In the pre-release preface to Essential Benefits: Balancing Coverage and Cost, the Institute of Medicine articulated the purpose of the report as giving guidance to the secretary of health and human services regarding the "essential health care benefits that must be offered to individuals and small groups in state-based purchasing exchanges and the existing market." The report attempts to balance the arguments advanced by groups representing providers and consumers, who urge the broadest possible coverage of services, against groups representing small and large businesses, who are pushing for affordability and flexibility.
This is not unfamiliar territory for our government. Since 1965 it has defined minimum benefits for Medicare and Medicaid. What is uncharted territory, however, is the federal government's venturing into the previously sacrosanct domain of private/commercial health insurers, whose ability to exercise great latitude in defining beneficiary benefits is at issue. As we move toward government-authored definitions, it might be helpful to take a step back to examine the forces that have brought us to this place and to revisit what we are actually trying to accomplish. In upcoming blog postings, I will discuss the market fundamentals of health care from the perspective of the American consumer. By "consumer," I mean both the 1% and the 99% -- the haves and the growing ranks of the have-nots.
Physicists constantly remind us that there are no special frames of reference when considering the fundamental laws of nature. Wherever you stand in the universe, the laws of nature apply equally to all things. Granted, we are not discussing laws of nature here. Nonetheless, when looking at the forces in our economy that are determinative of our ability to research, create, and propagate the technologies that save or improve lives, there really are no special reference points that distinguish the 1% from the 99%. Anyone who believes the contrary misreads the health care market -- and the reality of our interdependence.
We must all recognize that we are really having a much needed national debate about quality medical care for all Americans. We cannot make progress on definitions if there is space between us on that fundamental point, because some will believe that the conversation is really not about them -- that they, and by extension their families, operate from special reference points that give them a unique position in the health care market. They falsely assume that we are discussing essential benefits for others, not for them. Complete balderdash. The Institute of Medicine may describe the point of reference as "individuals and small groups in state-based purchasing exchanges and the existing market," but what we define for one, we are effectively defining for all.
How will Trump’s administration impact you? Learn more