State of America’s health care makes me sick


At year-end, most businesses that offer health care benefits have gone through the open enrollment process and wrestled through all the issues of vendor selection, plan-design options and decisions on cost sharing. In addition, they have usually spent a lot of effort and cost just to educate their employees about the various issues, so they hopefully make good elections and appreciate what the employer is doing for them. 

With regard to this last point, I suspect most employees are a mixed bag on how they view this benefit of employment. Most recognize the value of the benefit, but many don’t give very much credit to those who facilitate the programs. They see it as something that is basically a given. 

That is, until the cost sharing starts to put a bite on them or the design is revised so that when they need the benefit, they see the cost to them is considerable, especially if they have utilized some aspect of the benefit in the past and they now see a significant cost increase. Without the benefit, it could be worse, but it usually takes a while to get to this level of reflection.

No employer protection

If these employees then retire or become disabled and lose the coverage, their perspective changes rapidly. Others who do not have insurance because they are unemployed or they work for an organization that doesn’t provide such benefits already recognize the extreme costs to get coverage. 

Many just wait until they have some need and head off to the emergency room, where the fees to correct the issues are even more costly but get spread to the rest of the hospital expenses because the people can’t/don’t pay for services.

Where things stand now

Three years ago, I wrote a piece about this same situation and identified some possible options to help reduce the costs. Guess what? Since that time, there has been a lot more talk and continual efforts by Republicans to undermine the few improvements the ACA legislation put in place, not positive developments to improve coverage or reduce costs, which is increasing at better than 2-3 times the rate of inflation for other consumer sections. 

I place a great deal of blame on the Republications, but the Democrats haven’t done anything but hunker down to protect the status quo.

In the 2016 election, Bernie Sanders at least took a stand to say we should have universal health care — a rather controversial position. But once he lost the nomination, discussion seemed to fall by the wayside. In the recent elections, the only thing that really seemed to surface on this matter is that some of the polls flagged health care as an important issue for people. 

Heath care is a lot like gun control after each mass shooting. Our prayers are with you! I think the time is now that the Democrats have such a strong majority in the House to do something really bold. They need to get a referendum from the people to go for a total revamp of the health care payment system. 

We need a Brexit to leave behind the piecemeal for service payment system. Get the for-profit players (insurance and big pharma) to dance to the tune of the people, instead of the other way around. Don’t worry about them. They still do pretty well in those countries that have universal health care. 

The folks who might lose out a bit on such as change are the politicians who wouldn’t have this major source of revenue for their political ambitions. A step toward campaign finance reform; a topic for a different column.

A new vision

In conjunction with the payment system reform, health care needs to start to integrate all the providers into a single system built around the needs of a patient who evolves over a lifetime of activities. They shouldn’t have to have one system for old people another for poor people and another for those who have been in the service and those who can’t see and those with dental matters and let’s not forget the complications with generic drugs vs. those on a particular formulary or Medicare Part D and its “donut hole.” 

Did I forget to mention the complications of being in-network or out of network and the associated cost variations? Each fragmentation makes the care more complicated and the complications end up driving costs. All the plan designs that are supposed to help control costs are put in place not to improve the circumstances for the patient but to spread the risk so the administrators don’t lose money.

Those of us who remember the good old days in the auto industry will remember that when you bought a new car, you began a list of the things that needed to be fixed, and after a month, you took it back to the dealer to get the various items fixed. When the Japanese brought in their cars with superior quality, we learned there were other ways to do the job.  

Instead of adding more “fixes” that are just patches to a broken system, why not start with creating a new system that places the emphasis on health care results? Then set up a strategy to transition the various parts of the current system to the new plan. If we want to have the best health care system in the world, why not do our homework and build it from the best practices of the various systems that provide a form of universal health care for its citizens but do it better.

We have an opportunity

The leaders of the new House say health care will be a key focus for their legislative agenda, but they are pretty vague on what that means. The public and the various influential leaders in business and society should demand real progress, hold the government official’s feet to the fire and force an effective solution to a critical societal issue. 

Employers need to get out of the health care management process and focus on their various organization missions. Improved access, improved outcomes and reasonable costs are attainable, it just requires a vision and a new system with people willing to lead the charge. Annual enrollments, and all the anguish that goes with them, needs to be a thing of the past.

Ardon Schambers is president and principal at P3HR Consulting & Services.

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