The way forward on health care reform
By CORNELIUS HOGAN
Rutland Herald
Published: March 25, 2009
President Obama and Budget Director Peter Orzag are “on the money” in their views about controlling the cost of health care as the key to future health care access and quality, plus the role that controlling health care costs plays in our economic recovery. Without controlling cost, all changes and initiatives currently in motion and contemplated will not work and will quickly make things worse.
For example, in the two states of Massachusetts and Vermont, which were highlighted at the president’s health care forum at the University of Vermont on March 17, well-meaning programs and actions taken to date, are doomed to failure because they do not begin to address the cost issue.
In Vermont subsidizing health care has perhaps helped a very few people, but it is fiscally unsustainable in an environment where the cost of health care is rising at two to three times inflation. Nor will “disease management,” although good public policy, have an impact on controlling health care cost within our lifetime.
In Massachusetts, if it were not for the temporary and major largesse of the federal government, the mandate program would be dead in its tracks.
Both of these experiments, even though positioned as paradigms of progress, don’t come close to being remotely sustainable.
If we are to have even a chance at controlling the overall cost of health care, we need to put in place several basic practices, which at this point are not in evidence, or even being contemplated. They are: an integrated, enforceable budget (what other human enterprise doesn’t have one?); fair financing where we all contribute and all are in; health care planning based on the need of the population; and elimination of unnecessary and costly utilization review, benefit review, eligibility review, advertising, and the gross transaction costs of billing, collecting, generally chasing the money, much of it from people who cannot afford it.
Actions short of these will continue to promote uncontrolled cost rises (health care costs have doubled over the last eight years) which will result, at some point in the near future, in a collapse of our hospitals, physician practices, and other vital health care services. It will also result in pricing tens of thousands more Vermonters out of care. Federal bailouts won’t last forever.
Let us help our president control these costs. Put some bigger options, such as Medicare for all, hospital benefit for all, or even single-payer on the table. These broad-based approaches are our only chance at up-righting health care, which is now ever ripe for a collapse.
Cornelius Hogan was secretary of human services under Govs. Richard Snelling and Howard Dean. He was coauthor of “At the Crossroads: The Future of Health Care in Vermont.”