Argument two – Universal coverage would result in the government running the health care system making it worse than it is today – because the government can’t do anything right.
There are two separate statements here – first that UC will result in the Feds running the healthcare system, and second that the Feds can’t do anything right.
Let’s take the latter first – but in no way does that mean I concede the first statement is accurate.
I strongly disagree with the statement that government can’t do anything right. I’d also note that ‘the government’ is us; and if it can’t function effectively than we need look no further than the mirror. But it can, and does, work pretty well in many instances.
Among the numerous examples of relatively effective government are the Centers for Disease Control, US Coast Guard, National Oceanic and Atmospheric Administration, Head Start, AmeriCorps, NIH, the GI BIll, and the National Weather Service. No, none are perfect, but then again our private sector is not exactly stuffed with competence these days.
It is not the fact that an organization is ‘government’ or private that makes it competent or not, it is the leadership of that organization that is the determining factor.
But perhaps the best is the Veteran’s Administration health care system. As I noted last month,
– compared to commercial managed care plans, the VA provided diabetics with better quality care on seven out of eight metrics by NCQA.
– In 2005, VA hospitals were the highest-rated health system, outperforming other systems including the Mayo Clinic and Johns Hopkins.
– the VA achieves higher scores than private hospitals for patient satisfaction, staffing levels, surgical volume and other significant quality measures
– for six years running, VA hospitals scored higher than private facilities on the University of Michigan’s American Customer Satisfaction Index.
And costs haven’t increased nearly as fast as they have in the private sector. In the ten years ending in 2005, the number of veterans receiving treatment from the VA more than doubled, from 2.5 million to 5.3 million, but the agency needed 10,000 fewer employees to deliver that care – as a result the cost per patient stayed flat. (costs for care in the private sector jumped 60% over the same period).
The VA did this by closing down unneeded facilities, developing an industry-leading electronic health record system, opening clinics, and dramatically increasing the quality of care, especially for patients with chronic conditions.
Oh, and patients can access their own health records – securely – anytime on the web.
Sounds pretty good to me. But alas, universal coverage will not result in the Feds running the health care system. The current proposals under consideration keep providers private (for-profit and not-for-profit), brokers will keep broking, insurance companies doing their thing. Yes, there may well (and should) be a public insurance option, but there is precious little evidence to suggest that the public option will dominate the market. And the evidence that is touted is not compelling.
In fact, providers would not have to participate in a public option – they could refuse to sign up if reimbursement was too low or other terms not to their liking.
And, the governmental option would have to compete with what is already a very mature market, dominated by very few healthplans with overwhelming market share. Here’s just one statistic – In almost two-thirds of all HMO/PPO market areas, one healthplan has more than 50% market share.
Good luck to the Feds fighting for share in Texarkana where the Blues’ share is 97%, or Gadsden Alabama (95%).
Finally, those arguing against UC with the ‘government is incompetent’ meme must not have followed the accounts of healthplans canceling coverage for individuals without justification, employing medical underwriting to refuse coverage for any pre-existing condition, using skewed data to avoid paying what they should for out of network care, fraudulently enrolling seniors in Medicare Advantage plans, and slashing provider bills with the thinnest of justifications.
It would take a good deal of hard work to be more incompetent than some of the health plans out there today.
I’m thinking the VA stacks up awfully well against WellCare.
Apr
15
I was a little surprised by your support for the VA System; those I know personally, basically family and a few others, who have access to the VA are not at all “thrilled” at using the VA. Certainly their experiences do not match what you have touted above. They are spread out in San Diego, WA and OK, and I am just not seeing or hearing the support you are saying. The morale of the staff, in some cases the lack of staff, did not appear all that great. Some recipients of the VA system have often felt “stuck,” unless they were willing to travel elsewhere – not always an easy thing to do, or convenient.
Since you are consultant, I would think you would not be so quick to jump on statistics when they often do not tell you the entire story. I understand your commitment to your cause, but you often sound like the very people you are in disagreement with.
Man from Tulsa,
It’s a little too easy for me to say that “anecdote” is not the singular of “data” so I’ll expand my thought. I don’t doubt the experiences of your friends and relatives. But compared to what? I’m assuming that if they are going to the VA, they don’t have much experience with private sector facilities. Literally everyone I know has a horror story to tell about their experiences with private hospital ERs, inpatient stays, botched procedures, and lots and lots of billing and transaction errors. Anyone who has ever lost half a day on the phone trying to sort out a billing error, trying to figure out who’s to blame — the doctor, the hospital, the insurance carrier, the wraparound PPO, or perhaps just your own lack of understanding of your own policy — would be happy to have the VA system.
The shorter version is this: any human construct is subject to flaws worthy of complaint, healthcare even more so than most because it is perhaps the most complex thing humans do. The VA, while not perfect nor even ideal, gets many things right that the private sector does not, and in many cases cannot or will not.
I’d much rather see the private healthcare system become more like the VA than the other way around.
Joe– After many more decades than I care to enumerate in various parts of this business, I would have to say that both government and private industry get things right and get them wrong. We could all throw examples back and forth for days (what fun). I think the underlying concern is not that government never gets anything right. That is clearly not true. For every FEMA there is a VA or a Federal Crop Insurance Corp (a real gem among Federal operations). My own concern is that UHC will arrive on the sceme hopelesly compromised from birth by a Congressional process which will load it up with dozens of competing agendas. The resulting eight legged, five humped camel with a head at each end will never be able to function properly. The best Federal and state entities that I have seen in action usually have a fairly narrow focus– they do a few things and do them well. UHC will almost certainly try to tackle everything in sight because Congress lacks both the insight and the discipline to design a focused and coherent program. That’s my concern and I think it is 100% legitimate. The cure could well be worse than the disease– just look at the 2009 stimulus package Congress birthed a few weeks back. Not just one but several kitchen sinks. If UHC becomes a sinkhole of political pork– and tell me why it won’t– it will be dysfunctional from the git-go.
Any system will not answer all questions. The worst stories in medical delivery in my experience have come from the most complex structured programs. What do we want from UHC? Is it put the Docs on Salary and control waste is it spread the cost of the chronically ill to the healthy? Cover the uninsured? Single payer could take some inefficiencies out of the system and take a big whac out of the med legal pie, and subrogation expense. I have huge reservations, and I am usually a take a chance how bad can it be person. If medicare is any indication of UHC I am probably out.