Real Health Care Reform -- If You Want It

The push to bring American health care into the 21st Century is in full swing, but whether the debate is in full cry is another matter. That matter is pretty much all being left to the experts, while the rest of us wait to see what we'll get.

That's disappointing, but predictable: Aside from everything else -- the highly emotional issue of rationing, for instance -- the debate is deeply technical and statistics-laden; even the most curious civilian soon finds himself swooning over the arguments. Professionals, meanwhile, are likely to be blowing steam out their ears over one proposal or another.

But one things is perfectly clear; by any measure, the cost of health care will bankrupt this country by mid-century if we don't do something now. Looked at it this way, stalling or trying to derail the current push is deeply unpatriotic.

But dealing rationally with the issue seems to be out of the question; all we seem to hear about is the evils of socialized medicine -- read, the road to Communism -- and how any system of national health care will mean denying life-saving care to the deserving.

Try telling that to the widow of my best friend, who had first-class health insurance and excellent doctors; he died in one of New York's best hospitals after being denied a heart transplant, because there are only so many hearts available, and he was a poor candidate.

The truth is, we ration health care in this country every day. The decision about my friend was perfectly rational, and in the condition his problem had left him, he really didn't want to keep living. But that doesn't mean the doctors made no decision.

Meanwhile Congress is dealing with one of the least important of this clutch of issues, and ignoring the real dragon in the room; how to pay for health care means nothing if the cost of care keeps growing at anything near its current rate.

That's probably because nobody likes insurance salesmen, but we all more or less worship doctors. But it leaves out the fact that American health care is a profit-driven business, that maintaining profit margins is the whole point of business, and that America's health care systems is a messy collection of suppliers, each preoccupied with the care and feeding of their profits.

The obvious solution is to create a health care system that's like an integrated manufacturing company, in which providers of everything from aspirin to brain surgery deliver their goods at cost; it's how both Andrew Carnegie and Henry Ford drove their competitors out of business. No profit margin for suppliers means lower production costs for sellers.

Am I talking about a national health care system -- socialized medicine? No.

What I'm talking about is encouraging more integrated medical delivery systems like Kaiser Permanente and the Mayo Clinic, which operate very profitably on an integrated model, and deliver excellent care at much lower costs than their competitors. Nothing un-American about competition, is there?

Kaiser Permanente, which combines for-profit medical operations with a not-for-profit insurance division, is even more profitable than many private health care delivery systems; last year, it delivered $34.4 billion in annual operating revenues and $1.3 billion in net income, while in the same period Hospital Corp. of America, the private industry's largest firm, posted operating revenues of $28.37 billion, against $673 million in net income. Kaiser has been in business since 1945.

Clearly, it's got a practical business model, or it would have failed before now. Based on the facts, it's superior. And adopting it industry-wide would obviously encourage competition, and drive down overall health care costs, nationwide. Mr. Market would smile upon it. And it would do the same thing the Administration's public financing option would do -- encourage good, old-fashioned American competition.

Yet nothing is heard about the idea so far, probably because those who'd rather leave things as they are, are hoping to smother reform in its cradle. They're doing this, among other things, by waving all sorts of dishonest slogans in the air to confuse us -- many of which don't even have a basis in the facts, like the so-called "rationing issue".

The fact is that the arguments being made against taking real, effective action to deal with our health care problem are dishonest, at best, and designed to bully us into dropping the whole matter. Otherwise, the people behind them would have to think of somebody besides themselves. It makes you wonder if they really love their country, or just see it as a flag of convenience.

Comments

[schurr64]

Thank you for the cogent arguments.As a veteran I saw government medical care on base and I did not find it terrible.I thought it worked as well if not better than my present healthcare provider.This is a single payer type.While in the military I also used an English hospitals emergency service.I went on a Saturday evening and was immediately seen and recieved excellent care with NO wait.Try that any where in Americas system.Why aren't we looking at all the other countries ways of providing medical services and using a blend of the most efficient and cost effective ways.What Obama is advocating (which is not mentioned in detail at all) is keep it the way it is from what I have heard.The single payer service is foreign to Americans so much misunderstood and feared(especially by the people causing the exorbitant costs and poor service) and until fairly explained will continue in this light.As the baby boomers retire with the legacy of the Medicaid costs from Bush with love to the pharmaceutical industry will bankrupt us even further.This love is continuing with Obama as evidenced by the pharm. industry not going ballistic on him in ads.I want to hear about single payer even if HMO's and big Pharmaceutical companies do not want me to hear about it.

[Henryk A. Kowalczyk - Huffpost Blogger]

Dear Mr. Reinbach,

We already have socialized health care, and this is the reason that it does not, especially in the system designed to be run by the free market. Insurance companies make huge profits because they are so strictly regulated that for all practical reasons they are quasi monopolies protected by government regulations intended for public good. After all, they, not you and me, have an army of lobbyists making sure that whatever regulations might be, will be good for them. The fewer government regulations, the less lobbyists can buy.

[SeriousBlack]

"What I'm talking about is encouraging more integrated medical delivery systems like Kaiser Permanente and the Mayo Clinic, which operate very profitably on an integrated model, and deliver excellent care at much lower costs than their competitors. Nothing un-American about competition, is there?"

Mr. Reinbach.

Kaiser Permanente cancelled my health insurance after I was diagnosed with Hepatitis C. (And note that no one could figure out how I got it - a common occurrence of many who find out they have Hep C - I engaged in no "risky" behaviors so as far as I know it didn't happen to me because of any irresponsible or causal behavior on my part - so there rightwingers.)

And your response?

[schurr64]

FYI many people who are veterans contracted hep c from innoculations given in mass without changing the needle or sterilizing it.Perhaps something like this?

[jhNY]

We need health care, not insurance. We need the state to provide that care as a birthright to the citizens of the nation, to be paid for out of general tax revenues, like the Defense Department, which even after showing in a recent audit that it cannot account for $1 billion it received, nonetheless enjoys increases in funding with every new budget, including Obama's, with very little noise being made by anybody as to ballooning deficits. We should be so generous to ourselves, our parents and our children.
But money madness has destroyed our democracy. Insurance companies and the pharmaceutical industry have made themselves indispensible in the re-election process, and their wishes will be heard by the malleable careerists who overpopulate both parties, everybody's anecdotal health care horror stories notwithstanding. And many Americans, especially those whose intellects are incapable of resisting suggestion as confected by professional opinion-molders, will find that they feel about things pretty much the way the insurance and drug lobbies' ads persuade them to.

[Ginsights]

Rationing is an essential aspect of the European approach to managing health care costs - there is no magic to cost reduction.
Rationing is especially applied to the elderly - - primarily limited surgical choices and even expensive drugs are not on the list of paid-for-medications. That might be rational, but it also violates our and clinicians' expectations of good care.

A second cost-raising factor is due to fewer legal threats in Europe - US physicians feel obliged to repeat tests that were done by others already, because relying on such documentation does not absolve them from the possibility of malpractice suits if there are errors or omission in the medical record. Omissions increase when there are threats of privacy violations. And the medical record software providers enforce clauses that absolve them from any responsibility.

To obtain the benefits hoped for in a revised health care system some of these issues have to be brought out in the open.