Thoughts on Health Care Reform

Am I optimistic that we are going to make major headway in solving the problems in our health care system?

Not really.

There are just too many powerful forces opposing significant reform, and our political system is too paralyzed by its elaborate set of checks and balances. And then there is the fact that our politicians have become too dependent on political contributions from the big industries and wealthy contributors.

If Obama could just come up with a system from scratch, using the experience of the other industrialized countries like France, Canada, Germany, and Sweden, he would probably do a pretty decent job of creating a workable, universal, cost-effective health care system. But he can't. So he's trying to take the current system, that leaves too many people out and that costs too much, and bring all the major players together in such a way that it's win-win for everyone. And I just don't think it's going to work.

All the private players, such as the insurance companies, the pharmaceutical companies, the equipment manufacturers, the medical malpractice lawyers, and the medical specialists, have ridden the gravy train for so long, that they will oppose any curtailing of the flood of money.

And to make matters worse, there is no easy way that the free market can function in health care. When you go buy a car or a dress, you have choices, you check out the quality, the price, and you may even negotiate for a lower price. But when's the last time you checked how much the doctor really charges, or how much your hospital stay is going to cost before you go in? Even in getting our prescriptions filled, few people check out prices. You pay the copay, which is always the same, and forget about it. (Sometimes we ask for generic over brand, but we rarely know how much even the generic really costs.) The only time we really care about how much health care really costs is when we have to pay some or all of the premiums (or pay for the care itself, if we don't have insurance).

It is ludicrous to think that the free market can work effectively in health care. And if the market can't function, then some other mechanism has to plan and control the system. In utilities, it's heavy regulation of semi-private utilities. In defense, it's government operation and control. Isn't health care really more like the latter?

Another huge problem is the current fee-for-service system, which rewards doctors and hospitals for ordering more and more tests and procedures and operations. Hospitals, like Cleveland Clinic and the Mayo Clinic, spend about half of what many other hospitals and clinics charge, because their doctors are on salary and therefore don't directly benefit from more procedures. But most places aren't like that.

But an even bigger problem is that we in America have become very spoiled. We expect to live until we're 95, have every ache and pain and health issue solved with the latest drugs and medical tests, and all without any mistakes made or waiting in any lines. And so we're opposed to any changes that might cause these expectations not to be met.

What many people fail to realize is that all of the above is simply going to bankrupt us, individually and as a nation. People don't seem to be able to make the connection between the care they want and think is their right, and the cost. There is a vast ignorance about all of these things, and a consequent vulnerability to demagoguery.

My guess is that we'll expand coverage to more folks, perhaps eliminate pre-existing conditions as a reason for loss of coverage, and make it cheaper for persons to buy insurance on the individual market. All of these are good things. But none of it will contain costs, and therefore health care costs will continue to skyrocket at 8-10% a year. In a decade, few people will be able to afford normal health care, Medicare will be bankrupt, and we'll be right back in the same crisis we're in today.