The Alan Katz Health Care Reform Blog

Health Care Reform From One Person's Perspective

Comprehensive Health Care Reform Not Very Comprehensive

Posted by Alan on November 4, 2009

Once upon a time it looked like Congress and the White House would deliver meaningful, comprehensive health care reform to the American people. They certainly started down that path. The talk was of “bending the cost curve.” And of tackling issues like medical malpractice. There was even promises being made of moving toward comparative effectiveness programs and away from the costly fee-for-service provider reimbursement model of today.

Those were the days, but they’re over now. Whether as a result of the August Town Hall ruckuses, lawmaker’s ignorance, or general cynicism, those ideas are pretty much a thing of the past. Yes, there are modest efforts in the current Congressional bills to control costs. But to call them modest is kind. Politicians and pundits. will claim that what’s moving through Congress will make health care coverage more affordable and relieve the burden of medical costs on American families, but few actually believe it.

Over the past few months, the focus of health care reform has shifted to health insurance reform. And while some changes in the way health care coverage is marketed and administered are necessary, those changes will do little if anything to bring down the cost of care. On the contrary, some of the proposals being considered will, it is generally accepted, increase insurance premiums.

This shift by lawmakers from comprehensive health care reform to simply addressing marketing and distribution reform is, to say the least, disappointing. It also shows the challenge in accomplishing major change in Washington. The partisan divide is deep and cynical. The extremes within each party are in ascendancy, making compromise – the life-blood of the legislative process – all but impossible.

So instead of passing real reform, changes to the system that would restrain medical cost increases, the goal seems to have shifted to passing something – passing anything – on which the “health care reform” label can be hung. The result will do little to increase the affordability of insurance coverage or to restrain medical cost inflation. Lawmakers choose to ignore this reality – and to distract attention from it by keeping the focus on whether Congress will create a publicly run plan to compete with private carriers.

Yes, health care reform is hard while taking on the insurance companies is easy. And, as I’ve mentioned, there are some industry practices that need reforming. Given the political realities in Washington it may be that health insurance reform is all that lawmakers are capable of delivering any time soon. 

The shame of it all is that the current health care system is unable to meet America’s needs. The status quo, most objective observers from across the political spectrum agree, is unacceptable. America is the only developed nation in which medical costs bankrupts families. The cost of medical care is overwhelming state governments, threatening their ability to deliver other necessary services. Medical cost inflation is outpacing growth in wages and general inflation, resulting in increasing numbers of families and businesses being priced out of health care coverage.

Meaningful, comprehensive health care reform is critically needed. It’s what the American people desire. But Congress and the White House seem unable to deliver. The fault is not solely with the Democrats nor solely with the Republicans. This is a bi-partisan failure. And hiding behind health insurance reform won’t change that reality.


3 Responses to “Comprehensive Health Care Reform Not Very Comprehensive”

  1. JimK said

    The current legislation does have a section dedicated towards a “program” designed to study a different approach to physician compensation. It also has a “trust fund” provision to be used towards evaluating comparative effectiveness. The annual budget for the comparative effectiveness program begins in the range of 90 million dollars annually and then escalates by 10 million dollars over the next two years.
    I did not look at the physician compensation program that closely, so I can’t really say of this is just window dressing or is it a true blueprint for changing the fee for service model. The same can be said for the comparative effectiveness program. The initial budget dedicated to the program seem substantial but perhaps it is not. In addition, the legislation only sets up a Trust Fund and a panel to implement the trust fund. The legislation seems to lack a direction on what is to be done with the findings of the panel.
    There are other sections that seem to be dedicated to reviewing and adjusting the pay structure of the current coding system, but I believe Medicare already does this so its affect will probably be minimal.
    My biggest concern is on the employer mandated expenses, and again I did not thoroughly review the legislation but it seems to me that the legislation will impose stiff taxes on some employers and the mandates will discourage hiring and be an impediment to wage hikes.
    Finally, the dollar value of subsidies outside the US territories appear to be in the hands of the agency set up to administer the program and with that being the case the income levels eligible for a subsidy may actually be much lower than the original 300 to 400% levels discussed previously. There is caselaw that supports the fact that the subsidies will be lower than originally proposed. The case involved the Postal Service Reorganization Act of 1971 and under the original legislation there was a legislated pay provision whereby management would be guaranteed a minimum pay differential of 25% over that of the bargaining unit. The Court ruled that since the specific precentage was considered and removed it demonstrated that Congress did not set a base floor and the agancy had complete discretion on where that floor should be set.
    In closing, since in my opinion you have been very objective in your reporting on this issue I will take you at your word that this current legislation is seriously lacking and I can expect higher premiums if the Bill is passed. There is one interesting note and that is with regards to retirees. I am a retired Postal Employee and one section seems to indicate that had I retired after this Bill was passed my health insurance premiums would have remained the same as when I was working. This provision does not affect other Federal Employees as their contributions are the same whether they are working or retired.

    • Doug said

      According to the bill it will be up to the secretary of Health and Human services to set the “minimum” requirements for private insurance. Aside from the large power grab, I find it alarming that the federal government will be making detail decisions on what will be covered by insurance. We can cover spa treatments, massages, or even hair loss treatments. In reality they have showed up in mandates form state and foreign governments.

      How is this going to make private insurance cheaper?

  2. I think the dissent at the August Town Hall meetings resulted in the fact that people in this country have been watching Washington screw up everything they have touched for the last 20 years. You can not take care of the interest of corporate America and the interest of the people in it at the same time, these are two totally different agendas. Whatever comes out of this I am sure that the majority of people will be worst off for it.

Sorry, the comment form is closed at this time.

%d bloggers like this: