If Healthcare Reform Fails

While the changes President Obama and Democratic leaders in Congress are proposing are considerable (they could reduce the deficit within two decades), they aren't a government takeover.

"If Reform Fails", a NY Times Editorial (pub. March 6, 2010) states that the status quo is immoral, impractical and unsustainable. Here, with my editorial license are its main contentions:

While the changes President Obama and Democratic leaders in Congress are proposing are considerable (they could reduce the deficit within two decades), they aren't a government takeover.

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Cardinal Economic Principle for Egalitarian Healthcare Reform--The risk must be spread over the entire population and everyone* with legal status in this country gets coverage, or gets help getting coverage or pays a penalty.

*Job or no job, coverage is secure; preexisting condition like having a uterus or being only ostensibly healthy during the last second when applying for insurance--no longer a deal-breaker for insurers who want to be players.

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Where are the social workers when you need them?

But, the cost of medical care is rising far faster than wages or inflation! Coverage is made cheaper thru competition (exchanges or even eventually some form of private option) and thru comparative effectiveness research (CER), process and outcome studies, done dynamically and made practical through a decision support system (DSS), available at the point of care.

Care with Caring (spotty, but all of this already exists)o

oThe bio-psycho-social model of healthcare, early intervention, primary, secondary and tertiary prevention with better accessibility ('A stitch in time saves nine'). Point of care management (patient-centered medical home, complete with a safety net and plenty of primary care practitioners not given the short shrift in the payment system), advocacy (the Hippocratic tradition), but coupled with no-hurdle patient financial responsibility (ie, a degree of cost-sharing, but no balance billing; no barriers to care such as prohibitive out of pocket expenses), and triage by clinicians, not insurers. Who would have thunk possible?

Cost-effectiveness, not Cost-minimization

From Fredrick (MD, PhD, JD), sent March 8, 2010 12:54 PM (EST)

This editorial ignores all the bad things about the current bill (which I won't bother to list again), as well as the probability that trashing it would allow Congress to write a bill with what the majority of Americans want - to be out from under the thumb of the rapacious private insurance companies.

As an example, it uses the recent price hike by Anthem, but doesn't mention that this bill would do nothing to prevent such profiteering.