10 ways United States health reform may fail

One, develop a plan that the presently privately insured Americans, estimated at 200 million, pay more in premiums, and to just make sure you succeed, immediately starting raising taxes by $400 billion over the next decade.

Two, alienate those over 65, the most dependable voting bloc, by promising to cut Medicare by $500 billion over the next ten years with the false promise, which you know you cannot fulfill, of not cutting benefits.

Three, turn young voters, who supported you in droves in 2008, by mandating they buy insurance or face financial penalties of $750 or more, or 2% of their incomes, to be enforced by the Internal Revenue Service, or by a new bureaucracy.

Four, ignore polls of the American people, which now, on average, run +12.6 percent against your plan, as they now understand it, and dismiss those who attend tea parties, mass rallies, and marches on the Capitol as “misinformed,” “liars,” or “fascists.”

Five, exclude the political opposition from the debate, vote against their amendments, hide their alterative suggestions from public view, call them the party of “No,” and remind them they have no voice in a matter of such “historic” and “moral” magnitude.

Six, dominate and control the debate through pronouncements from intellectuals, policy wonks, and ivory tower dwellers, of known political persuasions, and through media filters and denial of media access, as if there were no other legitimate or credible points of view.

Seven, mandate everything in sight – from individuals, to employers, contents of health plans, to market options for obtaining coverage – to assure the government remains in the catbird’s seat and to make sure it is your way or the highway.

Eight, create the illusion, even the reality, that power corrupts and absolute power corrupts absolutely by buying votes or promising permanent political favors that Congress persons cannot resist, even if those favors lose elections for recipients of those favors and drive up federal deficits, already at a record high.

Nine, defy the wishes of Founding Fathers, the American Culture, and the Constitution, all designed to create checks and balances against an overly authoritative federal government run by the intelligentsia and to the elite and to give more power and a greater say to common people.

Ten, pay no attention to evidence that America outperforms socialist countries in medical innovations, market developments such as retail clinics and worksite clinics, superior results in treating cancer, heart disease, other life or lifestyle threatening disorders, and to health empowering information technologies.

Richard Reece is the author of Obama, Doctors, and Health Reform and blogs at medinnovationblog.

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  • http://www.familydocs.org/blogs/fp-forum Carla Kakutani MD

    Wow, cue the black helicopters!
    The HCR bills (now at great risk of being abandoned, but that’s another long story) are a moderate, market based attempt to approach universal coverage and inject at least the beginnings of needed cost containment into our bloated system. The basics have already been road tested in MA, and they are happy with it overall. Chances are, if the exchanges are implemented and gradually expanded, we could use this to slowly uncouple health coverage from employment, getting US companies back on a level competitive playing field with other industrialized nations.
    If we take a pass on this opportunity, things may devolve so far that the next proposal on the table is a much more restrictive single payer system. In hindsight, Dr Reece, you may regret attacking this year’s efforts with such heated rhetoric.

  • http://fertilityfile.com IVF-MD

    We all want a better quality of life for ourselves, our families and for others in our communities as well. And efforts at change should be aimed towards improving more individual choice and freedom and less government coercion and corruption. Instead of forcing down our throats a bill that does the opposite, if only the government would back off a little bit and let the people gain back what they’ve lost these past years.

    What most people want are: More freedom to choose your own doctor. More freedom for doctors to choose how they want to deliver better healthcare. Lower costs by eliminating bureaucratic waste and by instituting tort reform. More options by lowering the barrier to entry for innovative insurance plans and lowering the barrier to entry for all participants in the healthcare process. And let’s not forget the fundamental benefits of tax relief, so that people will be prosperous enough to afford better options of healthcare.

    Thanks for a great post, Dr. Reece.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    Eleven (related to number five): Lob the uber-nasty ad hominems (ala “racist”, “moron”, etc.) at anyone and everyone who disagrees with your plans.

  • ninguem

    you forgot teabagger

  • Arthur Lane

    Interesting point of view – but…..

    Point 1: Yes taxes will increase – but please let everyone know the whole picture.. We need to figure out how we are going to cover our $34 trillion commitment to Medicare over the next 75 years and that is just one of the challenges. In my opinion we can start planning now or we can wait and let the bubble burst.

    Point 2: See point one – the current Medicare system is not sustainable – would you like to bankrupt your children?

    Point 3: Really requiring insurance is a bad thing? Please explain why this is bad? We require people to have insurance for many other things?

    Point 4: Polls – Here is an idea stop watching the news and ask people who you know what they want? It has been my experience that people know the current medical system is broken and needs to be fixed. Granted the current political solutions offered by both parties does not really fix the problem, but people do want something to change.

    Point 5: Good point, and welcome to DC that is the way it works and always has. As soon as we the people realize that our elected officials are not acting in our best interests the better.

    Point 6: SEE POINT 5 – this is a redundant point….

    Point 7: That is your point of view – not sure that it is really true, but it is challenge with both parties.

    Point 8: Again that is your point of view – solution we need to get rid of pork barrel tactics

    Point 9: I agree with you here and we can do that by not voting the same people into office election after election or by setting up term limits

    Point 10: Are we better off as a society because of these points? They are all true, but can we afford the current system? Is the current system delivering the most bang for the buck? Are we the healthiest society? In the end it is all about outcomes.

    I have an idea how about 10 points on how we can create a health system that gives us the best outcomes, one that everyone can access and one that does not bankrupt the country. The reason why health reform will fail is because the proposal does not improve upon the current system or does not create a foundation that will allow us to improve the current system.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    I don’t consider “tea-bagger” or “right-winger” insults, but badges of honor;)

  • http://scienceblogs.com Orac

    pay no attention to evidence that America outperforms socialist countries in medical innovations, market developments such as retail clinics and worksite clinics, superior results in treating cancer

    Except that, when you correct for lead time bias, overdiagnosis, and various other factors, it is almost certainly not true that the U.S. has superior results in treating cancer.

  • Anonymous

    What most people want are: More freedom to choose your own doctor. More freedom for doctors to choose how they want to deliver better healthcare. Lower costs by eliminating bureaucratic waste and by instituting tort reform. More options by lowering the barrier to entry for innovative insurance plans and lowering the barrier to entry for all participants in the healthcare process. And let’s not forget the fundamental benefits of tax relief, so that people will be prosperous enough to afford better options of healthcare.

    Nice things to say (everyone has nice things to say when taking about things in general), but how would you actually implement them (the nice things people say get a lot less nice when all of the details have to be filled in)?

  • http://fertilityfile.com IVF-MD

    Anonymous,

    You are absolutely correct. An outlining of the fundamental “nice things” that are needed does not equate to a detailed plan. Summarizing the above took just a paragraph. Debating it in detail will take considerably more time, but it’s certainly worth the discussion. I agree.

    More freedom to choose your own doctor. More freedom for doctors to choose how they want to deliver better healthcare. Lower costs by eliminating bureaucratic waste and by instituting tort reform. More options by lowering the barrier to entry for innovative insurance plans and lowering the barrier to entry for all participants in the healthcare process. And let’s not forget the fundamental benefits of tax relief, so that people will be prosperous enough to afford better options of healthcare.

    What do all the concepts have in common? They are all founded on the principle that it is better for individuals and voluntary communities of individuals to make decisions that affect their own lives than for an elite small group of people far away to make those decisions for them. This is both the most moral way AND the most efficient, productive way. I believe it’s fundamentally moral because people own themselves and it’s wrong to force another person to do something by threat of violence. I know the morality part is subject to individual philosophy, so you are free to disagree. As for the efficiency part, that is something that can be debated objectively and scientifically without injecting any moral bias.

    Now the really amazing thing is that all the items mentioned above are actually the natural order. What I mean is that in the absence of overt actions that seek to stifle them, these things (freedom to choose your doctor, freedom of doctors to compete to deliver the best care, freedom of alternative sources of healthcare to compete to offer a better product, freedom to generate healthcare services without being handcuffed by horrendously wasteful bureaucracy and defensive medicine, freedom to reap the benefits of working harder and freedom to dictate how the fruits of your labor are spent) are all the normal natural order. We DON’T have to do anything to get them. The reason we don’t have them is not because somebody failed to do something to bring them about. The reason we don’t have them is because some people actively did things to destroy them. The joke is that it’s not about politicians being bad at doing good things, but rather that they are good at doing bad things. We need for government to limit themselves to doing the basics of what they are SUPPOSED to do under the Constitution which is to protect people’s rights. That’s it. It is NOT supposed to be in the business of micromanaging people’s lives.
    Rather than a world where people enter into transactions voluntarily, we have devolved into a system where people jockey to manipulate the coercive force of government to gain an unfair advantage over those who aren’t as good as manipulating that coercive force as they are. Ask yourself this. When does it become less cost-effective for a corporation to thrive by doing the right thing (ie lowering their prices to a competitive level and/or investing energy into making their products and services better) and when does it become cheaper and more cost effective to thrive by enlisting hired guns know as lobbyists and donating to politicians to rewrite the rules to disadvantage the competition?

    As a doctor myself, I am part of a group which is every bit as guilty of using politics to help us compete rather than solely competing by improving our product. Now, we do have an excuse in that OTHER entities are simultaneously using those political forces against us, so we might try and justify things that way, that we have to use politics just as self-defense against those who use politics against us. But my argument is that rather than have this system where every interest group is doing battle with each other by competing to harness the coercive force of the government for themselves, if we can get back to a system where every interest group competes morally (working their hardest to provide goods and services that will persuade others to VOLUNTARILY engage in transactions with us), then we will have a system that is much much better than what we have now. This is TRUE reform. A free system based on natural incentives and individual decisions will find the overall best solutions. It will not be PERFECT! But it will be a whole lot closer to being perfect than what we have now.

    Yes I know it has taken several years to step by step build up the destructive force of too much bureaucratic corruption and meddling and it won’t be eradicated in just a few years, but we can at the very least take steps to slow if not reverse the progressive metastasis of this cancer.

    So, to “anonymous”, you rightfully demanded a discussion beyond a statement of just “nice things to say”, so let’s have some fun and educate each other on the SPECIFIC points above. Shall we start with the first concept – [more freedom to choose your own doctor]? In order to figure out how best to improve that, we should start by examining if people are truly dissatisfied with this as it stands today. If they are, then why is it that they can’t choose? We can choose where to live. We can choose what car to drive. We can choose whom to marry. We can choose where to eat for dinner. Why is it that many are claiming that they don’t have the ability to choose their own doctor?

    By the way, I will apologize ahead of time for the inherent disadvantages of holding a discussion via a blog comment section, rather than by having a normal live discussion. But let’s try our best.

  • Anonymous

    You wrote several paragraphs that can be summarized as saying that a freer market with less regulation is more desirable. But how would you suggest getting there from here? I.e. how would you change existing laws and regulations to cause the system to move to a freer market? How long do you think such a transition would take, and what impact would it have on patients, providers, insurance companies, taxpayers, and the government? And how would you convince people and politicians to move in that direction?

  • http://fertilityfile.com IVF-MD

    Dear Anonymous,
    (I feel a little funny continuing to address you that way, but, oh well) :)

    You raise the million dollar question, asking how can we get back to a freedom-based innovation-filled competition-driven country with just the bare minimum bureaucracy to keep order? Actually, that’s more like a multi-trillion dollar question.

    When we carefully study the history of this country (however, not the version that is taught in schools), we notice a persistent growth of government with the corresponding loss of free choice. With an ostentatious declaration of good intentions, politicians will isolate a problem and devise THEIR way of fixing it. Perhaps for the very very short term, things will look better in a narrow box, but over time, the rigid coercive regulations will result in achieving close to the OPPOSITE of the desired goal. And then the lunacy will begin because the politicians will look at the disaster (that they helped cause) and use the bad situation as a way to panic the people into give over even MORE power to the government. You can find many examples but one glaring one is the use of measures such as welfare and minimum wage to try and fight poverty, which has resulted in increasingly MORE poverty as an indirect result of those measures. Healthcare is the latest example. I would argue that our healthcare situation is what it is today because of attempted government-mandated attempted “fixes” (swayed by the influence of special interst groups). And the politicians use the dissatisfaction that the people feel to further con them into relinquishing more power to the state.

    So back to your question of how to fix this mess? Well, one core principle of the free market is that no one person or small group of people can dicate the lives of billions of people any better than those billions can do themselves. Out of the so many counterproductive ways that regulations have messed things up, if we were to individually dissolve them one-by-one, then inevitably some special interest group will fight it. Examples: Expand the healthcare provider pool by opening up the market to alternative providers? No; MD’s will fight it. Allow free importation of drugs from Canada? No; pharma will fight it. Tort reform? No; trial lawyers will fight it. Tax relief so that a robust economy will enpower more people to be able to afford health care? No; politicians who rely on votes from the dependent entitled herd (which they themselves help create) will fight it.

    I think we all recognize this intricate web we’re in. This mess developed via a thousand small steps over several decades and it would be idealistic to think that it can be fixed in one fell swoop.

    So what ideas can we try? Well, first of all, it would be great if we could just halt the progressive damage from advancing any further, meaning we don’t let government keep getting even more and more powerful. The Constitution was supposed to do that, but it has completely failed, because it has been cleverly circumvented step by little step. Americans have blindly allowed this damage to continue year after year, because it has been gradual and disguised, allowing the politicans to gain more ground. But, there is a glimmer of hope in the recent events of Massachusetts. It’s the first indicator that the people are fed up with things. We can only hope that this doesn’t turn into a Republican vs Democrat battle, because then there is the likelihood that rather than giving power back to the people in the form of forcing leaner smaller government, we’ll just be trading in Democrat tyranny for Republican tyranny.

    Two ideas that come to mind are 1. Tax relief, so that power shifts back away from bureaucrats controlling it to the people themselves controlling it. This will give people more incentive to spend their energy producing value rather than spending their energy trying to lobby for political power.
    2. Shifting power away from the federal level back to a more manageable state or local level. This will vastly harness the power of accountability. Then, rather than having a bloated bulky one-size-fits-all policy, the creativity of the people can test out many different ways to best deliver quality healthcare at the best price. The ventures that fail will go bankrupt and die away. The ones that do well will be rewarded by the market and can then be copied and have their ideas spread virally. A billion minds interacting, making decisions, flowing naturally to get the best solutions rising to the top beats a few untrustworthy elite politicians trying to shove mandates down the throats of the populace.

    If you look at the number of internet companies that have come and gone, you see that the ones left standing are the ones that best provide what the people want. The great ones survive, and get copied and further improved upon. The bad ones die out, freeing up the resources to be applied to other new ideas. And 10 years from now, there will be even better internet entities than the ones we have now. No one Internet Czar is telling the people how many commerce sites, news sites and social media sites to have. Nobody is handcuffing progress with arbitrary biased regulations and policies. Rather, the ever-evolving collective wisdom of the free market is constantly morphing to determine how things succeed. It’s actually quite elegant and beautiful.

    Far be it for me to think that these are the only ideas. I would eagerly love to learn other opinions. We all want the same thing — better quality of life and more individual options and more freedom to choose our own balance of safety vs productive risk-taking.

    Personal freedom is the answer. Bureaucracy is NOT. Let’s work together to make this happen.

  • G. Sauers

    The truth of the matter is…………..we still have hundres of thousands of Americans without insurance. Thus, healthy visits with a physician are not taking place, minor ailments are not being addressed, or being addressed in the costly ER, or not being addressed manifest themselves into a host of costly hospital admissions…………………one must account for the costs of these unreimbursed services to the American people (today).

    Also, lets not forget the congestion of our ER’s by ailments best suited for a Primary Care Physician.

    We all have disagreements with the Obama proposal in some fashion, but in critiqueing the plan…………are there any other solutions being offered?

  • http://fertilityfile.com IVF-MD

    G. Sauers,

    Are minor ailments and office visits really the problem here? Or is the problem more focused on catastrophic illnesses?

    Providing for everybody’s medical visits for flu, urinary tract infections, or small cuts requiring bandaging is already solved.

    Ask yourself this. If your car breaks down, is it totally inconceivable that you would pay four hundred dollars to have it repaired and then also add a little bit to get some maintenance done? If you can’t, then what would you do?

    If you can’t find a health care provider to address the above issues for less than $400, then yes, there’s something not right about that. I hope I’m not wrong, but I suspect there are many physicians out there who would very willingly help you “fix” those ailments for that amount, fairly equivalent to what people pay when their car has a “minor ailment.” I personally have in the past, do at present, and would in the future provide care for a simple UTI or equivalent MINOR ailment for less than $100.
    Isn’t the crux of this health care debate more concerned with huge catastrophic illness? That’s why insurance is needed to cover the unpredictable. As for the little things, why would you not expect it to have at least as much value to remedy as it would to fix ones automobile?

    I’ll agree with you that coverage for major illnesses is a problem that we need to tackle, but if we cloud the issue by declaring the management of minor ailments to represent a “broken” system, then you could pretty much argue that everything in this country (clothing, auto care, dining out, entertainment) is “broken”. Agreed?

  • G. Sauers

    I firmly believe that many Americans who cannot afford their copay’s, or who do not have insurance, will not present themselves to a Primary Care physician or 24hr clinic for cold, flu and other minor ailments for treatment.

    Thus, a portion of these conditions end up manifesting themselves into a catastrophic illness (please forgive my spelling).

    It is the reduction of catastrophic illness that Health Insurance plans try to execute. After all, this is the reason Health Insurance was developed; to keep employees healthy and productive. It is the pay me now, or pay me later scenario.

    If I define a catastrophic illness as an episode of care that requires either an ER visit and/or a hospitalization – than many of these catastrophic illnesses could be eliminated and treated in an outpatient setting (physician office or clinic) at the onset of the change in condition.

    If this assumption is correct, then the question becomes, in the long run, would the reduction of costs associated with the uninsured recieving care at the ER and/or Acute setting be greater than the cost of providing Health Insurance coverage (either through payment of premiums to a commercial plan or a federal entitlement program)? If the answer is yes, then sign every one up for a Health Insurance benefit. If not, then lets spend the money elsewhere.

    An over simplification I know, but to me that is the Black and White of the issue.

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