Top 5 Signs That Healthcare Reform Is Coming

Over the past thirty-odd years, there have been numerous initiatives launched to address the massive health care snowball that's been careening down the mountain, crushing primarily children and the poor under its weight. What's different now is that everyone else is being flattened.

With much fanfare, these efforts have been designed, communicated, debated, put on life support, and finally, abandoned. What do you do with dead health care initiatives? Barium.

Jimmy Carter unsuccessfully sought support for national health insurance, welfare reforms, and controls on hospital costs. Do any of his proposals sound familiar?

• Comprehensive national health insurance
• End the health care bureaucracy that frustrates attempts to implement an effective national health care policy.
• Encourage alternative delivery systems such as HMOs
• Clean up Medicaid.

In his 1992 State of the Union Address, George HW Bush said the following: We must reform our health care system for this too, bears on whether or not we can compete in the world. American health costs have been exploding. This year America will spend over $800 billion on health, and that is expected to grow to $1.6 trillion by the end of the decade. We simply cannot afford this. The cost of health care shows up not only in your family budget, but in the price of everything we buy and everything we sell. When health coverage for a fellow on the assembly line costs thousands of dollars, the cost goes into the product he makes. And you pay the bill. Now we must make a choice.

That went pretty well, didn't it? Bush lost his bid for reelection, so we'll never know if he would have made good on his promise. The record shows he did little to solve the healthcare problem during his term.

In 1993, Bill Clinton's ambitious health care reform plan was created, with First Lady Hillary Clinton helping to lead the initiative. Republican's loathed the plan, calling it draconian and the socialization of medicine without offering an alternative. 

The Clinton plan was simple in its tenets. Every US citizen and permanent resident alien would be required to enroll in a qualified health plan, and you could not disenroll until you were covered by another plan. Each qualified plan had minimum required coverages and maximum out-of-pocket expenses.  The Clinton plan encouraged "regional alliances" of healthcare providers to be subject to a fee-for-service schedule, obviously to help avoid having insurers set up plans in specific states that were friendly to the industry, much like banks and credit card companies do today by incorporating in Delaware. Finally, anyone who fell below a set income level would pay nothing.

Led by conservatives like William Kristol, who most know as the person who has been wrong about everything he's ever written in his New York Times column, and then-Senate Majority Leader George Mitchell, the Clinton plan was dissected and reassembled with different body parts, including the exclusion of small businesses and pushing off enacting the plan until 2002, until it died on the table. 

This was, in my opinion, the crowning achievement of modern conservatism - since we don't have any ideas of our own, we'll kill yours and be victorious in your defeat - that led the Republican party to significant mid-term election losses in 2006 that continued in 2008, with control of Congress and the White House landing in the hands of Democrats.

George W Bush's plan wasn't as much a strategy as it was a collection of things to do that would cost the healthcare industry little and do nothing to solve the problem while foisting conservative morals into the science of medicine. 

W believed that we didn't need insurance - just a healthcare savings plan so banks and plan administrators could earn interest off of your savings until you had a catastrophic illness, at which point you could use your savings to pay a small portion of the medical bill and go into substantial debt for the remainder, since Republicans had also changed the bankruptcy laws to make it nearly impossible for individuals to declare.

Bush 43 was adamantly opposed to any sort of national healthcare insurance or plan, going so far as to suggest that people use the ER as their primary physician, which delighted the overworked, under-funded, and crumbling emergency medical services.

Barack Obama takes office in a matter of weeks, and healthcare reform was one of his key messages during the campaign, one that remained constant, with no wiggling in an attempt to placate key constituencies. Obama has recommended several foundational components:

• Quality, Affordable & Portable Health Coverage For All
• Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
• Promoting Prevention & Strengthening Public Health

Obama's plan also leverages information technology to lower costs, prevention and management of chronic conditions, and increased competition, reduced plan administrative costs, and lower industry profits, which thrills the entire healthcare industry. Unlike in 1994, however, changes will occur in how healthcare is funded, managed, and implemented during Obama's term. Here's are my five reasons why this will happen.

1. Doctor swag is going away. Starting today, January 1, 2009, the pharmaceutical industy is implementing a voluntary ban on branded items - think coffee mugs, Viagra pens, calendars, Zoloft clipboards, Lipitor paper pads, etc. - that have been used to curry favor with medical professionals while creating this incestuous relationship between big pharma and your physician. Some consider this to be a superficial gesture on behalf of the drug companies, because it excludes other items such as the crinkly exam table paper you lay on, pen lights, and countless other implements used in an medical office practice. What it tells me is that it's a bone tossed out in the hope that harder scrutiny is avoided on not only these implements, but more serious ethical matters such as funding of travel and conferences, paid engagements, and consulting gigs that doctors have used for years for their financial benefit that also serve as direct conflicts to acting in the best interest of their patients first.
2. Healthcare insurers want a seat at the table. In early December 2008, America's Health Insurance Plans (AHIP) CEO Karen Ignagni held a press conference to unveil the industry’s new health care plan. The AHIP plan is comprehensive, according to Ignagni, and seeks to address almost every element of health care reform - access, affordability, cost, and quality. However, it is in competition with the proposals of Sen. Max Baucus (D-MT) and the Ted Kennedy plan, and falls short in some of the areas articulated by Barack Obama, especially in one key area - the AHIP proposal wants to to build on the current employer-based system to ensure complete coverage, which Ignagni claims is “not negotiable.” The industry knows that change is coming, and wants to do whatever it can to limit the impact to their industry by conceeding on minor points while digging in on systemic changes, an approach that's destined to fail this time around.
3. Detroit automakers are in the dumper. As Chrysler and General Motors begged for bailout funds (with Ford peering over the fence like a nosy neighbor), it became clear that one of the primary drags on their finances was healthcare costs associated with union contracts, for both current workers and UAW retirees. Back when things were going well for the Big 3 (y'know, around 1970), automakers agreed to huge benefit packages to ensure labor peace with the unions, and the bill for such short-sightedness has been coming due ever since. For GM, healthcare costs add $1525 to the sticker price of every car that leaves the lot, and GM spent $5.2 billion on healthcare in 2004, more than it spent on steel. Conservatives love to compare US auto worker compensation to that of Japanese auto company workers, throwing around a misleading $71 per hour for US workers versus  $47 per hour for Toyota. One of the primary reasons for this differential might be that Japanese firms aren't sagging under the weight of aging retirees draining company profits. Japan requires enrollment in a public or private employer-sponsored plan, and the Japanese government spends about half as much on healthcare as the US to provide care for everyone. Big business in the US will have to jump on the universal healthcare bandwagon if they expect to survive.
4. The economy is too closely linked to the healthcare industry. The  current economic climate will cause significant impacts to the healthcare industry that will have downstream effects to care. In the past, the healthcare industry has been fairly recession-proof, but the current financial crisis is already causing concern in several areas. The tightening of the credit markets makes student loans much more difficult to obtain, and with the average medical student spending about $140,000 on their education, the inability to obtain loans to finance their tuition may limit the number of prospective medical students or cause them to attend less prestigous (or less rigorous) medical schools outside the US. Less medical students eventually means less doctors. The same formula can be applied to nursing students, physical therapists, researchers, and so on. Scarcity of supply leads to increased costs, so you'll certainly see broad support for educational and financial assistance for healthcare careers, possibly in exchange for providing medical care in under-serviced areas for a fixed period after graduation.
5. Public support for change. The success of Barack Obama's campaign, with the underlying concept that one voice can change the world, has empowered the citizenry to believe they can accomplish their goals in the face of previously insurmountable obstacles. Conceptually, in times like these, diverting resources from those who have to those who have not begins to seem less socialist and more Robin Hood. How can a country ignore the suffering of its children and the multitudes of the downtrodden when we've seen the alternative to be golden parachutes for incompetence, gaming the system for the personal gain of a select few, and an undeclared war on the shrinking middle class?  The time has passed when we could sit idly by and watch people go face down in the cake, because these are not strangers anymore. These are our friends, our neighbors, and our co-workers. Can we take care of our brothers and sisters? Yes, we can.

So there you have it - my top five reasons why we'll have a successful healthcare reform effort this time. It's the next battle to be waged by progressives in the war on the status quo. 

Grab your musket, fill your canteen, and get ready to march. The enemy has had years to dig in and fortify their position, so we'll do one of two things - we'll conduct a healthcare blitzkrieg and overwhelm them with our sheer numbers, or we'll flank them, cut off their supplies, and let them wither. Either way, this is a conflict none of us can afford to lose.

Cross-posted at The Daily Kos.