Ron Krall: Health care reform
Sunday, November 15, 2009
Three weeks ago, 35 to 40 people gathered at Off the Beaten Path Bookstore for a conversation about health care reform. I want to thank all who participated for frank, thoughtful, respectful conversation, and to apologize to the many people who came but could not find a seat or were unable to hear. I also want to thank Sue Birch, Carol Milligan, Brian Harrington, Todd Hagenbuch and Jay Fetcher for their informed perspectives as members of the panel.
Today, I want to break from the spirit of impartiality in which I tried to moderate the fireside chat and offer some comments about the pending health care reform legislation. In the three short weeks since our conversation, the House has passed its bill, and the Senate is poised to reconcile bills that have emerged from its two committees and begin its debate. Decision time is near.
There is much to like in these bills. They provide for nearly universal health insurance. They eliminate the most egregious health insurance practices: denial of coverage for pre-existing illness and rescission of coverage. They limit annual out-of-pocket expenses, eliminate annual and lifetime limitations on coverage and guarantee portability of insurance. They eliminate insurance rating based on gender and illness. Through a variety of approaches, they seek to reduce administrative costs.
Still, there is much to be concerned about. It is encouraging that some of the bills provide incentives for reducing liability costs but discouraging that none tackles tort reform head-on. It is not clear to me that these bills will increase competition among health insurance providers, a critical component of cost reduction. The bills rely on several laudable but largely unproven methods for achieving cost savings: accountable care organizations to provide better coordinated care and various payment schemes with incentives based on quality outcomes.
Much of the discourse in the coming weeks will be about the “public option.” We should remember that the purpose of the public option is to provide insurance primarily for those who do or will not have employer-provided insurance — estimates are that only 5 million to 10 million citizens will choose it — and to create competition in an insurance market where there is none today. The co-operative alternative will be expensive to deploy and historically has been unable to attract sufficient participation to be an effective market competitor. In my view, the public option is the preferred vehicle for achieving market competition — a component of cost containment — but it should not be allowed to defeat overall reform.
On balance, we ought to take these reforms if we can get them. Universal coverage with fewer of the fiendish, inequitable and unfair insurance practices will go a ways toward improving our health care system. But we need to know that delivering lower cost and better health outcomes will take many years, innovation in the methods of delivery and kinds of health care, and a sustained effort by all those with a stake: providers, payers, insurers and, of course, all of us.
Comments
trump_suit 3 years, 6 months ago
I think that this article by Ron was well written and brings out some excellent points that seem to get lost in the partisan debate on this issue.
This sentence right here sums up most of my concerns with the current system.
"They eliminate the most egregious health insurance practices: denial of coverage for pre-existing illness and rescission of coverage."
For those of you oppposed to these reforms:
Are you covered by an employer plan or are you self-employed?
Have you ever been diagnosed with one of the illnesses that insurance companies routinely refuse to cover once known. (Cancer, Diabeties, heart issues, knee problems etc.)
Have you ever been dropped by an insurance company?
seeuski 3 years, 6 months ago
Good morning trump, I will be happy to answer a couple of your questions, yes I have been self employed and have had health insurance independently without being dropped or denied. I have had operations for several things and have had heart condition issues. While I believe most people in this debate like yourself have good intentions I can also see the rhetoric and hear the talking points of others that are pro Government run health care. While reading this article I was surprised to see that Mr. Krall did mention tort reform and competition which is not in the existing bills. I will repeat this for the umpteenth time, those of us who are opposed to the Obamacare bills are NOT opposed to reform and have constantly spoken our ideas and opinions the most important one being is we DON'T want the Government to screw up the health delivery system that now works better than any in the world. What we need is tort reform, HSA's, freedom to purchase insurance across state lines and new laws to prohibit insurers from acting the way you have described so often. For the true number of "Americans" who CAN'T afford coverage they should be fit in to the existing Medicare programs and then Obama should address the $400 billion dollars of waste he so often claims that is in Medicare. For those like Mr. Krall and yourself to want to trust the Bureaucrats with the whole shooting match when they already have a mess in the tiny in comparison existing Medicare system is beyond comprehension to me. I am also trying to understand why so many liberals, who have always protested big brother, are alright now with the threat of stiff penalties that include possible jail time for not buying the coverage that the Government prescribes for you as they see fit. There will be overseers like a new IRS division that will handle these new torts against the Government and I for one DON'T want my life and freedom scrutinized to such a degree. And Paul Potyen, in the letters section, claims that people like me are agents of the big bad insurance companies because we oppose Obamacare and I say you poor man you love it now but you wait, if this terrible takeover makes it through the Senate and becomes law, in 4 years after Obama is reelected the pain inflicted among us will know no difference as to who wanted this nightmare. I did not bother going to the gathering at the bookstore because it seemed as though the only presenters were all Dems and pro Obamacare which I felt would create an unfriendly atmosphere for those of us who would show our discontent. Seems typical these days for the message to be controlled like claiming that the majority are in favor of this action when the opposite proves true in most polling data and again, poor Mr. Potyen. And Paul, I did call John Salazars office to remind him of his promise not to vote for a bill containing the public option.
Alan Geye 3 years, 6 months ago
Back in high school and college, I was active in Debate. One of the key things I Iearned, because one must successfuly debate both sides of any given issue, is that generally, both sides of an issue have some good arguments. Ultimately, however, we must evaluate each and every proposal for it's unintended consequences. Personally, I feel this health care discussion is often being swayed by emotion and less so by financial and functional reality. Accordingly, I find myself in support of "seeuski's" comments.
I believe there is a large consensus for addressing some of the insurance issues referred to above. Unfortunately the House proposal seems to rely more on smoke and mirrors when addressing functional and financial issues. What happened to the promised transparency in Washington?
May I also offer a revolutionary observation. Have you thought about why our health insurance industry operates the way it does (lacking national competition, etc.) despite the "Commerce Clause" of the Constitution? If that reference does not ring a bell, may I suggest that you do some homework. The point I'm making is that it was the Congress (politicians) that created this existing framework allowing insurance companies to operate in these current conditions and Congress certainly could open it up to national insurance competition. We really should be asking ourselves, why are these political leaders afraid of national competition (an attribute that is not present in any of the proposals)? Why is it that THEY feel they are in a better position to control access than in other industries that operate in true competitive environments which result in lower prices for most all customers. Why is it that they are afraid of tort reform to help address the cost structure created by defensive medicine? Are folks even aware that there are a handful of states that have taken the tort reform issue by the horns and their results are quite favorable? Yes, these are rhetorical questions, as the answers should be obvious to the thinking person.
JLM 3 years, 6 months ago
There is a naivete to the discussion about health care which is so innocent as to be truly charming. Most of the "ills" of health insurance are truly issues related to the pricing of the product. Nothing more.
Most large insurance programs today rely upon the size, diversification and age of the group being insured to blunt the impact of individual conditions and therefore do not require a pre-enrollment physical.
They are, in effect, insuring a statistically "normal" distribution of risk given the projected health risks of that specific group. This is how they set the pricing for their product.
Obviously, if the group includes more young women of childbearing age, the cost of having a child is reflected in the pricing of the insurance program. In addition, the coverage of the program is tailored to that reality also.
They generally do require a pre-enrollment questionnaire with an objective of identifying any conditions which do not fit within the PRICING model for the policy. If one lies on this questionnaire, the insurance company objects rightfully to being defrauded. Is that unfair?
Folks have attempted to demonize (successfully, I add) the insurance companies because they object to providing the same insurance product at the same given price when an INDIVIDUAL fails to conform to the risk profile of the group.
Said another way --- pre-existing conditions are going to be "insurable" and the price of that risk is now going to be spread out amongst the entire group.
What nobody is talking about in the health care discussion is that the pricing has to be a function of the risk. If you want to insure pre-existing conditions --- which certainly should be insured --- then the PRICING of the coverage will reflect this new reality.
Not even Barack Obama can cause the cost of a serious illness --- heart attack, cancer, diabetes --- to disappear whether pre-existing or newly discovered. What will happen is that the cost for every group insurance policy will go up to include those realities.
Be prepared to take a pre-enrollment physical just as today large life insurance policies require such a physical before offering coverage. Be prepared to pay for your and the members of your group's real risks.
You cannot increase the breadth and depth of coverage without increasing costs for EVERYONE.
Clearsky 3 years, 5 months ago
If we want to be number 1 in the world for Health Care then we should copy the number 1 health care system -FRANCE. It's that simple. All arguments aside Number 1 is Number 1.
David Ihde 3 years, 5 months ago
They are not number one in cancer outcomes or heart disease outcomes. Most of these ranking systems are about public coverage and insuring everyone, not really about the health care itself.
Requires free registration
Posting comments requires a free account and verification.
Or login with:
OpenID