A Businessman’s Message to Congress:
Health Reform Dos and Don’ts

by David Edman

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As Americans, we are facing one of the greatest challenges of our lifetime — how to fix our broken healthcare system. There is widespread agreement on the following set of goals: address the cost of health insurance, improve access to care, and reduce wasteful spending. We face a choice of protecting our children’s future with constructive health reform or behaving like them and achieving nothing. President Nixon tried National Health Insurance reform in the early 1970s and failed. Twenty years passed until the Clintons tried again in the early 1990s — and failed. After 15 more years of the status quo, we can ill afford to fail again.

There is a way, and it does not cost much. Instead of the two sides retreating to their corners and entrenching in their positions, let’s focus on specific, considerable areas of common ground. We shouldn’t try to remake 1/6 of the United States economy in one fell swoop. So, here is a short list of dos and don’ts that focus on our areas of agreement. If you agree with these principles of health reform, pass them on to your members of Congress.

Health Reform Dos

1. Underwriting Reform. Individuals and small employer groups are often unable to obtain health insurance due to exclusions for pre-existing conditions, waiting periods, and other similar underwriting practices. These practices must end.
2. Increase Competition. Everyone agrees that we need more competition in the current health insurance system. It is painless and inexpensive to allow private health insurers to compete across state lines.
3. Purchasing Alliances. Establish guidelines that encourage the individual states to establish purchasing groups, particularly to help individuals and small employer groups. If a state cannot or will not comply, give these purchasers access to buying their coverage through the Federal Employees Health Benefits Plan (FEHBP) — an existing and effective alliance.
4. Level the Tax Playing Field. Everyone should be able to deduct health insurance premiums, but these deductions should be capped. This will encourage the growth of Health Savings Accounts (HSAs) and other more efficient ways to purchase health insurance.
5. Fix ‘Medicare Advantage.’ Like with Medicare supplemental insurance, the federal government should establish a limited number of plan design options. This simple step will increase competition, leading to lower costs and better results.

Health Reform Don’ts

1. A Public Option. The federal government should not be in the business of contracting with doctors and hospitals, setting rates of payment, and cutting the checks. This is an expensive, inefficient, and politicized system of healthcare (e.g., Medicare).
2. Non-Profit Cooperatives. There are some, but few, successful examples of this model in the United States. If non-profit cooperatives were the solution to the problem, there would be many more existing plans of this type. It is an expensive and unnecessary approach to increasing competition.
3. Mandated Coverage. Let’s agree not to add to our tax burden now or require individuals to buy insurance until the above health reform changes achieve their desired results. Then, it makes sense to require all citizens to purchase health insurance (like car insurance) and subsidize those who cannot afford to purchase coverage.
4. Rush the Process. Healthcare reform is too important a process to be rammed through Congress (e.g., a 1,300-page bill that people cannot understand). It does not need to be that speedy or that complicated.
5. Create Unrealistic Expectations. As a society, we cannot expect to have all the health services that we want, when we want them, and at someone else’s expense. Whatever healthcare we receive must be paid for by individuals, employers, and taxpayers.

America is the last, best hope. We have always thrived and prospered because of innovation, hard work, and personal responsibility, and not because we follow the lead of Europe. We have to be willing to blaze a new trail when it comes to healthcare delivery and financing, and the solutions are within our reach.

And, if we fail again at health reform, we will have snatched defeat from the jaws of victory. If we cannot constructively reform healthcare, a single payer system may be the only remaining option, and we will get what we deserve — the same type of “lowest common denominator” care that is available in Canada and Great Britain. But, in the tradition of America, we can and should do better.