OP-ED

Saving Health Care, Saving America

So far, Congress’ response to the health care crisis has been alarmingly disappointing in three ways. First, by willingly accepting enormous sums from health care special interests, our representatives have obligated themselves to their benefactors’ interests rather than to those of the American people. More than 3,330 health care lobbyists – six for every member of Congress – contributed more than one-quarter of a billion dollars in the first and second quarters of 2009. A nearly equal amount has been contributed on this issue from non-health care organizations. This exchange of money prompted a Public Citizen lobbyist to comment, “A person can reach no other conclusion than this is a quid pro quo [this for that] activity.”

Second, by carefully avoiding reforms of the practices that drive health care’s enormous cost growth, Congress pretends to make meaningful change where little is contemplated. For example, current proposals would not rebuild our failing primary care capabilities, which other developed nations depend upon to maintain healthy people at half the cost of our specialist-dominated approach. They fail to advance the easy availability and understandability of information about care quality and costs, so purchasers still cannot identify which professionals and organizations are high or low performers, essential to allowing health care to finally work as a market. They do little to simplify the onerous burden associated with the administration of billing and collections. The proposals continue to favor fee-for-service reimbursement, which rewards the delivery of more products and services, independent of their appropriateness, rather than rewarding results. Policy makers overlook the importance of bipartisan proposals like the Wyden-Bennett Healthy Americans Act that uses the tax system to incentivize consumers to make wiser insurance purchases. And they all but ignore our unpredictable medical malpractice system, which nearly all doctors and hospital executives tell us unjustly encourages them to practice defensively.

Most distressing, the processes affecting health care reflect all policy-making. By allowing special interests to shape critically important policies, Congress no longer is able to address any of our most important national problems in the common interest – e.g., energy, the environment, education, poverty, productivity.

Over the last four years, a growing percentage of individual and corporate purchasers has become unable to afford coverage, and enrollment in commercial health plans has eroded substantially. Fewer enrollees mean fewer premium dollars available to buy health care products and services. With diminished revenues, the industry is unilaterally advocating for universal coverage. This would provide robust new revenues. But they are opposing changes to the medical profiteering practices that result in excessive costs, and which often are the foundation of their current business models. And these two elements form the troublesome core of the current proposals.

Each proposal so far contemplates additional cost. But we shouldn’t have to spend more to fix health care. Within the industry’s professional community, most experts agree that as much as one-third of all health care spending is wasted, meaning that a portion of at least $800 billion a year could be recovered. There is no mystery about where the most blatant waste is throughout the system, or how to restructure health care business practices to significantly reduce that waste.

Make no mistake. A failure to immediately address the deep drivers of the crisis will force the nation to pay a high price and then revisit the same issues in the near future. It is critical to restructure health care now, without delay, but in ways that serve the interests of the nation, not a particular industry.

Congress ultimately must be accountable to the American people. The American people must prevail on Congress to revise the current proposals, build on the lessons gleaned throughout the industry over the last 25 years, and directly address the structural flaws in our current system. True, most health industry groups will resist these efforts over the short term, but the result would be a more stable and sustainable health system, health care economy and national economy, outcomes that would benefit America’s people, its businesses and even its health care sector.

Finally, the American people should demand that Congress revisit and revise the conflicted lobbying practices that have so corroded policymaking on virtually every important issue. Doing so would revitalize the American people’s confidence in Congress, and would re-empower it to create thoughtful, innovative solutions to our national problems.

Brian Klepper is a health care analyst and industry advisor. David C. Kibbe is a family physician and a technology consultant to the industry. Robert Laszewski is a former senior health insurance executive and a health policy analyst. Alain Enthoven is Professor of Management (Emeritus) at the Stanford University Graduate School of Business.

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Sidney Fruitdaniel laneDavid KernrobertAG, M.D., J.D. Recent comment authors
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Sidney Fruit
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Sidney Fruit

You’re an old fart? Please, I’ve had my AARP card for seven years now

daniel lane
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daniel lane

I dont think we’re going to get the results we want but, this healthcare is getting outrageous its unfair to those who cant afford it. People are dying daily and it need to be addressed now the company has made there billions cut our people some slack !

pbnesbitt
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Nate, contact me at pbnesbitt@gmail.com. I would enjoy discussing our experiences in containing costs within the self insured market.

Nate
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Nate

pbnesbitt I think I actually listed other alternatives no? two of them. Far from failing to see them 6 days a week I am actually implementing them. If your aware of any I missed please do share, I can always use a new method to reduce cost; even a tenth of a percent is a huge vistory these days. I am actually a huge fan of immigration, please try to avoid the liberal fall back of calling someone racist or nativist when you lack any other argument. I think we should have open borders for scientist, researchers, people with business… Read more »

pbnesbitt
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I am continuously amazed by Nate. I’m reading his rather condescending argument against Maggie only to find myself reading a diatribe against immigration.
Actually, he’s quite accurate in his old school view of provider negotiations. It’s just that in his arrogance, or is it frustration, he fails to see that there may be other alternatives.

Nate
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Nate

“Private insurers already follow the Medicare fee schedule–adding a % to each fee. So if Medicare cuts by 6%, they’ll cut by, maybe 5%.” And Maggie knows this from all the contracts she has with hospitals. All those thousands and millions of claims Maggie has processed prove she is correct. For anyone that cares Maggie is full of BS and doesn’t have a clue how contracts come to be. Private insurance fees have next to no relationship with Medicare fees in being set. Medicare fees might be used as a reference point but lowering Medicare has the opposite effect on… Read more »

MD as HELL
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MD as HELL

Nate,
This is not about healthcare. You know that. It is about shredding the Constitution and moving into the post-American era.
Medicare is toast no matter what. Insurance still leaves you subject to financial ruin, so why even bother with it?
No one hs to take “no” for an answer anywhere in this country regarding healthcare. Just go to an ER and bring up EMTALA, tell them you are not stable yet. You will get treated until the cows come home. (They are working for the government, too).
Pass the free cheese, while you’re at it.

maggiemahar
Guest

Peter– Thanks. Here’s what I forgot to add: Private insurers have been chafing at the bit to reduce fees for diagnostic testing (another WSJ article) And private insurers have told MedPAC that if Medicare cuts fees for docs, they will follow suit. They just want Medicare to provide political cover. Private insurers already follow the Medicare fee schedule–adding a % to each fee. So if Medicare cuts by 6%, they’ll cut by, maybe 5%. This means that by the time we roll out the public option (in 2013) fees for many procedures will be much lower–and fees for primary care… Read more »

David Kern
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As a nation, the thought “our collective intellect is but a cork, floating on the global ocean of emotion”, is hearkened, as we churn through the frustrations of pulling disparate private sectors and elected officials interest’s, into some form of a “healthcare delivery system”. Each segment responds according its primary interests, as do we all, yet indignation drives much of our discussion. It makes little sense to privately finance elected officials and expect voting behavior not reflective of those interests; short of the voting constituency overruling financially rationed “free speech”. Similarly, within healthcare silos, on balance, why would provider, underwriting,… Read more »

Nate
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Nate

Maggie if reform really is a long process that will come in steps why didn’t your einsteins in congress start with reform everyone agrees on like tort and medicare fraud. They could build trust and save billions and everyone would be happy. Instead they pick the handful of ideas most controversal and least likely to improve anything or save money and you applaud them…

Margalit Gur-Arie
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Margalit Gur-Arie

Concierge medicine, Nate?

Nate
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Nate

“one of the most impressive speakers talked about the need to recruit more low-income students, even if their GPAs and test scores are a tiny bit lower (which,on average, they are.) Low-income students are far more likely to choose primary care–and to go back to the inner city or rural areas where they grew up.” This worked great with teachers, can’t imagine it failing as bad with doctors as it has with education. As they recruited more teachers with lower scores and IQs they surprisingly did a poorer job. “all I can say is that after 12 years at Barron’s,… Read more »

robert
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robert

“I have had many long talks with primary care physicians. Five to 10 pecent, plus bonuses for joining accountable care organizations, or managing chronic diseases, etc. sounds like a good start to them.” ‘Here’s what Ted Epperly, board chairman of the 95,000-member American Academy of Family Physicians, told Bloomber “It’s a great step forward.” ‘ As a practicing family doc for the past twenty five years, I have not met anyone who would agree with either of these two statements. If you honestly think this represents what primary care MDs are thinking, you are truly out of touch with the… Read more »

Margalit Gur-Arie
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Margalit Gur-Arie

Maggie, I will admit I don’t know any Congressmen or Senators and I don’t hang out with CEOs and I have no inside sources. I am just an average American from the Midwest, a.k.a. the suckers that pay the bills for all this secretive wheeling and dealing. But I do know a little bit about business and it does not take much knowledge to understand that companies do not consistently invest in something that has no ROI. If lobbying had no effect, there will be no “contributions”, certainly not to the tune of billions. I happen to think that this… Read more »

Peter
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Peter

Maggie, long posts are exactly what is needed here (except rants by Nate) but you point out that these changes are for Medicare, not the care I will be able to access or the long suffering premium payers that will not get subsidies from this plan. I see shifts from Medicare cuts to private pay – that’s me! Medicare already takes care of seniors, so why is it important to just highlight Medicare reforms when all the abuses in the system are for non-medicare beneficiaries if you discount the cost to the taxpayer, which by the way I will pay… Read more »