08/29/2009 05:12 am ET Updated May 25, 2011

Un-Spinning Healthcare Reform: Part 1

As Congress prepares to leave D.C. to sip cocktails by the pool, the healthcare debate is mired in spin, slick advertising and parliamentary brinksmanship, leaving the rest of us dazed, confused and not a little scared. This is not change, and we don't believe in it.

One of the most infuriating aspects to the issue of healthcare reform is the lack of honest debate by our public officials. Hardline attack dogs on the right like Senator Jim DeMint (R-SC) are openly salivating over potential reform failure as "Obama"s Waterloo". On ABC's This Week with George Stephanopoulos, DeMint again beat the drum that Obama has ruined this economy and now he wants to do the same thing to healthcare. Funny how this analogy fails in the face of Newsweek's current cover story that "The Recession is Over" and the very positive housing numbers that were reported this week.

Of course hardliners on the left, like House Speaker Nancy Pelosi (D-CA), are doing us no favors either. They bullied the process early on by acting purely partisan and locking House moderates (of either stripe) out of key bill drafting. This drove the Blue Dog Democrats barking mad, causing them to team with GOP leaders and lock the bill(s) down in committee. And so the summer passes at a perfect impasse.

As one of the 46 million uninsured, I am very interested in the outcome of this debate, but as a small business owner, I am also deeply concerned about how it will be resolved. To be frank, I am not at all certain who or what to believe. Reform is needed. Period. But that's the only thing of which I -- and most Americans -- feel sure. The people we rely on for clarity (the news media), have done little more than stir the waters muddied by clever partisan advertisers like the ersatz Conservatives for Patients' Rights who were the first to launch the "kill bill" ads that offered loads of spin but no alternative solutions.

As a professional marketer, I'm pretty darned good at reading between the lines of spin, but this issue is so tangled that I decided to call friends here and abroad who are intimately involved with healthcare and the optional systems being discussed to put some of the biggest spin to the test. (Note: the last names of some of my sources are withheld as a courtesy.)

Here's "Part 1" of what I learned (there's just too much muck to wade through in one post). Perhaps this will help others who, like me, need to figure out what we want to say to our elected representatives when they arrive home next week.

A Government Run Plan: The slippery slope to Socialism?
The claim: Government run healthcare will destroy free market competition.
The truth: Some current government run health programs are examples of "managed competition" and private insurance providers like Blue Cross Blue Shield and many HMO's participate in (and make profits) from these programs.

Let's be perfectly clear: This is not Socialism with a capital or small "s." That hype does nothing productive and only stirs the political pot. The important distinction is that in Socialized medicine government controls, manages and delivers all aspects of healthcare.

This is in stark contrast to the current "government run" health care programs that are highly rated such as the Federal Employee Benefits Program which covers (and is cherished by) every member of Congress... including its most conservative members. According to Terry Lierman, chief of staff to House Majority Leader Steny Hoyer (D-MD), federal employees are given a choice among a list of insurance providers.

In that "government run plan," patients have choice and the private sector has healthy competition. Lierman says that one of the major sticking points in the current negotiations is whether and/or how to replicate this offering to uninsured Americans.

When it comes to the issue of Socialism or the supposed blow a larger government presence in healthcare would levy on free market competition, one can argue that if we had a truly free market that doctors -- the true healthcare providers -- would be able to set the prices for care and not the big corporate insurance companies who fix the prices and provide as little coverage as possible and limit the scope of care at every turn to secure their profits.

Universal Access: Who decides who gets care?
The claim: Government bureaucrats will decide what care you receive.
The truth: Insurance company bureaucrats already decide what care you receive by economically denying access and by denying coverage for doctor recommended procedures.

My best friends are also small business owners, and they have two young children. Their insurance premiums increased more than 27% every year, doubling every three to four years. Their remedy was to continuously raise their deductibles to manage the high cost of insurance premiums. As Susan K. explained to me, it became a situation of, "What are we paying for because now we can't afford to go see the doctor when we need to." So much for preventive care. Susan's solidly middle class family was effectively denied access to quality healthcare because they were priced out of the market.

Another friend, Elizabeth H., is an American with the unique perspective of having lived under the traditional U.S. healthcare system and the British system on which the now much maligned Canadian system is based. When she was in the U.S., she had comparatively excellent healthcare coverage via her employer Johnson & Johnson. Yet she found herself in a pitched battle with her insurance company over a bill. They refused to pay for something her doctor recommended and which was supposed to be covered by her plan. In the U.S., insurance company denials are the norm more than the exception under our current system, too often with devastating results.

By comparison, now living under the National Healthcare System in England, Elizabeth routinely goes to the doctor for preventive care check ups, and when she needed specialized care for her hip, she was referred to an orthopaedic surgeon. Sure, she was told it would be a few weeks before an appointment was available with the specialist, but then again, another friend Art R. who needed a hip replacement here in Atlanta had to wait a few weeks for an appointment for a consultation with his orthopaedist. Specialists are just that... specialized, and it takes a while on both sides of the pond to get an appointment and to receive treatment. If either Elizabeth or Art were dealing with an issue of extreme pain or a life threatening injury, both would have had access to top drawer medical care. The difference is that Elizabeth would not face potential financial ruin as an outcome whereas Art would be saddled with a frighteningly long bill and a stressful battle with his insurance company during recovery.

Also, Elizabeth never had to speak with a government official, nor did her British physician have to get clearance from a government official for the forward referrals of additional care. Under England's National Healthcare System, the only persons determining the course and quality of care Elizabeth needs are Elizabeth and her doctors. And she has not been charged a penny. The small national healthcare tax will cover every step of her care, including pharmaceuticals. And, if Elizabeth opts to seek the equivalent of the "Mayo Clinic" or "Johns Hopkins" level of care for her hip, she is free to do so, also at no charge.

That does not happen in America where our supposed "free market" insurance company bureaucrats must grant permission to go beyond primary care -- if you can afford the primary care to begin with. Certainly the cost of most specialist care is well out of the reach of many patients here.

Tomorrow, we'll address issues of "rationed care," "quality care," and we'll begin to do the math on how healthcare is paid for in other countries. You'll also get insights from another friend of mine who is a physician practicing family medicine who is also a professor of health care economics.