Commentary: A few lessons about health care

The Lexington Herald-LeaderOctober 7, 2009 

It's no wonder people are frustrated by the debate over health care reform.

The issues are complex. None of the proposed solutions is perfect. And, more often than not, the arguments seem to dissolve into emotional oversimplification.

Besides, there's a lot of money at stake. Whole business models have been built around the inefficiency of America's health care industrial complex.

Last Thursday, the Lexington Forum hosted one of the better discussions I've heard on the subject.

The panelists were Dr. Michael Karpf, the University of Kentucky's executive vice president for health affairs; Dr. John White, president of the Kentucky Medical Association; and Melodie Schrader, executive director of the Kentucky Association of Health Plans.

Some points of view weren't represented, and the discussion lasted only an hour — not nearly long enough to do the subject justice. Still, it was enlightening.

Here's what I took away:

The key issues are access, cost and quality. Some people want to change the entire health care system. Others want to preserve the status quo — or at least their current coverage or company's profits.

But the key is figuring out how to control costs, maintain the quality of care and provide access to more of the millions of Americans with little or no access to affordable health care.

Karpf noted that a significant portion of uninsured Americans are young working people. That's because employer-sponsored health insurance is becoming more scarce because of costs.

America has too few doctors, especially in small towns and rural areas. White estimated that Kentucky needs 2,300 additional doctors to meet national standards.

Many of us will have to give up something. Increasing access and controlling costs will mean people who have insurance now will have less freedom to choose expensive procedures that have little proven effectiveness.

They also won't be free to forgo coverage. Schrader said the only way to guarantee that everyone can get access to insurance is to require everyone to have it.

Health care companies and insurers must give up some profits. For example, White said, Medicare Advantage programs — enacted during the Bush administration and criticized as government subsidies for insurance companies — should be eliminated, with the money going directly to pay for more Medicare patient care.

Malpractice litigation must be addressed. Republicans see tort reform as a panacea; Democrats dismiss it as insignificant. But the fact is many doctors feel compelled to order expensive tests and treatments of questionable value for fear they'll be sued if they don't.

A better balance must be found between protecting patients from medical malpractice and forcing doctors to practice costly "defensive" medicine.

We can't be distracted by sideshows. For example, some reform critics warn that government bureaucrats will overrule doctors' medical judgment. White said that is done too often now by insurance-company bureaucrats.

Another sideshow is the debate over coverage for illegal immigrants. As Karpf said, they'll be treated one way or another to some degree — and somebody will pay for it. They'll come to emergency rooms after accidents, when they are about to deliver babies or when suffering with serious illnesses or communicable diseases.

We must take more personal responsibility. Karpf noted that the health care economy now is based on fee-for-service, rather than prudent management. That encourages more spending.

Plus, he said, there's not enough incentive for patients to live healthy lifestyles and make wise choices.

One key to lowering health care costs is to make the cost structure more transparent — and personal. People will use health care services more wisely if they see it's in the best interest of their own pocketbooks.

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