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Bruce Hector: Health care reform needs to be bipartisan

SCV Voices

Posted: August 2, 2009 10:02 p.m.
Updated: August 3, 2009 4:55 a.m.
 
The Republican Party has raised objections to the health care idea of a public option which would allow individuals and companies to purchase insurance from a federal entity, presumably similar to Medicare for seniors.

Republicans cite two main concerns, among others. On one hand, they state the public option would rapidly enroll up to 100 million Americans and drive private insurers out of the marketplace.

On the other, they say such a plan would lead to rationed and delayed care, citing experience with the Canadian and United Kingdom plans, disappointing millions.

However, it seems to me that if this occurred, citizens/employers would quickly flee the public option for private care, especially if premiums and coverage were reasonably comparable.

The Signal recently conducted an online poll offering five reform options: private only, public only, private and public choice, free for all or no change.

Of the 341 votes collected, private and public choice received 155 (45 percent) with the next nearest, private only, receiving 70 (20 percent).

In our conservative district this reflects significant concern about the private sector's ability to solve the problem and should be noted by our representative in the House, Republican Buck McKeon.

I would request that The Signal obtain a response from him.

Clearly, if this small survey is reflective of the will of his constituency, a position of thwarting a public option at all costs is contrary to their wishes, though it may be supported by his big political donors.

According to Open Secrets.org, in 2008 McKeon received 27.1 percent ($190,950) of his political contributions from the finance, insurance and real estate sectors; this was his largest single campaign source.

The inability of the private sector to control costs echoes my experience as a private practice physician of 35 years in the San Fernando Valley now living in Santa Clarita.

In the late 1980s the private sector touted HMO coverage as a means to control high costs as well as medical fraud and abuse.

This system offered through employers allowed carriers to contract with participating physicians, either in a group model or IPA (Independent Practice Association).

Physician names were published in provider booklets given to potential enrollees. If the employee saw his physician's name, he would usually select that plan since it was cheaper.

Thus, the primary physician was the main marketer for the plan but received no fee.

Rather he received a capitation fee, initially as low as $7 per member per month, now about $13, regardless if the patient was seen once, 20 times, or never.

However, the plan controlled the utilization of basic ancillary services like X-ray and laboratory which previously had comprised about 50 percent of private visit charges.

This forced me and other primary care providers to seek other income sources, reduce staff and shrink office size when the lease ended.

The ancillary services control had an even more devastating impact on specialty providers who were not selected.

In the intervening years plan administrators grew by 2,000 percent compared to less than 20 percent provider growth with no reduction in the spiraling cost of premiums.

Currently, marketing, administration and profits comprise about 25 cents of every private insurer's premium dollar, compared to 3 cents for Medicare.

Private health care companies also have committed the greatest fraud in the Medicare system.

Why should we still believe the private sector is capable of self-regulation and cost containment?

Regarding options, I suggest that no one - Republican, Democrat, scientist or bureaucrat - knows what system will work best for America.

Rather than trying to presume so, we need to conduct appropriate research.

We should select several plans as proposed by their advocates, have states or regions prioritize preferences (by voters or legislators), have the National Institutes of Health establish success criteria, demographically match states/regions seeking to provide coverage matching regional desires without research compromise, and run the experiment over several years.

When one system establishes a clear advantage over others based on multiple predetermined criteria including access, cost control, patient satisfaction and health outcomes, it could be adopted on a national basis.

This approach avoids the need for political compromise that so often leads to a less than adequate plan, allows advocates to prove if their ideas are right and like medical research, gives scientific answers.

To date, I have seen no advocates of such a seemingly reasonable proposal.

Instead, we continue the endless spin and scare tactics, leading to ever more divisiveness designed only to score political points while 18,000 Americans die annually because of lack of health care coverage and politicians remain safe and secure.

Perhaps if politicians lost their insurance until they solved the problem, we could get some bipartisan action.

Dr. Bruce Hector is a resident of Santa Clarita. His column reflects his own views and not necessarily those of The Signal.

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