Issue link: http://cp.revolio.com/i/1520
May/Jun 2009 | www.MyFamilyDoctorMag.com | 21 President Barack Obama's health-care plan at best is not reform at all, and at worst will expand the poorest performing segments of our health-care system and further erode what little choice currently exists at the indi- vidual patient and provider level. "Universal health-care coverage," according to the president's plan, would be largely driven by enrollment in public programs, such as Medicaid and SCHIP, in which the government sets benefit levels and provider reimburse- ment rates. Being nominally "covered" in a public health insurance program is of little value if prohibitively low reimbursement rates and administrative hassles prevent physicians from accepting you as a patient. Although the patient is the central figure and the key decision maker in the health-care system, the president's plan unfortunately appears to continue the paternalistic view that government, not the individual patient, should decide the value of health-care services. Individual pa- tients, regardless of income level, are capable of making appropriate decisions about their own health care, given the proper incentives. Giving patients ownership of their health-care re- sources and choice over how those resources will be spent will also increase the demand for transparency about the cost and quality of services. Rather than attempting to control the behavior of payers and providers through mandates and price controls, the president should realign incentives by giving patients the financial support they need and allowing them to choose from a variety of insurance coverage options, ac- cording to their needs. This is the same system available to President Obama and all other federal employees. Ultimately, the goal of real reform should be for the government to stop trying to design and operate public health-insurance plans and instead focus on provid- ing disadvantaged individuals with the necessary funds to buy into the same system that everyone else uses. The Obama health-care plan is headed in a positive direction by all historic indicators. It began with February's expan- sion of the State Children's Health Insurance Program after years of failure, providing insurance to millions of additional vulnerable children. Then, the passage of the economic stimulus bill helped states maintain current lev- els of care for their poorest citizens. Now, a new secretary, Gov. Kathleen Sebelius, with a dedicated commitment to the common good has been nominated. The administration has undertaken a summit at the White House to explore all the possibilities, with four par- ticularly key objectives. The first is finding ways to insure every American. At a time of foreclosures and job losses, the last worry anyone needs is whether they can get thoughtful care with appropriate follow-up if an emergency befalls them. Current law provides for continued insurance under COBRA if a job is lost, but this is incredibly expensive for families—particularly if someone has no job. But SCHIP expansion aside, more than 40 million people still have no insurance. A second objective has been transparency, so the remarkably expensive enterprise of medical care doesn't become a new pork barrel of inefficiency. This leads to the third goal: cost efficiency. Tremendous efficiencies are possible because they are currently being achieved by our econom- ic competitors around the world. Increased health-care efficiencies were probably the leading engine for the eco- nomic expansion during the 1990s. The United States currently has the developed world's most ineffi- cient system, costing more than twice as much as other systems while performing poorly on many health indices. Thus, a fourth goal is heightened quality, like that sup- ported by the significantly expanded medical research in the stimulus bill. Better health, after all, is a goal shared by everyone, and Obama has moved us a giant step closer by forcefully articulating these four objectives. reBUTTAls yes NO Dr. O'Shea's I agree with Dr. Whelan that the last thing that families need in difficult times is to worry about whether they can get appropriate health-care services. I also agree that the recent expansion of SCHIP is the first indication of President Obama's vision of the fu- ture of American health care. However, by historical indicators, spending more money on public programs like Medicaid and SCHIP, that provide health coverage in name only, will not re- ally solve the problem for uninsured Americans and is not really reform. We need a new approach, like giving patients a voice in the system. Dr. Whelan's The insurance industry blocked reform in 1993 to protect profits. They denigrate Medicare and the Veterans Administration as "the poorest performing segments of our health-care system" because Medicare has administrative efficiency 10 times better than private insurance; VA health outcomes are tops. Our well-paid surgeons hate government-set reim- bursement. But universal health care won't take choices from patients. What influence do we have now on drug formularies or procedure approval? And could the red tape get any worse? Obama has called for everyone to have the same health-care options as Congress. Details aside, ignoring the current profit-driven inefficiencies, quality shortcom- ings and disparities is morally unacceptable.