Weeks ago I started writing a series of posts dedicated to health care reform. I argued that medical education needs to change from a primarily drugs- and surgery-based model to a more holistic one that focuses on getting to the root of illness. My next post was going to discuss how health care reform should require insurance companies to cover all licensed healthcare providers.
Unfortunately, in the weeks that have passed, the health reform debate and efforts have gone from optimistic and bipartisan to vitriolic, divisive and, in some circumstances, downright scary. I find it ironic that one of the changes I planned to argue for -- more emphasis on preventive medicine -- is now a moot point. The patient (health care reform) is already so sick that triage is required.
It's painfully evident that wholesale reform of our healthcare system isn't going to happen. I fear the legislation that ends up on the President's desk for his historical signature will neither decrease healthcare costs, nor improve patient outcomes.
President Obama has squandered political capital and misused his bully pulpit. The effort was doomed to fail from the beginning because it was trying to do too much. The President was too aggressive in trying to take on all the special interests simultaneously at the federal level--insurance companies, hospitals, doctors groups, healthcare informatics and pharmaceutical companies. The plan included reaching across the aisle to form consensus of sweeping reform, promoting universal coverage, eliminating pre-existing conditions as a reason for denying healthcare coverage, decreasing reimbursements to doctors and hospitals and mandating that healthcare organizations implement electronic medical records technology.
His "let's-fix-all-now" approach appears to have backfired as the public's opinion of Obama's handling of the healthcare reform effort has dwindled. The Administration and its supporters in Congress have lost the momentum for reform they had earlier this year and are now discussing whether or not to push a bill through Congress without bipartisan support.
The polling numbers don't paint a positive picture. On July 21 Time Magazine reported that more than 60 percent of respondents believed healthcare reform will make the system more costly and more complicated. On August 7 the Wall Street Journal reported that 63 percent of adults agree with the President's assertion that "We must make it a priority to give every single American quality affordable health care," but just five days later, on August 12, the Gallup Poll reported that 49 percent disapprove of how the President is handling health care versus 43 percent who approve. While it once held the high ground, the Administration is now fighting back from a position of vulnerability.
Part of the problem appears to be that President Obama's efforts have been too broad. Instead of trying to fix the entire system at once, he should have narrowed the efforts to three objectives that would likely enjoy undeniable public support. These efforts do not dictate the type of care administered and avoid the new third-rail of the reform debate -- universal coverage. They are: (1) deny insurance companies the right to refuse coverage for preexisting conditions; (2) require insurance companies to provide coverage for all children; and (3) pressure governors to come up with solutions that will solve the problems on a state-by-state level.
Insuring all children is a no-brainer. This population is one of the most vulnerable in our society. Countless studies show that long-term health is established in childhood, and that problems caught at an early age may be dealt with before they develop into serious and expensive diseases. That 8.1 million children don't have access even to well-child exams that chart a child's growth and provide a forum to vaccinate and discuss proper nutrition and lifestyle issues with parents, represents a missed opportunity to promote a lifetime of good habits and health.
Denying insurance companies the right to refuse people for preexisting conditions puts the emphasis squarely in these companies' laps to deal with a burgeoning problem of their own making. Some would argue that this would cause the insurance companies to raise premiums so high that health insurance becomes even less affordable for many. This is where my third suggestion comes into play. The insurance industry is currently regulated on a state-by-state basis, as are health care providers. Governors could be pressured by the Administration to come up with novel solutions that can serve as models for the rest of the country. Instead of one large federal government solution, we would have fifty states acting as entrepreneurial incubators for reform. As the states come up with viable solutions, other will adopt them.
There are already successful examples of states and local governments improving health care coverage for their residents. Last Sunday's New York Times op-ed discussed San Francisco's Healthy San Francisco program. Under this program, which went into effect last year, nearly all city residents now have health care coverage. Massachusetts now has only other near-universal health care program in the country.
In 1996 Washington state legislators enacted the "Every category of health care providers" law, which requires "health plans provide coverage for treatments and services by every category of provider" and that "health carriers shall not exclude any category of providers licensed by the state of Washington who provide health care services or care within the scope of their practice for conditions covered by basic health plan (BHP) services." Regulated health care professionals in Washington covered by this law include medical doctors, osteopathic doctors, naturopathic doctors, nurses, physician assistants, chiropractors, massage therapists and acupuncturists. This law has given Washingtonians greater access to choosing the health care they want and need.
And in West Virginia, West Virginia Rx (WVRx) is a partnership among state government, private philanthropy and pharmaceutical companies to provide prescription drugs and high-quality pharmaceutical care while reducing health disparities. WVRx is improving health outcomes and reducing the cost of health care for uninsured West Virginia residents.
The majority of Americans want to eliminate the preexisting conditions loophole and want kids to have access to quality healthcare. Simultaneously, states are pioneering health care solutions that may serve as models for other states to adopt, which might be more appropriate for the needs of their residents than overarching federally mandated programs. In focusing on these three areas, I believe President Obama would have the majority of public opinion strongly behind him. It also would make it nearly impossible for legislators to oppose the reform unless they wanted to commit political suicide.
John Neustadt, ND is medical director of Montana Integrative Medicine and the co-founder, with Steve Pieczenik, MD, PhD, of Nutritional Biochemistry, Incorporated (NBI) and NBI Testing and Consulting Corp (NBITC). The doctors created Osteo-K, a calcium supplement formulated by physicians from Harvard, Cornell, MIT and Bastyr that contains nutrients shown to decrease osteoporotic fractures by more than 80 percent. For more information on osteoporosis supplements and decreasing your risk for osteoporosis and fractures, visit www.bonehealthproduct.com.Their latest book, Foundations and Applications of Medical Biochemistry in Clinical Practice, is available on Amazon.