What will the next 4-8 years look like for health care?

With a presidential election coming, it might pay to get ready for the next “era” in health care. Regardless of whether our next president is a Democrat or Republican, I believe a strong focus on cost control will be an effective strategy. Here’s why:

If Republicans win the white house, one stated goal is to repeal Obamacare. Rather than dig in and fight for another cycle, Democrats should consider embracing a strong cost control approach as a way to blunt the attack. If Republicans see a pathway to budgetary control even with Obamacare structurally in place, the more moderate elements in the party might accept a future of market based reforms instead of legislative reforms. If Democrats ignore the need to control costs, they can look forward to attack after attack on the legal foundations of the law itself. And yes, continued escalation of costs does indeed threaten the entire economy.

Now if Democrats win the white house, they will have an opportunity to embed key features of Obamacare deeper into the fabric of our society. In doing so, they will either do something that is great in the long term, or ruinous. If they ignore the need to control costs, and instead allow an entitlement to spread wider and wider, while not reining in the providers of these services, other important national needs will be squeezed out- or our taxes will rise to punishing levels- or our debt will increase accordingly. A Democratic administration will need to ensure that the law works economically- not just socially.

So regardless of who wins the next election, the next 4-8 years in health care should focus very closely, and aggressively, on costs.

Is it a good thing that some states refuse to implement the health care reform law (Obamacare)?

One of the more significant results of President Obama’s reelection is the impact on the health care reform law- his reelection eliminates the threats to repeal the law on “day one”.  However, some states are actively resisting the law’s implementation.

Specifically, one aspect of the law requires states to set up health care exchanges, where individuals could buy insurance at a competitive price (the exchange does not actually provide the insurance, but determines which insurers can participate).  Many states are refusing to set up the exchange.  One notable example is Texas.  Recently, Texas’ governor Rick Perry refused to implement an exchange in his state.

The Federal government will step in and operate the exchange in states that are unwilling or unprepared to implement an exchange on their own.  The deadline for implementation by the states is January 1, 2014.

So here is the question- how do you feel about states that refuse to implement the health care reform law, even after the Supreme Court decision and the reelection of President Obama?

How do you feel about states that refuse to implement the health care reform law even after the election and Supreme Court decision?

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Prepare yourself during 2013- knowledge required!

Now that the Supreme Court has upheld the Affordable Care Act, should we all just sit back and go for the ride? Hardly.

Progress among the states is a patchwork- only 13 states have moved forward setting up health exchanges- a key enabler. An additional 22 states have started planning. The remaining states continue to resist.

What this means is that when 2014 arrives, the states will not all be ready. Your ability to access decent, affordable care will depend very much on where you live.

And so you should be prepared to look out for yourself, to some degree- with knowledge, so talk to your physician and do your own research; with tools, so use a personal health record, know how to research the quality and cost of hospitals and physicians; and have a network, whether it be through a traditional advocacy group, or through an online social network.

As our system changes and improves, we will collectively be much better off. But during the transition, there will be gaps, and we will all need to become more self reliant.

So now the hard work comes- reducing costs.

First, let’s acknowledge the incredible victory in passing and then having confirmed by the Supreme Court the health care reform law.  It’s a great thing that millions will gain access to health insurance.

But this is only the beginning…

First, let’s face it, costs will rise in the short term.  With insurers covering millions who have previously gone without, many with pre-existing conditions, costs will rise.  The real challenge is in reducing costs, not so much of the insurance, but of the basic care services that the insurance must pay for- doctor visits, hospital stays and drugs.

The core problem underlying our runaway costs is that our system is designed, at nearly every stage, to deliver the highest cost service possible, and as many services as possible.  Reasons for this include:

  •             Fee for Service pay structure
  •             Defensive medicine and the fear of litigation
  •             Overcapacity of some service lines (supplier induced demand)
  •             A huge medical complex that can and does influence regulations

Until we focus on costs, and change key structural aspects of the health care industry to support a lower cost model, health care itself, whether accessed through insurance or not, will remain out of reach for many.

 

Does this make sense?

Have you ever considered-

Someone is hungry, so they stand outside a restaurant asking for food. Eventually the owners may call the police. Someone is homeless, so they stand outside a hotel or motel asking for a room. Again, the owners may eventually call the police.

Because this person is homeless and hungry, eventually they collapse from exposure and/ or hunger. Now, we have a very expensive hospital bed and a very expensive hospital meal just for them.

Something to think about…

Should our health care system be a for-profit system?

Some have said it is the profit motive that is at the core of our health system’s problems:

  • Insurers need to provide profits to their shareholders
  • Hospitals and hospital systems need to provide profits to their shareholders
  • Physicians perform tests with their own economic interests in mind
  • Pharmaceutical companies and device manufacturers charge too much

A system that is not designed for profit might look as follows:

  • A single payer health system
  • All hospitals should be not-for-profit
  • All physicians should be employees, and their employers should be not-for profit
  • Pharmaceuticals, devices and supplies should be subject to price regulation

What do you think?  Please select only one response.

Should the profit motive be removed from our health care system?

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It’s Time to Really Look at Costs

As we all know, the federal government and nearly every state is facing huge budget gaps.  Health care is a large part of every crisis:

  • Medicare is a large part of the federal budget crisis
  • Medicaid is a large part of every state budget crisis

Health insurers are not to blame this time:

  • The Medicare discussion is about Medicare, not Blue Cross, Aetna, Cigna, United or Humana.
  • The Medicaid discussion is about Medicaid, not Blue Cross, Aetna, etc.

The health care reform bill that we recently passed was really health insurance reform- yes, we needed to reform the insurance system.

Since Medicare and Medicaid are not traditional insurers, but still seem to be drowning in costs, the question is, “Where should we focus our reform efforts going forward?”  What do you think?

Since the Medicare and Medicaid discussion is not about the insurers, where should we focus our reform efforts going forward? Select all that apply.

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