I can recall sitting in my doctor’s exam room and he would walk in and say to me, “This may sting,” just prior to giving me a shot that did more than sting! The same is going to hold true for National Healthcare Reform in our country, as we are lead to believe that there will be “mildly painless” and no increase in taxes. But a substantive Healthcare Reform Program will not be possible without an increase in taxes and/or significantly reducing many other government programs.
There is no doubt that the US needs major changes in our Healthcare System. How can the worlds richest county allow an estimated 50 million to be without healthcare insurance and have many having to decide between eating their next meal or purchasing their medications? Our healthcare system consumes 16% of our economic output, which is by far the most of any country and three times what is spent in Japan. And to compound this issue, we are facing an increasingly expanding aging population with an estimated one in every three will be over 60 by 2050, the group that utilize 80% of the healthcare expenditures! The Congressional Budget Office (CBO) reports that this will push government spending on healthcare from 4% in 2007 to 12% in 2050, which will cripple the system and our economy. Mr. Obama wants to mandate health insurance coverage for all Americans. This would be ideal, but how do we pay for it and implement it to work the way it would need to for most to benefit? One idea is to tax employer provided healthcare, which would generate $250 billion per year in tax revenue. This added to increasing the funding for expanding Federally Qualified Health Centers, which are the most accessible and cost-effective aspects of our healthcare system, as well as educating the public of these centers and their services since the costs of utilizing these centers can be as low as 10% of the costs of utilizing an ER, could significantly offset the estimated $1.2 trillion needed to provide insurance to all. Another idea is to have all Uninsured Americans join either Medicare, Medicaid, or the Federal Employee Health Benefit Plan (FEHBP). The FEHBP is the governments choices of health plans that almost all insurance plans bid to participate and is the “model” that the Mr. Obama wishes to use for regional health “exchanges.” An alternative concept for funding these additional costs is to charge an “excise tax” on petroleum projects. A tax of about a $1/gallon would generate in excess of $140 billion per year to fund the anticipated shortages in the program’s budget, and that’s just from gasoline consumption. In the early years of the current plan, the funds not needed could be used to create future reserves, particularly for Medicare. A petroleum excise tax would also help Americans become more efficient with our fuel consumption, thereby helping us to become less dependent on fossil fuels and helping clean the environment. Even with the increased tax requirements and the employer and individual mandates used to bring almost all Americans into some form of coverage, the fact remains that health care costs for just “pure claims” will continue to increase without some form of rationing. The largest “Age Wave” of citizens, the Baby Boomers, are headed to age 65. And without rationing and some form of income selection criteria ,the Medicare plan is insolvent. The AMA, for now, has endorsed Mr. Obama’s Plan, as they are satisfied that they have gained some agreements to the prospective pricing formula for Medicare. However, that maybe short lived. The government believes that Medicare reimbursements to be lower than insurance companies, therefore shifting to Medicare reimbursements will lower spending for the government’s plan. In fact, and as those of us in the industry know, Medicare is the benchmark used by health plans to begin discounting their payments as a method of negotiation. When this “short fall” accumulates providers will either be required to offer the Federal Government the “most favored nations pricing provision” (lowest price negotiated) or to accept the governments “lower” prices for services. Let’s not forget “rationing.” Do not believe that the government will let the doctors and other health care providers practice the art of medicine as the doctor and the patient deem appropriate. The Health Care Advisory Panel set up to recommend “uniform best practices” nationwide is code words for rationing. If we all thought the health insurance plans were too involved in the practice and judgments in healthcare in the past, just wait until the government steps in. Most of us already know what to expect, as we deal with Medicare everyday. The good news is that if Mr. Obama proceeds with his plans, 50 million Americans who currently do not have health insurance will be able to obtain it. That should lower premiums (vs. health care claims costs) and help reduce bad debts and collection costs for all health care providers, including physicians and hospitals. But can we afford healthcare reform now? Some believe that we need to make this our national priority and fix it now before it gets too far out of hand. Unfortunately, a shot, even from a large gauge needle will not be an adequate treatment to fix our problems or make us even “feel better.” The decision is a major one, like choosing between angioplasty now or a heart transplant a few years from now. We only hope that this is not a rushed decision, since “it is going to hurt!”
