Health
Care Reform: Reset With a Blank Page
By
Leonard
Zwelling
By now we have all been to sufficient
numbers of cocktail parties with doctors complaining about the effects of
ObamaCare on their practices. We have also been at cocktail parties (could be
the same ones, could be a different set of friends) with people who argue for
ObamaCare or at least say it is better than nothing as some additional people
have gained access to health care. True but not all that many and far fewer
than the 34 million originally hoped for. The lack of full Medicaid expansion
and the Presidentially ordered delays in the implementation of some mandates
haven’t helped.
Some additional people have gained access to insurance
that SOME, but not all, did not have access to before. Whether anyone is any
better for all this activity remains to be seen except we know that the
insurers, big pharma and the hospitals are better off for it was their bill
that Congress passed and the President signed.
The people in the group who believe ObamaCare has
produced some good argue that it should be the basis for further legislation
that fixes what it got wrong. The people in the anti-OCare group just want it
all to go away and go back to the way it was when doctors ruled the land, the
sea and the golf courses. Not gonna happen.
Why?
Economics.
Too many people are making too much money in the current
system to change that and the ACA preserves all of their revenue streams from
the high cost of insurance, to the high cost of drugs to the ridiculous charge
masters of hospitals. No one wants to put the brakes on spending because to
lower costs will lower their revenue. So what’s a country to do?
Start again.
The only logical response to ObamaCare is to hold one’s
nose and live with it while trying over again to generate the real discussion
on health care. Is it a right or a privilege? Until we answer that question, we
will never get to an equitable or workable health care delivery system that is
uniquely American. My guess is that would look like some baseline level of care
for all with the option of buying ever-increasing coverage for ever-increasing
premiums. Concierge medicine would be allowed but might price itself out of
existence if good quality care could be had via high end insurance pools. The current
insurance model under ObamaCare simply doesn’t work if rating and underwriting
are eliminated (thus not allowing the gradation of risk) and the insurance is
for an event that is undoubtedly going to happen (getting sick or injured).
My idea is simple:
Have a national referendum on whether or not health insurance and
access to health care is a right: yes or no?
If yes, redesign the system to create this. There are many models in
the industrialized world from which we can borrow parts.
If no, redesign the system to create that. This could be all out
capitalism which only hastens a single payer system as too many people would be
priced out of a free market solution. If only the government can afford health
insurance like only the government can afford fighter jets, that will be the
solution. Medicare for all.
Then, toss ObamaCare out as a failed attempt.
As someone who was at ground zero in 2009 (the US Senate
Committee on Health, Education, Labor and Pensions; (Chair Edward Kennedy
(D-MA), Ranking member Michael Enzi (R-WY)) when the Democrats rolled out the
ACA, I can assure you that this discussion did not take place. The lobbyists
swarmed. AHIP hovered. PhARMA was there and so was the American Hospital
Association. The docs were there in groups of 10; about 100 groups of 10 all
asking for something different. Surprise, guess who was easy to ignore?
So let’s press the reset button as ObamaCare is on the
fire and cooking away. Let’s not get too wedded to it for it really needs
replacement, but let’s also not go through the same exercise again that gave us
ObamaCare in the first place.
We need to do health care reform like we pick a pope.
Behind closed doors-cardinals and/or senators only. No staff. No lobbyists. No
labels.
Yeh, right!
