Saturday, October 14, 2006

Observations on what others say about health care reform

Many community groups and politicians in Connecticut are talking about health care reform. However, because of the complexity of this misinformation gets spread around, discussion becomes focused on blaming something,and most importantly there is limited discussion on the cost of medical treatment. While discussions on this important issue are certainly good I happen to believe the focus needs to be on what approaches to reform can realisticly work. Thus, I'm sharing some observations from two recent insightful papers on ideas for effective reform.

First, a statement, which brings out the basic problem facing the health care industry, made in an article titled “White Paper on Medical Financing” by Andrew Schiafly, Esq. and Jane M. Orient, MD in the Fall 2006 Journal of American Physician and Surgeons, Vol. II, Number 3, is that – There has been no free market in American medicine for some 60 years.

The authors bring out two key points which I believe are important for everyone discussing health care reform here in CT to be aware of:

The drive for “reform” to accomplish “universal coverage” through subsidies and coercion will only exacerbate current problems including cost inflation with diminishing quality and access.

The second, related to the lack of an open market, was - "Government with the distortions it has imposed on the medical and the insurance market is the problem not the solution".

Two other statements, which I believe could be useful in discussions on health care reform:

The first is that the goal of true reform should be to optimize access to care, stimulate quality improvements, and lower costs not to “equalize” access by leveling down and assuring misery for all; not to impose uniformity and conformity; and not to redistribute wealth to achieve “social justice”

The second statement is made up of two related points:

In a free economy, government does not attempt to design a one size fits all benefits package and force it on citizens in an uncontrolled experiment.

The optimal solution cannot be designed since no possible design will guarantee full protection of all against all possible hazards, or eliminate the need for a social safety net, such as family, church, or community charity

The paper concludes with another statement,
important in reform discussions - no system should be considered that impairs the basic rights to life, liberty, and property exercised in buying medical care with one’s own resources.

advocacy groups, politicians, and individuals advocating universal health care do not directly state it but it is implied that more government involvement is the solution. In looking around at what is known about what happens when a government run or single-payer approach is used we find a paper – High-Priced Pain: What to Expect from a Single-Payer Health Care System. It was written by Kevin Fleming, MD from the Mayo Clinic Division of General Internal Medicine in Rochester, Minnesota, published Sept. 22, 2006 by the Heritage Foundation, and is well documented with extensive detail and 198 footnotes. The full paper can be found on this link.

Doctor Fleming indicates there is renewed interest in “socialized medicine” but just as nations have learned political management and control is not the best way to run the coal, steel, farming, banking, airline, or electrical power industries, policymakers should conclude the political process is a poor way to manage health care.

Also brought out is the point the very real problems of America’s health care system, including the problem of uninsurance, can be addressed through innovative market based solutions.

In the concluding section Dr. Fleming
quotes from Professor’s Michael Porter and Elizabeth Teisberg book - Redefining Health care: Creating Value-Based Competition on Results – this point:

“It simply strains credulity to image that a large government entity would stream line administration, simplify prices, set prices according to true costs, help patients make choices based on excellence and value, establish value-based competition at the provider level, and make politically neutral and tough decision to deny patients and reimbursement to substandard providers.”

The paper includes three talking points one of which relates to the lack of an open market:

Market based reforms, however, would dramatically expand coverage, promote innovation and economic efficiency, and eliminate existing market distortions in the health care system. Real market competition would allow more efficient and productive providers to thrive, while less productive providers would either become more efficient or go out of business.

Another advantage to private market based reform efforts, not stressed in the paper, is that it provides consumers many choices. Experience tells me choices
are very important. Why? Having choices enables people to select, through their employer or when buying on their own, the coverage they are interested in and which fits their current financial and lifestyle needs.

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