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  Home Page » Opinion » Editorial » Healthcare Reform

Health-care reform

Polarization, entrenchment serve no one well

In the early 1990s, the debate about health-care reform somehow became all about Hillary Rodham Clinton. She was going to take away patients' choice of physicians. She was going to force socialized medicine down American throats. She was the embodiment of evil.

She also was a convenient target for segments of the health-care industry that did not want to see their profits shrink. In fact, she was so convenient that just by invoking her name, opponents managed to delay serious discussion of health-care reform by 15 years.

They could not, however, manage to make the problems go away. Health care still is not affordable for too many Americans, including many who are fully employed. Increases in the cost of care have far outpaced inflation, which, in turn, has outpaced salaries in many parts of the country. And now, Americans are talking about noncitizens and socialists instead of about the real problems that exist.

Part of the increase, of course, is attributable to the fact that Americans simply receive more care. Technology is expensive. Everyone wants the finest care available, and who can blame them? Especially when analyzing cost effectiveness is so difficult.

But another significant part of the overall picture is the cost of providing care for those who do not have insurance. Despite recent efforts to narrow the focus of that discussion to care for non-U.S. citizens, the problem is considerably larger. It includes the working poor whose employers do not provide insurance and who cannot afford private insurance; in fact, it includes all whose employers do not provide insurance and who do not, for a wide variety of reasons, qualify for private insurance. It includes patients covered by Medicare and Medicaid, whose care is funded by the government. It includes people who suffer from severe and expensive problems because they could not afford early treatment. It also includes patients who would not have been exposed to serious illnesses if others could have afforded care.

As unemployment increases, as good jobs move overseas, as baby boomers leave the work force, as promised retirement benefits are negotiated away, fewer people are responsible for paying, through their own medical bills and their payroll and income taxes, for more who do not have private insurance. That is a basic math problem, and it is a problem that simply turning the government into the sole funding source for health care will not solve.

Universal basic coverage is a laudable goal, and it may be a fiscally logical one, as well, but it is far from the only problem that has to be solved. The ever-more-complicated funding picture has changed - and, in many rural communities, reduced - access to basic services even for those who can afford them. Ratcheting down provider reimbursement for services cannot be allowed to drive primary-care providers away from the industry, nor can lower reimbursements in rural areas be allowed to drive providers to cities and force rural hospitals to close their doors.

Yet another Catch-22 is the cost of research and development, not only in the pharmaceutical industry but in other areas of treatment and diagnostics, as well. On one hand, it is hardly fair to expect patients to fund research that does not benefit them directly. On the other hand, the results of some of that research eventually drive costs down, not up.

None of those issues are primarily political. Members of Congress need to spend their August recess truly listening to the funding and access problems Americans are experiencing. They - and their constituents - need to acknowledge there is no system so perfect it cannot be improved. They need to take the time - and yes, spend the money - to thoroughly research potential solutions. Then, and only then, they should craft the legislation necessary to begin straightening out this mess.

The United States badly needs health-care reform, but the wrong reform package would be worse than none at all.