More on health care reform

I wrote yesterday that the only way to significantly reduce medical costs in private plans is to ration care. Let me explain.

There will be some savings from going to electronic records (although many of us worry about the inevitable errors that expose patient's confidentiality). But that plan will go forward. Projected advantages are really more in efficiency of patient care than in lower costs, although there will be some monetary savings, especially from less need to repeat laboratory tests, x-rays, MRIs, etc. done in another doctor's office.

Another place that could lead to savings is in some sort of tort reform so that doctor's malpractice insurance premiums are decreased, as well as the current need to practice "defensive medicine," where doctors order tests that are unnecessary except to avoid being attacked in court for failing to do those tests (even if they were are not indicated).

Of course, all this can happen within a private insurance system, just not so easily enacted.

Where the real savings could occur, however, is in revamping the whole health insurance system to remove the profit motive; ie, to end the current private insurance industry and go to a single payer, government sponsored plan.

It seems totally impossible in today's political climate to bring this about any time soon. But it's astonishing to me how much we have moved in that direction -- just in this last election cycle. First, as expected, Republicans are screaming "socialized medicine," but it's not really catching on the way it once did. More and more, the response is: "So?"

Second, we now have leaders who are committed to universal coverage, as an important first step, and who are at least friendly to the idea of eventually having single payer coverage.

The best we can hope for is a step-wise plan over time: first, a competing government sponsored, not-profit plan -- such as "Medicare for all." Then let the market do its work. Over time, insurance companies will phase out medical plans as not profitable. Or they will downsize to providing supplemental policies for those who want more than the basic coverage -- just as we now have the Medicare supplemental policies.

Opponents' are fighting tooth and nail to prevent this part from passing. Their claim is that is will be unfair competition. Fine. That just proves the point that the private plan is too expensive and without redeeming advantages.

The example that proves this: Bush introduced the Medicare Advantage plan to the Medicare system that was working fine. It subsidized private companies to lure away Medicare patients with minor tweeking inducements. Even with the government subsidizing them, they didn't work. Patients were dissatisfied, some plans went out of business, and the whole thing was a failure -- at great cost to the government that could have gone to the uninsured.

The goals of a reasonable plan: (1) universal coverage, no more pre-existing conditions or denial of coverage and not tied to your job so that you lose insurance when you lose your job; (2) emphasis on prevention, which private insurance has little incentive to cover because it's advantage is long-range, not short-term profits; shift the emphasis from profits to service and health.

It will be a tough fight to get the non-profit plan approved in Congress. Let's hope the camel doesn't have too many humps and that it can at least walk.

Ralph