E-mail Story
Print Friendly
Send E-mail
Reprint story
Monday, June 08, 2009
Health care war a given
By Winthrop Quigley
Of the Journal
It begins.
Congress returned from its Memorial Day recess last week to confront one of the toughest public policy problems of all: creating an affordable health care system that serves every American fairly. It is an issue that has defeated presidents since Harry Truman. Barack Obama says he wants a health reform bill on his desk before summer's end.
New Mexicans have had more than a little experience with health policy debates. They are an annual fixture in our state Legislature. Legislators have considered everything from a statewide single-payer system to a health insurance exchange.
With hope that Congress can benefit from our countless hours of hearings and legislative sessions, here are some things New Mexico has learned about debating health policy.
People enter the debate with their biases intact and unshakable. Someone who believes the government should take over all health care financing has, in my experience, never been willing to consider a role for insurance companies. People who have enshrined free markets will accept no wider role for the government than that of referee.
There is a lot of middle ground, though. Indeed, there is some consensus among employers, labor unions, insurance companies and health care providers that the health care system in America's future will be some sort of blend of public and private programs.
However, New Mexicans know that a lot of people can say no to one key component of any health care financing strategy and thereby scuttle the entire project. Gov. Bill Richardson once proposed an omnibus reform of health care that included a requirement that physicians had to accept Medicaid patients. Physicians objected. The provision came out. The proposal required businesses to offer employees health benefits. Businesses objected. The provision came out.
One interest group or another has objected to mandatory enrollment of eligible children into publicly funded programs. There are debates over who gets to pick governance bodies. Public employees and retirees fought tooth and nail against consolidating the administration of their health plans into a single agency.
Health policy debates regularly devolve into fights over trivia. In the last legislative session precious time was wasted on a proposal that the agents who sell health insurance be required to disclose to purchasers what their commissions are. Whatever the motivation for such a bill might be, the sales commission share of a national health care tab that is approaching $2 trillion a year is not even loud enough to be noise level. It is also hard to believe anyone is going to make a different health insurance purchase decision based on the commission an agent earns, but that is the kind of nonsense that consumes deliberative bodies.
If health care was inexpensive, we would not have any of these debates. Health care is amazingly expensive. If Congress is anything like the state Legislature, they will ignore the big-ticket problems.
We know what keeps health care costs high in the United States. Americans use a lot of health care, and they use an astonishing amount of it in the last weeks and months of life when the value of care is questionable at best. Physicians order the wrong treatment about 40 percent of the time, according to Rand Corp., which means lots of money is simply wasted. The way bills are paid encourages medical providers to keep the meter spinning, which keeps utilization high. Administrative burdens are big, so money that should be spent on care is lost to paperwork.
Studies consistently show that most of the nation's health care dollar is spent on medical providers, equipment and drugs. In New Mexico, about 85 cents of every dollar spent by an insurance company goes to care, 4 cents goes to premium taxes, about 8 cents goes to administration and 3 cents is profit. Naturally, a lot of legislative energy is expended on the 8 cents.
If health care is going to be affordable and available, some difficult things have to happen.
Citizens are going to have to be forced to accept some form of coverage. It is estimated that as many as half of the 400,000 people without health coverage in New Mexico either can afford health insurance or are eligible for some kind of public help. The cost of their care is shared by the rest of us, in the form of higher insurance premiums and taxes.
Is the Congress prepared to order everyone into the actuarial pool? Our legislature was offered the chance to enact such a requirement and declined.
Medical providers are going to have to get better at their jobs. Compensation will have to be based on success, not on how many tasks a doctor and hospital perform. The Centers for Medicare and Medicaid Services and insurance companies have been pushing on that rope for a long time with decidedly mixed results.
Americans are going to have to accept the fact that resources are finite, that not all boo-boos are worth a hospital stay, and that death is not an option, it is an inevitability. I can't wait to see how they write that into law.
You also can send comments via our comment form
|
|
