Wednesday, May 14, 2008

Universal Health Insurance Coverage

As the Democratic primaries come to a merciful end, focus will shift to the November general election. The topic that waxes and wanes depending on which voting group the contestants are reaching for is the rekindled discussion on national health insurance.

Clearly, as time and time again we are reminded, the healthcare system is in crisis and something must be done. No argument there. The question is fixed by whom and how much is this going to cost? Will the American public be willing to see taxes rise to support a universal health system? Will the insurance companies willingly give up billions of dollars under a one-payer system? Will the healthcare providers see this as a the savior of their way of life?

Who has the ability to bring all of the groups together, consumers, doctors, hospitals, nurses, insurance companies, government, employers, states, etc.? Any meaningful reform will need to be accomplished in year two and three of any new administration. Should anyone consider that reform can be accomplished in year one of a new presidency is frankly, dreaming.

All of that aside, let me pose a series of questions. If one has been reading the reports now circulating, we have several shortages, doctors, nurses and other clinical health professionals. Additionally, over the last decade, treatment patterns have shifted to hospital outpatient and free-standing ambulatory settings. The end result that a significant number of hospital beds nationwide have been permanently removed from the available inventory.

Let's for a moment say that consensus is reached in a remarkably short period of time and we have some form of national health insurance for the 47 million plus who have none. Think the system is in disarray now? What do you think will happen when suddenly 47 million men, women and children have access to the care they need? They have access to the right care, at the right time, in the right setting. And this does not even address the illegal immigration discussion.

Some form of national health insurance will generate great demand on an already taxed and over extended system. Bed shortages, waits for care, queues are what await us as we move forward. Costs will be controlled not by improvements in the quality of care, but by a natural process of access being limited due to excessive demand placed on services that the current healthcare system will be unable to provide.

A burgeoning new sub-segment of the healthcare system will arise. Service will be provided on an immediate basis to those who can pay privately for care outside of the system. A three tier system so to speak, those who can pay, those who have private or employer health insurance and those who have government. The more things change, the more they stay the same.

I am not saying that we should not have national health insurance for 47 million people. Personally, I believe that in one of the wealthiest country's in the world that it is unthinkable that we have such a situation.

This is one very complex issue and until all the issues are out on the table and under discussion instead of the simplistic proposals and idealistic views, change will happen and the unintended consequences of goodwill and policy will make an already bad situation worse.