13
March
2007
It is a story that the papers run year after year. A working mother has her medical bills laid out on the table. They are overwhelming. She just doesn’t know what to do. She has to put food on the table, but the creditors are calling. Her only goal was to raise her two boys well and then she got diagnosed with cancer.
It is a compelling story and according various stats it is not uncommon. It is the plight of the under and uninsured. If you aren’t lucky enough to have healthcare coverage through your employer, then one major medical crisis and it could happen to you. You could be a great person, contributing to society, but at the moment you are between coverage and then bam, it hits you – a heart attack, a car accident, a weird disease that you have never heard of that puts you in the hospital for a week.
What do you do then? What should society do? If I have taken a position on anything in the “fixing healthcare” debate it is that we have to give the purchasing decisions and hence the responsibility for payment to the person that has the most interest in the outcome: the patient. Now that is not synonymous with “every man for himself” – if you get cancer then you have got to pay for your cancer. But (and here is the but…) if we as a society are going to decide to pay each others medical bills (or share each other’s risk), then we have to make a conscious decision to do so as a nation. We can’t just say “let’s fix the system” or “let’s make health insurance available to every American”. I honestly believe that won’t work.
The conversation needs to be about the common good or the benefit we all share from knowing it won’t be me that gets financially wiped out when misfortune strikes. In Catholic healthcare there is the concept of social justice, of the equitable distribution of medical resources, of providing for the most vulnerable in society. I think these are the concepts that should be at the forefront of our national discussion. I am not even proposing this because I am huge social justice advocate, I am proposing these topics, because these are the real decision we have to make about how we are going distribute our medical resources. With consensus around these issues, the money part of the conversation will work itself out.
Posted: Fixing Healthcare
24
January
2007
President Bush gave his State of the Union Address last night and there were only a few minutes dedicated to healthcare. Thanks to the magic of DVR, I was able to watch the healthcare section of the speech a few times to make sure I heard each precious word.
One of the first words that popped out to me was “poor children”. The President was saying that we have an obligation to provide healthcare for the elderly, disabled, and poor children. Poor children is not all children. I think this shows that the President is not looking at major changes in eligibility to public programs in order to expand coverage. I think this is unfortunate, as expanding eligibility is good incremental way to cover at risk populations.
The center piece of the President’s proposals was obviously tax breaks for the purpose of subsidizing the purchase of private insurance. I firmly believe that unless people see more money in their weekly paychecks - not a promise of a lower tax bill/larger refund in April - then the tax incentive will not give people sufficint cash flow to purchase health insurance. Now I am not a tax expert, but I don’t think these tax incentives put more money in people’s wallets. What the President didn’t talk about was the concept of a tax on generous employer-sponsored health benefits. Between this tax and the tax incentives, this appears to be money in one pocket and out the other for a number of Americans. This is not the basis of a broad and systematic solution for our industry.
The second piece of President Bush’s proposal are the “Affordable Choices Grants”. Unfortunately, I have to agree with the AHA on this one. These grants - again, while well intentioned - take money out of one pocket, the Disproportional Share Hospital payments, and put them into these grants. Taking money away from DSH hospitals threatens the safety-net for our most vulnerable populations. Again, no new money is being created here.
Coming away from the speech, I am suprised at the tinkering around the edges approach to the President’s plan. The taxation of employer-sponsored benefits is the only new source of healthcare funding, but it amounts to punishing individuals and businesses for the very thing we are trying to encourage: private healthcare coverage. The fundamental problem with our healthcare system is that we are not funding the right things with the right funding sources. If we, as a nation, think that all children should be covered, then we should all chip in though income tax to expand CHIP to everyone under 18. If we think obesity is killing us, then we should tax fast food and coke machines. If we want to expand employer sponsored coverage, then we should not tax it, but propose things like association health plans (I will give Bush credit for that) that encourage it.
With Iraq being such a front and center issue for the President over these last few years, I am not suprised that he hasn’t been able to give much attention to healthcare. And even though there are alot of groups out there now rallying for change, the government will eventually have to come to the plate and make real changes in how we purchase, pay for, and deliver healthcare.
Posted: Fixing Healthcare
23
January
2007
Here was my post from February 1, 2006 (on Hospital Impact), covering the President’s State of the Union Address. It will be interesting to see how the message has changed in one year. Visit Healthcare Tomorrow later this week for coverage of the President’s speech tonight.
President Bush gave his State of the Union last night and, as expected, healthcare was featured in his domestic agenda. Also as expected, the President spoke about EMRs, extending tax benefits to individuals and small businesses, and HSAs. As I mentioned on Healthcare Tomorrow yesterday, the President’s healthcare playbook is a monograph called Healthy, Wealthy, and Wise, and the President stuck to the playbook. There were a few comments that I thought were interesting, however.
First, President Bush preceded his comments on healthcare with a call to study the effect of the Baby Boomers on Social Security, Medicare, and Medicaid. While the provider community has been thinking about the Baby Boom in terms of increased volume, President Bush’s comments remind us that the government is going to have to pay for all of those extra bypasses and torn ACLs. I haven’t necessarily seen estimates on the increase in Medicare spending as a result of the Baby Boomers, but the numbers could be pretty scarry.
Second, the President merely mentioned the use of healthcare information technology to help reduce medical errors and reduce cost. I suppose I was hoping for a little bit more on the topic, given his declaration that all Americans will have an EMR in ten years, and the billions of dollars that the industry is going to be spending on the technology, and the fact that David Brailer has been touring the country drumming up support for the initiative. I hope this isn’t an indication of the governments financial commitment to HIT, because the $60M given to the effort last year wasn’t but a drop in the bucket either.
Lastly, President Bush’s most vigorous healthcare comments were on making health insurance more portable. Wasn’t this what HIPAA was supposed to do? Nonetheless, I intend to give the President’s healthcare program a more thorough discussion on Healthcare Tomorrow in the coming weeks, so I hope you will join me there.
So, in the words of our President, “Good night, and God bless America.”
Posted: Fixing Healthcare
