If I were king, no politician or health care lobbyist in Washington would have health insurance until every other American had it. They would be the only Americans who could be bankrupted by health care bills until no one else could. With those rules in place, I bet they would fix our health care mess faster than a scalpel fixes an abscess.
It appears, however, I am not to be crowned anytime soon, and the recent election of the 41st Republican to the U.S. Senate means Democrat-led health reform efforts there have been cut off at the knees. Despite that, no one should give up on the possibility that our leaders in Washington could still earn their pay and bring big improvements to American health care this year.
Consider this quote: “The health care system has serious problems. Costs are rising at three times the inflation rate. Many Americans are uninsured. Millions more fear losing their insurance in a weak economy or because of pre-existing conditions. Doctors are ready to close their doors because of high malpractice insurance costs and low government reimbursement rates. Everyone agrees that something must be done.”
That sounds just like Democrats, like President Barack Obama, but it’s conservative Sen. Charles Grassley of Iowa, the ranking Republican on the Senate Finance Committee, in his December 2009 essay “Health Care Reform — A Republican View” in the New England Journal of Medicine. He calls for reform that “would change Medicare so that it paid not for the volume of services provided but the quality of care delivered,” the formation of health insurance purchasing exchanges that would help lower insurance premium costs and a ban on pre-existing condition insurance coverage denials.
Grassley’s agenda sounds a lot like part of the Democrats’ agenda. If the two sides could get their collective acts together and pass legislation doing those three things, this would be a relatively great year in the long, slow march to remake the American health care system into something viable.
Just changing Medicare’s payment system from one in which the more tests doctors and hospitals do the more they get paid to one in which Medicare pays for better care could be extraordinary. While not easy, getting hospitals, physicians and other health care providers to be more efficient and effective in their spending of Medicare dollars could substantially cut Medicare costs. That, in turn, might help Medicare avoid going bankrupt in the next 10 years, and serve as a model private insurance companies could follow to reduce costs for all.
With that done, Congress could take a deep breath and then tackle universal insurance — the toughest health care reform nut of all — at some future date. Substantial progress on this seems unlikely this year for one simple reason: our politicians do not feel enough urgency to overcome their differences and get this done. Urgency in the context of a partisan political environment can be defined as that moment when the political pressure on both sides to do something trumps the political expediency and advantages of doing nothing. That moment is clearly not now.
Someday, however, perhaps next year or the next presidential election, there will be enough urgency to force our political leaders to figure out how to insure every American. It is inevitable; the inexorable rise in health care costs will continue to make health insurance unaffordable for an ever-growing portion of the middle class, which will then generate a political pressure no politician in America will ultimately be able to withstand.
That the richest country on Earth must bankrupt more families with health care bills, kill more people for lack of health insurance and produce a sea of misery threatening Congress with political drowning in order to insure every American is a travesty. But it remains an intransigent travesty for a while longer.
In the meantime, we should all resist the urge to crow or cry over the increasing likelihood that the Democrat’s health reform bill is dead in Congress for the rest of Obama’s current term, and try working together instead. A compromise bill based on Grassley’s suggestions could be a big step forward.
Erik Steele, D.O., a physician in Bangor, is chief medical officer of Eastern Maine Healthcare Systems and is on the staff of several hospital emergency rooms in the region. He is also the interim CEO at Blue Hill Memorial Hospital.