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Jamie Court

Jamie Court

Posted April 7, 2009 | 02:11 PM (EST)

White House Summit In Denial On Regulating Health Care Costs


"Prevention" was the word of morning at the White House Western forum on health care reform in downtown LA.

Led by Oprah's Dr. Oz, Governor Arnold Schwarzenegger and Washington State Governor Chris Gregoire, the assembled "stakeholders" rattled off how prevention pays in health care.

20% of the patients account for 80% of the costs.  75% of the costs spring from four conditions. The most expensive medicine is bad medicine  It's no doubt true, but keeping kids out of McDonalds, treating heart disease preventively, and making sure Grandma takes her medicine isn't going to get us where we need to go in health care reform.

We need to rein in the charges of the medical-insurance complex. And that's a subject the politicians, hospitals, insurers, doctors and health care professionals assembled today didn't want to acknowledge.

Well, it's true, health care reform boils down to regulation of medical charges, which is hardly popular with the medical establishment. None of the two hours set aside today in largely scripted testimony dealt with the public option to the private market or mandatory health insurance and how to make it affordable. 

The kumbaya spirit was encouraging, but the reality is standardization of medical insurance charges and costs is going to determine whether there is enough money in the health care system to cover everyone. The Obama Administration largely listened today, but Schwarzeneggeer was selling three essentials in health care reform: 1) getting all the stakeholders together 2) mandatory health care 3) prevention.   Only #3, prevention, will have a positive impact on reform.  To please the stakeholders with consensus risks letting their out of control costs remain out of control.  Making health insurance mandatory on its own won't bring costs down, and Americans are losing coverage today because they cannot afford it.  Schwarzenegger refused to regulate premiums in his failed 2007-2008 effort and Capitol Hill is not likely to do better.

The California Nurses Association brought nearly one thousand nurses and activists to a rally on the street outside the forum. Their calls for a Medicare For All system weren't heard in the auditorium, but guests couldn't miss the message as we entered the auditorium.   The testimonials from patients inside were heart breaking, but none of the answers from so-called stakeholders inside were compelling. None of the solutions dealt with how patients who lost coverage would be able to afford it again under an overhaul where the only cost savings come from medical prevention.  

 At some point the White House is going to need to get tough on health care and insurance charges, in addition to trying to pay for performance through "comparative effectiveness," which Obama has promoted.  A truly public option like Medicare offers the best hope to drive down costs and force the insurers to compete.  Recently, Senate health reform architect Senator Max Baucus seemed to suggest the public option was not really needed. In the absence of health care cost standardization and regulation, a genuine public option may be national health care reform's main saving grace. Let's just hope Obama isn't in as much as denial about the need for cost regulation as the assembled potentates today.