Universal Coverage: Fix Old Problems Before New

Fix Old, No New.

This sign held by a woman standing outside the president’s New Hampshire town hall meeting sums up how Americans feel about government “meddling in their healthcare.” Whether lawmakers or the president label it a public plan, universal healthcare or a plan “by any other name,” Americans don’t want it right now and said so loudly and clearly in resounding choruses across the nation. But Americans do have the appetite for and would support REAL reform in the country’s existing public and private payer system.

So what should Republicans do? (As angry voters gear up to send Democrats and the president a message, it seems the GOP is poised to pick up some seats in the 2010 mid-term elections.) I don’t think the time is quite ripe for the party to talk about universal coverage but I do think Republicans should begin to be the bearers of solutions for healthcare reform “we can believe in.”

People want to know their concerns are being heard and lawmakers don’t view them as “idiots.” Over and over again, Americans rose up at town hall meetings across the country and talked about the inefficiency and waste in current government programs like Medicare. Repeatedly, they told their congressmen they didn’t want more government in their lives and feared a government takeover of healthcare would mean less choice, more waste and inferior care. During Rep. Gene Taylor’s town hall meeting, a man said his nephew, who lived in New Zealand waited nine months for shoulder surgery which cost $40,000 and the government only paid half that amount. Not the kind of coverage most Americans crave.

In 2008, the US spent about $2.3 trillion on healthcare. Of that the federal government spent about $810 billion and of that Medicare accounted for $468 billion in spending. Medicaid (state and federal funds) spending accounted for about $340 billion in 2008. The Centers for Medicare and Medicaid reported in 2007 that they paid about $10.8 billion in fraudulent claims that they are aware of. By 2017, Medicare will go bankrupt unless the government finds ways to make it work more efficiently.

Why would any sane American believe adding another government run program into this mess at a price tag of another $1 trillion would be a good thing? The gamble on such an investment in debt is too costly right now for the American people to stomach and the prospect for return too low.

In the midst of all this angst and frustration Americans are feeling over Obamacare, most would agree the current system is broken and needs fixing before the country entertains a dialogue on universal coverage. With the rise of HMOs and PPOs, people with coverage have ever shrinking choices in providers or the type of care they receive. And when you read the fine print of your policy so much in the way of prevention isn’t covered, which means more out-of-pocket costs to you.

Even more insane, is that the insurance companies have determined all doctors no matter what their quality of care charge too much and should all get paid the same rate even for poor care. I’m sure I’m not the only person sick and tired of getting a claim back from my insurance company telling me my doctor who is thorough and caring charges more than their “allowable rate.”

Year after year, America spends the most on healthcare of any nation and yet our average life expectancy ranks near the bottom. The 90% of Americans who have insurance would like to see our system work better and find a way to help those who don’t have insurance get some coverage. Of the 45 million people who lack insurance, there are quite a number of these people who can afford it but choose not to pay for it.

But before anyone starts suggesting universal coverage, the American people want to see waste and inefficiency wrung from the current system and improvements made. If some real changes occur, maybe down the road the country would be receptive to discussions on coverage for all. By tackling real reform in Medicare and Medicaid such as: cracking down on fraud; focusing on prevention and healthy living; and devising a payment scheme which rewards doctors for keeping patients well, maybe then people would begin to believe government is capable of meddling in healthcare.

Instead of using town hall meetings to ram a healthcare plan down the throats of Americans, the Republican party should launch a series of town hall meetings to test real ideas on improving the nation’s current healthcare system. It could be called “Listening to America: Finding Meaningful Solutions to Healthcare Reform.” In advance of the town hall meetings, the party’s leadership could collaborate with other Republicans to develop a platform of ideas to discuss with Americans across the country and get their feedback.

Republicans need to emphasize that the meetings will be about dialogue - not a foisting of ideas upon people, but rather a two-way conversation about improving a broken system not inventing a new one. After the talk is done, Republicans will need to work in a bipartisan way to get legislation passed which turns these ideas into solutions for healthcare reform. The healthcare debate is giving the GOP an opportunity to transform itself from the party of naysayers to the party of problem solvers. I hope it rises to the occasion.

Some ideas for reform which Americans would be receptive towards:

• Antitrust Exemption for Insurers: End the antitrust exemption for insurers.  Insurance companies are exempt from the nation’s antitrust laws, which means they can band together and fix prices on everything from premiums to the rates they pay providers.
• Fraud in Medicare and Medicaid: Really get serious about it.
• Tort Reform: Lawsuits without merit against healthcare providers drive healthcare costs up and put good doctors out of business. The country needs to put the brakes on trial lawyers.
• Pre-Existing Conditions: Allow people with pre-existing conditions to obtain coverage.
• Prevention: Force both government and private insurers to lower premiums and provide incentives for people to live healthier lives. Obesity and related illnesses drive up healthcare costs.
• Mandate Individuals Buy Coverage: Those Americans who can afford healthcare insurance but choose not to purchase it should be penalized in their tax filings.
• Insurance Portability: Allow insurance companies to compete across state lines to increase competition.
• Medicare D: As the biggest purchaser of drugs, like the Veterans Administration, the federal government should have the ability to negotiate drug prices with pharmaceutical companies. The drug benefit is currently managed by private insurance companies and government can’t negotiate prices.
• Pharmacy Benefit Managers and Transparency: Pharmacy benefit managers (PBMs) are middlemen hired by insurance companies to handle their drug benefits. These companies have been the target of many lawsuits because PBMs don’t disclose the rebates and discounts they get from drug companies for pushing certain drugs or pass the savings on to insurers.