
The system has become South Florida's largest nongovernment employer, with more than 11,200 workers, and the region's biggest healthcare firm, with $1.5 billion in annual revenue and a net surplus of $136 million.
Even with all this success, Keeley is concerned about America's conflicting views of healthcare. He succinctly portrays the tensions this way: ``We all want the absolutely best care, and we want someone else to pay for it.''
Like many industry leaders, he is convinced the country's healthcare system is in a ''death spiral,'' because the number of uninsured keeps rising. These people tend to skip primary care and end up in emergency rooms, where they run up big bills that they frequently can't pay, meaning hospitals must charge private insurers more to make up for these losses. That tends to make private health insurance less affordable, causing more companies to drop coverage, increasing the number of uninsured, and so on.
At times a bubbly cheerleader for new ideas, Keeley has announced recently two major initiatives: Baptist Health South Florida will favor using vendors who provide health insurance for their employees and it plans to provide affordable housing to attract workers.
Q: America spends twice as much on healthcare as other industrial countries, but we have the same or shorter life expectancy. Do we spend too much?
A: Yes, America spends a lot, for various reasons. One is the demands of the American consumer, but also we have a highly fragmented, highly inefficient system. And we're the only one of those [industrial] countries without a national, single-payer system.
Q: Where is one area where we cut back on costs and not hurt healthcare?
A: I think the administrative overhead and the lack of any integrated medical record system is a huge opportunity. We have so much duplication because we have these little silos of information in each doctor's office and every hospital. And no one talks to each other, and so consequently when the physicians order things they have no idea what other doctors ordered.
If we could come up with a single electronic medical record system that everybody shared, in my estimation we could save trillions of dollars because everybody is accessing the same information. . . . Everybody has to share. I am an extremely strong advocate of this.
Q: America has 45 million uninsured. Give me a short take on how to get people covered.
A: You can take the Democratic approach -- universal health [insurance], government control. Or you can take the Republican approach -- the free enterprise system. I'm for the free enterprise system.
The system will not self-correct right now. The market forces aren't aligned to make it self-correct.
I love what Massachusetts is doing with the mandate [requiring employers to provide insurance]. They have less of a problem. Their uninsured is 6 to 8 percent. In Florida it's 19 percent and in South Florida it's approaching 30 percent. . . . California is similar to what they're doing in Massachusetts, maybe a little more aggressive. California has about 20 percent uninsured, so they're similar to us. . . .
But I love the idea of a mandate: If you're going to play in the arena, you have to provide health insurance, and if you don't, guess who picks it up? We do because there's a cost shift to the private sector [in which private insurers have to pay higher premiums to cover hospitals' costs for treating the uninsured], or they're put on Medicaid rolls and we pay through our taxes. So a mandate makes tremendous sense to me if we're going to operate under the free enterprise system.
Q: Hospital gross charges are often three or four times what private insurers or Medicare pays. Why not just do away with gross charges?
A: The complex gross charge structure is incongruent, incoherent, indefensible. I will not defend the way hospitals charge, but we don't control that because we have all these impositions that are brought down on us by the federal government, which by the way pays us two different ways for Medicare and Medicaid.
And then every managed care company decides at its own discretion that they're going to pay us differently.
If we had a uniform, single methodology for reimbursing hospitals and physicians, we could save a huge amount of money, but it's beyond our capability to force that upon these payers out there, because they're the ones who set the rules. And we need to make this consumer-friendly, especially as we have this major shift to consumer-driven healthcare.
Q: Baptist Health South Florida has a very healthy bottom line, and insurance companies say you charge too much. As a nonprofit, how would you explain your surpluses?
A: Yes, we do have a profitable operation. And we're mission driven. We're faith based. And what that means is every single penny gets pumped back into the community for the benefit of the community, through charity care, through community service, through building new hospitals, like Homestead, which nobody would ever build down there because we're still losing $7 [million] to $10 million in Homestead.
We're making a huge commitment over there and in West Kendall [where Baptist plans another new hospital]. So it's not going in anybody's pockets.
By having a strong bottom line, we can also give a significant amount of charity care. People are eligible for charity if they earn up to 300 percent of the federal poverty level -- in contrast to Jackson, where it's up to 200 percent.
Sunday, January 14, 2007
Attached an article from today's Miami Herald reporting that a Miami-Dade heart surgeon facing criminal charges for perjury and fraud for allegedly exaggerating his qualifications about his experience doing open-heart surgery while giving a deposition for the plaintiff in a Michigan malpractice case, in which the federal government was the defense.
I personally know Dr. Zakharia and was saddened to hear that a dedicated surgeon faces such serious charges.
What can we learn from this case?
- Carefully prepare your testimony
- If in doubt do not guess, but answer " I have to get back to you"
- Be prepared that your entire performance records are discoverable and can be subpoenaed.
|Posted on Tue, Jan. 09, 2007|
Heart surgeon faces criminal charges
In a rare move, a federal grand jury indicted a Miami heart surgeon for allegedly lying in a Detroit malpractice case.
BY JOHN DORSCHNER
Alex Zakharia, 68, a Miami-Dade heart surgeon for more than 30 years, is facing criminal charges in Detroit for perjury and fraud.
The doctor was indicted by a federal grand jury, which alleged that he exaggerated his qualifications about his experience doing open-heart surgery while giving a deposition for the plaintiff in a Michigan malpractice case, in which the federal government was the defense.
Zakharia told The Miami Herald on Monday that the defense lawyers didn't understand him, he didn't exaggerate and the issue of his experience wasn't even material to the central subject in the case, which he said involved botching the presurgery tests of a patient.
''They should be going after the doctors who did this to this veteran, instead of a doctor who gave his honest opinion,'' Zakharia said. He has hired a lawyer and hopes to have the case resolved shortly.
The qualifications of doctor-witnesses are often challenged in hotly contested malpractice lawsuits, but officials of the Florida Medical Association and the Florida Justice Association, the new name for the state's trial lawyers group, could not immediately recall any other examples of doctors being criminally charged with misstating their qualifications.
Many doctors testify against other doctors only in proceedings far from their own states, and the Florida Medical Association has been pushing the Legislature to pass a law licensing out-of-state medical witnesses so that juries can be sure of their qualifications. Trial lawyers have vehemently opposed the measure, which has repeatedly failed to pass.
The charges against Zakharia were pushed by the U.S. Attorney's Office in the Eastern District of Michigan, which was also the office that provided the defense attorneys in the malpractice lawsuit, brought by a man whose last name was Rodgers against the Veterans Administration and the U.S. government.
Zakharia said notes in the medical case file clearly indicated that, before the coronary bypass surgery, an ultrasound to detect blocked carotid arteries was inconclusive and needed to be redone. But new tests were not done before surgery.
During his deposition in that case, Zakharia was asked by defense attorneys about his qualifications on coronary bypass surgery.
The indictment alleges Zakharia testified he performed 10 to 12 such operations a year and was the lead surgeon during the operations. When defense attorneys said records of the hospitals he mentioned -- Cedars and Miami Heart -- did not support his claims, he said the hospital records were in error, the government alleges.
Later, an attorney ''who had paid him thousands of dollars to testify as an expert witness,'' asked him about the discrepancies in his experience, and Zakharia continued ''to mislead the attorney concerning the extent of his surgical experience,'' the indictment alleges.
Zakharia said Monday he participated in those surgeries, but he made his role clear to attorneys. ``I told them I'm not the lead surgeon. I assist.''
But the indictment includes a portion of a transcript:
Q: ``When you say you are doing about 10 CABG procedures a year, are you the attending physician, the guy in the chest doing the sewing and cutting?''
A: Yes. I'm not including many cases where I assist or supervise other younger surgeons, you know.''
Q: ``You would be the man who signs the operative note?''
Zakharia said Monday he doesn't testify in many malpractice cases and maintains a full practice. He will turn 69 later this month.
''I'm held in very high regard,'' he said. ``I did five procedures and saw 16 patients today.''
even though everyone has to chip in." (Governor Schwarzenegger)
Governors Schwarzeneggers bold healthcare reform proposal has triggered a wave of support and opposition.
Dear Friends and Colleagues:
I think its important to understand his proposal and to learn how to refine such an approach, so that it can achieve what it is supposed to achieve.
California now has about 6.5 million people who are uninsured or underinsured, a higher level than any other state. According to the Census Bureau, 15.9% of Americans lacked health insurance in 2005; in California, it was 19.4% ( in South Florida almost 30%!!).
The plan would require employers with 10 or more workers to provide health insurance or pay a 4% tax on all wages covered by Social Security: The plan would be financed by charging a "dividend" (i.e .TAX) of 2% on doctors' revenue and 4% on hospitals' and $10 billion to $15 billion in new money coming into the medical system from so many people being insured, as well as a proposed increase in the state's Medi-Cal plan.
Such a "tax", camouflaged as a "dividend", guarantees opposition from California physicians who already voiced their concerns.
David Henderson brings up a very important point; does universal coverage provided by the government work?
He raises two concerns:
"Why doesn't increased government power tend to solve the problem of the uninsured? There are two main reasons. First, when government provides health insurance, many people who take advantage of it drop their own privately provided health insurance. In a 1996 article in the Quarterly Journal of Economics, Harvard economists David M. Cutler and Jonathan Gruber found a 50% "crowding-out effect." As the federal Medicaid program expanded, for every two people who gained insurance through Medicaid, one dropped private health insurance. Although this is a net addition of one, the costs to taxpayers are much higher than expected because now half of the newly covered, instead of paying their own way as they previously did, become wards of the state.
Second, of the 46 million or so people without health insurance at any given time, about 45% will have health insurance within four months. This is one of the main findings of a 2003 study by the Congressional Budget Office, "How Many People Lack Health Insurance and for How Long?" That shouldn't be surprising in a country where most private health insurance is employer-provided and most unemployment spells last 11 weeks or less. Solutions that involve government mandates on employers or employees will, therefore, miss connecting with about half of the people who are uninsured at a given point in time."
Maybe Governor Schwarzenegger should consider the following:
1) Abolish or reduce government mandates, which have contributed to an increase in insurance premiums
2) Open the market place and let insurance providers from all over the US compete for customers, thereby allowing average citizens to buy health insurance in the same way as they currently can but car insurance.
Again David Henderson points out:
"In the last few decades, state governments, the main regulators of health insurance in the individual and small-group markets, have mandated coverages for many kinds of health care. According to the Council for Affordable Health Insurance (CAHI), a pro-market association of insurance carriers, there were 1,843 state mandates in 2006. Among the most common, and most expensive, mandates are chiropractic care, treatment for alcoholism and drug abuse, and mental health benefits. California's government mandates coverage for all of the above, as well as for many other benefits, including, for example, infertility treatment -- a very expensive benefit.
Abolishing these mandates would allow people who don't want to be covered for these things to buy cheaper insurance, while still allowing those who want them to buy and pay for them. Would such an approach work? That's like asking whether, if the government currently required new cars to have CD players, eliminating that requirement would lower the price of a car. Of course it would work.""
On Fight for Health Plan
By JIM CARLTON
January 9, 2007; Page A2
(See Corrections & Amplifications item below.)
California Gov. Arnold Schwarzenegger proposed a sweeping plan to mandate universal health care in the nation's most-populous state, putting forth measures that would require employers to pay into the health-care system as well as tax hospitals and doctors to help offset medical coverage's spiraling costs.
The move makes Mr. Schwarzenegger, a Republican, the latest governor to try to tackle a problem -- covering the uninsured -- that the federal government has been unable to solve. Massachusetts Gov. Mitt Romney, who is seen as a Republican contender for the presidency, struck a bipartisan deal with his state's legislature last year mandating universal health care in the Bay State. Mandates for some employers to pay more of their share if they don't already have been passed in Vermont and Maryland, as well as New York City and San Francisco. Maryland's law was thrown out by a federal judge last year after a legal challenge.
California, with 36 million residents, could influence other states to follow suit. But Mr. Schwarzenegger also faces potentially one of the fiercest battles of his political career, because his plan calls for some level of sacrifice from many of the parties affected.
The governor anticipated criticism in his remarks yesterday to a Sacramento gathering of his staff and business executives, saying the long-term rewards of having lower medical costs would make the pain worthwhile. "It appears we are taking something away from everyone here," Mr. Schwarzenegger said by video link as he recuperated from a broken leg injury he suffered while skiing over the holiday break in Sun Valley, Idaho. "But when you look at the math, they actually benefit. Everyone is left with a better deal, even though everyone has to chip in."
The governor said his plan to charge a "dividend" of 2% on doctors' revenue and 4% on hospitals' would be more than offset by what his office estimates would be $10 billion to $15 billion in new money coming into the medical system from so many people being insured, as well as a proposed increase in the state's Medi-Cal plan.
California now has about 6.5 million people who are uninsured or underinsured, a higher level than any other state. According to the Census Bureau, 15.9% of Americans lacked health insurance in 2005; in California, it was 19.4%.
The Schwarzenegger plan drew some skepticism. "There may be some unintended consequences," said Joel Fox, president of the Small Business Action Committee in Sacramento, in a panel discussion organized by the governor's administration after the speech. "For example, will some businesses opt out of covering employees and go into the pool [of state-insured workers], thus overwhelming the pool? Will some companies cherry-pick their employees so that they hire those more easily covered, instead of guys like me that are older?"
Allan Zaremberg, president of the California Chamber of Commerce, questioned whether the plan would really make health care more affordable for those who already are insured. Mr. Zaremberg said the taxes on doctor and hospital revenues could be passed onto consumers and the companies that already provide insurance in higher premiums.
Others praised the plan. Officials of Blue Cross of California called it "bold and visionary," singling out the provision to provide medical coverage to all uninsured children in the state, even those of illegal immigrants. "Taking each part separately, there's something for everyone to hate, but taken as a whole, there's a lot to like," said Bruce Bodaken, chairman, president and Chief Executive of Blue Cross of California.
Some other business leaders, including the chief executive of California-based grocery titan Safeway Inc., are also backing the plan. One reason: They already pay to fund medical plans for their employees, and resent the competitors who don't. On balance, the governor likely will have a tougher time persuading members of his own party to back the measure than the Democratic lawmakers who control the California Legislature. Indeed, Mr. Schwarzenegger's plan isn't hugely different from versions recently proffered by state Senate President Don Perata and Assembly Speaker Fabian Nunez. Mr. Nuñez said in an interview that he just had a few issues with the governor's plan -- most important, that it would shift money from one program for the poor into this health-care program. "On its face, this is a good start," Mr. Nuñez said.
he California government could allow any Californian to buy health insurance from any willing insurer in any state and be subject to the regulations of that state. That way, people could shop for the degree of paternalism they want. If they want insurance from a state that requires many coverages, they could do so and pay the high premiums that result. If they want bare-bones coverage, they could do so also. The result would surely be that some of the current uninsured would buy insurance. Were I in the market for individual insurance and given the choice, I would not bother paying for coverage for alcohol or drug abuse.
---- Mark Golden contributed to this article.
By DAVID R. HENDERSON
January 10, 2007; Page A17
MONTEREY, Calif. -- On Monday, Arnold Schwarzenegger presented his proposal for reducing the number of Californians who lack health insurance. His proposal is almost indistinguishable -- except in details -- from that of the Democrats who dominate the California Assembly and Senate.
The Democrats tend to favor solutions involving regulations, government spending and taxes, and Senate President Pro Tem Don Perata's proposal -- the main contending Democrat plan -- hits the trifecta. It would require employers to provide health insurance; give them the option of paying a tax instead of providing health insurance; and increase spending by expanding both the Medi-Cal and Healthy Families programs, which provide care to low-income children -- including children of illegal immigrants and the disabled.
Mr. Schwarzenegger's solution hits the trifecta also. He would require employers with 10 or more workers to provide health insurance or pay a 4% tax on all wages covered by Social Security: Look for employers with 10 to 12 employees to get creative about outsourcing. And look as well, as Harvard economist Jonathan Gruber has documented, for wages to fall in firms that offer health insurance because of the mandate. Gov. Schwarzenegger would throw in a 2% tax on doctors and a 4% tax on hospitals to help fund Medi-Cal, California's name for Medicaid. And he would expand Medi-Cal to adults earning as much as 100% above the poverty line and to children, even those here illegally, in poor and middle-income families. He hopes, by doing this, to shift $5 billion of Medi-Cal's annual cost to the federal government.
There are two problems with such solutions. First, they infringe on economic freedom, preventing, in Robert Nozick's phrase, "capitalist acts between consenting adults." Second, government solutions rarely work.
Why doesn't increased government power tend to solve the problem of the uninsured? There are two main reasons. First, when government provides health insurance, many people who take advantage of it drop their own privately provided health insurance. In a 1996 article in the Quarterly Journal of Economics, Harvard economists David M. Cutler and Jonathan Gruber found a 50% "crowding-out effect." As the federal Medicaid program expanded, for every two people who gained insurance through Medicaid, one dropped private health insurance. Although this is a net addition of one, the costs to taxpayers are much higher than expected because now half of the newly covered, instead of paying their own way as they previously did, become wards of the state.
Second, of the 46 million or so people without health insurance at any given time, about 45% will have health insurance within four months. This is one of the main findings of a 2003 study by the Congressional Budget Office, "How Many People Lack Health Insurance and for How Long?" That shouldn't be surprising in a country where most private health insurance is employer-provided and most unemployment spells last 11 weeks or less. Solutions that involve government mandates on employers or employees will, therefore, miss connecting with about half of the people who are uninsured at a given point in time.
But what if the governor could solve some of the problem by making health insurance cheaper? He can -- not by regulating more, but by deregulating.
Let me explain. In the last few decades, state governments, the main regulators of health insurance in the individual and small-group markets, have mandated coverages for many kinds of health care. According to the Council for Affordable Health Insurance (CAHI), a pro-market association of insurance carriers, there were 1,843 state mandates in 2006. Among the most common, and most expensive, mandates are chiropractic care, treatment for alcoholism and drug abuse, and mental health benefits. California's government mandates coverage for all of the above, as well as for many other benefits, including, for example, infertility treatment -- a very expensive benefit.
Abolishing these mandates would allow people who don't want to be covered for these things to buy cheaper insurance, while still allowing those who want them to buy and pay for them. Would such an approach work? That's like asking whether, if the government currently required new cars to have CD players, eliminating that requirement would lower the price of a car. Of course it would work.
It is important, though, not to overstate its benefits. The gain to Californians from abolishing these mandates would not be huge. CAHI compiled data from America's Health Insurance plan and eHealthInsurance for the individual market and from the federal government for the small-group market and found that in 2003, although California had more mandated coverages than all but six other states, it had among the lowest insurance rates for individual health insurance policies ($1,885 versus a top rate of $6,048 for New Jersey.)
The reason, explains CAHI, is that in other ways California is much less regulatory than many other states. It does not, for example, require guaranteed issue on individual policies -- which drives up premiums by forcing insurance companies to supply policies to all comers, regardless of health status. Yet the governor's proposal would reverse this somewhat and prevent insurance companies from saying no because of age and health.
California should not, contra Gov. Schwarzenegger, do new regulatory harm; rather it should repeal existing regulations that cause harm -- so as to make health insurance even more affordable.
There is one other way to deregulate: The California government could allow any Californian to buy health insurance from any willing insurer in any state and be subject to the regulations of that state. That way, people could shop for the degree of paternalism they want. If they want insurance from a state that requires many coverages, they could do so and pay the high premiums that result. If they want bare-bones coverage, they could do so also. The result would surely be that some of the current uninsured would buy insurance. Were I in the market for individual insurance and given the choice, I would not bother paying for coverage for alcohol or drug abuse.
If a version of Gov. Schwarzenegger's plan passes, the only thing certain is that there will be more regulation, more government spending and more taxes. A better path would be to deregulate, and thus achieve some increase in the number of insured -- without new spending or taxes or regulation.
Mr. Henderson, a research fellow at Stanford's Hoover Institution, was the senior economist for health policy with President Reagan's Council of Economics Advisers (1982-84). He is co-author of "Making Great Decisions in Business and Life" (Chicago Park Press, 2006).
Tuesday, January 02, 2007
"The only reason universal coverage seems hard to achieve here is the
spectacular inefficiency of the U.S. health care system."
Dear Friends and Colleagues:
I want to wish you a Happy and Health New Year to all of you!
Attached an interesting OpEd from today's New York Times emphasizing an issue that many politicians still avoid discussing: COMPREHENSIVE AND UNIVERSAL HEALTH CARE REFORM.
Many may disagree with the authors proposals, but just ask your self why:
* we spent more money per capita and GDP on health care and still cannot provide comprehensive coverage
* we still struggle to exchange information in order to coordinate health care delivery
* we deprive citizens of insurance solutions just because they have a preexisting condition
* in South Florida the number of uninsured residents approaches 29% of the population!!!
* we neglect the development of preventive health care
* we still have wide variation in quality and outcome of health care delivery
As doctors we have to be part of the solution and not part of the problem. We must pro-actively participate in the discussion for comprehensive health care reform and provide positive and realistic perspectives.
My personal New Years resolution is to promote the discussion regarding universal coverage and comprehensive health care reform and will post articles discussing this issue on my blog http;//floridadocs.blogspot.com.
I also invite any interested colleague to join me in the development of a book in which doctors provide different perspectives for health care reform.
Such a book can be self published and can serve as a platform for an ongoing reform initiative.
Contact me if you are interested.
January 1, 2007
A Healthy New Year
By PAUL KRUGMAN
The U.S. health care system is a scandal and a disgrace. But maybe, just maybe, 2007 will be the year we start the move toward universal coverage.
In 2005, almost 47 million Americans — including more than 8 million children — were uninsured, and many more had inadequate insurance.
Apologists for our system try to minimize the significance of these numbers. Many of the uninsured, asserted the 2004 Economic Report of the President, “remain uninsured as a matter of choice.”
And then you wake up. A scathing article in yesterday’s Los Angeles Times described how insurers refuse to cover anyone with even the slightest hint of a pre-existing condition. People have been denied insurance for reasons that range from childhood asthma to a “past bout of jock itch.”
Some say that we can’t afford universal health care, even though every year lack of insurance plunges millions of Americans into severe financial distress and sends thousands to an early grave. But every other advanced country somehow manages to provide all its citizens with essential care. The only reason universal coverage seems hard to achieve here is the spectacular inefficiency of the U.S. health care system.
Americans spend more on health care per person than anyone else — almost twice as much as the French, whose medical care is among the best in the world. Yet we have the highest infant mortality and close to the lowest life expectancy of any wealthy nation. How do we do it?
Part of the answer is that our fragmented system has much higher administrative costs than the straightforward government insurance systems prevalent in the rest of the advanced world. As Anna Bernasek pointed out in yesterday’s New York Times, besides the overhead of private insurance companies, “there’s an enormous amount of paperwork required of American doctors and hospitals that simply doesn’t exist in countries like Canada or Britain.”
In addition, insurers often refuse to pay for preventive care, even though such care saves a lot of money in the long run, because those long-run savings won’t necessarily redound to their benefit. And the fragmentation of the American system explains why we lag far behind other nations in the use of electronic medical records, which both reduce costs and save lives by preventing many medical errors.
The truth is that we can afford to cover the uninsured. What we can’t afford is to keep going without a universal health care system.
If it were up to me, we’d have a Medicare-like system for everyone, paid for by a dedicated tax that for most people would be less than they or their employers currently pay in insurance premiums. This would, at a stroke, cover the uninsured, greatly reduce administrative costs and make it much easier to work on preventive care.
Such a system would leave people with the right to choose their own doctors, and with other choices as well: Medicare currently lets people apply their benefits to H.M.O.’s run by private insurance companies, and there’s no reason why similar options shouldn’t be available in a system of Medicare for all. But everyone would be in the system, one way or another.
Can we get there from here? Health care reform is in the air. Democrats in Congress are talking about providing health insurance to all children. John Edwards began his presidential campaign with a call for universal health care.
And there’s real action at the state level. Inspired by the Massachusetts plan to cover all its uninsured residents, politicians in other states are talking about adopting similar plans. Senator Ron Wyden of Oregon has introduced a Massachusetts-type plan for the nation as a whole.
But now is the time to warn against plans that try to cover the uninsured without taking on the fundamental sources of our health system’s inefficiency. What’s wrong with both the Massachusetts plan and Senator Wyden’s plan is that they don’t operate like Medicare; instead, they funnel the money through private insurance companies.
Everyone knows why: would-be reformers are trying to avoid too strong a backlash from the insurance industry and other players who profit from our current system’s irrationality.
But look at what happened to Bill Clinton. He rejected a single-payer approach, even though he understood its merits, in favor of a complex plan that was supposed to co-opt private insurance companies by giving them a largely gratuitous role. And the reward for this “pragmatism” was that insurance companies went all-out against his plan anyway, with the notorious “Harry and Louise” ads that, yes, mocked the plan’s complexity.
Now we have another chance for fundamental health care reform. Let’s not blow that chance with a pre-emptive surrender to the special interests.