Frustrations with healthcare reform

From my perspective, it has been a frustrating few weeks.

The number one reason for my frustration is the country’s lack of courage in doing anything about healthcare reform. Now, I’ll point out to you that I’m a bleeding heart liberal. At the same time one of my hobbies, my main hobby in fact, is studying American presidential history. Knowing it as I do, I don’t get as upset when there is partisanship and infighting in Congress. Having the perspective that when the country is ready for things, it does take action.  Unfortunately, it’s usually crises that make us take action, whether it was the Civil War, Pearl Harbor, Kennedy being assassinated leading to Lyndon Johnson being able to create a lot of reform, Katrina, and of course 9/11.

I don’t know what it will take to get the country to realize what a catastrophe we have right now without healthcare reform.

For 17% of the gross domestic product it continues to rise by a quarter percent per year.  It will make our country absolutely noncompetitive in the world market. What’s frustrating is, one party tries to do one thing and the other just opposes it regardless or one party declares “let’s start from scratch,” when we all know that the lobbyists for the insurance companies and those who benefit by keeping the status quo do everything in their power to keep it as-is.  This is done regardless of the fact that we all know how much waste there is in healthcare and how our total outcomes compared to other developed countries is only average.

On top of this, I read this week that Anthem Blue Cross, a Wellpoint subsidiary in California, says that their insurance plan will see increases as high as 39%. They are in what Paul Krugman calls a classic insurance death spiral.  Insurance only works if insurers can sell policies to both sick and healthy customers. He says that if too many healthy people decide that they’d rather take their chances and remain uninsured the risk will deteriorate, forcing insurers to raise premiums.  This in turn leads more healthy people to drop or send the risk pool even further, and so on and so on. Unless someone, a national leader, perchance the President, gets up and says we have to do this or we will continue to see healthcare eat away at our economic lives.

On top of this, the week was further made enjoyable by the constant bombardment of regulations and bureaucracy. Every United States hospital is regulated by at least 38-40 regulatory bodies; all the way from Joint Commission, CMS, to OSHA. Each one in of itself has hundreds if not thousands of rules that we need to abide by. I’m not opposed to regulation — we saw what happened in the banking industry — but at the same time there has to come a point where you are drowning in them so much so that you can’t even face doing the work you need to do.

On top of this, of course, are all the new quality measures that are being required by AHRQ, NQF, NPSF states, etc., with dozens if not hundreds of criteria that one has to try to meet to make sure that we get paid or that we keep our accreditation. It is almost incomprehensible to try to figure out which are mandatory, which are not mandatory but will lead to more payments, which would be nice to do, and whose in charge of them. I know many people are opposed to a centralized body overseeing quality and healthcare but I would tell you without it we have hundreds of companies telling us what to do and none of us know which ones to listen to. We try and listen to all and of course and of course if we listen to all we’ll never be successful.

I don’t know if we try to keep up or are we better served by realizing what every other service industry, manufacturer of products, knows and understands, it’s the value equation. Give people continuously better quality in your product or service which you can prove, give them service that meets their needs and do it at lower and lower costs. My sense is if all of us would focus in on that, then all of the other things would take care of themselves.  Until then I’ll just keep plugging away, beating our heads against the wall and feel a little more frustrated. What do you think about the state of healthcare reform in the U.S.? Leave a comment below.

Phil Kibort, MD, is Children’s vice president of medical affairs and chief medical officer. Read his bio here.

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