Healthcare Professionals for Healthcare Reform

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What I would have said to Paul Krugman

Paul Krugman had an Op-Ed piece today about his perception that the Obama administration is balking on healthcare reform. I attempted to post a comment on-line, but between the time I logged on and the time I tried to upload it they stopped talking any more comments. So I decided to post my comments here:Gil

The aim of healthcare reform should not be to save money or even to achieve universal coverage; it should be to improve the health of all Americans.

To do this in an affordable, efficient and politically expedient way, we need to recognize that at present there is no oversight body that directs the complex US healthcare system with clear goals of how to achieve these health goals. In addition we must acknowledge 3 things; the existence and role of rationing in all healthcare systems, the need to include private insurance in any American system and the inequities that now exist in the current publicly funded system.

In the current US system, rationing is manifested by limited services for the uninsured, underinsured (as in Medicaid) and even for those with private insurance (e.g. pre-approval/denials of test and procedures). Other systems (Canada and Britain), ration services more rationally, often based on scientific data. It is most likely that this is why, in part, countries with these publicly funded systems have better outcomes in infant and maternal death rates and have longer life expectancies than the US while spending less than half per person. This rationing is more codified than in the US but often leads to patients seeking services “outside the system”. This tends to lead to unregulated “private” parallel systems that compete with the public system, to the detriment of both.

Another problem in adopting these “single payer” types of system into the US is that they tend to be more expensive and politically unacceptable. This latter point is exemplified by a House bill (HR 676) introduced more than 2 years ago that advocates a single payer system that excludes all private insurance. It has sat in committee since introduction and, though picking up some sponsors, has not moved (and is rarely mentioned by the leadership or the Obama administration).

With these points in mind, what is the solution?

First, the creation of a “Federal Healthcare Board” that, like the Federal Reserve, is a quasi- non governmental body charged with improving US health outcomes in an efficient and affordable manner.

To better allocate public money a 3 tiered system needs to be established where these funds would cover a basic tier that would cover all services proven to be life saving, life extending or preventative. A second tier for services that improve quality of life would be funded by private insurance, while services deemed to be “luxury” (e.g. Botox) care would constitute a third tier and would not be covered- as is the case currently.

Although a single payer, universal system is theoretically the best for health outcomes, the reality is that we need to craft a truly American plan. Our group, Healthcare Professionals for Healthcare Reform ( believes that intelligent rationing is the most likely way to achieve universal coverage that will be effective in improving health and politically viable. 





January 30, 2009 - Posted by | Uncategorized

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