Health Care

Fixing our broken health care: Part I

January 31, 2014
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Editor's note: This is the first part of a two-part post. The second part is here.

The issues surrounding the Affordable Care Act, or Obamacare, have been some of our nation's biggest news and political stories — and they promise to continue. That’s because the act is neither a panacea nor a curse.

The act is only the beginning of a lot of work that still needs to be done.

Our politicians deserve our scorn for their handling of the act at state and national levels.

The Dems obviously didn’t read the act and haven’t done a good job of explaining it or its background.

The GOP clearly wants to blindly repeal the act without having anything realistic to substitute for it.

National polls verify that we are disenchanted with the way our politicians are behaving.

Consider why the act was brought up in the first place. Almost every president, both Republican and Democrat, in the last century had made health care an issue, but few have been able to actually do much about it. Health care is important, but few really understand the scope of the problems or the required solutions.

Our health care system is broken and badly needs repair. Most policy wonks say that our issues are summarized in three areas: cost, quality and access.

Here's where the key issues stand now.

Cost

We all know that health care can be expensive. But we aren’t prepared to discuss why it costs so much and what could be done about it.

In over four decades of work on health care, I’ve seen a moderation in increasing hospital costs only once: when the federal government threatened to insert price controls, and the hospital industry responded that it could engage in a voluntary effort to moderate prices.

That worked only until the heat was off, and prices resumed their steep rise. Since then, highly paid lobbyists have been very effective in maintaining the status quo for fee-for-service payment systems that assure that costs will continue to rise steeply.

Our fascination with high tech seems to get in the way of our rationality.

The volume of procedures, those specific things for which health providers are paid, has risen sharply.

If one can bill for it, one simply does it. Lab tests, imaging, surgical procedures, etc. have risen out of proportion to the population growth.

Yet, providers are simply responding to the incentives they have. What is needed is a system with new incentives — market-based incentives to keep quality high and prices low.

Quality

The quality of care generally seems acceptable to those who receive care.

Yet do they know that in the U.S., the standards of care for specific conditions are followed only about half the time? Do they know that their health often is endangered by unnecessary procedures? Are they aware that uncoordinated prescription drugs can pose a danger? Do some wait to see their caregiver about truly important conditions due to roadblocks in the scheduling/appointment systems or costs? Do people take part in their own care or are they passive non-participants?

Access

Financial access was promised in part by Obamacare.

Many appear to think that having health insurance equates to having health care.

This is a fallacy of the highest order. Your insurance card is only good if a caregiver will accept it, and it is only good if the associated co-pays and deductibles are affordable for you. If not, good luck.

If your access is through Medicaid, think how welcoming providers will be to patients for whom they will receive deeply discounted payments.

Remember that the majority of people who declare bankruptcy due to medical costs are insured at the time. Perhaps some were insured by those plans the president said they could keep if they liked them.

Much work needs to be done.  

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