Reform could take many years

By Nicole Lucht

Friday, June 12, 2009 | 3 a.m.

SAN DIEGO — If you thought the federal bills bailing out financial institutions and U.S. automakers or the recent wrangling over the state’s budget were complicated, you haven’t seen anything yet. Reforming the country’s fragmented health care system is going to make those earlier — and less costly — challenges seem like a cakewalk.

And because the system is so fragmented, there are several powerful interests in play.

Health care reform was at the top of the agenda at the America’s Health Insurance Plans conference in San Diego I attended last week.

The organization did a fair job of providing a balanced forum for discussion, inviting doctors, hospital executives, health insurers, and state and federal leaders to speak.

But not everyone was invited. At the start of the governors’ forum, a single-payer activist ran up onstage carrying a banner in the form of a check and calling for insurance companies to be removed from the health care system.

In such a system, one government-backed health insurance plan would be available.

Proponents of the single-payer option have struggled to get their ideas to be part of the debate in Congress and by President Barack Obama, who has said the option is too difficult to attain.

For the most part there was agreement on a need for universal coverage. But the question remains: How is that accomplished?

That is something Congress will have to figure out, as the number of people without insurance grows from 45 million to 52 million by next year as people continue to lose jobs, according to University of California, San Diego researchers.

Former Vermont Gov. Howard Dean, speaking during the convention’s governors’ forum, said reform “isn’t worth doing” unless there is an option for the public to buy insurance offered by the federal government.

Others disagree. Health insurance companies fear that a such an option would drive them out of business.

Dean said putting some of those companies out of business “would not be a bad thing.”

For-profit insurance companies pose a problem to the health care system because not only do they have a fiduciary responsibility to clients, but also shareholders, he said.

“That’s money not left in the health care system,” he said. “For every dollar that ends up in equity, that’s another dollar not going to health care.”

But Dean also said that the system needs to be a public-private hybrid because innovation happens in the private sector, not the public one.

Doctors are also skeptical of a government-based system, saying that their experience with Medicare and Medicaid leads them to believe that the government would continue to keep payments to doctors too low.

Perhaps the best example of the basic problem with American health care came from former Senate Majority Leader Tom Daschle, who described the country’s system as an inverted pyramid.

In most developed countries such as France, Germany or England, wellness and primary care are at the base of the system, with most emphasis on prevention and early care. The most expensive and complicated care is at the top of the pyramid and is sought most infrequently. However, in the U.S., that pyramid is flipped, with more emphasis (and money) put on illness and high-cost care than on wellness and primary care.

Wellness was a major topic at the convention, offering hope in lowering costs, but it will take a concerted effort by all parties — consumers, health insurers, doctors and other medical professionals — to change the country’s mind-set.

Businesses expressed concern at an insurance mandate, but an option for the public to buy federal insurance could be a way around any mandate requiring companies to offer health insurance. If people are happy with the coverage offered by their insurer, they should be able to keep it. If not, or if insurance is not offered, they would be able to pay into a federal or state coverage plan.

Although a bill is expected in Congress later this month, don’t expect to wake up one morning with a brand-new system. Many at the convention expect reform to take years to accomplish. Former Oregon Gov. John Kitzhaber expects it to take 10 years, considering all the change that needs to happen such as retraining a workforce used to ordering “unnecessary” tests, and refocusing efforts on wellness.

Nor will costs go down suddenly, he said.

Some were more optimistic that reform would happen this go-round. But not Daschle, once tapped as Obama’s Health and Human Services secretary, who still seemed to feel burned by the failed reform effort under the Clinton administration, and isn’t optimistic reform will be accomplished this year.

“The chance of reaching that goal is 50-50,” he said. “We are dealing with nearly 20 percent of the economy (gross domestic product) and the most complex (part) of the economy.”

Later Daschle added, “The best we can hope for is a framework ... as we evolve over the next few years.”

The major stakeholders agreed on a few fundamental problems with the health care system, such as accessibility, quality, uniform information technology and cost.

But there still needs to be consensus on how to remedy those problems. And goals need to be set to tackle those problems, otherwise nothing noteworthy will be accomplished.

Nicole Lucht covers health care, workplace and banking issues for In Business Las Vegas and its sister publication, the Las Vegas Sun. She can be reached at 259-8832 or at [email protected].