• Healthcare Reform Part III: - There Will Be Pain!
  • September 15, 2009
  • Law Firm: Holland & Hart LLP - Denver Office
  • One of the unfortunate realities about Health Care Reform is that there will be pain.   The current trajectory of health insurance costs is unsustainable.  We are pushing 18% of the Gross National Product, more than double other industrialized countries and severely depressing our competitive edge in the world economy. Left unattended health care will continue to eat into American productivity, lifestyle, competitiveness and influence.   The solutions are not difficult to understand. The question is how to equitably distribute the pain. The strategy of “just saying no “ will just momentarily and ineffectively defer the pain. There are three ways, or combinations there of  to do it. The menu please!

    1. Control Access. I mean really control it. If you can afford it you get it. If not you don’t.  Repeal EMTALA and refuse to allow people in extremis into emergency rooms. Just refer them to real “death panel” alternatives for disposal.   The present system of not providing universal health care coverage and prevention services expands the severity of people appearing in the emergency room of hospitals and results in cost transfers in increased charges by health care providers which ratchet up the costs of insurance premiums. The withholding of prenatal care frequently results in massive societal costs in the care and treatment of abnormal children whose afflictions could have been prevented with proper care. Leave it up to individuals to pay for the health care insurance, not companies. that would make us more competitive and further limit utilization by the rapidly constricting middle class. If health care is a benefit, not a right you have only a limited number of choices – earn it; steal it; beg for it or lump it.
    2. Control Utilization.  Yes, we are talking about the “R” word – rationing.. It is going on right now. Just ask your insurance company for access to a promising, but experimental drug regimen or procedure and see what the result is. Expect more of it and get over it. Yes you can get it, if you can afford it.  We can approach the expensive chronic illnesses and end of life care with rationing of care or with prevention or with greater efficiency of evidence based medicine, and EMR, but not likely without significant government intervention. We Americans are always looking on the horizon for the prospect of a cure that will extend our useful lives, but that dream will likely require some modifications and limitations. If you want to live free or die, die might just be the answer, unless you can afford it. If health reform arrives, expect at least a three tiered system here – the Cadillac; the Chevy and the Yugo.
    3. Control Rates.  Lots of issues here. Those insurance systems and medical systems that effectively control costs operate on a physician salary basis. Kaiser, the Mayo Clinic all pay their physicians a salary with some structure of bonus. Fee for service medicine is a luxury that has had its day and will not likely survive meaningful health reform.  We cannot continue to turn out more and more doctors with more and more school debt to recover in more and more narrow specialties so award more and more  compensation based upon more and more tests and procedures.  We cannot duplicate expensive medical technology in every urban hospital and bill the government and the public for the down time. Again the idea of  private medicine will be a fixture of the past.  Those physicians who can truly stand on their own without government or insurance support will likely be free to do so, but that will be a narrow segment of medicine. Are we heading to socialized medicine. No, we arrived  many years ago. The public sector is only now insisting on a return on its investment. Insurance reform will need to be part of the picture as insurance companies will have to and frankly should justify their reason for existing and generating those huge executive salaries through meaningful contribution to the system.

    These are the moving parts of health care reform – so simple and yet so complex, with so many oxen to gore and so much pain to be distributed. Scalpel please!!!