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Analysis: Obama Reforms Require Sacrifice
Sacrifice is emerging as a recurring theme in President Obama's call for healthcare reform. At a half-day healthcare summit at the White House on Thursday, the president told a room full of key stakeholders on the issue that there should be no "sacred cows" in the discussion on healthcare reform, which he said will require sacrifices from everyone.
"Each of us must accept that none of us will get everything we want, and no proposal for reform will be perfect. If that is the measure we will never get anything done," Obama told about 150 people from the across the healthcare spectrum who were invited to the meeting. "But when it comes to addressing our healthcare challenge, we can no longer let the perfect be the enemy of the essential."
Bill Roper, MD, the CEO of UNC Health Care and the former director of CMS and CDC, says the public will most assuredly have to make adjustments in their own healthcare services to make the reforms work.
"Sacrifice is inherent in remaking the system," Roper says. "It's right to start talking about sacrifice because that is what is going to have to happen if we are going to have better quality and more cost-effective care. We've got to implement better information and better protocols and guidelines for the management of patients."
"We spend more per capita than any other nation in the world, so I would stipulate that we have plenty of money in the system. So, to cover those other approaching 50 million uninsured people means taking something that is currently being spent on you and me and spending it on a person without health insurance. That by any other name is a sacrifice."
Americans weren't willing to make that sacrifice in 1993, when President Bill Clinton tried unsuccessfully to push through sweeping healthcare reforms. "The Clinton reform effort ran aground when the average American realized that what was really being discussed was restricting their ability to do something and thereby save money from their care and use that freed up money to fund the care of somebody else," Roper says.
Roper says he has long been "deeply committed" to evidence-based medicine and he supports the $1.5 billion in Obama's stimulus plan that is earmarked for the process. "But what that means is we will come up with better information on what works in what setting and that means we will say 'no' to your request for knee surgery or x, y, or z procedure," Roper says. "That means a sacrifice. The American people are owed our honesty in this debate and I'm delighted that we are beginning to do that. To go around saying, 'We have the world's best healthcare system,' which we don't, and saying, 'You can keep every bit of healthcare you got if you want to keep it,' are just not going do it."
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hobcarroll (3/9/2009 at 11:00 AM)
Yes, there is enough being spent now to provide all legitimate eligible citizens/residents with a reasonable level of health benefits. However identifying the "fat" and shifting it to a position of better use is easier said than actually done. You need a mechanism for allowing this transition to happen effectively. The biggest "sacrifice" needs to be made by the federal government itself. It needs to relinquish its totally improper power of forcing price controls on providers, which shifts cost to the rest of society in the form of what is in reality an unauthorized and irresponsible tax that they do not have to "own up to." In addition, the BUCAHs must be deprived of their only real claim to fame - network discounts. You accomplish both of these goals and free a heretofore shackled market to operate much more efficiently by demanding transparency and fairness in provider pricing - what I call an "all payer" system. Providers should be allowed to set their prices where they deem appropriate based upon their own costs, quality, and perceived market conditions. They must charge that schedule to all patients, no matter what third-party payer (government program or insurer/health plan) is involved. Any amounts charged in excess of whatever the third-party payer allows in their contract with the patient must be balance billed, along with contractual cost sharing such as deductibles and coinsurance, to the patient. The provider should be allowed, on a one by one basis, to modify/reduce ONLY the net amount due from the patient, but on no basis that is in any way related to a relationship to a third-party payer. In other words, there can be no "proprietary" discounting of provider charges. In such an environment, true consumerism could come to the fore, as would true value added services from health plans in that they would now have to actually evaluate quality and price for establishing networks, innovating payment packages, benefit plans, and other services. In such an environment, we would be able to better plan for the other elements of system reform necessary to fixing current problems because the landscape would not be all foggy from the obfuscation created by the current pricing chaos. The congress will never do the right thing because the government is the biggest vested interest in the current way of forcing price controls onto the system. Fix the pricing structure, then you can mandate coverage, do away with underwriting, and move to fair semi-community rating. However, the market and the private sector could flourish in such a world. It won't happen till the travesty of justice represented by cost shifting is allowed to continue.