Guest Feature: Medical Mire

By Robert Sloan

The president has called the nation's attention to national health reform. He campaigned to change the system and following the economy, it has become his top domestic priority. While his intentions are good and the system needs dramatic reform, it is very complicated, difficult and mired in the age old politics of Democrats vs. Republicans.

There are at least three legislative proposals in the House of Representatives and two in the United States Senate. All of these proposals have been reviewed by lobbyists who are interested in protecting their clients’ interests. As a result, they represent less health reform and more "insurance" reform than anything else. All of the proposals will be weighed against the impact on costs to the American taxpayer and compromise will be the order of the day.

In the end, there will be legislation passed and some reform will be accomplished — but it will be far less than candidate Obama promised. Even though President Obama is very personable and wants to present a fresh approach, he is still a politician. He will get as much accomplished as the system will allow, and he will claim victory (and some credit will be warranted).

The Democrats must demonstrate that they can govern and that is why legislation will be passed. Unfortunately, it will be on a partisan basis with Republicans claiming that it costs too much, does too little and invites bigger government.

Both sides will be able to win political points for their base, but the problems of rising health care costs, a less than healthy population, lack of coordinated care, Medicare on the brink of insolvency, chronic illness, a poor public health system, lack of preventative care, over utilization of emergency departments, obesity and other social issues will remain to be solved another day.

These "structural" reforms are hard and none of the legislation addresses how to get real reform accomplished. The reason is that real change will create the need to say "no" to current lifestyle habits. People will need to sacrifice and it must be bipartisan to be achievable. There will be big winners and big losers and our system of politics does not do well with difficult choices. We have a tendency to put off the pain until the future, and then we avoid it as long as possible. The medicine tastes bad and so we do not want to take it even though we know it must be taken some day.

The Senate Finance Committee will complete the mark up of their bill and then combine the bill from the Finance Committee with the bill from the Health, Education, Labor and Pensions Committee. The U.S. House will combine their three bills into one and then the Conference Committee process will start to work to get a bill that the president can sign.

The end result will be that the Congress will try to cover as many uninsured people as possible (it will be far fewer than they would like, but the costs estimates will force a compromise.) Insurance companies will be prohibited from refusing to cover people for "pre-existing conditions," the government will mandate that everyone over 18 years of age must purchase insurance or be fined, there will be some subsidy for those who cannot to pay for insurance (sliding scale insurance premium subsidies).

There may be insurance exchanges established so there can be comparison shopping for insurance plans. The labor unions will claim victory, the plaintiff bar will settle for a few demonstration projects without real tort reform, the wealthy will be taxed more and current issues of the way care is delivered in this country will continue. This will be the extent of health reform.

It will be left to the next Congress, or President Obama will campaign that he started reform and he needs to be re-elected to complete reform. The Republicans will oppose the democratic plans and then campaign that they are the party of responsible reform. That is how our system works. It is incremental until a watershed moment (such as the Social Security, Medicare or Civil Rights Act that changed the country in a dramatic way).

We have the need for change now, but we do not have the money, the President does not have the power and the democrats are not united in a way to get major reform passed. If you look at the points in time when legislation was passed that had a dramatic impact on the country, the legislation was bi-partisan and passed overwhelmingly by both parties. That is not the case now and so the legislation will have some benefit but not the dramatic change that is needed.

Whether he admits it or not, whether he likes it or not, the President and Congress will end up "kicking this can down the road" and we will be back at this debate for several more years. The issues will not disappear nor will the need for real reform of the healthcare system. It is an interesting process to watch. Stay turned for more in the near future.

Robert Sloan is president and CEO of Sibley Memorial Hospital in Washington D.C. and a 1968 graduate of Olivet.