Inaugurating Health Care Reform: Managed Care 101 in 2010 (Part I-b)

January 20, 2009

Today is Inauguration Day and "Hope" and "Change" are waiting in the wings.

Today is Inauguration Day and "Hope" and "Change" are waiting in the wings.

Two-thirds of the opinion leaders in the Commonwealth Fund/Modern Healthcare Health Care Opinion Leaders Survey say that the new administration should vigorously pursue an ambitious healthcare reform agenda that simultaneously expands coverage, improves quality, efficiency and controls the cost of care. The vitally important tools of transformation mentioned in the Commonwealth Fund's source document, "Health Care Opinion Leaders' View on Priorities for the Obama Administration" include, but are not limited to: "investing in health information technology, providing federal Consolidated Omnibus Budget Reconciliation Act (COBRA) premium assistance for recently laid-off workers, and allowing long-term unemployed Americans access to a public health insurance program."

- The RollingStone, online magazine, January 14, 2009

Paul Krugman, the Nobel Laureate economist, in an open letter, advises the now President that he has a mandate for change and that the "biggest, most important legacy you can leave to the nation will be to give us, finally, what every other advanced nation already has: guaranteed health care for all our citizens.

Krugman sets the stage by drawing a parallel to President Franklin Delano Roosevelt.

FDR had to take the helm "at a moment when all the old certainties have vanished, all the conventional wisdom been proved wrong [and when we are] not living in a world you or anyone else expected to see. Many presidents have to deal with crises, but very few have been forced to deal from Day One with a crisis on the scale America now faces."

He continues: Mr. President, "Universal health care... should be your biggest priority after rescuing the economy."

The "vulnerability of Americans whose health insurance is tied to jobs that can so easily disappear" is palpable. And, the "current system is bad for business, too - the Big Three automakers wouldn't be in nearly as much trouble if they weren't trying to pay the medical bills of their former employees as well as their current workers."

Yet he doesn't feel that a single-payer system, (ie, Medicare for All) is "politically achievable right now, simply because it would represent too great a change. At least at first, Americans who have good private health insurance will be reluctant to trade that insurance for a public program, even if that program will ultimately prove better." So Krugman repeats the blueprint that then candidate Obama had spelled out as a compromise:

1) Provide universal access to care

2) Require that all children be covered

3) Allow people to keep their private insurance, or

4) Give everyone the ability to buy into a public plan, subsidizing insurance for those families with lower-incomes (if necessary by using a means test)

All this will be very costly, however, especially paying for those insurance subsidies. The naysayers will tell you that the "nation can't afford major health care reform given the costs of the economic recovery program." Here's why they're wrong:

1) The economic-recovery program will be "intense but temporary."

2) It "won't place all that much burden on future budgets [because with] long-term federal debt paying the lowest interest rates in half a century, the interest costs on a trillion dollars in new debt will amount to only $30 billion a year, about 1.2% of the current federal budget."

3) Furthermore, there's good reason to believe that health care reform will actually "save money in the long run," and that "a public plan…. will probably end up being cheaper and better than private insurance."

Referring to the opportunity, the 'low hanging fruit' as it were, Krugman indicts our current system, calling it "grossly inefficient," having huge gaps in coverage of both people and procedures, especially in terms of prevention, health maintenance, continuity of care and recidivism. It suffers from "huge bureaucratic costs," and he accuses the insurance industry of cherry picking and obfuscation—intentionally putting up bureaucratic hurdles and making us wait interminably on the telephone to have our care "authorized." Indeed, under a universal system, it will be much easier to use our health care dollars wisely and to direct patients to "medical procedures that work and not on those that don't. Since rising health care costs are the main source of the grim, long-run projections for the federal budget, the truth is that we can't afford not to move forward on health care reform."

To my readers: Isn't the lament that our system is "grossly inefficient" with gaps in coverage and missed opportunities for case management, etc, a call for universal managed care that will allow us to "spend money only on medical procedures that work and not on those that don't"?