LOWER COSTS TO MAKE OUR HEALTH CARE SYSTEM WORK FOR PEOPLE AND BUSINESSES – NOT JUST INSURANCE COMPANIES – “The key is to provide information, incentives and support to help physicians and others work together to improve quality of care while reducing costs.”  ”The Obama-Biden plan will improve efficiency and lower costs in the health care system by: (1) adopting state-of-the-art health information technology systems; (2) ensuring that patients receive and providers deliver the best possible care, including prevention and chronic disease management services; (3) reforming our market structure to increase competition; and offering federal reinsurance to employers to help ensure that unexpected or catastrophic illnesses do not make health insurance unaffordable or out of reach for businesses and their employees.”  HOW CAN ANYONE BE AGAINST GOALS LIKE THIS?  IT IS HOW THEY ARE ACHIEVED THAT MATTERS.  IF WE CAN REDUCE THE AMOUNT WE SPEND ON HEALTHCARE AND HAVE A HEALTHIER POPULATION, WE ARE BETTER OFF AS INDIVIDUALS AND AS A NATION.  IF WE CREATE A NEW BUREAUCRACY THAT BECOMES A MONEY PIT, OR IF WE LOSE CONTROL OF QUALITY HEALTHCARE, AS WITH MEDICARE, WE ARE ALL WORSE OFF.  

AFFORDABLE, ACCESSIBLE COVERAGE OPTIONS FOR ALL – “Barack Obama and Joe Biden will guarantee affordable, accessible health care coverage for all Americans.”  ”The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; DOES THIS MEAN THAT INSURANCE COMPANIES WILL NOT BE ALLOWED TO EXCLUDE CERTAIN APPLICANTS FOR HEALTHCARE DUE TO PRE-EXISTING CONDITIONS?  IF SO, THIS WILL DRIVE UP THE COST OF ALMOST EVERY HEALTHCARE OPTION.  MR. OBAMA CANNOT GUARANTEE ELIGIBILITY FOR “ALL” PLANS, AND, IT WOULD BE VERY UNWISE TO DO SO.  DID HE NOT KNOW THIS WHEN HE MADE A PROMISE TO POTENTIAL VOTERS?  (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; HAS MR. OBAMA EVER FULLY EXPLAINED HIS CONCEPT OF A “HEALTH INSURANCE EXCHANGE”?  FROM READING ABOUT IT, THERE SEEM TO BE MORE CHANGES TO THIS THAN I CAN COUNT.  ONE MINUTE IT IS AN INSURANCE COMPANY WATCHDOG.  THE NEXT IT IS A POOLING OF BUYERS TO STRIKE A BETTER DEAL WITH INSURANCE COMPANIES.  IT WILL BE HARD TO CONSIDER THE PROS AND CONS OF THIS FEATURE OF MR. OBAMA’S PLAN UNTIL WE HAVE A CLEAR DEFINITION.  (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit;  TAX CREDITS HAVE BEEN SHOWN TO MODIFY BEHAVIOR.  ON THE SURFACE THIS COULD BE MONEY WELL SPENT.  THE QUESTION, OF COURSE, IS, WHERE DOES THE MONEY COME FROM?  (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; LIKE TAX CREDITS, LAWS REQUIRING CERTAIN ACTIONS WILL CREATE CERTAIN BEHAVIORS.  (5) requiring all children have health care coverage; I ASSUME MR. OBAMA MEANT TO SAY THAT HE PLANS TO REQUIRE THAT ALL CHILDREN HAVE HEALTH COVERAGE WHICH IS A WORTHY GOAL.  (5) expanding eligibility for the Medicaid and SCHIP programs; YES, THIS IS A SECOND NUMBER (5) AND YES IT WOULD DRIVE UP COSTS OF MEDICAID AND THE SCHIP PROGRAM.  IF BOTH PROGRAMS HAVE PROVEN THEMSELVES TO BE EFFECTIVE DELIVERY SYSTEMS THAT DON’T BURDEN THE OVERALL HEALTH SYSTEM BEYOND THEIR VALUE, THEN THIS IS WORTHY OF CONSIDERATION.  IN FACT, SCHIP HAS BEEN CHRONICALLY UNDERFUNDED FOR THE CURRENT DEMAND.  DOES THAT INDICATE A PROGRAM THAT IS SO WONDERFUL THAT EVERYBODY WANTS IN, OR, DOES IT MEAN THIS PROGRAM COSTS FAR MORE THAN PLANNED INDICATING AN INEFFECTIVE DELIVERY SYSTEM?   and (6) allowing flexibility for state health reform plans.”  THIS SEEMS TO BE AT ODDS WITH REQUIRING BUSINESSES TO COVER EMPLOYEES AND WITH REQUIREMENTS FOR ALL CHILDREN TO BE COVERED.

PROMOTING PREVENTION & STRENGTHENING PUBLIC HEALTH – “Barack Obama and Joe Biden believe that protecting and promoting health and wellness in this nation is a shared responsibility among individuals and families, school systems, employers, the medical and public health workforce, and federal and state and local governments. All parties must do their part, as well as collaborate with one another, to create the conditions and opportunities that will allow and encourage Americans to adopt healthy lifestyles.”  AGAIN, PROMOTING HEALTH AND WELFARE ARE HARD GOALS WITH WHICH TO ARGUE.

TO ME, THE OBAMA HEALTHCARE PLAN HAS ALWAYS BEEN A LONG LIST OF ADMIRABLE GOALS PUNCTUATED BY A DESIRE TO HAVE HEALTHCARE RUN BY CENTRAL GOVERNMENT.  I AM HIGHLY SKEPTICAL ABOUT HOW A GOVERNMENT RUN PROGRAM FOR HEALTHCARE WILL NOT BE HIGHLY INEFFICIENT LIKE CENTRALIZED CONTROL OF EDUCATION.  IT IS SAFE TO ASSUME THAT OUR CURRENT HEALTHCARE DELIVERY SYSTEM COULD BE IMPROVED.  IT IS GOOD THAT WE ARE HAVING A DEBATE ON HOW TO DO THAT.  THE NEXT POST WILL EXPLORE SOME OF THE PITFALLS TO BE AWARE OF AND MAY EVEN SUGGEST A FEW ALTERNATIVES.

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