Posted by: Audrey Erbes | October 11, 2009

Why Health Care Reform Needs the Public Option

The U.S. Health Care System is complex—so complex that there’s no graphic to do the interrelatedness of its organizational parts justice. Some would even say that to call health care delivery in the U.S. a system is an oxymoron—there is no system. Unlike the establishment of a totally new Social Security program where there was no existing system to replace or reform, it was possible to create a new agency without “goring anyone’s ox.”  The attempt at a major overhaul, for the most part, of a uncoordinated tangle of highly bureaucratized and interest-group-beholden and burdened units, is viewed as almost impossible. There’s agreement that change is necessary as the costs of this approach to health care are untenable. But how can a democratic society, where private interests hold no much power, accomplish this?

My earlier career in the research and analysis of the operations of political systems and how change was accomplished without a revolution left me with the conclusion that a total change of U.S. health care is not possible. But incremental change is. That’s why governmental budgeting is so different than that of businesses—typically, you introduce change with associated new costs—incremental costs—while you never entirely erase earlier programs, no matter how dysfunctional they might have become.

Now to the point of reform of U.S. health care—since we can’t eliminate the current operations or dismantle tjhem with the passage of a bill in Congress. we can only hope to achieve a redirection in its mission and outcomes which will achieve the goals of affordable health care for all. As noted in today’s Philadephia Inquirer article by Stacey Burling “What Behind Rising Health Care Costs? Lots;” he concludes it’s relatively uncontrolled prices, insurance that hides real costs from consumers, heavy use of procedures, marked differences in treatment patterns, and excessive administrative costs.

In a report by the Kaiser Foundation summarized in a recent Seattle/Local News Group article “Why Are Health Costs So High?”, the conclusion is health care costs are growing so rapidly because physicians deliver more health care than is necessary or good for the patient—in fact about a third of the care is unnecessary. The reasons for the escalation in care are multi-factorial. It’s due in large part to the method of physician payment by  “piece” called “visits” and “procedures”; increased specialization of doctors as medical students learn that primary care doctors earn far less than specialists whose visits and procedures are more highly paid; administrative cost of interactions with insurance companies; and defensive medicine (equals more visits visits and procedures) to avoid lawsuits. My husband, with whom I’ve discussed this issue a lot, suggests I include the support of high insurance industry profits, salaries, advertjsjing budget and lobbying war chests to keep it that way. In other words, changes not only can provide better, affordable care for more people but also potentially negatively affect the jobs, incomes or future election support for others.

I suggest that some form of a public policy option is necessary as part of the likely incremental changes any successful Congressional bill will achieve.  It will provide a reference point of pricing for health care services that forces real competition.  Initially, managed care organizations and insurance companies provided their stockholders the ever increasing profits per annum by increasing the number of patients covered. The appearance and growth of “cancellations” and “denials of care” for “preexisting conditions” and “experimental drugs” provided a source of continued growth when treatable patient enrollments became saturated. Profit seeking has distorted the mission of delivery of health care.

I personally think the public policy option of a federal program with the ability of states  to opt out discussed in today’s Huffington Post might be a basis of a bipartisan solution.  Those who fear the change can avoid it without depriving others who want it. We’re often heard that democracies are experiments in action—this would be another laboratory  test to watch.



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