Monday, July 27, 2009

Another take on healthcare reform

I'm on a few email lists which deal with medical billing and payment issues. Most of the time, we're discussing the nuts and bolts of how to bill and how to get paid. Occasionally, we detour to more broadbased, policy discussions which can get pretty heated since,like the country, we are representative of every political persuasion.

Recently, a dyed in the wool Texas Republican initiated a discussion of healthcare reform with a complaint about a specific portion of one of the proposed bills. Below is the response of another more liberal (centrist by his own description) list member which I found compelling. Since it was published to a public email list, I trust that I'm not violating any Internet protocol by reprinting it here:

I haven't replied till now because I have a business to run and long threads on three different lists are not compatible with that. Now that we both have our rants done with, my friend, we can talk about this in a less humorous and satirical way. As I said in my initial response, "we need to really look at this issue as citizens of a democratic republic, take a deep breath and find out enough about all the issues (not just what I'd like or what you'd like) and voice our opinion with suggestions to make reform as reasonable and fair as possible for as many people as possible. Maybe we will need to recall or not vote for some folks. Maybe we need to realize that getting the same amount of money back from the Feds as we put in in taxes is not the way a united country works for the best of all citizens."

Let me set my parameters. Sociologists generally refer to the middle class economically as those making between $30,000 to $80,000 per year. Those making above that amount (to about $150,000) are either upper middle class or considered lower upper class (see any text on social class). The most recent reliable poll I have(from Kaiser, one of those who sit on the fence because of their insurance connections and confirmed by POLE from St. Norbert's College) is that 56% of Americans want health care fixed now and believe they and the country will be better off. Interestingly enough, the figures of those folks go up to the 70% - 80% when limiting the responses to the economic middle class. Further, 60% want a public plan. I understand we differ in politics. I tend to vote centrist but can look at and adopt policies and stands from both right and left. That tends to make me unpopular with the folks from either the conservative or liberal side. One final thought, I never ever trust the Lewin Group for anything. Their track record as objective, accurate predictors and as being reliable is somewhat worse than that of the pharmaceutical research and besides they are owned by United Health Care (such a reliable group:-0)

Let's talk about what you said. "It does no good for either of us to rant about what damage the previous presidents did." I see that you do not choose to include Obama in the category of those who should not be flamed. The president inherited an economy just shy of complete chaos and depression (from one of the past presidents you want to exclude from consideration). He and his administration had to spend their initial time cleaning up after George which makes George part of the problem. Obama and his administration have passed stimulus bills and aids in a few months that seem to be working, if slowly. The successful idea was called "priming the pump" when Roosevelt did it. Obama has had only 6 months to fix George's problem, the financial crisis and health care. That's the same sort of thing that took President Franklin Roosevelt over 8 years and a war. We might note from a historical perspective that both Obama and Roosevelt inherited their disasters from Republicans. Both recoveries took a huge amount of money and some serious Supreme Court issues. This is no different.

I did point out before that no matter what, you do have 3 choices, join a plan, keep the plan you have or after taking what consequences may be put into a final law, drop out completely and put your premium in the bank or under the bed. But those choices do not exist now because we do not have a law. Odds are they may not exist by the time the Senate gets done with its input. What we have is a proposal or actually a couple of proposals still being negotiated. Discussion on the various points is good. If you want to make a change, get to DC and talk to folks or do so on the phone, by fax, e-mail or whatever. That is the way of the democratic republic that I swore an oath to when I went into the Army.

Now someone asked why are we in such a hurry. We can do nothing to change this growing economic and health disaster at a cost of roughly 10 times what it will cost us to change. As a nation, we have been fighting this growing disaster since Reagan and the end of Carter's time. We tried MAC limits and freezes on reimbursement income, DRGs, diddling with details such as requiring CPT and I-9 and tighter regulation. Then we did Mangled care, PPOs and other HMO related delivery systems and gate keeper docs. Then we went to the whole new coding system and tied that to a new ZERO (0) sum reimbursement system called RBRVS. We let ourselves be scared out of change by Harry and Louise and massive lobbying by payors, changed Medicare updates to stricter guidelines, reduced payment regions and other juggling acts, a whole new appeals system, then increased audits, health care saving accounts, etc. till now when we have special audit groups set up to take away cash earned. So we've tried a lot but the problem gets worse and now the problem has become too much for the economy for us to do business as usual.

On top of which (as Business Week noted), there is no real and serious competition in the insurance industry. 94% of the metropolitan areas in this country are controlled by one or two companies. In over 15 states, one payor has 50 % or more of the entire market. Clearly we need the public option, whatever form it takes, to actually get some real free market competition. That is part of why health care reform is needed as part of the economic fix. It might be nice if we could lay back and argue again all the possible and impossible options, But if we do that ,then we truly will be spending ourselves so deep in debt that our grandchildren and their grand hildren will be paying for it. Denying the problem and setting up Obama as a straw man villain doesn't change the facts. We are at a point where it costs us more money to maintain the status quo than it would to change the system. That is why we need to get something passed.

As usual in the U.S., what we pass will not be perfect. Perfection happens in the hereafter, not here. What we will do, however, is amend what we have and pass new stuff to meet whatever we did not hit this time or fight it out in court till it becomes clear and the best we can do. It seems to me that we'd be much further ahead talking to our reps than scaring people by referring to shadows that are not yet incorporated into a single proposal, yet alone a final bill or law.

1 comment:

Susan said...

Outstanding. He rationally and calmly addresses the earlier writer's issues intelligently and respectfully. This is the way to argue.