Health care reform needed

During a recent town hall-style meeting in Colorado to bolster support for his health care initiative, President Barack Obama was asked why he had changed his rhetoric from using the term “health care reform” to “health insurance reform.”

I believe it was a smartly-asked question that required a more thoughtful answer than the president provided. For me it’s never been about health care reform, but health care finance reform.

Whether we realize it or not, in Minnesota and throughout the Upper Midwest we are blessed to have the nation’s best health care delivery system. We are fortunate to have some of the most talented physicians, nurses and health care practitioners working in state-of-the-art hospitals, clinics and health care facilities.

A high percentage of our care is delivered through large multi-specialty clinics and integrated health care systems that are among the nation’s leaders in quality — achieving efficiencies that other parts of the nation can only dream about. Names like Mayo, Fairview, Allina, Avera, Sanford, Altru, MeritCare, Gunderson and Marshfield are recognized for their quality, efficiency and effectiveness. We don’t need to completely scrap our health care delivery system.

On the other hand, the way our nation finances and pays for all this great care is a total mess. This is just as true for our public payers as it is for private payers.

It’s too expensive, 47 million Americans are uninsured and it is financially unsustainable. Here are some examples of the problems with the current financing system:

n A physician working in a highly efficient, multi-specialty clinic in Minnesota who sees a patient for a routine office visit or a hospital in North Dakota that admits an elderly patient with a simple uncomplicated case of pneumonia will receive a much lower Medicare reimbursement than a physician or hospital treating a similar patient in Dade County, Florida. In other words, Midwest providers get penalized for their efficiency, while physicians and hospitals in other regions of the country get rewarded for their uncoordinated and inefficient care. A major concern of insurance companies in health care reform is the impact on providers if they were reimbursed at Medicare rates.

n An uninsured patient who enters an emergency room with a deep gash in their leg will receive a significantly higher bill for services in the E.R. than a similar patient whose insurance company has negotiated deep discounts with the hospital for their enrollees. Unfortunately those who can afford it the least get charged the most.

n A 24-year old patient with a serious chronic disease is virtually uninsurable in the health insurance marketplace when they leave their parents’ family insurance plan upon their 25th birthday. Health insurance is often unavailable to those who need it the most.

n More than 14,000 Americans have lost their health insurance each day this year after being laid off by their employer. We are the only industrialized nation in the world where if you lose your job, you lose your health insurance.

When the president was asked about this change in rhetoric, I wish he would have simply told the questioner the reason he now uses the term health insurance reform is because that’s where the problem lies.

We should have a health insurance market that doesn’t deny you coverage if you have high blood pressure, diabetes or another pre-existing condition. If you lose your job you have enough things to worry about. Keeping your health insurance shouldn’t be one of them. Unemployed people get sick too.

Many insurance companies support doing away with underwriting based on pre-existing conditions as long as there is a strong requirement that everyone purchase insurance to maintain an adequate risk pool.

The most universal federal health care finance program we have is Medicare, which covers millions and millions of elderly Americans. If this is a socialistic takeover of health care, where are all the Medicare-employed doctors and nurses? Where are the Medicare hospitals and clinics? Where is the federal takeover?

Of course this is all political hyperbole. Medicare beneficiaries get to choose their doctor or change their doctor just like the rest of us with private insurance. They use the same private clinics and private hospitals we do. Medicare is simply a publicly-funded insurance program.

Let’s dial down the rhetoric and dial up some of our best ideas and find a way to improve our nation’s health care system together.

Whether we need a “public option” or not is open to debate. But wouldn’t it be great if at the end of the process we ended up with a decent basic health plan that all Americans would have equal access to and that all insurance companies could sell for the same price?

Geller is a professor and head of the Arts, Humanities and Social Sciences at the University of Minnesota, Crookston. Geller also serves as the director of the federally-funded Economic Development Administration University Center at the university. He can be reached at gelle045@umn.edu.

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