Honesty in health care reform-what really has to happen


I am assuming that the pending health care legislation is signed into law by the end of January 2010, not much a risk in that assumption.

Don’t go to the doctor with every distemper, nor to the lawyer with every quarrel, nor to the pot for every thirst.

Along with enactment come a myriad of new regulations, direct and indirect taxes, cost shifting and creative accounting for the federal budget.  In other words, a somewhat less than honest presentation to the American public of what it takes to truly reform health care in the United States, a goal yet to be reached even with this legislation.

So what would it take to reform health care and be honest with all stakeholders?

Here are a few thoughts; you can likely add some of your own.

  1. Look folks, high cost does not equate to high quality health care.
  2. The fee-for-service payment for health care provides the wrong incentives and rewards and has to change.
  3. Health care can never be affordable (or of the highest quality) if you follow the concept that nobody will ever come between you and your doctor when making treatment decisions
    1. Not every procedure or test that is ordered is effective or medically necessary and in some cases they should not be paid for.
  4. Some inconvenience in receiving health care is a fact if we are going to manage costs.  That means you may have to travel longer than five minutes to receive a test or the closet hospital may not have every service possible.
  5. As long a you are not paying for 100% of your own health care, the people who are (that’s all of us) do have some say in how the money is spent.
  6. Health insurance was never intended to pay 100% of every health care expense, it is insurance (or was originally) and thus intended to protect you from unforeseen, unmanaged medical expenses, not pay for routine expenses. You have a personal responsibility to pay many of your expenses and those expenses come before other things you may wish to spend money on.
  7. One of the drivers of health care costs is the fact that most Americans do not have a direct financial stake in their care.
  8. Americans, if you want to help control health care costs, get in shape, change your lifestyle, and maintain your health.  This is your responsibility even if it costs you money to do so.
  9. You do not have a right to not carry health insurance (because it is impossible for your health care expenses not to affect other people in one way or the other).
  10. The favorable tax status of employer based health benefits is unfair to millions of Americans who pay for their own coverage, at a minimum there needs to be some limit on how much of a tax free benefit each person can receive.
  11.  Assuring that all Americans have access to health care and that the cost of providing that care is spread fairly among society requires a great deal of money.  To truly pay for basic health care for all Americans requires that each American pay 8% of his or her income (a rough estimate) toward that goal.
  12.  Health insurance companies are not responsible for controlling health care costs, you are.
    1. The premiums charged by insurance companions are not the problem; the problem is that insurance premiums are high because of the underlying cost of the care provided.
  13.  Affordable health care cannot be sustained while maintaining today’s income levels for physicians, especially for many types of specialists.
  14.  Advertising for prescription drugs and health care services, hospitals, etc. serves no valid purpose other than to generate additional revenue for the advertisers and must stop and be replaced with fact bases resources so patients can evaluate all health care options and services.
  15. There is no valid reason for the best treatment technique of any kind to be an exclusive right of any hospital or organization but rather should be shared across the U.S.
  16. Health care costs will continue to increase at rates above general inflation no matter what is done with legislation as long as we have an aging population, expect the latest in technological advances, indirectly subsidize other countries health care costs, maintain a largely fee for service system, do not change our lifestyles, continue to have unrealistic expectations for the health care we receive and play politics with health care.




  1. You lost a lot of credibility with this health-insurance-centric list. Do you have some kind of financial interest in a health insurance company? The contradictions are rampant, for example, how can Americans have a financial stake in their health care when the current health insurance model reduces the perception of value of care. The public perceives the cost of healthcare to be what they pay in a deductible.

    If you want to be consistent why not advocate HSAs and catastrophic health coverage (consistent with your item 6).

    If this is the best analysis you can provide, then you are just another example of why we have the problem that we have.

    Empower patients and bring free market reforms into the system via health savings accounts. Force transparency into the system so that patients can know the quality and cost of the services they seek. Return health insurance to the emergency only contingency that it was always meant to be.


    1. Not sure how you come to your conclusions on this one. You obviously read numbers 6 and 7, how does that sound like I advocate less involvement by the patient in the cost of their health care?

      HSAs may be one tool, but they are not the whole answer because as currently constructed that put too much of a burden on lower income people (not poor, just lower income).

      I would advocate returning to the old fee schedule approach we had back in the 1960s where you knew exactly what was going to be allowed by your plan and then you made a judgement whether you were willing to pay the difference. The discount networks we have today distort the entire fee process.

      When I started in employee benefits our company (a Fortune 200 organization) offered only coverage for hospital and medical surgical, no outpatient coverage and no prescription coverage, but even in those days it was a bit more than emergency only contingency as you advocate.

      For the record I have no affiliation with and no stake in any insurance company and never have.


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