Monday, December 04, 2006

Solution-Based Health Care Reform

An article in the Journal Sentinel this morning discusses how health care costs are quickly becoming the top problem faced by farmers in the state, which is prompting the Wisconsin Farm Bureau Federation to place health care reform at the top of its legislative agenda this coming year.

This is good news because the more pressure that's put on the legislature to act, the more likely something will get passed this upcoming session. At the very least, the more interest health care reform is receiving at the state capitol, the more it's likely receiving in the state news.

And when people in the state begin to see what's possible with health care reform -- i.e., lower costs and broader access -- they are likely to join the chorus of reformers at the capitol.

But the key ingredient in this is to have voices that are solution-based rather than ideologically-driven.

To explain, I have had a good number of commenters on this blog who have opposed universal health care calls solely because they perceive them to be antithetical to the free market. In their view, universal health care involves government regulation of the health care industry, which never can be good. It's always best, they claim, to let the market do its thing.

My stock response to this is that the health care market is not the same as the market for traditional goods and services. While most people pay a retailer directly for their TV, for instance, most people do not pay their health care provider directly for the care they receive. Instead, the money is channeled through insurance companies, which, in turn, negotiate prices in advance with health care providers.

Due to this principle of negotiation, it's most advantageous for the consumer in the health care market to be a part of as large of a pool as possible to amass the greatest amount of purchasing power. Pooling payers also lowers administrative costs by simplifying the payment system in the market.

In addition, it's also advantageous in the health care market to reduce the number of uninsured because all of the unpaid medical bills aren't simply swallowed by the providers, but instead shifted into the cost of care for those who do have insurance.

So pooling everyone in the state into as few plans as possible has the effect of leveling and reducing system costs while simultaneously providing every citizen with access to affordable health care. But, to the free marketer, it's still tantamount to "socialism" because it doesn't leave the supposed invisible hand untouched.

And that's what's most concerning about the comments I receive -- they're not solution-based, but ideologically-driven.

I, for one, could essentially care less about the ideological manner in which the health care crisis is solved. The concern for me lies with the uninsured and the growing strain rising health care costs are placing on families, businesses, and public finance. If this concern can be alleviated with free market-friendly reforms that tinker around the edges of the existing system -- like so-called consumer driven health care -- then I'd be all for it.

But, the fact is, the evidence just doesn't suggest that tinkering with the existing system is enough. The evidence, on the contrary, points toward the need for fundamental reform.

Thankfully it appears the Farm Bureau is open to investigating all options for reform. Let's hope the investigation is solution-based, not ideologically-driven.

UPDATE: The Recess Supervisor has another great post up, this time on the sick leave issue. At the end, an excellent point is made about health care reform:
However, one cannot address this topic without noting that many of the screamers on this issue have their priorities backwards. A lot of this hue and cry over sick leave conversion is coming from people who likely are just bitter or angry that their own employer doesn't take care of them as well as the state would.

So instead of engaging in a dialogue about how their employers can do better to provide adequate and affordable health care, they simply rag endlessly on people who actually do have good health plans. Instead of fixing the problem, they're content to try and make everyone suffer.

Our time would be spent more constructively by finding ways to help everyone have great health insurance rather than figuring out ways to take it from those who do.
Well put, and right on target.


Blogger Puba said...

I think we have to answer ideology with ideology:

I've had co-workers respond that they would rather pay the high cost of health care in order to have the doctor of their choosing, appointments at their convenience, and the best treatment that money can buy. They have no conception of what is right and fair for the common good. They have, unfortunately, been transformed by those in power in our governement - who have worked to divide us using fear and selfishness and have found willing accomplices.

My advice to them is not to fear what working for the common good can accomplish. Fearless and selfless is the better way.

December 04, 2006  
Blogger Seth Zlotocha said...

Thanks for your comment, Puba.

I agree that ideology should play a role in responding to the crisis. Solution-based reform certainly doesn't need to be (and likely can't be) devoid of ideology. What I think we need to avoid is being boxed in by ideology.

And I think what needs to be explained to co-workers like yours is that health care reform that lowers costs and expands coverage doesn't need to come at the expense of doctor selection, convenient appointments, or excellent treatment. In fact, countries with universal care -- such as France -- have more hospital beds per capita, higher health care satisfaction rates, and better national health than the US, in spite of the fact that they pay 1/2 of what the US does in cost per capita.

December 04, 2006  
Anonymous state rep josh zepnick said...

State has role in health care reform

Posted: Dec. 2, 2006
Recent news coverage of health care reform suggests there are two components necessary for expanding coverage and holding down costs: state vs. federal government and the market trumping the public sector.

I respect my federal colleagues who want more results than rhetoric when it comes to health care reform.

However, it is not entirely true that the federal government is without solid options despite a widely shared cynicism after what happened in the early years of the Clinton administration.

However, a few things have changed in the last 15 years. I think there are healthy reasons to also be skeptical of a "states-first" approach or, as the headline for the Nov. 26 Business section column by John Torinus put it, "Solutions for health care costs should stay private."

• First, health insurance companies have restructured and in many states turned into for-profit organizations.

• Second, providers continue to consolidate to the point where there are really only three major hospital networks in the metro Milwaukee area.

• Third, states have, in fact, already started experimenting with expanding coverage through Medicaid programs, like the federally funded CHIPS program that helps states like Wisconsin expand BadgerCare to more working-class families.

• Fourth, markets and consumer-driven models do not always lead to lower costs. That's especially true in health care, where no one wants the Ford Focus if the Volvo is safer and more comfy.

On that last point, the current "best practices" that Torinus points to might work well for a fixed population like his work force.

But Wisconsin and the United States are not finite pools of workers. Serigraph Inc. can fire people who use too much health care or not hire them in the first place.

That option does not exist when looking at the general population. People are born and die each day; certain diseases parallel ethnic or income groups; and it's hard to always monitor or reward individual behaviors in a free society.

For 50 years, the federal government has invested heavily in life-saving research, expanded health care access to older Americans and those with lower incomes and generally protected the employment-based insurance model.

Markets have given us doctors who make false claims to Medicare; for-profit insurance plans and hospitals; expensive marketing of drugs; a fragmented system of service delivery; costly and duplicative technological advancements; administrative charges that hover in the 15% to 20% range; and a dizzying menu of Medicare Part D options.

I also challenge the premise that "what works in New York might fail in Texas or that two states as different as Massachusetts and Mississippi should be treated differently."

The notion that cancer is unique to one part of the country or that old age hits Northerners harder really has no place in a national debate.

The federal government could very easily and quickly do three things: Pull the senior portion out of Medicaid and fold into Medicare where it belongs, continue to give states flexibility to expand coverage and start tinkering with Medicare to include everyone in the nation.

Once we are all at the table and have a fair stake in the process, let's talk about which ways to control costs over time are the best.

Until then, the healthy and wealthy will continue to call the shots, and I think that is plain un-American.

Rep. Josh Zepnick (D-Milwaukee) represents the 9th Assembly District.

December 06, 2006  
Blogger Seth Zlotocha said...

Thanks for posting your op-ed, Rep. Zepnick.

I look forward to Dems in the state legislature this upcoming session fighting for the kind of reform you discuss in your column, although your point about the need for the federal government to do more is well-taken.

December 07, 2006  

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