Senator Ted Kennedy's passing has reminded us all of his legacy of legislation, and that many of his accomplishments came as a result of reaching across the aisle. Senator Kennedy did not compromise his values while doing so; he was adept at finding areas where the goals of the two sides were not mutually exclusive, and fashioned legislation that was palatable to both sides. In that spirit, we can do the same with health care.
This idea was partly the result of a recent foray into the current health care system. My wife works for one of the best hospital systems in the country, and as a result, we have access to those hospitals and doctors. She is pregnant right now, and recently had some pregnancy-related issues that sent her to the emergency room, where an ultrasound was ordered. In order to do the ultrasound, however, the doctors ordered a catheter. Now, we have had a number of ultrasounds done, and never before or since has a catheter been necessary, so we challenged the necessity of this procedure. They responded that it is their policy to do this, and no catheter = no ultrasound. Our concern was such that we went ahead with the catheter.
Here is the outcome of our emergency room visit:
- An incorrect diagnosis. The actual problem was not detected until two days later, when the same issue sent us back to the doctor (thankfully, this one occurred during business hours). In fact, the ER diagnosis said that there was no such condition present.
- An infection. As can happen with a catheter, my wife developed a bladder infection, which required antibiotics.
- Additional cost. We recently received the bill for our ER visit. Though we still only had to pay our $50 co-pay, we noticed that the insurance company was being billed $180 for the catheter. In other words, the hospital is profiting from an unnecessary medical procedure.
In my mind, this visit showed me a few important facts. First, even "the best health care money can buy" isn't always that great, especially in the emergency room. But far more importantly, there is enormous waste in our current system. My wife's issue (which thankfully seems to have resolved itself) could have been dealt with (and eventually was) with a simple visit to her obstetrician and one ultrasound. Instead, it took an ER visit, FOUR visits to the OB (a couple of which were caused by the bad diagnosis at the ER), a total of four ultrasounds, and a prescription for antibiotics that should never have been necessary. And who profits from this waste? The hospital. There is no incentive for the hospital to hold down costs that it knows will be covered by insurance, even if it knows the procedure is not 100% necessary. The only cost-control mechanism present is if the insurer decided not to cover the cost, in which case that cost is passed on to the patient.
So where can we find this mythical common ground with Republicans on health care? Well, I think both sides can agree on a couple of things:
- Waste is bad. Republicans can't like this story any more than I do. After all, a non-profit corporation is profiting at the expense of a defenseless insurance company. The lack of an effective cost-control mechanism is costing the insurer thousands of dollars.
- Choice is good. Republicans love to attack the public option for taking away choice, an irony that I'm sure is hilarious to the 50 million people who can't afford to choose their own health care. But provide these same Republicans with a system that allows patients to choose their own insurance adventure, and they will find it difficult to attack on these same grounds. Current insurance, for those who receive it from their employers, gives employees a choice between that insurance or no insurance. It is by no means a free market.
- Most people with insurance now are generally happy with their health care. I believe that this is true; most people that can see a doctor are happy with their doctor. I also think that most people tend to hate their insurance company. That's partly a product of the fact that doctors tend to make you feel better, while insurers just charge you for things that you feel you shouldn't always have to pay for.
Finding a health care system that provides choice while reducing waste is not all that difficult. It actually starts to look a bit like what was once derided as "Hillarycare." It also looks quite a bit like Social Security, when viewed in the proper light. The parameters are simple:
- Everyone is covered by a government insurance program that allows doctor visits and prescription drugs with similar co-pays to most insurance companies. This is the public option portion: a relatively bare-bones insurance plan designed to provide some measure of preventative care for the uninsured.
- Additional insurance can be purchased directly from insurers, or partially supplied by employers. In this option, employees get to choose who their insurer is and how much additional insurance they want. This is much more choice than what is available now.
- Should employers stop providing health insurance to their employees due to the presence of the public option, they must pass on their portion of the monthly premium to the employee.
These parameters should make people on both sides of the aisle happy. Democrats have the benefit of covering everyone, while Republicans still have provisions that allow wealthy people to have coverage for additional care. It's also harder for Republicans to fight against on the basis of limiting choice, because a significant portion of this plan actually calls for the patient to choose their own health care. In fact, this makes health insurance finally a free market system. As a provider to every patient, the federal government has the ability to implement cost-saving procedures to limit the sort of waste that my wife and I encountered, and they can get people to primary care physicians instead of sending them to emergency rooms.
A system like this is also analogous to Social Security, where the government provides a bare-bones retirement benefit, while allowing anybody to save additional retirement funds on their own; effectively, "purchasing" retirement benefits in the form of mutual funds, IRA's, or what have you. It provides for the bare minimum for all while enabling more for those who strive for it.
Senator Kennedy was a great legislator because he could get both Democrats and Republicans to see that their goals were not always mutually exclusive. In this case, we should at least be able to show that the progressives and the Blue Dogs have some of the same goals (including getting reelected), and a plan like this will enable them the achieve their goals.