404-892-8494 
Home > Blog
Health Reform as a Social Mandate
- Dr Tim
- Blog Archives
- No responses
There is much discussion of late in political and social circles regarding health reform and the inclusion of the so-called “public option”. The suggestion from opponents often includes comments about their concern for small businesses and the need to stimulate opportunities for small businesses. I own a small consulting practice and am considered a small business person. I’ve come to believe all of this emphasis on small business in reflection of healthcare reform has yielded no rewards for me from the current private sector driven frame for health insurance management. Currently my monthly health care premium costs are $750 for each employee (yes, that is monthly)! Every year, when I have to renegotiate price, while it is undeclared, I am ominously suspicious that the previous year’s use of our practices health insurance coverage somehow plays a significant role in the percentage increase in costs that I will pay in premiums for the forthcoming year.
There have been moments in the negotiation with health insurance providers where I have had suspicions that the private insurance company would be just as happy to take my money and not have the bother of insuring our small business at all. In all of the 30 years I have been providing health coverage in our practice I have never had a sense that the insurance companies were interested in the quality and effectiveness of my healthcare coverage and services. Indeed, when my health insurance company’s services were actually utilized for covered events, I have suspected that it is somehow related to a higher percentage increase in premiums for those years.
I have come to the conclusion that there is precious little real competition in the private sector with regard to health insurance. Besides, in my consulting work and travels around the world I’ve discovered that the level of access, satisfaction, and health in countries with a public health plans is, at a minimum, comparable to the United States. In fact, I have a difficult time getting past comparative data produced by the Commonwealth Fund, the World Health Organization, the Organization for Economic Co-operation and Development, and the Kaiser Family Foundation and a host of others that clearly demonstrates that while the United States is number one in terms of cost of healthcare, it hovers close to 22 or 23 in terms of its citizens comparable health status. Regardless of the arguments that can be made for private healthcare in the United States, they simply do not alter the data. Private healthcare has not been cost effective, service effective, nor has it advanced the net health status of American citizens to the extent experienced by other first world countries. However, there is no argument with regard to the financial health of the health-insurance industry, demonstrated by some of the healthiest profit margins of any businesses in the United States. It’s one of the few industries where their success demonstrates little relationship between the profitability and quality, efficacy, service reliability, and outcome (healthy people), of its product.
I have now come to believe that simply tinkering another time with the private system and adjusting the mechanics of how it’s paid for or regulated simply avoids the real issues. While private healthcare has certainly advanced the technology associated with the tools addressing illness intervention, there is precious little evidence that it has affected, in any comparable way, the primary and basic health of Americans. Good evidence suggests that whatever health gains have been made on behalf of Americans relates more to good public health measures than by the efforts of private health care. Its focus on illness and treatment merely extends life already compromised by poor health choices, bad diet, a serious lack of primary health care priorities, and a healthcare system focusing on late stage, illness-based interventions. Doctors and other healthcare providers are paid for how many procedures and processes they undertake rather than by how much health they produce. It’s simply a bad compact, the foundations of which have simply fanned the flames of chronic illness, high cost, and late stage intervention.
At this point, it is reasonable to pursue the dialogue and decision-making regarding an effective health care system along the lines of a public-private partnership. This is certainly not a radical departure or an untried process. Both Germany and Australia have such workable systems producing health status data superior to US health statistics. Still, private insurers cry out that a public option would mean the death knell for private health insurance. Yet, the fact that private health insurance is prospering internationally in a number of different public-private national partnerships fails to inform their thinking. The competition embedded in such a public-private partnership has caused private health insurance to perform more effectively, ultimately outperforming their public partners while attending to service-centered and cost effective care. While no system is without challenges, such a partnership begins to introduce into the United States opportunity for a transforming set of standards related to payment, performance, impact, and health outcomes. It challenges the private sector to match performance in each of those arenas and to be able to do so in a truly competitive framework.
I fully recognize that legal parameters must be established in covering every American that manages the probability that corporations and others may “turf” their employees or undesirable persons (meaning those sicker and more expensive than others) into the larger public sector in order to avoid or eliminate any obligation they might have to them. Also, standards of performance and measures of quality and efficacy must be more clearly articulated in a way that creates comparable expectations and a level playing field in both the public and private sectors. Much has been written about this. At any rate, it’s now time to build an evidentiary and value-based frame for health service. The technology and tools are available today to make this happen.
As an international health consultant and traveler, I have many opportunities to share my reasons why I am a proud and confident American. However, American healthcare is not one of them. As a clinical professional for 40 years, I’ve experienced a consistent struggle with the design and delivery of American healthcare. It seems, we Americans are very nation-centric; not always available to learning, data, and insight gained by those in other parts of the world that can better inform our own thinking and help us make better decisions. There are times when I have felt that the United States is intellectually, politically, and socially narcissistic, ignoring the evidence of good thinking, planning, and applications that come from outside of our borders. Healthcare is clearly one of those arenas. When we broaden the discussion to include the health system experiences of other nations, Americans become very polarized, narrow, rigid, and defensive. Nothing is a better example of this than when the American healthcare system is compared to Canadian healthcare. While the Canadian healthcare system simply could not be imported in its current form to the United States, that does not mean that there are not elements in it that can positively inform future design and structure of a uniquely American system. Instead, many American providers, insurance leaders, and policymakers, deride the Canadian healthcare system, attacking it as though it is inadequate and ineffective. In fact, that’s simply not true. My 11 brothers and sisters with their children, nieces and nephews uncles, aunts, etc. are all citizens of Canada and partakers of the Canadian healthcare system. They are not dissatisfied with their healthcare, do not have greater or more substantial problems with health service than Americans do. They have comparable or better clinical outcomes, are more satisfied with their providers, have better more timely provider visits, all with lower total costs of healthcare delivery. The Canadian healthcare system is not better, it’s just different. Here again castigating it, or any other, doesn’t change the facts and, indeed, is simply a waste of good time. At the end of the day, we will still need to develop an effective American healthcare system that represents America needs, values, politics, and dollars.
In the end, I believe if there is not real health coverage reform, there is no real incentive to transform the health-care system and change it in ways that will positively affect both the cost of the system and the health status of the American public. Without building this new kind of public-private partnership, costs will continue to spiral, access will continue to be a challenge, the private sector will continue to fail to meet the real health needs of the American public in a cost effective manner and we will not become a better nation. With those options likely in our future we must work hard to build a more effective American private-public healthcare partnership that can ultimately advance the health and sustainability of people of the United States. — Dr. Tim
