Sunday, August 2, 2009

We Have The Month of August To Think About Healthcare Reform: Let's Not Waste It With Choice A or Choice B

Whew! That pressure cooker known as Congressional health reform has taken a one month break. During this legislative downtime, our elected representatives will have a month to hear what their constituents think. If they’re smart, they’ll also check in with the health policy bloggers from time to time for insights unavailable anywhere else. Readers just need to watch out for all those preconceived non-transparent and recycled notions based on inflexible ideology.

Speaking of which, the Disease Management Care Blog distrusts anything that offers BIG solutions in the health reform. That includes big health care insurers, big government solutions, big power held by a single group of insulated experts or big piles of regulations. The DMCB likes small overlapping regional insurers that are tightly regulated by State governments. It’s a messy patchwork but the DMCB thinks it works pretty well for most people most of the time.

What isn’t working for the small insurers is the battle against health care inflation: as costs spiral up, the patchwork is raising prices. It doesn’t have Medicare’s advantage of being able to print money or Medicaid’s ability to pay pennies on the dollar. The DMCB also doubts the huge multi-state commercial insurers are all that effective in controlling costs either. Ultimately, because health care costs are so expensive, everyone’s ability to pay for hospital and physician services is being frayed and getting more ragged. This is effectively shutting millions out of affordable coverage.

No wonder vituperative critics to point to the ‘immoral’ and ‘villainous’ business logic of insurers diverting some of the premium dollar to administrative costs or shareholders. They have a point. Yet, the contrarian DMCB wonders why more of our leaders aren't visibly shocked by the absolute amount of premium dollar that is going to health care costs in the first place. It asks if pumping even more money toward the medical-industrial complex will only feed the beast. Which is truly better: a) insurers returning income to their investors that can be used to support other productive areas of the economy, or b) insurers spending premium in their networks that is used to build another hospital wing the size of an ocean liner (with a fountain in the lobby tossed in for good measure), buy more magnetic resonance imaging scanners so we can scan even more patients more often, pay for stratospherically expensive chemotherapy that adds weeks to cancer patients’ life expectancy or open more bariatric weight loss surgi-centers?

The DMCB thinks the real answer to the question is ‘c).’ The answer is complicated, multi-faceted and some of it is scattered in prior posts.

So far, it seems to the DMCB that the current batch of reform proposals before Congress favors making things bigger without really addressing the underlying inflation problem. No coherent ‘c)’ option from inside the beltway is in sight yet.

That’s the DCMB’s preconceived notion during the August recess, but unlike other bloggers, it is a) alerting readers to its biases ahead of time and b) is more than willing to change its mind over the next month.

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