“Edwards to Press Insurers on Health Care Premiums”

Mr. Edwards states that he would force insurers…

In the June 14, 2007 NY Times article, “Edwards to Press Insurers on Health Care Premiums”, Mr. Edwards states that he would force insurers to spend at least 85% of their premiums directly on patient care. He also wants to limit the amount of time on patent protection that pharmaceutical companies currently enjoy. Mr. Edwards understands that regulation is the key to changing behaviors of abusive monopolies. Will efficiencies be realized with the Edwards Plan for Health Care Reform? Maybe.

There are many ways to impact the way insurers conduct business from a regulatory standpoint. What about mandating preventive benefits coverage? How about fixing the entire medical reimbursement system? Cost is what needs to be addressed. Insurance company profits can be limited too, but the true cost of medical services needs to be fixed. Chronic illnesses, like diabetes, are predicted to cost more than 10 times what they cost now in just 5 years. Americans want the best possible choices at all times when they access the medical system. Edwards, like many other candidates is manipulating statistics to influence public opinion. He does have the right idea.

The reality is that our U.S. health care costs more than other industrialized nations…

Intervention is obviously necessary to control the escalating cost issue within our U.S. Health Care System. One of the nation’s largest consulting firm’s most recent annual survey stated that more than 85% of Americans who have health insurance actually do like our system. They don’t like the cost shifting. The reality is that our U.S. health care costs more than other industrialized nations but is far from unsatisfactory for those who have insurance or utilize medical services in our country. Every American has care. Close to 50 million Americans do not pay for it through health insurance. Taxpayers bear the expense. Does anybody remember that the U.S. Government does not operate without the tax money that working American citizens contribute?

Most doctors and hospitals do provide excellent, necessary and fairly efficient care. Our highest paid Senators in Congress can’t even get bills passed for years sometimes. These are the same people that are going to force efficiencies upon our medical system. Not the most encouraging thought. As the Government gets more involved in regulation and creating alternatives to Employer Sponsored Healthcare, for instance expanding Medicaid income requirements, the administrative costs will skyrocket. If the US Government spent time actively pursuing every citizen that qualifies for an expanded Medicaid program, we would make a huge dent in the number of Americans without health insurance coverage.

So, Mr. Edwards, the road to Hell is paved with good intentions. We need a systematic, methodical and detailed approach to revamping the U.S. Health Care System and at least you have put your cards face up on the table. A lot more candidates should be doing the same. Then we can flush out the bad ideas and embrace the good ones.

David Leonhardt

David makes an excellent point…

In the NY Times article, “Health Care As If Its Costs Didn’t Matter” written by David Leonhardt on June 6, 2007, David makes an excellent point. Cost is the primary driver behind desired changes. There is a lot of unnecessary procedures and unproven technology that we pay for. Receiving the best possible care for the best outcome means embracing proven technologies in place of thinking that if it is the latest invention, it must be the right thing to do. I have been saying all along that the “cost factor” is not being addressed directly.

Information and data must be compiled and disseminated in a user friendly way over the internet. Transparency or cost data means little until we see whether it is tied directly to quality or not. Where is that data? We still must protect confidentiality and yet understand that legislation often serves special interests and gets in the way of progress. HIPAA is a cumbersome piece of legislation that needs to be amended for proposed changes to the US Medical System to take place. ERISA legislation is also outdated.

The reality is there is almost no chance of accomplishing Universal Health Care…

We have been led to believe by our presidential candidates that a few simple suggestions like electronic medical records and Universal Care will fix the ills of the U.S. Medical System. The reality is there is almost no chance of accomplishing Universal Health Care in the U.S. until politicians are honest with US citizens about what it will take to implement it. The U.S. Government is not going to flip a switch and all of a sudden we have Universal Care…whatever that means. It is a partnership with U.S. citizens, the U.S. Government and, of course, the private medical and insurance industry. Wasteful spending runs rampant in many areas of medical practice.

There are several good suggestions being proposed. However, Congress and our next President have a tremendous challenge on their hands. They have to figure out how Americans can continue to benefit from what is good about the U.S. Medical System while they work on changes to the system that will eliminate costly inefficiencies. That concept is not Universal Care. Showing Americans how to achieve Universal Care over a timetable of very specific achievements is a separate and important step to overcoming continued medical inflation. What is our part? What is the Government going to do? How much will it cost? When will it be done? Is Universal Care rationing of health care?

Where are the innovative programs that utilize these statistics for improving care more efficiently?

We have medical outcomes data locked up in the Federal Government (Medicare and Medicaid) and at all of the major Health Insurance Carriers in America to uncover the best practices for cost efficiencies. We don’t publish it, break it down for the entire population or do much about it. The large consulting houses crunch numbers and statistics of the claims experience data for their specific clients to shape new plan designs that may save the Employer some money. Health plan actuaries use experience claims data to apply for increases every year. What about the entire U.S. population that uses medical services whether they have insurance or not…private insurance or public programs? Where are the innovative programs that utilize these statistics for improving care more efficiently?

If a new and improved U.S. Health Care System is ever going to work, American citizens must fully participate. American citizens must feel that we own it. Health is our greatest asset. Unhealthy people can not protect their freedom or their families. Most people take their health for granted until a health crisis puts them in a precarious position. All of a sudden, whether you have insurance or not, when you are sick, it becomes clear that the U.S. Health Care System performs well, but at a higher cost than other countries. What about the difference in our economy versus that of other countries that have socialized medicine? Statistics can be manipulated to make almost any point. Preventive care, access, awareness, incentives for difficult healthy lifestyle changes, education and consequences for not embracing change, are necessary for cost efficiencies to be realized.

There is no doubt that some type of reform is necessary

Legislative changes, teamwork with the private sector and innovative ways of sharing information will help informed consumers and their providers make better decisions regarding their health care. There is no doubt that some type of reform is necessary. Presidential hopefuls need to show Americans a detailed plan for health care reform that includes a timetable to achieve each dynamic proposed change within the U.S. Medical System and how each change will lead to the next progression towards whatever they as candidates are proposing. Then, you will have believers rather than polarized potential voters. If Americans, the U.S. Government and private industry are all truly working together toward change, is will be hard, but cost efficiencies without sacrificing quality of care can be accomplished and the U.S. Medical System will be improved for decades to come.