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Legal Speak

Health Care Reform

Published June 30, 2009 9:00 AM by Tony DeWitt

The trumpets have already sounded, and the fight is on over health care. The warriors are riding toward the battlefield in DC, and they are armed with their powerpoint slides, their position papers, and of course, their checkbooks.   

On the one side we have the insurance companies who are not eager to compete for health care customers, and on the other, we have the consumers who are tired of having a wallet-ectomy every time they get sick. Add into the mix more than 90 million uninsured (or underinsured) citizens, and what you have is a recipe for the most jumbled, complex, mess of government regulation and oversight ever in the health care system. Is that good? Of course not!

The problem with the American political system is that every interest group, from the National Fisheries Institute (a trade association "committed to assisting its members to succeed in the global seafood marketplace") to the National Association of Catholic Diocesan *** and Gay Ministries has a lobbyist (and usually more than one) spreading its message and its cash around in large quantities on Capitol Hill. It has been said that if lobbyists could not buy meals for congressmen and their aides, 60 percent or more of the restaurants in the District of Columbia would have to close.   

While there are more than a few congressman who won't sell out their political views for a five-star dinner, there are even more who will at least bring these interests groups into the tent and get them involved in the negotiations for the kind of massive government legislation that health care reform is going to have to be. 

There are two problems with this approach. Given the amount of clout and the amount of influence the long-established lobbyists for very influential companies and industries have, the ability to craft a universal solution for healthcare gets hijacked by what kinds of changes the automakers need in such a health care plan. Similarly, large organizations of hospitals not only worry from the standpoint of who pays the bills, they recognize that they will be facing the same burdens with providing the same kinds of care for their employees that the national plan is going to involve.  With so many voices screaming to be heard on the details, the broad outlines of the reform plan are as fluid as hot olive oil, and likely just as dangerous. And, if everyone gets a hand into the process, you can bet that the process will take so long that nothing will ever happen.

If we are to get health reform, this is what must happen. A small commission of individuals must be developed.  The commission would ideally include one representative from a large manufacturing industry (like the automakers), and one representative small businesses who currently pay for the majority of health care in the country. Congress could then name up to three additional representatives to represent the poor and uninsured, and at least one person who's only job was to look out for working people who pay way too much under the current system, and would like a system they can both understand and use. Included in the commission would need to be representatives from the hospitals and the health device makers, as well as one representative from the Pharmaceutical Industry, and one physician.  If the number of players could be kept to nine, that would be workable. A non-voting member who is a federal judge would keep the commission on schedule and offer legal analysis if requested.

These commission members would have no support staff, and there would be one secretary whose job would be to record the meetings and draft up the recommendations. The commission would meet in an undisclosed location without telephones. Food would be provided, but the commission would be given a short two-week deadline within which to complete its work. No cell phones, no faxes, no emails and no communications with the outside world until the commission came up with a plan that would do the following:

1. Allow the currently uninsured access to quality health care at a rate that was affordable for a working family or single-mother.

2. Allow employees with a current health care plan they liked to keep it; and if the plan was not one of their liking, offer them similar options at different price points. (For example, a 21 year old might not want to have an option for long-term-care insurance, whereas a 58 year old might want such an option and be willing to pay for it.

3. Be fair to all payors in that people who had abused their bodies with drugs, alcohol, or other substances would be required to pay more than those who had not. Similarly, older Americans should pay more for coverage than the young, because they consume more health care.

4. Impose cost reductions and cost savings on the health care industry to reign in price inflation that always outstrips the national average.

5. Leave individual physician autonomy and decision-making unencumbered, but provide incentives for physicians who follow national practice models and who have fewer claims for medical negligence.

Without cutting off the access to the commission details will leak to the press, and those details would cause industry and other lobbyists to pressure commission members to oppose or support propositions that might negatively affect a particular industry, but would be ultimately positive for the country.

It is too bad that this approach isn't going to be advocated or tried, because it could work. The mess that will be made in Washington DC when health care reform takes center stage will more likely resemble the making of sausage than legislation.

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About this Blog


    A.L. "Tony" DeWitt, RRT, CRT, JD, FAARC
    Occupation: Attorney
    Setting: Jefferson City, Mo.
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