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Where is the REFORM in all of the “Health Care Reform” bills being Debated in Congress?

I have a problem with the health care reform bills being bantied about these days on Capital Hill. Actually I have a few problems.

My problem with all of the “health care reform” proposals is that they don’t reform anything!

What do I mean by that? Let me count the ways:

1. There is no reform! All they are doing is forcing businesses to provide health care of some type to employees (what is next? Mandatory employee pensions?) And having the government cover those who are not employed. This is not reform. This is the creation of a big new entitlement and employer mandate. Sure. It expands the number of people who are likely to have access to Health Care – and that is arguably a good thing. But it doesn’t do a thing to fundamentally reform Health Care. Mandating a screwed up system on employers and expanding its reach is not a good thing in my book. 

2. A flawed payment system proposed by the House of Represenatatives. Why should 1% of the population (1,115,000 households) pay for health care coverage for up to 50 million uninsured people? Surely all taxpayers should pay part of this burden if it is such a societal good. I’d be ok if we had a debate about this and said there would be an across the board 1% tax increase. If you make more you pay more. If you don’t make a lot, you probably aren’t paying taxes anyway. But to single out one narrow economic class of people to pay for a benefit for everyone but themselves? This is class warfare and I don’t like it. Sure. I know that candidate Obama promised not to raise taxes on anyone making under $250,000 per year. But the times have changed. The economy is worse. Either scale back the grand idea or find a more broad-spectrum way to pay for it. Everyone who works pays for social security even though people benefit from it quite differently in the end. Everyone who works pays for medicare – even though people benefit quite differently in the end based on what they paid in. Why not have everyone pay for this new benefit? 

3. No cost cutting. Nothing in the reform bills will fundamentally drive down costs. Except vague promises from pharmaceutical companies to slow the rate they raise prices. Last I did my math, this wasn’t cost cutting. I can’t recall EVER seeing a government entitlement program that ended up costing the taxpayers LESS than was forecast when it passed. Most in fact are utter cost disasters compared to what lawmakers voted on. Social Security? Going bankrupt. Medicare/Medicaid? Worse off than social security. Prescription Drug Benefit? Way over budget for a program that isn’t even 10 years old. So why do we even pretend to believe the trillion+ dollar cost estimates here?

4. Supply and demand of doctors! You take 50M uninsured people and plop them into an overcrowded system where existing patients have to wait months for a doctors appointment. Doctors today see upwards of 30 people a day for 8 minutes each. I Guess now they will see 35 people each day for 6 minutes each? Oh and Congress is going to further cut their reimbursement rates. I was an economics major a long time ago and I know a little bit about supply and demand. I don’t think less money and more patients will bring more doctors into the profession. No way! Seriously – why isn’t anyone talking about who exactly is going to treat these 50M uninsured?

6. Unintended consequences: I predict we will see two serious unintended consequences. Remember. You heard it here first. #1. Businesses will start offering less-expansive health care benefits to their employees and will dumb down their plans to just barely meet the federal mandate. Why offer more than you have to? Who loses here? The 200M+ people with employer provided insurance. #2. Concierge or restricted access medical practices will surge in popularity. The perfect storm is brewing here. Frustrated with the inability to make a doctor’s appointment, those that can afford to go outside the system will sign up in droves for restricted access medical practices – where doctors charge a monthly fee for access – yet still participate with your insurance plan. Sure. They will “double dip” and make money from you every month as well as every time you visit. But the patients won’t care – as they are at least seeing a doctor who can spend time with them. Similarly, doctors caught in the vice of increasing patient loads and lower federal reimbursements (which of course lead to lower insurance reimbursements) will leave their assembly line practices and start practicing as they dreamed they would – like Marcus Welby MD. This, of course, will exacerbate the doctor shortage for everyone else. In 5 years I predict these will be the biggest tragedies of this so called “health care reform”. 

What should we do? Two simple things. First take primary care out of the insurance system. That’s right. For everyone. Lose the 40% cost overhead burden that the insurance system imposes on primary care doctors. Without the insurance albatross, Primary Care can be provided for under $1000 per year per person. Over a hundred clinics in at least 14 states are doing this right now. Qliance is one of those companies in Seattle that we have invested in that is doing this today. $39 per month for a child.  $59 – $79 for an adult.  All the service you can use with appointments between 30-60 minutes.

Think its crazy?  Massachussetts started requiring insurance a few years back.  Their wait times for a doctor’s appointment are the worst in the country at almost 60 days.  And what are they proposing?  FLAT FEE.  Look at the recent article here: http://online.wsj.com/article/SB124779934452456083.html Go ahead and make employers offer direct primary care to their employees. 90% of disease issues can be handled right here. And you really want to promote wellness and catch problems early. This is what primary care does. Co pays and deductibles and insurance reimbursements keep people away from primary care doctors. That is just plain dumb. Next, create true catastrophic insurance bundles that EXCLUDE primary care coverage – these policies will be dirt cheap. Less than half of the cost of an insurance policy today. THIS is real reform. Because we can actually change the way health care is delivered, make it available to more people – cheaper, and actually improve the health of our population by removing all barriers to primary care access. 

I hope that someone on Capital Hill is listening!