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Commentary: Politicians' Stab at Healthcare Reform is Unreasonable and Unworkable

Russell Libby, MD, for HealthLeaders Media, December 4, 2009

Is it possible that I just cannot do the math? Perhaps I just do not have the right perspective to understand the projected economics and concepts put forth in the variety of House and Senate bills flying fast and furious from our nation's brightest on Capitol Hill?

The premise seems to be that everyone can keep his favorite insurance coverage, keep his doctor, reduce her insurance premium, cover 30 to 40 million more people, keep Medicare the wonderful program it is, expand Medicaid to as much as 20% of the population, and, to add sugar to the deal, cut the federal deficit by $130 million.

Let me have some of that Kool-Aid. I can imagine how it's going to happen. They'll squeeze the evil capitalist insurance, pharmaceutical, and hospital industries, and create untold numbers of new government agencies to oversee and implement such efforts. Fortunately, we have seen how effective the government has been at running healthcare.

Medicare and Medicaid fraud has been rampant at about $120 million per year. The revenues to keep Medicare going are expected to be inadequate in just a few years, even without considering the 8,000 new baby-boomer beneficiaries per day who will be coming into the system. Meanwhile, Medicaid has already put a number of states into bankruptcy. I am not inspired.

If we have to legislate coverage, payment, and benefits, the political currencies will distort value and undermine success. When none of the bills include meaningful tort reform, changes that might recapture some of the $60 to $200 billion in estimated costs and better serve the public, something is wrong. The current system promotes cover-up, not safety or quality. It is a paradox that a reform effort to make healthcare an entitlement could be so short-sighted and self-righteous.

I thought Congress got solid negative feedback on the public option and several other elements in this legislation through town hall meetings and polls. However, they must have decided that we spent our gas and won't get in the way as they turn healthcare into another government-bungled bureaucracy.

With the persistence and insight of a testosterone-driven high-schooler with one thing on his mind, they keep coming back with a partisan approach saying "trust us; it's the right thing to do." What you can expect next is "I'm sorry" when they leave us with a single-payer healthcare system that will take decades to correct and which will sap our retirement funds.

There is no hope for an adequate revenue base in a society that has lost its ability to create jobs. The younger generation is looking at tax rates of 50% to 60%, with no guarantee of quality or access when they come of age.

I would much prefer seeing a two-tiered system that is defined in such a way that might preserve some of the attributes of our current system and inspire excellence and service. I would prefer to see the government subsidize physician and ancillary medical professional education that is paid back through work in these community health centers.

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