We need healthcare reform, but is this it?

I have been closely following the ups and downs of the healthcare debates. I have spoken to lots of people. Clearly the media coverage and the rhetoric have influenced the thinking of the general public and the consumers. Everyone seems to be thinking about things from a different perspective. Medicare members think everything is fine. Employees still don’t understand how little of the cost they bear. And those who need to buy insurance have wars stories about declinations, exclusions, and prohibitive costs. Interestingly, most of the people I consider experts think the politicians (especially the House of Representatives) have gotten this one wrong.

Let’s start with some points where everyone seems to agree:
#1 The healthcare system is broken and needs fixing.
#2-Making healthcare accessible to all is a desirable goal and the right thing to do.

On point #1, the healthcare system is broken in four main areas—
• Too many people are uninsured and lacking access to healthcare.
• Medical inflation and overall medical costs are too high.
• The quality of care can and should be improved.
• Information is not shared effectively between the various healthcare providers and patients.

The proposed legislation (every version) has focused on point #2, making healthcare accessible to the masses. Unfortunately the other areas where the system is broken have not been adequately addressed.

Everyone does have access to, at least critical care. If an uninsured person gets into a car crash and is lying in the road, the ambulance driver still takes the person to a hospital. The person still receives care whether they can pay or not. The hospital absorbs the charges and increases the cost of care to everybody else. This appearance of inaccessibility worsens to the other broken areas of the healthcare system.

Lots of discussion has occurred on the “public option”. Note that this does not address any of the areas where the system is broken. Mandating access can be accomplished without a “public option”, but many of the supporters of this approach don’t seem to understand this point. To the public option fans, being against a public option means being against access to care. Not true. Our present system is dominated by government-provided (to government employees) and employee-based care. The marketplace for individual purchasers of healthcare is weak. This could change with the right legislation and refinements to the present insurance options. The key to having a system that works is that everyone must be in the system. This will require employers to provide medical benefits to their employees and for other individuals to purchase their own insurance. No opt outs to the young and healthy should be allowed. Or else we end up with a poor risk pool. But high surcharges to those who don’t want to participate is “politically unacceptable”. For those who cannot afford coverage, subsidies should be provided. But everyone must be in the system.

So how about the other broken areas? How do we control the future cost of care? How do we improve the quality of care? How can we use data more effectively? I have some ideas. (Check out a blog in the near future on these topics).