Health Care-Barack Obama’s Vision

Well, now that Super Tuesday is over, there’s only one candidate to review; Barack Obama. McCain has effectively eliminated his Republican opponents, while Clinton and Obama have turned the Democratic race into a much needed slugfest.

Turning my attention to Obama’s Healthcare plan gives me reason to think that all of the candidates are looking at hybrid systems. Shame. In the long run, they are not going to work. If the goal of universal healthcare is the goal, it shouldn’t have to cost more than it does now. And it IS going to cost.

Obama’s plan varies from some of the others in that there is no mandate for coverage. If you want to opt out and pay, you can. If you come in contact with the healthcare system, such as a hospitalization, you will be required to sign up. Seems reasonable. You can read Obama’s entire plan here.

Things I like; universal care available, but not mandatory; sense of personal responsibility for your healthcare coverage; concentration on chronic disease management and disease prevention (same as everyone else); National Health Insurance Exchange and portability; guaranteed eligibility

Things I don’t like; expanding SCHIP; protect against natural disasters?; government subsidies; small employers to contribute a percentage of payroll; Federal reinsurance; ensuring healthcare quality and transparency; promise of maplractice “reform” isn’t really reform at all.

There are many common themes in the healthcare plans of all the candidates. Obama’s seems to vary from Clinton’s mainly with mandated vs voluntary coverage. I like the idea that people take responsibility for themselves in some form or fashion. Entitlement programs, to date, have created a subpopulation of our country that are so dependent on their government that they CANNOT care for themselves. It’s time to wean them.

Obama’s National Health Insurance Exchange is a good idea to promote some forms of competition, make shopping for insurance easier by offering comparisons (although, according to Obama, all plans have to offer similar benefits anyway-how much shopping will you need to do?), and provide a location for comparison’s of qauilty-which I think is it’s best benefit.

EXTREME care needs to be given to the assessment of quality as is currently being reported by such places as Healthgrades, some state government websites and being contemplated by Medicare. So far none of the reporting sites takes into account differences in documentation, severity of a patient’s illness (some people with the same illness are just sicker than others), complications or comorbidities.

Documentation is the key to assessing true qaulity and outcomes. If the documentation comparing two hospitals, for instance, is exactly the same, then you could compare them with a greater expectation that the “grade” they are given is an accurate reflection of quality. Take Healthgrades as an expample. Compare two hospitals in your area and look up their grade for Stroke, Pneumonia or Myocardial Infarction (heart attack). Look at the ranking of the two hospitals, then expand those hospital’s specific data. If the hospital with the lower ranking has a lower rate of mortality, then the issue is most likely poor documentation, not poor quality of care. But of course, that’s not the perception that Healthgrades gives you.

Expanding SCHIP, or any Medicaid program without eliminating the waste in it is irresponsible. Looking back at an earlier post with the national healthcare data shows how expensive Medicaid and SCHIP are already. Not a very cost-effective way to provide care. And now the government is trying to contract out Medicaid in an attempt to develop a product comparable to Medicare Advantage, which Obama acknowledges contains a large amount of administrative waste. It also means that the new administrative overhead is NOT being spent on patients or the providers who care for them.

The plan as a whole will be more expensive. Employers will be expected to contribute a percentage of payroll towards coverage if they don’t offer it as a benefit. The natural response to keep the employer “budget neutral” will be a reduction in wages. Federal subsidies just mean the government will be spending money on healthcare indirectly, but spend it nonetheless.

His promise of healthcare reform really doesn’t address two important areas. First is tort reform. Our current system rewards attorneys for large settlements. That alone is a huge incentive for the attorneys to file frivolous suits in hopes of hitting the jackpot. Award caps or reasonable caps on attorney fees/charges would help to stem alot of that problem. No more contingency fees. If the case has merits, they’ll take it anyway. also, states with caps have seen liability insurance rates decrease significantly.

Second, with regards to tort reform, is protection from prosecution if the providers have followed accepted best practice guidelines. Shit happens and not every death is preventable despite our best efforts. Why should someone be sued if they have provided the best care possible and followed accepted best practice guidelines?

Obama’s plan also stinks of “Big Brother”. The National Health Insurance Exchange is going to monitor quality, competition, pricing, monopoly, benefits offered, profit and premiums. Sounds a lot like a public service commission. Regulation does work to control cost but not to foster competition, which is the reason most industries were deregulated in the 1980’s. Prices did increase, but each company did it’s best to differentiate itself from the competition, either through innovation or products/services offered.

All in all, the big three have similar plans with some differences. Too bad all of them think that the government’s involvement in a partnership with the insurance industry is a good idea. Insurance companies are greedy and the governement is wasteful and inefficient. What a combo.

Doc B

My opinion is free.
Advice is worth exactly what you pay for it.


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