Stanley Feld M.D.,FACP,MACE
There are many issues involved in healthcare reform. The major issues to decrease defensive medicine with malpractice reform, rapid affordable installation of electronic health records, control of the obesity epidemic, effective chronic disease management and a change in the healthcare insurance model are not on the radar screen of the President or Congress.
The issue with effective healthcare reform is about money. In order to save a significant amount of money the above problems must be solved. As President Obama plan progresses in the congress the battle is all about political tactics and positioning for the midterm elections in 201
The Democrats want to get a handful of GOP Senators to support the bill before in gets to the floor. The goal is to short circuit a bloody debate before it begins. The Democrats are to join their fold. Chuck Grassley, Orrin Hatch, Susan Collins and Olympia Snowe voted for expanding the state children's insurance program (Schip).
SCHIP was a compassionate bill and logical. However it is a bill that does not create patient incentives. It is difficult to imagine Republicans defecting to the poorly constructed bill that will created greater costs and more dysfunction to the healthcare system.
“This new entitlement -- like Medicare but open to all ages and all incomes -- would quickly crowd out private insurance as people gravitated to heavily subsidized policies, eventually leading to a single-payer system. So Democrats are trying to seduce diffident Republicans with a Potemkin compromise.”
All the the Democrat’s rhetoric in nonsense. Without a change healthcare insurance healthcare costs will continue to rise . We need only to look at the Massachusetts experience.
The administration is prepared to make promises to Republican such as the government healthcare plan would only be sold to the uninsured and small businesses that can not afford to provide employees with healthcare insurance because of the costs. Once the Republicans on on board and the bill is past the administration could modify this proposal and make it all inclusive.
“ The White House strategy is to dilute the healthcare plans proposal just enough to win over credulous Republicans. That is what has always happened with government health programs:”
President Obama is playing a game of got uh. Some one wrote to me and called it Rope A Dope.
“When Medicare was created in 1965, benefits were relatively limited and retirees paid a substantial percentage of the costs of their own care. But the clout of retirees has always led to expanding benefits for seniors while raising taxes on younger workers”.
Medicare’s cost to seniors has also risen with a base month cost of $99 per month per person or $2400 per year per couple. The catch is the deductible are $999 for hospital admission and and 80/20 deductible. The monthly payment per person is means tested and can go to $275 per month per person with after tax dollars. The a senior has to by Medicare Part F for deductible coverage. Its cost is 170 per month per person. Medicare Part D at it least expensive is $47 per month per person with high deductible.
In order to get full coverage the cost can be as high as $15,000 per year in after tax dollars.
Congressional actuaries expected Medicare to cost $3.1 billion by 1970. Medicare today costs $455 billion and rising.
Medicaid was intended as a last resort for the poor. It now covers one-third of all long-term care expenses in the U.S.. Its annual bill is $227 billion, and so far this fiscal year is rising by 17%.
Over time end stage renal disease and disabled person have been added to the Medicaid roles Other person also have been included.
“SCHIP was pitched a decade ago as a safety net for poor kids, and some Republicans helped sell it as a free-market reform. But Schip is now open to families that earn up to 300% of the poverty level, or $63,081 for a family of four. In New York, you can qualify at 400% of poverty.”
A common denominator to all of this unsustainable increases is the way the healthcare insurance industry controls the healthcare dollars. This leads to abuse by other stakeholders. Incentives must be aligned with the consumer controlling their healthcare dollars.
The Lewin group estimates that 119 million more persons with private insurance could be added to the 90 million already on Medicare and Medicaid. Health habits must be changed to combat obesity. The only way it will be changed is a change in farm policy and the consumers owning their healthcare dollars. Otherwise we are doomed to every increasing premiums and overuse of the healthcare system.
Any new federal health plan will inevitably follow the same trajectory, no matter how much Republican Senators might claim they've guaranteed otherwise.
President Obama is going to mount a public opinion campaign for his plan. The Republicans are going to cave in. They are trapped
Republicans would spend the rest of their days deciding whether to vote for tax increases to finance this, or stand accused of denying health care to the middle class.
President Obama will have successfully “Roped A Dope” Who is the Dope? All of us unless we get wise quickly.
The only way to Repair the Healthcare System is to enable consumers to own their healthcare dollars and to provide incentives to consumers to be responsible for their health. The government should make the rules to level the playing field and empower consumers to drive the healthcare system to their benefit.
These actions allow healthcare affordable to all including the government.
The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.
Dr.Feld:
You raise a very important point that has in fact proven success stories around the world. Singapore makes healthcare consumers directly responsible for their healthcare dollars, although the Government and Employers chip in also. But eventually YOU are responsible for your own healthcare dollars there and it seems to be successful.
Read "The Singapore Model"
http://www.american.com/archive/2008/may-june-magazine-contents/the-singapore-model
Thanks
Nari
Posted by: Nari Kannan | June 11, 2009 at 08:49 AM