Wanted: Health Care Finance Reform

During a recent town hall-style meeting in Colorado to bolster support for his health care initiative, President Obama was asked why he had changed his rhetoric from using the term “health care reform” to the term “health insurance reform.” In my opinion, it was a smartly-asked question that required a more thoughtful answer than the president provided. For if I were to lay my cards out on the table, I would admit that for me it’s never been about health care reform but rather it’s about health care finance reform.

Whether we realize it or not, here in Minnesota and throughout the entire upper Midwest region we are blessed with the best health care delivery system in the nation. We are fortunate to have some of the most talented physicians, nurses and health care practitioners, working in state-of-the-art hospitals, clinics and health care facilities. A large percentage of our care is delivered through large multi-specialty clinics and integrated health care systems that lead the nation in quality; achieving efficiencies that other parts of the nation can only dream about. When we talk about our health care systems up here names like Mayo, Fairview, Allina, Avera, Sandford, Altru, Meritcare, Gunderson and Marshfield are all recognized for their quality, efficiency and effectiveness. Simply put, we don’t need to nor want to change our health care delivery system.

On the other hand, the way we finance and pay for all this great care is a total mess. This is just as true for our public payers as it is for our private payers. It’s too expensive, excludes more than 40 million Americans and is financially unsustainable. Here are some simply examples of the illogic of the current financing system:

· A physician working in a highly efficient, multi-specialty clinic in Minnesota who sees a patient for a routine office visit; or a hospital in North Dakota that admits and elderly patient with a simple uncomplicated case of pneumonia, will receive a much lower Medicare reimbursement than a physician or hospital treating a similar patient in Dade County, Florida. In other words, Midwest providers get penalized for their efficiency, while physicians and hospitals in other regions of the country get rewarded for their uncoordinated and inefficient care.

· An uninsured patient who enters an emergency room with a deep gash to their leg will receive a significantly higher bill for services in the E.R., than a similar patient whose insurance company has negotiated deep discounts with the hospital for their enrollees. In other words, those who can afford it the least get charged the most.

· A 24-year old patient with a serious chronic disease is virtually uninsurable in the health insurance marketplace, when he/she leaves their parent’s family insurance plan upon their 25^th birthday. In other words, health insurance often is unavailable to those who need it the most.

· More than 14,000 Americans lost their health insurance each day during 2009 due to being laid off by their employer. For you see, we are the only industrialized country where if you lose your job, you lose your health insurance.

So when the president was asked about this change in his rhetoric, I wish he would have plainly told the questioner that the reason he now uses the term health insurance reform is because that’s where the problem lies. That we want a health insurance market that doesn’t deny you coverage if you have high blood pressure, diabetes, or other pre-existing conditions. That if you lose your job you sure as heck have enough to worry about; and keeping your health insurance shouldn’t be one of them. For you see, unemployed people get sick too.

Unfortunately, those who try to characterize this as a government takeover of “health care” are just trying to scare you. For you see, the most universal federal health care finance program we have is Medicare, which covers millions and millions of elderly Americans. So if this is the socialistic takeover of health care where are the Medicare-employed doctors and nurses? Where are the Medicare hospitals and clinics? Where is the federal takeover? Well, as we all know, this is all political hyperbole. Medicare beneficiaries get to choose their doctor or change their doctor just like you and me. They use the same private clinics we do; and the same private hospitals we do. Medicare is simply a publicly funded insurance program; nor more … no less.

So let’s dial down the rhetoric and scare tactics and let’s dial up some of our best ideas. Whether we need a “public option” or not is certainly open to an honest debate. But wouldn’t it be great if we ended up with a decent basic health plan that all Americans would have equal access to (let’s call it the Basic American Plan) that all insurance companies would sell for the same price. If insurance companies want competition, well let them compete on quality and service; but not by cherry-picking the healthiest among us, and denying coverage to those who need it the most. Now wouldn’t that be something!