The Long Road to Healthcare Reform

Please read this carefully.  Interesting.
By Doyle McManus

September 14, 2009

President Obama set out a long list of worthy goals in his healthcare speech to Congress last week, but at least one of them was utterly unrealistic. "I am not the first president to take up this cause," he said, "but I am determined to be the last."

If Obama succeeds in winning a comprehensive healthcare bill, he will have established, for the first time, a federal government obligation to make some kind of health insurance available to every citizen. That’s a monumental achievement.

But it will be only the first step in a process of designing, launching and improving a new healthcare system for a nation of some 300 million. That’s a monumental task.

And it won’t be completed in a single presidency — not even a two-term presidency that would run until 2017. If Obama succeeds, most of the new program won’t even be launched until 2013, so his successors will inherit the job of managing the system he builds and — when flaws reveal themselves, as they inevitably will — the obligation to make adjustments.

"The repair is going to be a process, not a one-time event," Atul Gawande, the celebrated physician-journalist at the New Yorker, wrote last week. "Reform will have to be more like a series of operations, with X-rays and tests in between to see how we’re doing."

Whatever bill gets through Congress this fall — and it seems increasingly likely that one will — is almost certain to obligate citizens to obtain insurance, require insurance companies to offer "affordable" basic policies and impose taxes and Medicare payment cuts to help pay the insurance bills of low-income families.

But no matter how specific the bill gets, it can’t guarantee that the president’s proposals for funding the plan will generate enough to cover the costs.

And the bill won’t reshape the medical system to focus on overall care instead of individual procedures — at least, not yet. It only launches a series of experiments and studies to see what works and what doesn’t.

The most intriguing question the bill can’t answer is this: How will the practice of medicine — the way doctors, nurses and hospitals actually treat their patients — change to make all this work?

There’s no question that it will have to change. "If you talk to doctors, they’ll tell you, ‘Yeah, we’re practicing inefficiently, and we know it,’ " said Dr. Mark McClellan, who ran Medicare under President George W. Bush and supports the basic thrust of Obama’s plan.

How do we get from our current patchwork system to one that works better? Reformers want to nudge doctors in the right direction by changing the way they’re paid.

The Democratic proposals include bonus payments for doctors and hospitals that coordinate care, for example, so patients don’t bounce from specialist to specialist, repeating the same tests at every stop. But the bills are still too tentative, in McClellan’s view. "We need more carrots, more incentives on the positive side — but we need more disincentives, more sticks too."

For one thing, some doctors won’t be willing or able to move into new payment systems. The government currently plans to wring savings from them the old-fashioned way, by cutting Medicare fees across the board. But that kind of cost-cutting doesn’t do anything to make doctors more efficient or effective.

One answer, McClellan said, is to track doctors’ practices more closely, to offer targeted rewards for those who improve both service and efficiency — and targeted penalties for those who don’t.

This is called "provider payment reform," a term you’ll hear more often as 2013 nears. Does it mean a more intrusive government role in medicine? Sure. But federal, state and local governments already pay almost half of all the healthcare bills in the country. Government is already involved. And with increased scrutiny will also come a beneficial side effect: more transparency.

Right now, the U.S. healthcare system is a patchwork of different systems — Medicare for the elderly, Medicaid for the poor, military and veterans’ medicine, private insurance for the fully employed, and a lot of cracks in between.

Decisions about how much to spend on health, and how, have often been made through backroom battles among big institutions: employers, insurance companies, drug companies and hospitals. Doctors and patients have been among the least influential players.

By expanding the federal role in healthcare, and by setting up a system that guarantees all citizens access to affordable insurance, Obama’s plan gives everyone a stake in its success. Voters will want to know that this system is working well at a reasonable cost. They’ll demand — even more than they do now — evidence that their money is being well spent. Future Congresses and presidents, far from being relieved of the issue, will find themselves debating it year after year. American medicine is being politicized — and that may not be a bad thing.

Looks like an uphill battle.  Your thoughts, please.

Have a wonderful week.

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6 Responses to The Long Road to Healthcare Reform

  1. Joe says:

    All the unanswered questions and the problem with the big problems coming up later including that troubling little question about where the money comes from continues to bother me big time and I know I’m not alone in this. I know that there’s trouble with the system but don’t see how we can do that much with the current financial crisis. I’ve been concerned that this swine flu thing could end up not just pushing a vaccine that could be dangerous on us but also pushing a broken socialized health care system that will do more damage than good. I figure we won’t see the end of this battle anytime soon.

  2. john says:

    Interesting…it has been all Obama…there has been no mention of the republican proposal. The scary thing is the government running the system….the bureaucracy grows and the care stays the same. Also the government works to the losest level of compentency it does not strive for the brass ring. I have been under just about every type of care there is and the best care is still the private care. There is gouging of drugs, so where is the proposal to change the patents for drugs so that there will be more comptition. Where is the proposal to drop the barriers on interstate carriers and the regulations. Where are the proposals to curb the abuse of the medicare system of double, triple or more billing for the same procedure. Healthcare is very complicated and I do not trust the government to run it efficiently. The premium for Medicare costs $150 -200 per month and only provides about 50% coverage. The elderly need a supplemental plan that adds another $100-300 premium to get the rest covered. So with medicare one has to pay between $250.00 to maybe as much as $500.00 per month prmium. For $300.00 a month i can get excellent health insurance. somebody better wake up and look at the numbers and start comparing coverages and expenses. Like you said the poor are covered by medicaid, my and your tax money, so really where are the uninsured. Do some hard looking and those complaining about not insured and that’s because they do not want to pay the money for a policy. There are so many areas that are not being addressed. what you posted is a nice sounding glossy bit of verbage that sounds good but has no substance. So many reporters do not do much research any more they are spoon fed and spit out the paplum they have been fed. We have a healthcare problem but we need to adress it openly…thanks for the post….always interesting reading here.Are the Dodgers gonna hang in there or flop.

  3. john says:

    There are two groups that I can think of that are not insured. First group i doubt would ever accept health care….the christain Science people do not beleve in medcine, only prayer. Second group is the druggies, alkies/winos. they have indigent care, I have seen some pretty sad cases arriving at General Hospital. Another group is the working poor. They sometimes make poor decisions. Rather then pay for a policy they want the money so they turn it down and become a stat. Personally I doubt there are over 2 million people without care that would like it. These people often are taken care of by church groups at times. Look what the churches did in the hurricanes cimpared to FEMA.Personally I feel everybody that wants care is covered in one form or another. As a nation we are very compassionate and look out for each other, IE the 9-11. Lots of groups used like pawns by the powers that be and Obama is a fairly decent chess player.As a tax payer how much more money do we want to spend to make the rulers look good?

  4. Fizz says:

    You know… I"m a a moderate, or if you prefer a different label, a blue dog democrat… I don’t like this government supplied health care. I agree, health care should be affordable and I feel for my friends who don’t have it, truly. I would be financially bankrupt but for health care, but if the government provides health care, then my company will dump it quicker than lickety-split. I know my company and others will too. That’s the most expensive part of employing peope… Healthcare.I like what one man from the GOP said… open wide the state boarders and let people get insurance from other states. The competition will drive down healthcare prices. I personally think that’s the way to go. In other ways, I do agree with Obama’s plan, just the Government proveded bit I don’t like.

  5. Sue says:

    I sincerely hope this health care bill goes through and changes are soon evident. The current system is too hard to deal with. I still think the systems abroad (government run) are the real answer, but don’t believe it will happen in this country for years. Eventually, I think it will come down to this…and it makes sense.

  6. Sanjana says:

    hey you get yourself on messenger now……………… already there………..

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