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Health Care Reform: Some Optimism Please

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"The hope arises anew, and the dream lives on." -- Ted Kennedy

Interspersed with the news of the death of Ted Kennedy are the comments from Senate members and pundits that the health care bill is now on a last leg. I am as totally baffled by this diagnosis as I am about the lies, distortions, and misunderstanding concerning Obama's plan that have taken firm root.

I had just read about the guy at the town meeting who went berserk screaming that the Government was not going to touch his Medicare, when my husband came home to share parallel confusion. His barber. whom he has known and trusted longer than he has known and trusted me (which is almost 30 years) told him that a health care bill would raise his taxes, ration and compromise his care, and that government bureaucrats would take away his doctor and decide his medical fate. This from a guy who voted for Obama!

I had thought that Hillary Clinton exaggerated when she talked of a right ring conspiracy that destroyed her attempts at heath care reform in 1993. I thought that if she had communicated and planned openly, instead of behind closed doors, involving dedicated health care professionals in her planning, common sense and success would have prevailed. I was wrong. Rationality is no match for concentrated hate and fear tactics, strengthened today in a world of 24 hour cable, and thriving technology.

The only match for lies and distortions are leaders with the maturity to come together and act for the good of their constituents, addressing this truth: We cannot afford not to move forward because our current system is financially unsustainable! Health care costs are consuming our national output, rising faster than inflation. They are the largest cause of personal bankruptcies and are rendering our industries noncompetitive in the world market. And what are we, American citizens, getting for this? Our life expectancy is lower than most industrialized countries, and our health care costs are considerably more than any of them.

Buried in the unnecessary turmoil and rancor, is a solid degree of consensus achieved in both the House and Senate bills which will benefit us all. For instance, there will be a requirement for all Americans to have health insurance, either through their employer, through government programs, or personally purchased. Those who cannot afford insurance will have either tax credits or subsidies for purchasing. The choices of benefit programs and their costs will be more easily understood through state based "exchanges" with specific transparency of information and rules as well as appropriate explanations of what is available. Insurance will no longer be denied because of "pre-existing" medical conditions.

There is even agreement about how to make the system less costly and of higher quality, with more money devoted to patient care. Doctors and hospitals offering efficient, high quality, evidenced based care (such as aspirin right after a heart attack, appropriate blood thinner for types of irregular heart beat, ordering only necessary tests... the list goes on and on) will be financially rewarded. There will be financial penalties for less than quality care and efficiency. There will be encouragement and funding for more primary care physicians and greater emphasis on prevention and maintaining good health, rather than emphasis on payments made during illness. In other words, doctors and hospital systems will be rewarded for keeping patients well!

Further, efficiency will be achieved through simplification of record keeping, communications with insurance companies, and by standardization of insurance forms. Electronic health records will be encouraged and finally mandated, improving communication among health care professionals, leading to less test duplication, waste, confusion, and error. There will also be a crackdown of fraud and abuse within the system, such as charging Medicare for equipment that patients never receive or doctors charging fees for patients they have never seen.

How are we going to pay for all of this? It is estimated that about 30% of the $2.5 trillion yearly spent on health care goes to overhead, which will be reduced greatly by addressing the above. Other funding will come from payment reform of Medicare and Medicaid, such as bundling of payments for physicians and hospitals for an episode of medical care. Funding will also come from employer payments to a general fund. Any new taxes that may be required will apply only to the wealthiest among us.

As for the distorted fear regarding "rationing of service," we have that now as insurance companies deny coverage and specify services. In the Obama plan there is no rationing; there is payment for treatment that evidence shows will truly work. And there is nothing in any bill that will take away one's doctor.

The major roadblock to health care reform is whether or not to include a "public option" plan, which would force insurance companies to lower their costs to remain competitive. Currently "for profit" insurance companies use the expression, the "medical loss ratio" to describe the percentage of the insurance dollar that goes to patient care. It has moved from the low 70s to the low 80's. The rest is overhead and profit. Medicare has an overhead expense ratio of 3%, which means that $0.97 cents of every dollar goes for health care.

Successful, beloved politicians are principled pragmatists who know that inflexibility is the enemy of progress. When our nation lost President Kennedy, grief was soothed when a divided Congress faced down hatred, insisted on compassion and united to pass the 1964 Civil Rights Act. Senator Ted Kennedy deserves this quality of recognition for his life work. The Health Care Bill need not be perfect. But it must be passed.

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