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Miles J. Zaremski

Miles J. Zaremski

Posted March 4, 2009 | 06:21 PM (EST)

Health Care Reform: Now or Never


Media reports indicate that later this week the White House will be holding a summit on health care reform. We also know that Sen. Kennedy has been holding meetings every other week since last fall with many "stakeholders" sitting around his table. And, President Obama also said during his "unofficial" state of the union address last week that health care reform is on its way. So, let's assume that money were no object in fixing what ails the delivery and cost for health care -- like we have a googol worth of money for this (for those of you who don't know what a googol is, it is the number 10 raised to the power of 100 (=1 followed by 100 zeros) -- which would make the currently proposed $3.6 trillion budget over 10 years look like a paltry sum).

First of all, do we need a restructuring to our health care system? To answer this question requires one to believe in the notion that all Americans (including those immigrants actively seeking this status) have a right to health care. We should maintain that health care is a right because, without it, we cannot be productive to ourselves, our families, our community, our jobs (assuming we still have one), and thus also to the economy. If we are ill or sick, we become an expense and burden that the economy can not afford.

Next, if we do not reform healthcare now, a catastrophe will slowly and inevitably be cast over a system already in a crisis -- like, for example, the plague that descended upon the lives of the first born in Egypt as described in the Old Testament (and in the flick with Charleton Heston as Moses). Is everyone for change now? Undoubtedly; even the corporate types, large and small, which cannot afford to pay for health insurance premiums for employees any longer.

Should health care reform be incremental, such as has been suggested by the noted Harvard physician-author, Atul Gawande, M.D. ("Getting There From Here")? No, because what has worked in the past has no place in the present. There is too much calamity daily in delivering and paying for health care that tweaking the system as has been done in days past will simply not work. And the situation will, and is, only getting worse -- the more layoffs occur in an ever weakening economy, the more Americans will have no insurance to pay for sickness and disease -- thus adding to the roles of the 45-50 million folks uninsured, underinsured, and who have been forced into bankruptcy due to an inability to pay skyrocketing medical bills. Concomitantly, however, change that President Obama is talking about should be phased in over time. To do a restructuring of the system over night would be a culture shock that Americans should not have to endure.

So what should we change in our present system?

1. There should be health care coverage for every American provided through a public-private partnership. The first layer would be funded with tax dollars; any additional coverage would be paid for privately through individuals or through the employer base. The base level could be provided through a mechanism similar to a Universal Health Care Voucher system advanced by Ezkiel Emanuel (the brother of Obama's Chief of Staff) and Victor Fuchs. See: "Solved." The point here, though, is that we as a nation are not ready to have a totally nationalized system, like we see in Britain or Canada. Having just said this, one must wonder why those approaching the age for Medicare can't wait to get into the system -- thus, what's so wrong with socialized medicine?

2. Any health care coverage would be portable, across state lines.

3. Pre-existing conditions would not bar coverage.

4. Much waste exist administratively, and duplication and unnecessary procedures abound in the present system. This must be eliminated.

5. We must motivate health care providers to stay in practice, and provide the motivation to those who wish to become health care providers. This includes doing what is necessary to stem the tide of the nursing shortage in this country.

6. Any health care reform must provide for wellness and prevention too. But, Americans must also be motivated to stay healthy; being a country that is continuing to produce, for example, overweight folks is not the sine qua non of health. How about considering a tax credit for being healthy on an annual basis?

7. And, any discussion of health care reform should include the immigrant question, since our country cannot afford to treat those who come across our borders who are not seeking to become citizens in earnest. Our system is just too broken to do this.

Let's see what happens with the White House summit. But in the end, it is fourth down in the last quarter of the game with seconds left on the clock. It is now or never for health care reform; sure hope the "Hail Mary" pass called change in health care is caught in the end-zone for a touchdown.