To Hell with the Devil! Let the Angels In
If the devil is in the details, then it is the angels that proclaim the broad principles.
During the upcoming congressional recess, Republicans plan swarm attacks on the devilish details of the various health care reform plans in circulation. Advocates for a major overhaul of health care need to keep their eyes and their voices focused on the prize.
Health care reform is not an insurance issue.
It is a workforce development issue and an economic development issue. It is an issue that affects not just the health of our people, but the health of our economy and the health of our nation.
England recognized this when they adopted the National Health Service after World War II. It was prompted in part by concerns at the highest levels of British society that so many working class and poor Brits could not pass the army physicals during the war.
The issues facing this country are very different but no less critical to the future of the American economy.
We have a health system that fails on two fronts. It fails to foster the health of the American workforce and it fails to foster a vibrant American economy.
The first point has become a staple of political stump speeches – the poor international standing of the U.S. in such public health measures as longevity and infant mortality.
The current system is a drag on the economy
It is not just the cost. Reforming health care financing, payment and delivery should be the focus of every politician interested in revitalizing the American economy and the American workforce for the next century.
Our distorted an uneven employer centric financing of health care distorts competition and it distorts workforce incentives.
We don’t need to look outside the United States to see how health care costs distort competition. We have the auto industry bankruptcy / bailout / crisis, whatever you want to call it. Too often the fault is laid to “overly generous” health care benefits.
What is the standard for “overly generous”? The auto companies and the auto unions provided benefits to their workers and their retirees because that was what responsible companies did.
This is not the fifties anymore
It is absolutely a holdover from the days when a few lumbering giant corporations dominated the economy. They could afford the luxury of saying, don’t let the government do it. We can do it.
But then foreign companies came here to compete. They didn’t necessarily offer less generous benefit packages. But they did hire younger workers and they did not have any retirees with burdensome retiree health care costs.
So everything else being equal, they started out with a competitive advantage – health care costs. Is that a level competitive market? No! Especially with regard to retiree health care costs.
But there are also companies who seek that additional competitive advantage by providing no or very minimal health care benefits. Wal-Mart is accused of being such a company. While not offering benefits themselves, they don’t hesitate to let their employees know what tax-supported programs are available.
Why should some companies assume the expense of health care for their employees and others be allowed to rely on tax supported programs? Is that a level competitive market? Absolutely not!
A third distortion occurs when companies pay for the health care costs for employees of companies that do not offer insurance. A study by the Commonwealth Fund found that nearly 18% of employer health care costs pay for the health care of dependents who work for companies that do not offer health insurance. In some cases, companies may be paying the health care costs of their competitors. Is this a level competitive marketplace?
De-couple health care from employment
De-coupling health from employment totally is the key to a vibrant workforce and a revitalized economy and eventually, a healthy workforce.
What are the trends in the workforce? Even before last September, younger people were entering the workforce later, older people were, and still are, interested in continuing to work past retirement either part time or part year. Mid career workers are increasingly interested in leaving their jobs to learn or enhance skills or to do volunteer work for an extended period.
Workforce consultants and progressive employers promote such concepts as paid time off, part time work, freelancing, job sharing, work hardening, and phased retirement.
Freelancing and part time work has grown at least in part because employers avoid health care costs. But freelancing has its appeal to many workers. How much more so if health care costs were not also a concern on the employee side?
Health care is a fixed cost. It is fundamentally incompatible with variable work hours and schedules. The current system is an impediment to every one of those trends.
Liberate American workers and employers
De-coupling employment from health care will mean that employees can accept other risks – like working for a start-up company or starting their own business. They may work part time while doing more volunteer work. More part time employment will mean more employed people and less poverty.
It means that employers will be able to choose employees from among the best and not just the available. The available excludes those not willing to risk losing their current health care insurance.
De-coupling employment from health care will permit reforming the patient delivery system. Academics and health care policy wonks endlessly ponder reforms to the health care delivery system. But such concepts as the medical home, payment reform, patient centered care, chronic condition management will never gain traction as long as the patient population is fragmented and cycled through health care silos by income, age or employment relationships.
Put common sense ahead of ideology
There are lots of heartbreaking stories about individuals who have suffered through their encounters with the maze of US health care and health care insurance. But these aren’t just stories of financial, physical and emotional distress, these are heartbreaking stories of citizens who have been denied opportunities to maximize their contributions to the American economy.
It is time that the health care system be put to the service of the 21st century American economy and the 21st century American worker instead of sacrificing the American worker to the American health care economy.
(A version of this was first published in The Nelson Report)
We need to decouple employment from medical insurance! The current system bodes the question of whether the employer has any liability if the plan or medical insurer offered doesn’t oversee the behavior of its providers who are negligent.
I believe medical insurers have vicarious liability for overseeing their providers and direct supervisory responsibility to follow up on provider complaints to the insurer if the insurer advertises such oversight in its literature to attract members and increase market share. The provider is in essence a contract employee.
Health care laws are vague on all these points. Any true reform would look into revamping such liability in its laws — not just focusing on whether to limit medical malpractice awards. Medical malpractice amounts to only 1% of the cost of medical care in the U.S. and it wouldn’t even be that much if doctors stopped making avoidable errors.
In fact, only a small number of suits are actually brought against negligent providers because often, the injured can’t afford the attorney fees and court costs to file suit. That is my predicament. I became disabled while insured by Cigna Healthcare because specialists just kept referring me for more and more tests and to other specialists. They couldn’t decide who was responsible for the diagnosis and treatment.
Until we revamp how health care is delivered, such wasteful spending will continue to mount. All my tests and doctor visits over two years cost nearly $50,000 and I was never diagnosed or treated. Now your tax dollars are paying for my Medicare and Disability award. This entire incident could have been avoided with a proper medical care system in place. The really sad part is I found this is a common occurrence that Americans don’t want to face because it is too depressing.