Obama's Speech a Good Start

HealthLeaders Media Staff, June 19, 2009

I've been at the Healthcare Financial Management Association annual meeting in Seattle all week, so healthcare's been on the brain even more than usual. In fact, I wasn't even able to escape it in family e-mails this week. That's because my dad got his EOB statements from his recent cataract surgeries performed on both eyes.

Incidentally, the surgery went great. My 73-year-old father, who still runs about 15 miles a week, is now able to see without glasses—something he hasn't been able to do since he was about 14 years old. He also has figured out that in bright sunlight, most people—now including him—need sunglasses, something his cataracts kept him from noticing much in the recent past. So he's more than pleased with his eyesight, thank you very much. What he's not so pleased about was the cost of the care he received. His anesthesiologist bill for the surgery was just less than $1,000 for a 10-minute operation.

So his question to me was:

"Am I am paying for all the free healthcare given to others or what?"

On the surface, it's a simple question. But most of you know how complicated a full explanation really is. So as I always do when family members ask me to explain something about healthcare, I took a stab at answering.

"In short, yes, you are." I said. "But not as much as I am" (because he's on Medicare).

"Hospitals subsidize free or uncompensated care by making it up with commercial insurance plans, one of which covers all my healthcare. That's known as cross-subsidization. Most of yours is covered by Medicare, which doesn't pay enough to subsidize free care. Of course, what I'm saying is a blunt way to answer a question that's very nuanced, but essentially true."

So what's the point of all this? You've probably given a similar explanation to friends and family as the one I gave my dad.

Now, my father is not the biggest Obama fan. He agrees with Democrats about as often as often as my seven-month-old twins recite the Gettysburg Address, which is to say, almost never. I am skeptical not only of Democrats, but Republicans, independents, et al. At best, most of them are only interested in getting re-elected. At worst, they're interested in lining their own pockets. Either way, they're out for their own narrow self-interest.

But I give the president high marks for trying to tackle some of the seemingly intractable systemic problems that affect healthcare today—chief of which is its unaffordability—in the short-term for the uninsured—in the long-term for all of us. Not only is he working to solve a very pressing problem from the bully pulpit, but he even managed to make it through a speech at the American Medical Association's annual meeting this week.

Granted, healthcare reform still isn't very specific. There's still no bill, and lots of options are still on the table. But that's leadership, folks. Being frank and open with constituencies about potential solutions to difficult problems—not particularly caring where good ideas come from.

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