Wednesday, July 22, 2009

How will health care reform change health care for the average American?

I've followed the current effort at so-called health care reform in the media, with various descriptions of the various changes embodied in the various proposals, but it is still unclear what the net impact will be for the average American, or even for any American.

First, the overall reform effort is really focused on coverage and insurance, not actual care. Sure, there is a lot of talk about how incentives impact care, such as how many tests are performed, but ultimately that does not translate into a net impact on care per se and doesn't tell the average American (or any American) what changes they can expect to see. Or, are we all really expected to see a dramatic decline in the number of tests that doctors perform? I'm sure there is some fraud with regard to tests, but my hunch is that the vast bulk of tests are performed because the doctors simply need the information to provide better care. What exactly would you want to change here?

I am sure that some of the uninsured will be provided with coverage/insurance, but not all. So, how is the average uninsured American supposed to figure out whether they will become insured? And, at what cost. Even low cost insurance will likely still be unaffordable to many people in the uninsured category.

I still have not heard a good, solid reason for why health care reform, other than simply covering the uninsured, should cost anything, let alone a lot of money. Maybe the real bottom line is that a single-payer system is much cheaper and more efficient, so our "desire" to maintain a much more complicated system means that it will inherently be much more expensive and much more inefficient. Makes sense, sort of, in a bizarre kind of way.

There is a lot a talk about reining in health care costs, but even the talk focuses on the long-term, with expectations that costs will continue to rise in the short term. In truth, even with all of the talked-about reform, health care costs will continue to rise, albeit at a somewhat slower rate, at best. Why no serious effort to actually dramatically reduce the cost of health care? That's an easy question to answer, if you are not a politician: Because the single best and maybe only effective approach to dramatically scaling back health care costs is to do something resembling a single payer system, and that is unfortunately political dynamite. They disparage it as socialized health care or socialized medicine. Makes it sound horrible. The alternative, what we have now, is... anti-social health care or anti-social medicine. Is that really better. Do we really need medicine and health care that is so much less social?

I continue to believe that health care reform will come in two stages. The current effort is stage one. The good news is that this current effort will break the logjam and finally get people in a frame of mind to actually change the current "system." The bad news is that the system will remain somewhat broken and horribly inefficient and horribly expensive. The second stage, real health care reform, will come three to five years from now when people realize that the current reform "package" is simply not good enough to deliver the changes we need, and people begin to focus on how to transition from the current reform to something that actually resembles an efficient, effective, and economical health care system.

Meanwhile, I, like most Americans, continue to have no idea what my own personal slice of the health care system will look like a year or two or three from now.

-- Jack Krupansky


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