Those of you who read my previous posts on health care reform know where I stand – that while its creators had the best of intentions, the bill ultimately failed to accomplish two key goals: increase quality and decrease costs. The most critical pieces that legislators missed include tort reform, competitive insurance across state lines and much more aggressive pay-for-performance measures and disease management-based incentives. With these additions, health care reform would have been viewed as much more cost-conscious and quality-focused. Instead, we’re now left with a “Frankenstein” system that was cobbled together with, in many ways, the best of the worst – one that’s expensive to maintain and challenging for physicians, providers and ultimately patients.
So, where’s Frankenstein headed in the context of mid-term elections? We’ve already seen some significant backlash against health care reformers – Blanche Lincoln was down by 23 percent last I checked, and many other original supporters have been slipping in the polls as well. The smart say that the Republicans will take the House, but won’t get the Senate. As a result, the passing of legislation will stall dramatically, and while Republicans may be able to stall funding and pick at the edges of health care reform, they won’t be able to dismantle it completely as the President will veto anything that smacks of a step in arrears. And what about the $400 billion in Medicare cuts that hospitals have to fork over in order to get their 31 million newly insured? What happens when the dozen plus states that are enacting legislation to forbid mandatory health insurance for their citizens roll out those laws? Healthy people who were supposed to pay for the sicker ones will be the first to opt out. You can imagine how this uncertainty permeates the C-Suites of health systems across the country. How do you plan for the future other than just get as mean and lean as possible, which can’t be good for the long term health of our health care institutions?
The irony in all this is that while Igor helps the U.S. Frankenstein system take its first awkward steps out of the lab, our European counterparts are slowly moving away from a single payer/socialized health care system. Post-election in the UK, the NHS is systematically moving towards local governance of hospitals, cutting layers of national bureaucracy. Every employer worth working for over there offers several tiers of private insurance to insulate their workers from the dreaded waiting lists and over-managed care. Both Germany and France are cost-cutting across the board, implementing DRG-like reimbursement models, performance incentives and fee-for-service structures. Greece, as part of its penance for getting into too much debt, is being forced to privatize its health care system.
One thing is for certain – it’s the patients and hospitals that will pay in the long run. No matter what happens in these elections, healthy people will still be paying for others, and hospitals will be in a holding pattern for too long, limiting their ability to forecast and plan.
It’s all pretty scary if you ask me. Happy Halloween!
I won’t end on that sour note. I do see a number of very promising private sector efforts that will be providing workarounds and new models of care to the coming chaos. All this new legislation will provide huge market-based opportunities. Just in the last couple of months I’ve seen providers, physicians and payers getting together, breaking down silos and exploring ground-breaking new models. Look for more insight on some of those efforts in my next post. . .
– Todd Cozzens
