Health Care Reform Roadmap

HEALTH CARE REFORM

Let’s Start the Process With a Few Smaller Steps

The Wall Street Journal reported on Feb. 23, 2010 that “in a last-ditch effort to salvage his overhaul of the sector, the President unveiled a $950 billion plan that lays the groundwork for his party to push through legislation without Republican support.”

A ZOGBY INTERNATIONAL poll reported in the Feb. 17, 2010 Washington Times showed that 57 percent of Americans are not in favor of either healthcare bill produced by the Senate or House and believe Congress should start over.

This “new” plan is based primarily on the largely unpopular Senate reform bill, but costing roughly $75 billion more.

All this is happening even though many Americans reportedly don’t want it. A Zogby International poll reported in the February 17 Washington Times showed that 57 percent of Americans are not in favor of either healthcare bill produced by the Senate or House and believe Congress should start over.

It’s true the healthcare system is large, complex, and fractured – making reform a daunting task. However, couldn’t we start the process with a few smaller steps, and then build upon the framework instead of trying to change it all in one fell swoop?

For instance, consider the following initiatives as a starting place:

Standardize Plan Designs

Imagine standardized benefit plans similar to the current Medigap model. For example, 10 standard benefit packages could be developed that all include minimum hospital and medical coverage.

Then add back in more expensive coverage provisions until you have an array of plan offerings, with a more basic package on one end of the scale and a plan offering all the bells and whistles on the other end of the scale, while still allowing for plenty of consumer choice.

Premium rates for these plans could be filed with a central governing body such as the National Association of Insurance Commissioners, whose affiliates now oversee rates on a state level. This could represent a good compromise on the state versus government regulation of rates.

With centralized rates and standard plans, carriers could sell across state lines, competing on price, quality and service. Plus, employers or unions could still offer additional benefits above and beyond those included in the standardized packages if they wanted to.

Control Costs

All the major stakeholders realize we can’t have true healthcare reform without addressing the underlying costs. Let’s start with holding 2009 Medicare rates for 2010. Since employees across the country have gone without raises and millions have lost jobs, how can providers lobby for a pay increase during one of the most severe economic recessions in our history?

ALL THE MAJOR stakeholders realize we can’t have true healthcare reform without addressing the underlying costs. True payment reform must reward providers for shortened hospital stays, better outcomes and better health.

Of course, that’s only the beginning – true payment reform must reward providers for shortened hospital stays, better outcomes and better health. Providers will find efficient ways to manage costs that cannot be dictated by law.

If providers are paid a lump sum to treat a certain condition or event, they’ll have an incentive to collaborate and get the best results for their patients at the lowest cost. Several pilot programs have already proven success with this type of arrangement.

Another way to offset reform costs is to find additional sources of revenue. One idea is to tax the value of benefits employers provide. It is estimated this tax shelter was worth about $133 billion in 2008 alone, and over a 10 year period it could completely offset the costs for expanding healthcare coverage to insure all Americans.

Not only does it make economic sense, but it will also level the playing field for individuals who purchase insurance in the free market and aren’t offered the same tax shelter.

And how much more money could be saved just by targeting fraud more aggressively? A report on www.CNNmoney.com (1/13/10) stated that fraud costs Americans more than $100 billion every year, and the leading cause is healthcare identity theft.

This typically occurs when someone sells patient records to organized crime, who then files claims and gets paid for services or equipment that was never provided. Let’s improve financial safeguards to prevent fraud in the first place, but also increase enforcement and stiffen the penalties.

Improve Technology

Finally, by improving technology, patients and providers would have better access to information about the most cost-effective treatment options available.

Standardized electronic medical records would provide a complete and accurate picture of a person’s health history. For example, if you’re out of town and get sick or injured, all of your records would be available for your new doctor to see if you have any allergies or other conditions that could affect your treatment, and then your doctor at home would have updated information to effectively continue your care.

It would also help different doctors avoid ordering costly tests you’ve already had, or may help one doctor find something another one may have missed. Electronic records can also reduce prescription errors and lower costs—clearly a win-win situation.

We also need more transparency when it comes to cost and quality. Patients need to easily see how costs for the same test or procedure can vary at different hospitals or outpatient centers and which facilities have the fewest infections or other complication rates. With better information, patients can truly make informed decisions about where to receive care.

Starting with these steps may allow us the time we need to tackle those prickly issues like tort reform, guaranteed-issue portable individual coverage with play-or-pay penalties, and elimination of pre-existing conditions, instead of trying to figure out how to do a total overhaul all at once.

Angela Handa

ABOUT THE AUTHOR

Angela Handa is vice president of Sales & Service at Health First Health Plans. A cum laude graduate of Boston University with a Bachelor of Arts/Economics and Psychology, she has also earned accreditation as a Certified Financial Planner, Certified Managed Care Executive, and Certified Employee Benefit Specialist. The views expressed in this article are hers alone and do not represent the views of Health First Health Plans, Inc. or Health First, Inc.

Space Coast Medicine