By Pam Linn

To your health . . . care!

Let’s get something straight. We probably should stop referring to health care reform as Obama Care since the President has yet to write a plan or even to clearly define his objectives. Instead, we might discuss the points on which Republicans and Democrats say they could agree.

Most would admit that health insurance needs some reform. At least a law that precludes an insurer from dropping those who become ill, or refusing policies to those with “pre-existing” conditions.

Some view providing basic coverage for the millions of uninsured (or uninsurable) as a moral imperative. For the richest country on the planet to ignore the health of so many of its people is seen by others as a national embarrassment.

All seem to agree that health care delivery costs must be controlled, but have differing views on how this might be accomplished. Rates have soared at three times the rate of inflation, while wages have remained stagnant. Hospitals raise fees on insured patients to pay for mandated treatment of the uninsured in emergency rooms (the most costly and least effective method of care). Insurers pass on those costs by increasing premiums, co-pays and deductibles. Those who favor a “public option” believe that would “keep the insurance companies honest” and lower costs overall.

Doctors in private practice must pay a full-time insurance specialist to file claims on different forms from dozens of insurance companies with different plans that cover various procedures. It’s my understanding that most use the Medicare formula for reimbursement amounts. Doctors also have to pay malpractice insurance at rates that have driven many to early retirement.


That brings us to “tort reform,” possibly a suggested cap on malpractice awards. Republican and Democratic lawmakers agree something needs to be done but find little consensus on how this might be accomplished fairly.

Employment-based insurance is a huge part of the problem, many hospital administrators and doctors agree. But lawmakers of both persuasions see no practical way to change what has become an integral part of our system, dysfunctional as it is.

Current laws vary by state, and insurance companies are somewhat regulated by each state’s insurance commission. Rates for all types of insurance are based on population or distribution of the risk pool. When people say they want “portable” policies, or the option to cross state lines to purchase plans not available in their home state, they may not understand what this would entail. These same folks say they don’t want the federal government involved in their health care. But if insurance were to be truly portable, from state to state, who but the federal government could regulate the insurers?

Currently, primary-care doctors are free to refuse patients with Medicare or any private insurance that similarly limits the rate of reimbursement. Specialists, in some cases, including HMOs, accept only patients referred by their “primary care provider.” Very few areas of the country have enough doctors who provide basic care, and some have none.

At every turn, a patient may be required to have duplicate tests instead of the specialist requesting results of X-rays, MRIs, blood panels, etc., from the patient’s family doctor. This sort of redundancy is commonplace but wastes everybody’s time and money. Electronic records, in clinics that use them, seem to facilitate this.

The fact is that even if some Americans are satisfied with their coverage, they can lose it in a heartbeat, not to a government takeover, but at the whim of their insurance company, which can double the premiums, without cause, beyond what the employer can afford. At that point, the employer can try to switch to a different insurer, an HMO or one that offers a more affordable plan with higher deductibles, premiums, co-pays, and fewer covered services and providers. Or health care for the workers may have to be dropped to keep the business viable. So much for keeping the coverage you have.

These are the important things that many Republicans and Democrats agree need to be fixed. We’ve heard enough from the partisan protesters decrying “Government take-over of our health care,” “Socialized medicine,” “Keep your government hands off my Medicare,” and “Death Panels to decide how Granny will die.” Please let us get beyond this sort of nonsense.

So if we’re serious, we can tell our elected representatives to focus on the current system failures that must be fixed: Figure out how to control costs; see that everyone has access to basic care; prevent insurers from dropping the sick and refusing coverage based on “pre-existing conditions.”

If Congress could write a simpler bill, free of loopholes for the vested interests, it could be passed and signed by the President. Then, if they must, lawmakers might just agree to disagree for now on the rest.

The Malibu Times is the first newspaper in Malibu, serving the community since 1946.

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