Reform debate fought on many fronts

By Marshall Allen (contact)

Thursday, July 2, 2009 | 2 a.m.

Kara Kelley

A young boy falls off his bike, hits his head and briefly blacks out.

The emergency room doctor’s exam shows with 90 percent certainty that the boy will be fine. That cost, say, $150.

For an additional $500, the doctor could order a CT scan and be 95 percent certain that the boy will be OK.

And for an additional $1,500, the doctor could order an MRI, and the parents could be 99 percent certain.

Dr. Ron Kline posed the theoretical scenario to illustrate a complexity of the health care reform debate. Many people say health care providers need to spend less on patient care, said Kline, president-elect of the Nevada State Medical Association. Insurance companies and employers that pay high premiums would oppose excessive testing.

But try telling the parents of a child who’s suffered a mild head injury that the tests are excessive.

As a doctor seeks 100 percent certainty in a diagnosis, “the costs go up exponentially,” Kline said.

Number of uninsured disputed

Congress is debating many major health care changes to correct a system that is collapsing financially. Health care spending is about 17 percent of the country’s gross domestic product and climbing. The federal budget is on an unsustainable path, primarily because of rising health care costs, according to the Congressional Budget Office.

The high cost of diagnostic procedures — and whether doctors are ordering too many tests — is just one of dozens of issues being raised in the discussion.

A larger part of the problem is the number of uninsured Americans, estimated at 47 million by the U.S. Census Bureau. People without insurance delay care until their diseases become more severe — which makes them expensive to treat — or get their health care in emergency rooms, where it is most expensive.

The many stakeholders in the health care reform debate — patients, business owners, unions, doctors, insurance companies, hospitals, and drug and medical device manufacturers — agree that change is necessary. But the challenge of the debate is that the same groups may be allied by one proposal but torn apart by another.

Sometimes they can’t even agree on the starting points for the discussion.

Take, for example, the debate about the number of uninsured Americans. The Census Bureau uses the 47 million figure, which is widely accepted by many reform advocates. But some conservatives dispute that figure, claiming that a large percentage of those 47 million are “voluntarily uninsured.” In other words, they could afford health insurance but choose not to buy it. The U.S. Chamber of Commerce estimates that 15 million of the uninsured Americans can afford health insurance.

Is health care a basic human right?

Myriad proposals are in play. Some suggest mandating that every person be insured. Some promise tax credits to help people pay health insurance premiums. Some want to require employers to provide insurance to workers. Some propose a public/government-run health insurance option that would be available for the uninsured and compete with private insurance companies. Some say the system needs to invest in preventing disease, or improved information technology, which could save costs in the long run.

Every proposal has detractors and supporters, special interest groups that are aligned on some ideas and opposed on others. The Las Vegas Chamber of Commerce opposes forcing employers to provide health insurance.

“We don’t believe it should be employer mandated because we believe there should be many choices and it should be consumer-driven options,” Kara Kelley, CEO of the Chamber, told the Sun’s sister publication, In Business Las Vegas.

Ethicists say the health care reform debate is being bogged down in nuts and bolts details when it should be grounded in the philosophical belief that no Americans should go without health care.

Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, points out that the main threat to reform is the lack of agreement that health care is a fundamental human right — like food and shelter.

“If you think that health care is a right then everything else gets worked out,” Caplan said. “If it’s a right, then how are we going to implement it? If you don’t think it’s a right, then you say: ‘I don’t like a public plan, information technology, etc.’ You’re not forced by a common commitment to reach a compromise.”