Healthcare Reform? They're Just Messing it All Up Again...

I had high hopes for healthcare reform; it appeared to be a once in a generation opportunity for our politicians to deconstruct a costly, broken system and build it up again in a manner that was sustainable and economical.
Those hopes are fading fast.
What I have seen thus far is a lack of political will to address the truly difficult and costly elements of our healthcare system, and instead focusing on creating a gargantuan new coverage program.

What don’t they get?
Our healthcare delivery system needs to be reformed, but they have continued to focus on the healthcare financing system, which also needs to be reformed and adjusted but can only be addressed once we figure out the issues within the delivery system. I have heard physicians and hospitals argue that the costs are going up because there are simply more patients to treat; not true, costs per-procedure have risen dramatically. What’s more there are great variations in any given marketplace for what the government and other insurers will pay for a certain procedure.
This is not how the system should work.
The government should be utilizing their massive purchasing power to drive down prices, much as any large business would do, and pass those inherited savings along to their consumers (taxpayers), but to date they have shown frighteningly little willpower to address this issue head on, far too afraid of upsetting the powerful hospitals and physician lobby’s they are ultimately beholden to.

A truly reformed system would have had a radically different look and feel from our current system; with care, profits, and services being redesigned to meet the needs of taxpayers, patients, and healthcare professionals. Incentives would be aligned so the government is paying the best price possible, while also delivering high levels of care to their customers, the insured.
Homecare and comprehensive hospice and palliative care services most certainly would have played a much more central role in the process as they produce massive savings and synergy relative to institutional based care…but was that really ever part of the process? I saw much more from the big insurance companies, big pharmaceutical companies and big hospital and physician lobbyists than I saw from any small homecare or hospice agencies. I nosed my way into a few “conversations” with high ranking government officials and tried to deliver the message of homecare. They listened and nodded politely, the look in their eyes betraying their intention to brush aside everything I said, if only so they could look back at the end of the process and tell a story about “engaging the American people.”

We haven’t reformed the system and we won’t. They will take care of their favored causes and groups, make sure they don’t upset the big business (for profit and not for profit) apple cart, and march forward to pat themselves on the back for providing our country with “reform.” By the time the general public realizes they still have a broken and unsustainable system, the politicians will have long since retreated to a comfortable retirement, or moved onto the much “greener” pastures provided by government lobbying roles and “industry consulting.”
As a small business owner my concerns are many, but my chief concern is this; our government doesn’t operate with any fiduciary concern for the overall welfare of the country or the people who pay for what they do. They don’t seem to work as if they have any “skin in the game,” and seem consistently more occupied with “political realities” than national realities. On a micro level it is very simple to me; if they allow our system to continue to disproportionately reward hospitals and physicians they will continue to see costs skyrocket. If they take the time to study the system – instead of capitalizing on a moment in time, a political convenience resulting from campaign and election cycles – they could build a system that works better for beneficiaries, doesn’t choke businesses with the costs and actually has a long-shot of working well into the future, aka “sustainability.”

I am frustrated. I am disappointed. I am scared.

There are too many people who are rushing headlong down this reform road right now, and I haven’t heard much logical or rational discussion about it. A lot of platitudes about covering the uninsured, enhancing the system, efficacy, accountability, rationing, socialized healthcare…the droning goes on and the partisanship has long since gotten very ugly. But what’s lost in the discussion is a healthcare delivery system that is badly in need of reform and service providers and payers who have gotten away with bludgeoning the American people to death with fees and cost increases, while others of us have had to consistently swallow reductions to pay for their increases. Who do you think Congress has come to every year to pay for the “Doc Fix?” DME providers pay the piper every time to make sure the doctors still get their money. A physician recently wrote a Wall Street Journal editorial and asked what other providers have actually seen reimbursements decrease over a 20 year period? Me…thanks to you.

Call your Senator or Congressman if you share my frustrations – it’s the small act that makes a democracy what it is. But know that while your leaving voicemails with an intern, some lobbyist may well have him out on a golf course, or in a luxury box, and be spilling little white lies about how they need to reshape the system…come the next election cycle they’ll also stuff their campaign coffers to ensure they still have a friend in DC.