Looking for some common sense in health care reform

August 31, 2009
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When one enters the discussion on health care, regardless of position, there will be people who see things differently or have a different agenda.

Although this is human nature, if we want to improve the system, there ought to be some common principles that would unite people to take some positive steps. However, when we watch our representatives in Washington, the common thing we see is everyone jockeying for position and power.

It raises the question: Are they looking out for our best interests or their own? Maybe we need to give them some common sense direction.

Let’s start with the supposition that it is a good thing for everyone to have access to health care when they need it: one piece of common ground. It is hard to imagine anyone saying we don’t want our citizens to be healthy. The issues of cost, what we can afford and what should be covered are what begin to separate people’s positions on health care reform.

Since cost is a major hurdle, let’s discuss the question: Can we afford it or not? If we, as the most affluent economy in the world can’t afford it, how do many of the European countries do it, or Canada or even tiny Costa Rica?

The answer is simple: It’s a matter of priority. When Americans say we can’t afford universal health care, there are three issues involved: 1) I don’t want my taxes raised to pay for this. 2) I’m nervous that reform might mean my plan coverage will be lowered to cover others and I’ll have to pay more to get back to my current level. 3) I own a business and I’m going to have additional expense for my non-covered employees.

If we step back for a broader perspective, we find many of the non-covered people are getting some form of health care treatment, through government or private clinics, special treatment programs or emergency rooms. The higher cost of these programs is passed on to the rest of us through higher premiums or taxes. These secondary delivery systems are often less effective and more expensive.

So providing coverage for non-covered citizens may help maintain or perhaps even lower costs for those with coverage. All we need is a little creativity — for example, shift the social security tax payments of the employee and employer to an existing public health plan until the employee reaches a threshold level of earnings or the company reaches threshold profit per employee to pay the premium. Demand efficiencies to cover the non-working person under a public plan (see point 4 below).

Health care issues aren’t going away; we will pay the cost one way or another. But what we are doing is letting the policymakers avoid making hard choices and so position themselves to gain position, power and maybe a campaign contribution or two from those who make money off the system.

Why not get this leverage out of policymakers’ hands and demand they do the job they are sent to Washington to do?

We could make great strides forward with some very common sense strategies.

1) Agree that we can afford a universal system: We just have to make it a priority. We did that just recently with loans to the banks. Maybe fewer loans/subsidies to other countries, less travel and fewer planes for legislators, reduced expenses for government employee health care plans — which by the way are topnotch — should be considered.

2) Build some real competition into the new system. A public option is a must. This is not “socialized medicine,” a term that people against system change always throw out. The scary idea about government designing our health care system, people standing in line for care, and the playing field not level so private enterprise can’t compete is a lot of bunk. All we have to do is list all the government plans that are in place already.

The concern about a “new public plan” is how such a plan would be financed. So make it very simple: Any public plan introduced in the new legislation has to be self-sustaining, with rates that cover expenses. Set the rates based on what private plans are charging but with a modest twist: Charge 95 percent of the average lowest one-third of the private rates in a marketplace. If these private companies can survive, so can the public plan.

3) Coverage is also a critical factor to the health care debate. Again, let’s apply some common sense. Let’s demand that our legislators be enrolled in the “new” public plan. The public plan can become the standard for cost and coverage. While they look out for themselves, they might accidentally look out for the taxpayers and citizens of this country.

4) Finally, let’s link the government programs and gain some efficiencies from all the plans — Medicare, Medicaid, CHAMPUSVA, My Child, etc. Continue to fund them with government subsidies or use the new method proposed above. Perhaps the funding could be applied to other private plans, if the people wanted out of government plans. Then government gets out of the health care business down the road if the private sector does a better job.

The changes proposed are not complex, they make common sense, and they would open the door for private industry to compete for the new markets and maybe drive down costs and improve service.

Ardon Schambers is president and principal of P3HR Consulting and Services, which provides a range of HR-related services.

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