Is President Obama trying to do too much with health reform?

by J.E.B. Johnson, MD

Dear President Obama:

We agree that our health care system can use some improvement, but it is difficult to agree on how to accomplish this. It seems as if your desire for a major overhaul is far from certain. Some pundits have suggested this may emasculate your presidency, but I beg to differ on this point. This is not a failure of policy as much as it is a realization that the speed and the scope of the goal you have set is unrealistic.

It is time for an honest re-appraisal. Re-forming our health care system should be a continuous improvement project not a one time slam dunk solution.

Lead us. Accept the blame for an ill-conceived picture of health care reform and begin the orderly process of improvement with a blueprint. May I suggest that you begin with Medicare? Medicare is neither a model of quality health care or efficiency. It is a model of government bureaucracy and it is a logical place to begin demonstrating that you can lead us to creative solutions.

Set a reasonable timetable. Five years would be a very ambitious timetable to achieve significant improvements in Medicare. Two and a half years would be a reasonable time to start Medicaid on a five year improvement cycle. Your legacy after 2 terms will be to pass on to the next President a populace with confidence in our government’s ability to nurture and encourage good health care and the opportunity to expand it to serve all.

J.E.B. Johnson is a family physician.

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Comments

Rezmed09
Aside from the difference in payment scale, how is Medicare more bureaucratic and difficult compared with many PI companies? As far as I can tell the drug plans and pre-approval problems with PI is often more complex and maddening.
Medicare is always going to be a low end coverage plan – it cannot easily or silently raise premiums to cover costs. I agree it needs to be reformed but it will never be like a high end PI plan. Plus PI just doesn’t have the degree of oversight and QA that is going to always be required by the American people.
Donald Green MD
The problem in health insurance is the payment system. The problem in delivering health care is an outgrowth of our present reimbursement. Instead of assured income for service it becomes a ever more complicated game to get paid. Medicare sits with a 3% overhead, rated high as a payer by Athena Health, and is strongly supported by its users. The private insurance lags behind and it is here reforms are needed more urgently. Any issues with Medicare must also be dealt with but it is not first in line.
Doc99
Milton Friedman identified the problem thirty years ago – Third Party Payors.
Doc Stone
There are many relatively minor tweeks that could be done to address many of the accumulated inequities in the system that are obstructed not so much by special interests, but by the reform movement itself, which resist incremental fixes holding out instead for the whole enchilada. Fixing runaway costs in Medicare need not await reform of the whole system and shouldn’t. In fact demostration of a capacity for doing so should be a prerequisite for the public allowing the government more control. Even fixing Medicare cost problems need not be a whole piece. How about congress just start by showing enough spine to stop the durable medical equipment grand larceny?
LW, MD
I think this ignores the political reality of the situation. Especially in these partisan times, the notion that small, continuous fixes can be passed and implemented seems to me hopelessly naive. No matter what you think of his politics, I think President Obama has to push for as much as he can right now. He just won election convincingly. He has a majority in the House and the Senate. A majority of the country supports some sort of public option. If he pulls back now and settles for a small, piecemeal approach to reform, he will be portrayed as weak and his opponents will have won a major victory. At that point there is no doubt in my mind that any substantial reform will not pass.
Doc Stone
Democrats have a majority but polls show most are against their reform plan. One problem impeding effective governance in Washington is the preoccupation of those in the beltway with the impact of policies on the public perception of the politicians. I don’t give a damned whether Obama looks weak or who gets credit for what. That is a less than a pimple on a gnat’s behind compared to the big issues of what kind of country do my children live in? Are they free to order their own lives or regimented by a bureaucracy? Can they trade, save, and invest with a stable currency or do they live in a North American version of Argentina? It is the impact of the reforms on the multitude of individual Americans that matters.
Before mandating this and that for us, the government should clean up the problems of it’s direct creation. Medicare and medicaid costs firsts and foremost. Tax policies that link insurance too strongly to jobs creating non-coverage as the natural consequence of even brief unemployment–and impeding entrepreneurialism.

Is President Obama trying to do too much with health reform?

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