In my previous entries, I shared the history of the whole universal health care debate, a debate that has been going on for almost a hundred years in our country.
President Obama rolled out the details of the Health Care Reform Initiative in the summer of 2009. As you may recall, there was an unbelievable amount of acrimony around the topic. This was where older folks, who really did not know what was within the 906 page document, were encouraged to come to Washington, D.C. (free bus ride and free lunch) and hold up placards that “yelled out” such lines as “Don’t kill Grandma.” This phrase, it turns out, was referring to a clause, somewhere in the middle of the 906 page document in which every patient would have a right to talk with their doctors about end of life issues and it would be covered by insurance.
Ah, yes. It was quite a period of time, back then. Representatives, who backed the President’s health care initiative, would hold town meetings, facing really angry voters, who, quite frankly, did not fully understand how this health care initiative would benefit them. I remember our representative in the Fifth District of Virginia, Tom Perriello, one of the finest politicians I have ever met. He was a straight shooter and he had the most impeccable manners. He held town meeting after town meeting after town meeting, where angry folk would challenge the initiative. In fact, it was known that the opposition sent in individuals with prepared questions on specific, if not, obscure points within the document. Congressman Perriello had such a grasp on what those 906 pages contained, that he was able to answer most every single person’s question, no matter how obscure. On the rare occasion that he was unfamiliar with a clause that was brought up, he took the person’s name and address and promised to get back with him/her within the 24 hour period with an answer.
In spite of his efforts, not only did he loose re-election because he stood firmly behind the health care reform initiative, but the anger and fear that had been stirred up to such a frenzy, made his answers fall on deaf ears. The people were not there to learn, but rather to try and trip up or embarrass the Congressman.
During a June 2009 speech, President Obama outlined his strategy for reform. He suggested seven steps that would bring down the costs of our exhorbitant health care costs: 1) electronic record-keeping; 2) preventing expensive conditions; 3) reducing obesity; 4) refocusing doctor incentives from quantity of care to quality; 5) bundling payments for treatment of conditions rather than specific services; 6) better identifying and communicating the most cost-effective treatments; and, 7) reducing defensive medicine.
In September of 2009, the President added a a few more points to the original plan: 1) by having everyone be part of the insurance plan, the plan would be deficit neutral; 2) implementing laws that would prevent insurance companies to discriminate based on pre-existing conditions; 3) individuals would have a cap on how much they would have to spend out-of-pocket; 4) the creation of an insurance exchange for individuals and small businesses so that these entities would not be unfairly penalized for not having the numbers that larger companies have and thereby lack the means of equal coverage; 5) tax credits for individuals and small companies; 6) the creation of independent commissions to identify fraud, waste and abuse; 7) in order to lower insurance costs for doctors to protect themselves against malpractice suits, the President added malpractice reform projects to the package. 
Atul Gawande, a surgeon, writing in The New Yorker, further distinguished between the delivery system and the payment system. He argued that reform of the delivery system is critical to getting costs under control, but that payment system reform (e.g., whether the government or private insurers process payments) is considerably less important yet gathers a disproportionate share of attention. Gawande argued that dramatic improvements and savings in the delivery system will take “at least a decade.” His recommendations were to address the over-utilization of healthcare in our country. That the focus of healthcare needs to move back to keeping people healthy rather than making profits. He also suggested that a comparative analysis system of the cost of treatments and outcomes across various healthcare providers be initiated. Gawande argued:
this would be an iterative, empirical process and should be administered by a “national institute for healthcare delivery” to analyze and communicate improvement opportunities.
When I read these points, they certainly make sense to me. So why all the anger? Why all the hostility? Why all the emotion?
Because a group would stand to loose quite a bit if the Health Care Reform Act were to become law. What group? The Health Care Industry which is made up of the insurance companies, the pharmaceuticals, and the hospitals. Oh, and then the investors in this industry. (To be continued)
© Yvonne Behrens, M.Ed 2012