OP-ED

Op-Ed: Reform- Why have our objectives been abandoned?

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In the campaign of 2008 and the first six months of 2009, the call for healthcare reform has been a refreshing and important theme.  It has been widely recognized that

1.    Healthcare costs are out of control.  You cannot have healthcare expenses inflating at 8% in an economy that is growing in the best of times at 4%.  (today, the current inflation rate is negative 1.3%)

2.    47 million Americans need coverage

3.    14,000 Americans lose their insurance everyday

4.    Medicare is in peril, and along with Medicaid, the combination of ever-increasing costs are the main drivers of this government’s budget deficits that threaten our economic future.

Our politicians pledged to deliver comprehensive solutions to address these problems and they promised budget neutrality. The President told us, that health care costs are driving our deficit; that the current trend is unacceptable, unsustainable, and we are going to change it in 2009.

Now we know they did not mean it.

The President and the Congress appear to be functioning as they always do- Job #1 is getting elected. Thinking out of the box, trying to break out of the mold of old and failed ideas requires courage and political will.  All seem to be missing. Instead, we get an approach that expands government. The demand for a public plan to achieve savings is silly. We already have two public plans in Medicare and Medicaid.  Where are the savings from these plans? The increase of taxes, on the top portion of the country’s citizens to pay for insurance for the uninsured, does nothing to save money or control costs.  In addition, there is no mention of the fact  that by adding complexity to a flawed system will only cause the system to fail faster, not reform it.  The CBO quickly came out and said the two current reform bills will not substantially reduce the cost of medical care over the long run.

There are viable solutions on the table, however, that do address the problem. These concrete solutions include:

1.    The Wyden-Bennett “Healthy Americans Act” to make people more accountable for their own health and health insurance.

2.     Proposals that remedy the inefficient and poor quality associated with the treatment of the chronically ill and excessive re-hospitalizations.

3.     Promising approaches in designing Value- Based Benefits that effectively lessen chronicity, improve quality and stimulate compliance and adherence to an individual’s care plan.

Why are we not hearing about and considering these concrete approaches?  Why are our elected officials so intent on a “quick-fix”?  We know that a quick fix is just that.  We must have a systemic overhaul.  Systemic overhauls require expertise and thought, not haste.  Quick fixes are the modus-operandi of politicians with eyes on the next election, not the behavior we expect from trusted public fiduciaries committed to the health of Americans and of our economy.  We have seen enough of that behavior for the past twenty years.

Dr. Albert S. Waxman PhD is a scientist, serial entrepreneur, investor and current CEO of the Psilos Group, a health venture capital firm.  Dr. Waxman is a frequent speaker and recent author of “Change, Innovation, and Investment in the New Healthcare Economy– a 2009 Outlook on Healthcare Venture Capital.”

If you enjoyed reading this piece by Albert Waxman, try reading “Innovation + Economics: Keys to Successful Healthcare Reform”

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Steve Beller, PhD
Guest

I didn’t know you’d be responding, Nate; I’m so glad you did! My comments follow. [Nate] On THCB previously I posted a very long and detailed explanation of what terms he [Mr. Potter] doesn’t appear to understand and where he was lying. When time permits I’ll try to find it. I think there are all sorts of abuses that could turn someone off of insurance companies and even lead someone to campaign against them [Steve] I would like to see your post. And I’m glad you are not defending the abuses of insurance companies, even though Mr. Potter pointed out… Read more »

john
Guest
john

My take on public versus private health care funding is here: http://healthcarefunding.blogspot.com

Nate
Guest
Nate

I own three TPAs. Besides administering self funded plans with stop-loss, instead of being fully insured, our most popular service now is self funding under fully insured high deductibles. For example they buy a 5K deductible plan, reduce their premium to the carrier 40%+ and we process claims back down to a $500 deductible. Both sides of my business entail helping employers offer insurance more efficiently. This is usually at the expense of insurance companies. We attack the fat. We have also been carving out a lot of drug plans because employers can self fund the risk cheaper then paying… Read more »

Steve Beller, PhD
Guest

Let’s start with Mr. Potter’s interview. I just noticed that the link to the interview I previously posted was incorrect; it’s at http://www.democracynow.org/blog/2009/7/15/health_insurance_whistle_blower_knows_where_the_bodies_are_buried In response to my observation that Mr. Potter’s interview was powerful and convincing, you [Nate] said my perception is such because “… he said what you wanted to hear and reinforced what you thought.” [Steve] It’s true that Mr. Potter’s scathing critique is aligned with many other things I’ve learned about the health insurance industry and that his comments reinforced those perceptions. Nevertheless, I have an open mind and am definitely interested in debate. — [Nate] “It… Read more »

Nate
Guest
Nate

“Nevertheless, his interview was powerful and convincing.” Because he said what you wanted to hear and reinforced what you thought. It does not bother you that factually he was totally off base and even though he was supposedly an insurance executive he misused basic industry jargon? What your admitting is you don’t care rather the facts are accurate as long as you agree with the point, not very scientific. Being paid by a left leaning pro reform organization means you should also not comment on Mr. Potter. I get paid to take money away from insurance companies so you can’t… Read more »

Steve Beller, PhD
Guest

Hmmm, Nate…Sounds like you’re downplaying empathy because there may be unintended consequences. It’s like saying, Why put yourself in someone else’s shoes and try to understand things from their point of view since there have been times when half-assed attempts to help those in need have backfired? I would take a completely different approach by asking: How can we use the understanding empathy brings to do things that are effective in helping those in need to help themselves in a sustainable way? Let me add that empathy toward healthcare providers is also important. Put yourself in the shoes of a… Read more »

Nate
Guest
Nate

Your report is off from the start and is built on the same faulty rationale as most liberal attacks on our healthcare systems. Notice the S on the end of system, we don’t have one homogenous system. We have 50 state, couple federal and thousands of employer systems. The vast majority of those systems are better then anything else in the world. That is the problem with studies, they are done by academics who don’t have any functional understanding of our healthcare system. Any study that lumps all US systems into one is worthless. Why would you scrap a highly… Read more »

Steve Beller, PhD
Guest

I wish I was joking, Nate! [Seems like Steve S and you are a tag-team] “80% of Americans have the best healthcare in the world” Not according to the reports I’ve read, e.g., http://www.facs.org/fellows_info/bulletin/2009/wenger0709.pdf “Ask doctors if they want to be reimbursed Medicaid and Medicare rates in a universal system and what happens to support?” Of course people don’t want to pay higher taxes, see their incomes lowered, change the way they do things, or to have to work harder to maintain their standard of living. But I disagree with your implication that healthcare professionals care only about money and… Read more »

Nate
Guest
Nate

Steve you got to be joking. “All nations having publicly-funded health care with universal coverage as the goal show more empathy than ours since the United States is the only wealthy, industrialized nation that does not provide universal health care” So the 22 year old that died in England because they refused him a transplant was shown empathy? The ICU baby brought down from Canada was shown empathy? 80% of Americans have the best healthcare in the world. Those enrolled in our empathetic public plans like Medicaid are those suffering. You want to reduce the quality of care and drastically… Read more »

Mike T
Guest
Mike T

There are so many special interest groups in the healthcare industry that try very hard with 100s of millions of dollars for lobbying to maintain the status quo of healthcare chaos and crisis. We absolutely need the Govt to involve in providing at least basic healthcare. The reasons are compelling. 1) Country’s GDP depends on the health of the people; no country can continue to grow with millions of sick people. 2) If Govt does not provide care, people end up in Govt care anyway (Medicaid and Medicare) after getting more sick. Why not provide care before they get into… Read more »

Steve Beller, PhD
Guest

My replies to Steve S follow: He asked: Can you please identify for me a country that is long on ’empathy?’ My reply: All nations having publicly-funded health care with universal coverage as the goal show more empathy than ours since the United States is the only wealthy, industrialized nation that does not provide universal health care (http://en.wikipedia.org/wiki/Socialized_medicine) He asked: Can you please identify for me a model of public sector healthcare efficiency? My reply: Read Maggie Mahar’s post on THCB a few years back titled ‘Why Medicare is More Efficient Than Private Insurers’ at https://thehealthcareblog.com/the_health_care_blog/2006/06/policy_why_medi.html He asked: Do you… Read more »

Sam Adams
Guest

… might help if folks stopped quoting the 47 million without insurance as correct. At the very least, knock the 10 million illegal aliens AKA people who broke the law. They should be covered why?

John Williams
Guest
John Williams

I love all these people that are no more than the rear of a donkey. I’m a CPA. If all the health insurers can make such great profits and bonuses while covering less and charging more, how can the government be any worse. The insurance companies are already between you and your doctors. Give me a break. Also the GAO’s ability to audit all government programs must be greatly increased to sufficiently monitor all the spending that is being done.

Biotech Analyst
Guest
Biotech Analyst

Litigation reform? Where is that? How much do we spend on defensive medicine?
Oh, sorry, didn’t realize President Messiah wouldn’t lift a finger to endanger his trial lawyer pals’ jackpots.

Nate
Guest
Nate

“47 million Americans need coverage” Unfortunately around 42 million of them disagree with you or they would have already signed up for the free coverage they are entitled to or bought coverage with their 75K plus incomes. You also have millions of young healthy 20s who refuse to pay anything for insurance because they don’t feel they need it. Around 5 million people “need” insurance and can’t afford it. 5 million is a far different problem then 47 million. “14,000 Americans lose their insurance everyday “ And roughly that number get new coverage every day. Most people are only uninsured… Read more »