Should the US have a national healthcare reform plan

First let me quote an article from the WSJ last Friday (September 4th) - How to insure every American

"Americans nationwide have voiced their desire for greater control over their care and for reform in digestible pieces." - JOHN SHADEGG AND PETE HOEKSTRA ¹

There are two very important aspects within that quote.  The first is Americans do want change in healthcare and recognize the need for some reform.  The second aspect is the change must be digestible implemented over time, and needs to come from a cross-party, intelligent team.  Ideally the plan for our healthcare reform would come from a round-table of industry experts who know the details of the problem, and have identified ways to improve in the past.  I do not admit to understand all the issues, but I do know this...we should treat this the same as we would a new business startup.  In fact if these companies knew what was best they would start to evaluate their businesses and evaluate their pricing policies to help consumers.  The ones who wait until the last minute or change after the new solution will be looked upon very poorly.  Imagine it is 2013 and your policy is adjusted down by XX^%...how are you going to feel, and are you going to ask why they didn't do that sooner.  Now the next day you talk with your neighbor and they said...oh yeh, back in 2009/2010 my company adjusted my policy down because they realized they could drive efficiencies within the process.  Imagine the goodwill the second company will have received vs. the first company who will probably experience a mass-exodus.  Of course the day after people are going to start going after them just like they are today after the bankers like BearStearns, and probably rightfully so.  Now given my statements above...I want to make it clear I'm not trying to propagate fear^7,8,13, rather I'm trying to suggest that the companies evaluate their policies and re-consider pricing.  Just remember mandates from the Government are NOT the answer...we need a jointly agreed upon solution.

First and foremost we need to properly identify the entire problem before we begin implementing solutions.  Now, I don't mean we just say that we have a problem, but drill into each and everyone of the issues creating a detailed fishbone diagram and/or process map analysis to identify exactly where we are having the problems and attach weights to each point.  This should allow the "expert round table" to focus on the most costly areas to drive quick improvement, later focusing on areas that don't have a high / costly impact.  One of the main components this needs to address is the fact ^1/₅^th of the American economy is spent on health care...or $2,500,000,000,000 (2.5 trillion)⁴. That said I am still confused about how countries outside of the US which have a government sponsored (universal health) are spending less per capita than the US, yet the talk is of expectations of an additional $1,000,000,000,000 (1.0 trillion)^4,12 of additional spending if the US moves to a universal health care program.

For congress to gain the support of their constituents they need to keep people informed, distill the facts into simple but factual presentations / documents / blogs, continue to refine the improvements and not bicker back and forth.  It will not do anyone good for either side to point the finger back and forth at the other one.  If we ran our business like the government nothing would ever get done because one faction would constantly blame the other, and we wouldn't make any progress for years!  I also think that Congress needs some severe motivation to solve this problem (again with a round table of experts)...and maybe they should announce they will pay for their own insurance or another radical idea to help them become motivated to reach a mutually agreeable and acceptable solution for the American people. ^{Above goes back to reference 6. Now everyone must remember we don't want mandates, we want CHOICES.}


As readily admitted in the article government helped create this problem so, why do we expect they will solve this problem by themselves.

"Government has caused the problems we face in health care." - JOHN SHADEGG AND PETE HOEKSTRA¹

Today I see ads for everything related to insurance and I even have the opportunity to buy insurance myself if I were a contractor.  But companies don't have a real opportunity to buy across state lines, so there is no real competition within the insurance industry.  As noted in the reference 1 car and life insurance companies can sell across state lines thereby increasing competition, decreasing costs to the consumers and naturally driving efficiencies into the process.  None of the aforementioned exists within health care because there is no real competition...and we haven't even really started with the drug companies, but we will probably leave that out of this post :-).  Most companies within the past year or so have taken to reducing costs, most of which have been salary reductions, but the next cost they may consider is health care benefits if the costs continue to rise. 

On the topic of pre-existing conditions...there isn't much really to say.  There is always some company that will cover a driver that has numerous auto-accidents, and while it is different than a pre-existing condition why don't we do the same for pre-existing conditions?  I do not recall if it was an urban legend or reality but I have heard some insurance companies treat pregnancy as a pre-existing condition.  Now I have two children and I would never say that my wife had a condition when she was pregnant and parenthood is anything but a condition.  I understand that everything comes down to money, but I think we should demand the health insurance companies really show us their books.  I don't know I'm convinced it really costs them serious money to cover someone with a serious illness that is pre-existing.  There are plenty of individuals who are health their entire life, without knowing the facts my guess is all the premiums they collect from those individuals overtime balance out against the costs and premiums they collect from those who get sick or have a pre-existing condition.

The last discussion point the article talks about Un-Insured Americans.  What a laughable topic...not laughable in the fact we have far too many people that don't have insurance.  Instead we have countless people who take advantage of our existing system by coming across the border for better health care and in effect getting free health care for which we pay out of our pockets later.  We also have numerous people going across the border OUTSIDE the US for dental care, and other procedures because the costs are cheaper in places such as Canada and Mexico.

From another post² Americans may generate a bit more of the problem themselves because...we don't eat and exercise like we should.  Having traveled just a little :-) within the past few years I have to agree.  I myself can even resemble the statement as I spend more time behind a desk and less and less time on a treadmill, elliptical, etc. In this case I think it was Safeway that had the right idea from the company perspective⁹.  They incent their employees to exercise, eat right and not smoke.  Again it might have been a different company, but my recollection from the TV interview was they covered more of the health benefits for the employees who ate right, etc...and they penalized employees who ate the wrong foods, smoked, etc.  Now they recognized that people can and do in fact change when properly motivated so, if someone was making progress they modified the benefits package accordingly to reflect the change in their behavior.

I guess my summary is...we must have a round table of experts within the industry, coupled with experts outside of the industry that know how to cut costs, while maintaining quality.  We need to have change, it needs to make sense, politicians need to work together (yeh right...when does that happen), and for a change they'll need to read the entire bill before they vote.  I am hopeful my children don't have to worry about this topic the same way my parents generation and I spend time thinking about social security¹¹.

I hope this post continues the debate and brings civility and discussion.

Thanks,

Bryan Karp

References and Related posts that drove my thoughts:

1. WSJ.com - How to Insure Every American
   We don't need radical change. Subsidies and high risk pools can get the job done.
2. Salon - The questions our healthcare debate ignores
3. Salon - Bill Moyers on the health care debate, Democrats, and Afghanistan
4. NYTimes - Following the Money in the Health Care Debate  
5. LATimes - Obama's big gamble on healthcare debate
6. YouDebate.com National Health Care Debate and Poll. Would you be willing to pay for National Health Care Plan?
7. NPR.org - In Health Care Debate, Fear Trumps Logic 
8. CNN.com - Rumors influencing health care debate
9. MSNBC.com - Big employers dip into health care debate
10. YouTube - Debate: Health Care - from 2008 democratic primary
11. Newsweek - Health Care as a Civil Right
12. WashingtonPost - States Assert Place in Health-Care Debate Health-Care Reform 2009
13. Jerusalem Post - The US health care debate - read during my business trip to Israel in August