Tuesday, November 10, 2009

What are we fixing with healthcare reform?

The House has passed its healthcare reform bill. The Senate has one out of committee. The two don't match. Why can't the members of Congress agree on what to do?

One reason is that we have apparently rushed to "reform." Reform what? Who has been the voice to ask "What is the problem?" or "What are the problems?" or even "What should the ideal future look like?"

Instead, it seems like individuals have their pet peeves with items under the umbrella of healthcare. We need tort reform? That's a fix. What's the problem and its cause? Some would say that lawsuits are too costly and drive up malpractice insurance costs. Ah, here is a cause for the problem lurking below the solution. How about another problem? We must reduce unnecessary medical procedures. Oops, that's another fix. What's the problem? Is it fear of lawsuits causing doctors to cover their unclothed hospital behinds (a problem every patient can relate to)? Ah, yes, another cause pokes it heiny out. But wait, is it the real cause? What about the poor coordination and information sharing among medical providers that causes duplicate testing ("We only trust 'our lab'"). Do we have more than one cause for the same problem? If so, which solution do we use, or do we need multiple solutions? Are these even the top priority problems? No. They are merely easy examples of what seems to be a non-systematic approach to the entire issue.

The rush to fix a system that is suboptimal is overdone. The current system may be imperfect, but it is not on life support. It seems unbelievably optimistic that legislation hammered out in a matter of a few months will effectively deal with such a mammoth and complex issue as healthcare. Particularly when it is brought to us by the same body that cannot make Medicare financially viable in the near future.

Even the terminology belies the insufficiency in the approach. People talk about healthcare "reform." You can "reform" a lump of clay, but it is still clay. You can "reform" an alcoholic, but he is still an alcoholic. You can reform healthcare and simply substitute one symptom for another. What we need is healthcare "improvement." Reform can be worse than the current situation and still be reform. This isn't just picking on terminology, it goes to the whole perspective being applied to the effort.

Bob Corker, the senator from Tennessee, made a short statement on TV news. He correctly pointed out that the current bill is hugely deceptive in its costing. The revenue support portions are due to start immediately to pay for the program, while the actual program itself does not begin for four years. Ten years of revenue vs. six years of costs is blatant distortion of the operating costs for this legislation. How can any reasonable Congressperson subscribe to this mockery of intelligent administration? No one in business could do this without being labeled a fool or a liar. This is nothing short of political camouflage for fiscal irresponsibility of the worst order. And, if I have this correct, Congress will maintain its own independent healthcare coverage after they "reform" it for the rest of us. A dose of its own medicine might cause it to cough up a more realistic result for everyone. Tell your Congressperson you want Congress to participate personally in the reform by using the system it creates. While you are at it, ask them to list the problems they are fixing and the causes of those problems.