OMG: Obamacare Passed!!! Next.
Posted by David Edman in Healthcare Reform Blog, March 2010 on March 25th, 2010 | 2 Comments »
Honestly, I didn’t think it would happen. I sort of saw it coming, but there were so many reasons why it shouldn’t have passed: public opposition, the exorbitant cost, new taxes at a time we need to stimulate our economy, and a new government healthcare bureaucracy that is startling in its scope and power. But Obamacare did pass. NOW WHAT?
I’ve worked in this business for 32 years and honestly, I’m not sure what to do next. Do I join with the forces crying ‘foul’ and work for repeal of a bad bill that was rammed through our legislature with little mandate, aided by arm twisting, unsavory deals, and outright bribery? Or, do I say to myself that we needed health reform and now that we have health reform, let’s work to fix what we have? What do you think?
The Road Ahead…
Truthfully, our options today for fixing what is wrong with health care in this country are the same ones we had a year ago. They are:
- Massive new debt and deficit spending.
- Government rationing of healthcare services.
- Increasing efficiency (i.e., cut the 30% of wasteful spending).
The President and Congress have chosen Option 1. The bill signed into law two days ago (and the fix still being debated) will insure tens of millions of new people into a broken health insurance system. There was little done in the way of meaningful healthcare cost containment, which is my business. That is why I was arguing against “throwing good money after bad”, but that is, in fact, what was passed into law. Health reform was passed AFTER our annual deficit spending was tripled. Therefore, “reducing the deficit” over ten years by $130 billion or so is of little consolation, and it is not even true (it is what CBO had to say—simply add back in the cost of the doctor ‘fix’ and we are increasing the deficit).
In time, when the levels of massive federal debt become unacceptable, we will inevitably move into a phase of massive rationing by government (Option 2). It is the only way to contain the unbridled demand for healthcare services at someone else’s expense. It may come first in the form of price controls. It may come in the form of fewer hospitals, waiting lists for certain services, less choice, and less control by the patient/consumer over their health care—this is how a truly socialized, single payer system works. But make no mistake—it WILL occur because it is the only ‘regulatory’ alternative to massive deficit spending. (NOTE: this approach can be described as “lowest common denominator” care available to everyone. It is a viable option, as in Canada, and a public policy position some people advocate, but let’s have an honest debate about where this type of health reform may take us.)
Or, we can seek a return to basic American principles and values represented by Option 3—massive increases in efficiency. It is a fact that approximately 30% of what we spend on healthcare in this country is wasted on unnecessary care, inappropriate care, and poor quality care. The country’s annual spend on healthcare is approaching $2.5 trillion, so just imagine what the possibilities if we could move towards good economics in healthcare. We can maintain cutting edge innovation in the best system of health care in the world, and still have money left over to subsidize those unable to purchase healthcare services on their own.
What Can You Do? What Should You Do?
If you’re like me, you’re going to take a break from the political wars, but it will be a short break. Constitutional challenges to certain provisions of the bill are worthwhile. Since outright repeal of the bill that has passed is unlikely, we have to keep working on fixes that will achieve the objective of Option 3, and in effect obviate the need for Options 1 and 2. We should focus on promoting HSAs, competition across state lines, tort reform, pooling for individuals and small groups, and other similar approaches. It can be done. It must be done.
Please join me in this effort. Sign up for my newsletter. Comment on this blog. Get involved.
Great article.
Wee done. We need to reacitvate the employers as they, along with their employees ultimately pay the bills. There is a growing awareness of “Dick and Jane” solutions (see The Checklist Manifesto by Guwande).