The objective of healthcare reform is to ensure all Americans can have access to the care they need by expanding coverage to the uninsured, as well as the underinsured, and reducing costs so the insured can maintain adequate coverage in the future. Although the current debate on reform has stirred some very strong emotions over what should be done, the need to address exploding costs is one aspect that almost everyone can agree on. There are a myriad of helpful ways costs can be controlled; however, how legislative provisions implement reform will determine whether or not it is successful. Most importantly, the focus of reform efforts must be to encourage healthcare providers to improve quality and reduce costs on a continual basis.
By improving quality, costs will initially increase, but this is an important step in healthcare reform. Expanding coverage to over 40 million additional Americans on top of the 91 percent of the population with coverage will also strain resources. Meanwhile, improving coverage for the underinsured, as well as forcing insurance providers to cover patients with expensive diseases, such as cancer and other supposed preconditions, will be used to justify price increases for all policyholders. Then again, forcing the marketplace to improve and expand coverage too quickly would create dramatic price hikes that can potentially be avoided if legislators are focused on creating momentum versus immediate results. Unfortunately, any efforts to guarantee Americans have adequate, meaningful coverage is sure push to up prices in the insurance industry in at least the short-term.
Today, America rations healthcare based on wealth versus need and the likelihood of effectiveness; however, the American capitalist system provides an answer. Even though increased demand strains limited resources, healthy competition in the marketplace can force greater efficiency and increased availability of a product at a lower cost. For the healthcare industry, this would mean forcing healthcare providers to serve a larger consumer base under well-defined standards of coverage. In turn, this could decrease inefficiencies in treatment and administrative costs as well as create greater opportunity for new healthcare providers in the long run.
One such idea to increase competition in the marketplace is a public healthcare option managed by a government agency or nongovernmental organization that would subsidize coverage for those who cannot afford care. This could be a useful tool for decreasing costs and expanding coverage depending upon how it is done; however, an overly subsidized public option with too good of coverage at too low of a direct cost for policyholders would destroy competition and reward price gouging. Plus, failure to prevent the insurance industry from dropping patients with preconditions and discriminating against high risk groups would dump large numbers of the most ill into the public option, thus burdening the system as we see with Medicare. Unfortunately, current legislative ideas would likely create an entity capable of dictating prices versus negotiating them, thus hindering competition as medical providers would simply displace cost savings for the public option onto private insurers.
On the other hand, there are other ways of creating competition to decrease costs. Support is growing for government sponsored national and regional cooperatives, or nonprofit entities, that could pool money and reduce costs by eliminating profit. Then again, pushing models where insurance and care are handled by a single entity may make sense in some regions. Of course, every region has its own unique needs while many of the models under consideration have yet to demonstrate cost savings. In addition, allowing consumers to directly purchase coverage across State lines could create competition; however, national standards would still be necessary to prevent the sale of junk insurance that would be inadequate in the face of a serious illness.
Furthermore, healthcare providers can improve care by developing better communication between providers and utilizing new technologies to ensure patients get the most effective treatment. Various communities have successfully experimented with different models; some which bring doctors under one roof to facilitate cooperation as well as others that pay physicians based on flat fees for all forms of insurance and offer competitive salary instead of incentive based pay for testing and prescriptions. In addition, modern technology can decrease medical errors with far more accurate medical records while improving diagnosis and treatment. It can even help prevent excessive testing and medicating. Of course, rearranging the healthcare system will likely require at least some upfront government and private investment as the initial cost of advancement can be quite prohibitive.
Meanwhile, cost displacement is another issue that must be addressed. The uninsured and underinsured already cost the healthcare system a great deal of money by displacing much higher costs from later stage illnesses and emergency care onto healthcare providers, government agencies, nonprofit groups, and policyholders. Preventive care is necessary to minimize serious illnesses that can develop from a lack of care while education can encourage healthier lifestyles. Furthermore, bankruptcy resulting from medical expenses hurts the entire economy and affects everyone indirectly. Lastly, cheaper and free medical care outside of the US also makes American medicine more expense. For example, AIDS drugs provided to Africa at lower cost means drug companies will displace costs onto consumers in countries like America. In addition, US healthcare dollars are heavily invested into research at the expense of Americans, yet for the benefit of the entire world.
Beyond current legislation, other reform efforts are needed. Tort reform is necessary as the cost of frivolous lawsuits burdens healthcare providers, yet the process will be complicated, because the right of patients to sue a truly negligent healthcare provider must be protected. Meanwhile, with individuals requiring the most care during the last few years of their lives, Medicare, as well as Medicaid and SCHIP, need reformed as they are becoming a greater burden on the national deficit while these socialist programs makeup a large part of our healthcare system and can be used to reform overall healthcare. Unfortunately, seniors represent a huge voting block and have demonstrated their fears over any talk of reform with hysterical protesting. Although the Democratic House proposals address these entitlements, the Medicare, Medicaid, SCHIP reforms should be presented in a separate bill and debate as too much anxiety has been created by lengthy proposals of a thousand or more pages while such an effort certainly needs its own debate. Moreover, until seniors are willing to work with reform efforts, versus against them, the healthcare system cannot be improved.
Lastly, costs outside of the healthcare industry also must be addressed for reform to be meaningful. Education costs have exploded, thus discouraging future doctors and other healthcare providers from entering the medical field. Furthermore, unstable energy costs undermine any savings from reform efforts as they push up all prices. Meanwhile, high petroleum and other commodity prices directly impact the cost of medication and medical equipment as these are the raw materials these products depend upon.
Moreover, there are plenty of areas where cost increases can be stemmed and coverage can be improved. Unfortunately, legislative efforts may not actually achieve these goals with meaningful, effective policy while a lack of reform certainly does not prevent a future healthcare crisis. Too much fear is dictating how, and if, America reforms its healthcare system versus a constructive public debate. Reform efforts need to focus on starting reform and reducing the pain of reform by allowing the market adequate time to reform. True reform will not be accomplished in one legislative push; however, current efforts will determine whether or not the momentum, necessary for meaningful reform over time, exists.