Patient-Centered Healthcare

Yesterday a message from Kansas Senator Sam Brownback about health care reform showed up in my email inbox. Here are a few excerpts from his message.. first a note about Senator Ted Kennedy's reform proposal:

"The bill creates a tax penalty on patients who cannot demonstrate they are covered by health insurance approved by the government board. This legislation also offers new subsidies to Americans earning up to $110,000 per year to purchase health insurance. Further, this bill creates the possibility of an employer pay or play mandate where employers must offer health insurance to employees or pay an additional tax or fine. This bill also lays the groundwork for a new government-run health insurance plan."

He also spoke to the cost of healthcare reform saying that it could cost between $1 and $2.2 trillion. He also spoke to other costs of this reform:

"President Obama mentioned cutting spending in Medicare and Medicaid, programs serving elderly and lower income individuals, by an estimated $600 billion. To raise another estimated $300 billion, he discussed tax increases including limiting charitable and mortgage deductions for higher income earners."

Sam went on to speak of the downside of a nationalized plan:

"In Europe, we have seen how socialized medicine has failed. Long waiting lines and inefficiency plague hospitals; doctors are essentially government employees; and there is no incentive for innovation or new medical technology. Consequently, the U.S. is the leader in medical technology, and has some of the most efficient and well run hospitals in the world. This would not be the case if government takes over health care. My specific concern is the creation of new government-run health insurance plan. According to a recent report, creating a new government-run health plan would cause an estimated 70% of people with private insurance - 120 million Americans - to be dropped and forced onto the government-run plan, where coverage for treatments and other life-or-death decisions would be dictated by the federal government."

He wrapped up his message by saying this:

"My goal is for every Kansan to have access to affordable health care insurance through a patient-centered, not government-centered approach."

That "patient-centered" phrase caught my eye.. it was a clarifying thought for me.. should the goal of healthcare insurance to centered on the "patient"? If so then it seems that the patient should be the main player in determining healthcare options.

Recent history has shown that insurance companies have taken an increased dominance in the decisions made by physicians and healthcare professionals. This involvement was initially predicated by a perceived trend towards abuses of medical insurance where unnecessary test and treatments were being ordered by healthcare professionals. I think that this involvement has progressed over the years to a point where insurance coverage has become an unwanted focal point in the process.

With that in mind I begin to imagine what it would look like to have the government taking a dominant role in healthcare. At first I think that it could be a very beneficial program for our country.. large insurance companies would no longer be able to disqualify people based on preexisting conditions.. people who lose their jobs would no longer have to worry about losing their medical insurance.. there are many other initial advantages to a universal healthcare approach.

Then I think about leaving something as important as our healthcare in the hands of politicians.. many of who are supported by the very large medical insurance industry lobby. I tend to go to some pretty dark places when I think about how government employees today have little flexibility when they are administering medicare and medicaid. They are bound by the minutia of procedural interpretations of the laws that legislators have passed.

When I consider reform I return to this idea of a patient-centered approach and I come to the conclusion that healthcare is not patient-centered today.. it has not been for a long time. So the question is: how much reform is needed? It seems that some reform is needed to help people who do not have insurance through no fault of their own. It is just not clear how much reform is enough.