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Beyond the Beltway – How Most of America Sees Health Reform

What are people saying about health reform beyond the beltway and outside the health wonk debates?  I’ve been meeting with Rotary Clubs and local Chambers of Commerce during the last several months, and they’re talking about different issues than the ones being debated in Washington, DC.  When I talk with these groups about the prospects for national health reform, what are the top three questions they ask?

  • Is this going to lead to a single-payer system with rationing, just like they have in Canada?
  • Why isn’t the malpractice problem being addressed?
  • Will this include illegal immigrants?

These are not the top issues being debated on Capitol Hill.  If you just read Politico.com, the Washington Post, and the pundits’ blogs, you would think that the big issues are the public plan option, the employer mandate, and the cap on the tax exclusion of employer-paid benefits.  There are important, but they aren’t the issues that most small employers and consumers are worried about.

Let’s take each of these in turn.

  • The concern about rationing under a Canadian-style single-payer system shows that the messages from right-wing opponents of health reform are finding a receptive ear, at least among some people.  I heard this issue expressed at every meeting I attended – often using the exact language the Frank Luntz has recommended.  In response, I try to explain that the most likely reform legislation would preserve the multi-payer private employer-based system for most people, and it would rely on healthy competition rather than government price-setting and rationing to slow the growth in health care costs.  My response usually falls on deaf ears; many people are convinced that Obama and Kennedy are secretly pushing for a government-run plan.  It will take a lot of work to overcome the fear factor that is being stirred up by opponents of health reform.
  • Many people – especially those with family members who are doctors – are convinced that the malpractice problem is the single biggest driver of high costs.  In the words of one person at a meeting I attended recently, “The malpractice lawyers are raping the doctors”.   I respond by acknowledging that malpractice insurance and the use of defensive medicine do drive up costs, but these are relatively minor factors; the way physicians are paid has a much larger impact on driving unnecessary use of tests and medical care.  But there is a real issue here: why hasn’t malpractice reform been seen as an essential building block of reform?  The likely answer is political:  the trial lawyers have traditionally provided financial support to Democrats, while doctors have usually supported Republicans.  Since most of the current bills are being written by Democrats, it’s not surprising that they don’t focus on liability reform. Pres. Obama’s recent comments to the AMA provided a glimmer of hope that the issue will be addressed.  If there is any interest in building bi-partisan support for comprehensive health reform, this ought to be on the table.
  • The fear of illegal immigrants is a hot button issue for many people.  In the current economy – with many people losing their jobs, and many more worried sick about the danger of unemployment – it’s sad but not surprising that some people would see immigrants as a threat.  So far, the President and Congressional leaders have been successful in keeping this issue from getting out of hand, but Senators and Representatives will get an earful when they spend time in their districts during the July 4 and August recesses.  Unless we find a way to manage this issue, it could become a flash point in the final phases of debate on a comprehensive reform bill.

Bill Kramer is an independent health care consultant, focusing on health care management, finance and public policy. Bill served as a senior executive with Kaiser Permanente for over 20 years. Most recently, he served as Chief Financial Officer for Kaiser Permanente’s Northwest Region. More information about Bill may be found at www.kramerhealthcareconsulting.com.

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GregPeterNateMD as HELLDeron S. Recent comment authors
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Deron S.
Guest

Peter – I read the Gawande article the day it came out, but it is only one article, looking at one area of the country, and focused on one cost driver. It does not serve as a complete picture by any stretch of the imagination.

Greg
Guest
Greg

The Canadian doctor waiting times are not as bad as one might suspect, especially in major cities. Wait times, especially for medicare and medicaid patients in the US, are long too. Malpractice is a bigger issue in the US than in Canada, though. Canadian doctors are surprised at how much overtesting occurs in the US, especially given for the most part, the doctor has no financial interest in the testing. As a physician who trained in Canada and now practice in the US, I practice defensive medicine much, much more here across the border than in the great white north.… Read more »

Peter
Guest
Peter

“The northeast is used to sponging off the rest of the country, so why should health insurance be any different.
MD, here are the FACTS.
http://www.seattlepi.com/opinion/211080_sciglianomoney.html
http://www.washingtonpost.com/wp-dyn/content/article/2009/05/29/AR2009052901548.html
Deron, did you not read this?
http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande

Nate
Guest
Nate

“many people are convinced that Obama and Kennedy are secretly pushing for a government-run plan.”
Would this maybe be becuase Ted Kennedy has been pushing for government ran plans for 35 years? He clearly said he wanted HMOs to take over healthcare becuase they are federally regualted. He has been pushing for government care for almost 4 decades and you expect the public to just ignore this?
Obama has also said he wants government controlled healthcare.

MD as HELL
Guest
MD as HELL

As an ER doc I can say that 98% of CT scans are defensive and 90% of chest pain admissions are defensive.
The northeast is used to sponging off the rest of the country, so why should health insurance be any different.
With this president the “illegals’ will not be illegal forever.
Canada has different utilization of healthcare, so they will have different data than the US. Anyone moving to Canada for the healthcare?

Deron S.
Guest

Bill – I disagree with your point that the payment model has a far bigger impact on overutilization than defensive medicine. You are assuming that a large percentage of physicians have financial incentives to order diagnostic tests. That’s definitely not the case in my local area and I can’t imagine it is in many other areas.

Health Plan Veteran
Guest
Health Plan Veteran

I”m not in the heartland, but in a traditional liberal area of the Northeast US where the big issue is concern about losing employer-based health insurance due to affordability. The themes we’re hearing in Congress and from the Obama adminstration are very much music to our ears.

Michelle from Iowa
Guest
Michelle from Iowa

Those of you screaming about potential tax increases to fund universal health care … wouldn’t you rather pay for that than some fat-cat’s bonus? The system has been broken for a long time and fixing it won’t be cheap. The engine light on the health care car has been ignored too long; after neglecting pay-as-you-go $25 oil changes, the motor either needs to be replaced or it’s time to buy a new car. Can’t afford it? Too bad. If you need transportation, you’ll just have to find a way to suck it up. If you keep your lemon and replace… Read more »

Steven Waldren
Guest
Steven Waldren

Regarding tort reform and health care reform, why is it that we always talk about the way providers are paid and how that drives up cost (which I agree) and we never talk about the way trial lawyers are paid (percentage of awards) and how that drives up the malpractice costs?

Myth Buster
Guest
Myth Buster

I am going to state the obvious and point out that Rotary Clubs and local Chambers are not populated by and large by government workers, labor, or well anyone who is a Democrate. The R’s lost the election and so their issues are no longer on the top of the agenda. People on the other side of the aisle do discuss and discuss and discus the issues you raised but they aren’t trying to solve the problem they are just reacting from fear. Here are some more myth busters. Myth: Canada is a socialized health care system in which the… Read more »