Sunday, April 4, 2010

Health care reform: This Edsel just might fly

In my most recent post, I laid out a 3-step process for ushering in single-payer health care. See it here. Actually, it’s only a 2-step process, the third step being to sit back and watch the new health insurance system crash and burn.

Here’s the summary:

Step One – Pass the law in spite of public opinion and zero bipartisan support: Check.

Step Two – Move the Supreme Court to the left by appointing one more liberal justice: Not so easy.

Step Three – Watch this unsustainable insurance reform spiral out of control—if anyone doubts this will happen, take a closer look at Massachusetts—necessitating another revamp of the system, namely, a government controlled, single-payer system.

What we’ve seen from the right since this law passed centers around two strategies:

1) Repeal the law.

2) Challenge its constitutionality.

Repealing the law seems unrealistic to me. Calls to do this ring more of sour grapes than anything doable. I don’t intend to confiscate anyone’s sour grapes—there are plenty of bunches to go around—but I don’t see a path to repeal, at least by a vote of Congress, without some unlikely, veto-proofing change in the balance of Congress.

Certain aspects of the 2010 Health Care Act, on the other hand, are the object of challenges by a number of states’ attorneys general on the grounds that these requirements are unconstitutional, the primary one being the forced purchase of health insurance policies.

I’m not a lawyer, just a bean counter, but I would guess that if some items in this 2000-plus-page reform law were to be declared unconstitutional, it would not undo the entire bill. Rather, it would just strike those clauses that don’t pass muster.

And that is likely to gum things up.

The argument goes that, if the requirement to purchase health insurance turns out to be unenforceable, a lot of people would wait to sign up for insurance until they get sick, then take advantage of the no-pre-existing-condition rule to purchase insurance just in time for chemotherapy and radiation treatments, dropping the policy immediately thereafter.

Massachusetts has had a no-pre-existing-condition law since the 1990s. Maybe some Bay Staters are pulling this stunt now, but I’m not reading about it in the press. More likely, they are heading to an emergency room and piling up a ton of bills (which the state reimburses a portion of to the hospitals, costing hundreds of millions of taxpayer dollars every year).

So let’s back up for a minute and assume that the health reform act stays intact, surviving all challenges. How do we avoid jumping on the express train to a complete government takeover of our health care delivery system?

Make it work.

Simple.

If my cynical conclusion is true, that this unsustainable 2010 Health Care Act is a backdoor entre to a single-payer system, then the most effective way to battle it is to make it work.

And that can still be done.

It’s time for Republicans and conservative “blue dogs” in Congress to put their money where their tongue depressors are by introducing legislation featuring the cost control measures that have become somewhat of a “usual suspects list:”

Tort reform

Electronic medical records

Interstate competition of health insurance companies

I would add to that list a correction to what I believe is also running up costs: The invisible invoice.

Even if you receive a billing through your insurance company that itemizes the cost of your latest doctor visit, the fact that your responsibility ends with the $10 or $15 co-payment makes it unnecessary to flip through that bill to see what’s in it.

In the old days, we had to pay the doctor, then fill out insurance forms to request a reimbursement. I didn’t particularly enjoy this exercise, but I did know exactly what we were spending on doctor visits. In fact, that 20% co-payment (after we paid the $1,000 family deductible) was enough to keep us from sitting in the waiting room every other day.

The low, fixed price of an office visit encourages the overuse of primary physicians’ services which exacerbates the cost of defensive medicine, that is, doctors being forced to order unnecessary diagnostic tests and prescribing expensive medicines and therapies in an effort to avoid costly litigation.

In an interesting chain of events, the invisible invoice pushes up the cost of health care which, in turn, pushes up premium prices, which results in an even higher utilization of health insurance. It goes like this: “If I have to pay $1,000 a month for health insurance, I’m going to damn well use it.”

And the spiral continues…

So this is our challenge: Coming up with ways to make this health care reform work in order to avoid moving to a system where everything is “free,” because we all know (or should know) that “there ain’t no such thing as a free lunch.”

Copyright 2010 Randy Hunt

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