Health care reform now (later, done right)!

I have spent the last 47 years designing, administering, managing and hearing claim appeals for health benefit plans in which nearly 40,000 employees and retirees participate.  Because of that experience I have developed many opinions on health care, what works and doesn’t work and I have learned a great deal about how the average person views health care and the paying of health care costs.   That experience also tells me that the direction of health care reform today is simply wrong, not only will it not work to control costs or improve quality, it will raise costs for everyone.

It is nice to know that despite my lack of academic or political credentials my views are consistent with the “experts.”  November 18 was an especially good day as I read the opinion piece in the Wall Street Journal written by the Dean of the Harvard Medical School.  His main points are that we are not changing the system nor are we controlling costs and down the road there will have to be “draconian” measures taken to cope with costs.  Where have you heard that before?

When I was meeting with legislative aids in Washington a few weeks ago I became embroiled in a somewhat heated discussion (to the extent you can have a discussion with people who already know it all) about the Massachusetts experience.  I was told that I was wrong, that it was in fact, a success and that costs did not go up.  Here is what the Dean has to say about that:

“There are important lessons to be learned from recent experience with reform in Massachusetts. Here, insurance mandates similar to those proposed in the federal legislation succeeded in expanding coverage but—despite initial predictions—increased total spending.

A “Special Commission on the Health Care Payment System” recently declared that the Massachusetts health-care payment system must be changed over the next five years, most likely to one involving “capitated” payments instead of the traditional fee-for-service system. Capitation means that newly created organizations of physicians and other health-care providers will be given limited dollars per patient for all of their care, allowing for shared savings if spending is below the targets. Unfortunately, the details of this massive change—necessitated by skyrocketing costs and a desire to improve quality—are completely unspecified by the commission, although a new Massachusetts state bureaucracy clearly will be required.” 

Hmmm, expanding coverage and costs going up, remember those words the next time you hear Nancy Pelosi or Harry Reid, or Barack Obama speak about health care reform.

Do you see the word “capitated?”  I remember when that was a good word, then a dirty word and today a virtually non-existent word in the world of health benefits.  Use that word with a physician and you mind as well be telling him about the delightful evening you had with his wife (OK, or husband).  The reality of course is that those types of changes in the health care delivery and payment system are necessary as are many other changes that people do not want to hear about and politicians are too cowardly to mention. If you want to fix many of the ills in the delivery system put people into a well run HMO…oops another dirty word from the past (those physicians may even be salaried-OMG).

So where does all this leave us?  Headed over an abyss in my view.  The average American and the average employer better start speaking up before it is too late.  Yes, we need real reform and yes, we need to find a good way to cover all Americans, but neither is what is happening now.  We are on the Polar Express, but this time we won’t make it across the ice.

Contact your Representative and Senators and tell them you want reform but you want it done right even if it takes a few more months to do so.