Will Obama’s Health Care Plan Work?

9 04 2009

I know we just met, so why am I talking about religion, politics, or money?  Well, regardless of your specialty, the much talked-about future health care dream has the potential to effect us all; therefore it needs to be discussed.  Sure, we’ve all heard the droning of pundits on the 24-hour cable news networks, but what about us?  What about the people that will be directly effected by the proposed sweeping change in American health care policy? I’ll try and be (1x) objective…

First, let’s take what the president said: here in speech form, and here in pdf bullet points.  The plan is broken into three main parts: lowering costs, universal coverage, and primary prevention.

Lowering Costs.  I think it’s impossible to argue that health care in America is cost-efficient, but I’m not writing to decry capitalism; actually, quite to the contrary.  This country is built on capitalism, the land of opportunity, and I think it is important that this be maintained.  That being said, pro-business does not equal anti-regulation, ever.  In fact, regulation is key to the success of capitalism.  Why?  Well, if people are allowed to cut corners, they will; it is only human nature.  So the government’s contribution should be closing the loopholes and making sure people are getting compensated appropriately.  Clearly that is not happening right now.  Most egregious has to be HMO’s and insurance companies.  The fact that the CEO’s of one of the first HMO’s could be one of the richest men in the world is at least a little bit sickening.  That’s not to say that we don’t need insurance companies or that insurance should be handled by the government (as we all know government also equals overhead), it does mean that competition is very important.  The problem is that people are essentially tied into the health care plan offered by their jobs.  One of Obama’s bullet points promises to change this.  This only works if either insurance is similarly and competitively priced, or if there is a set amount of reimbursement expected from the employer.  We’ll see.  

The first bullet point is actually about EMR’s.  This is some nifty forward-thinking.  Of course nobody would really be against this, but I am glad it is a priority.  Apparently, at least one estimation quotes an annual savings of $77 billion.  I’m sure everyone reading this is behind that one.

He also talks about allowing importing of cheap meds, and reducing the overall cost of brand-name meds.  My only qualm with this is if it would stifle R&D by removing some incentive to push the limits of science.  Realistically, I don’t think this will stop anyone, but I think it’s something worth keeping an eye on.

Finally, Obama’s plan includes tort reform (a no-brainer), and a soft “general cleaning” of the system. 

Universal Health care.  I’ll come clean at the get-go.  Health care should be a right.  For whatever reason, you can agree or disagree, that’s just how I call it.  However, a single-payer system is NOT the answer.  Health care should be available to everyone, and to some degree everyone should do their part to support their fellow American.  This is not only important morally, but fiscally.  A tremendous amount of health care dollars are wasted in the ER.  If everyone had health care, these pro-bono ER check-ups should decrease significantly.  I remember in medical school, the administration essentially told us that 30% of our $50,000 tuition went to pay for treatment of those without health care; they could have been lying, but I’ll never forget that.  So, available care would not only get everyone covered, but it would also decrease cost.  But why not a single payer?  Well, that is a monopoly.  We physicians already have a difficult time with reimbursement.  With a single payer, there’s no competition and we’d be forced to accept whatever was offered as payment.  FAIL.  Obama’s plan is clever in this way.  He would create coverage for everyone, but allow you to keep your own health care if you have it.  That may stratify treatment into a two-tier system, but anything is better than no health care at all. In his own words:

“The Obama-Biden plan both builds on and improves our current insurance system, which most Americans continue to rely upon, and leaves Medicare intact for older and disabled Americans. Under the Obama-Biden plan, Americans will be able to maintain their current coverage, have access to new affordable options, and see the quality of their health care improve and their costs go down. The Obama-Biden plan provides new affordable health insurance options by: (1) guaranteeing eligibility for all health insurance plans; (2) creating a National Health Insurance Exchange to help Americans and businesses purchase private health insurance; (3) providing new tax credits to families who can’t afford health insurance and to small businesses with a new Small Business Health Tax Credit; (4) requiring all large employers to contribute towards health coverage for their employees or towards the cost of the public plan; (5) requiring all children have health care coverage; (5) expanding eligibility for the Medicaid and SCHIP programs; and (6) allowing flexibility for state health reform plans.”

Promoting Primary Prevention.  This is another no-brainer and includes educational programs about everything from AIDS to obesity and should not be under-played, but for the purposes of this blog, let’s just agree that it is a good thing, that may or may not actually happen or may or may not impact people and achieve it’s stated goal.  I think it does, however, fulfill the purpose of rounding out a complete plan.

Finally, how do we pay for this? I mean that’s the trillion dollar question.  I can not begin to speculate on this.  Obama says money will come from increased taxes on rich people and repealing of tax cuts and from the reform of the bloated health care administration sector.  I think if anyone claims to know how this will play out is talking out their arse.  There are simply too many variables to calculate with any certainty how much it would cost and how much money would be saved/raised under this plan.  Here’s what Obama said in Illinois:

To help pay for this, we will ask all but the smallest businesses who don’t make a meaningful contribution today to the health coverage of their employees to do so by supporting this new plan. And we will allow the temporary Bush tax cut for the wealthiest Americans to expire. But we also have to demand greater efficiencies from our health care system. Today, we pay almost twice as much for health care per person than other industrialized nations, and too much of it has nothing to do with patient care. That’s why the second part of my health care plan includes five, long-overdue steps we will take to bring down costs and bring our health care system into the 21st century – steps that will save each American family up to $2500 on their premiums. 

First, we will reduce costs for business and their workers by picking up the tab for some of the most expensive illnesses and conditions. … Second, we will finally begin focusing our health care system on preventing costly, debilitating conditions in the first place. … Third, we will reduce the cost of our health care by improving the quality of our health care. … Fourth, we will reduce waste and inefficiency by moving from a 20th century health care industry based on pen and paper to a 21st century industry based on the latest information technology. … Finally, we will break the stranglehold that a few big drug and insurance companies have on the health care market. 

In conclusion, there are big positives and potential big negatives.  I just hope that we get universal care while keep capitalism and competition in play so everyone gets care, and I can still pay my loans back…

Agree? Disagree? Sound off below…

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