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Clark Vandeventer: Health Care — What’s Right, What’s Wrong and What’s Missing

Any reform package should include many of the provisions in HR 3200, but other aspects are cause for concern

The health-care system in America is a mess. The vast majority of Americans, whether they like their coverage or not, intuitively know this. And all reasonable Americans agree that we want to see the cost of health care come down, we want access to go up and we want to do it in a way that in no way compromises the quality of care we receive or the patient-doctor relationship. Furthermore, we want to do all of these things while remaining consistent with the expectations of individuals in a free society.

I am for those things, so I am against the health-care reform packages proposed in Congress and championed by President Barack Obama.

Clark Vandeventer
Clark Vandeventer

The House health-care bill, HR 3200, gets some things right. Any health-care reform package passed by Congress should include many of the provisions in the 1,000-page-plus piece of legislation.

Seniors should be happy that the bill finally would address the “donut hole” in the Medicare Part D prescription drug program. Currently, seniors under the plan are responsible for 100 percent of their prescription costs until they reach the catastrophic coverage threshold. HR 3200 would immediately give seniors in the plan 50 percent discounts on brand-name drugs, and more importantly, it would give the government the ability to negotiate lower prices from the drug companies.

Doctors should be happy that HR 3200 addresses reimbursement to physicians. Currently, doctors who live in areas where the cost of living is quite high receive the same reimbursement rate from Medicare as doctors who live in less-expensive rural areas. Because of that, doctors in areas where the cost of living is high are disinclined to take Medicare patients. The reforms proposed in HR 3200 should fix the problem.

The proposal also would take steps to train more primary-care physicians and to offer loan repayment to doctors who agree to practice in underserved areas. When facing the proposition of loan repayment, many doctors opt to become specialists because the pay is better. The result is a shortage of primary-care physicians. We need to address this, and HR 3200 does.

Those are just a few of the excellent reforms included in the proposals on the table, and Americans should insist that Congress include measures such as those in any bill passed by Congress and signed by the president. However, there is plenty in the bill that should make us very nervous. Others have spoken and written at length regarding the faults of a single-payer system (which
HR 3200 is not) or a public, government option (which is included in HR 3200).

I suspect youʼve heard these debated ad nauseum. Americans don’t have total agreement on this issue. I know great Americans who support the public option, and I know great Americans who oppose it. But I think all Americans should be alarmed by how the bill would affect their personal liberty and privacy. This intrinsic fear of government is deep in the roots of all Americans.

Recently I saw a scene that I loved very much. Two cars were parked right next to each other in a parking lot. One had an Obama sticker. One had a McCain-Palin sticker. But they each had a second sticker, too, and it was the same on both cars. It read: “I love my country but I fear my government.”

My new friend Dr. James Kahn, who represented the presidentʼs plan at The Vandeventer Group town-hall meeting on health care a few weeks ago, recently posed this question to me: Why are conservatives in a fuss over privacy as it pertains to this bill when President George W. Bush launched his own assault on privacy?

Here are Dr. Kahnʼs exact words to me: “Bush launched an unprecedented invasion of privacy, monitoring everyone’s phone calls, domestic as well as foreign, invading anyone’s computers if their e-mails had words in the subject line like ‘Arab,’ and everyone on the right supported that as necessary to our security. Yet, this bill provides for limited kinds of data collection in order to improve the health-care system of the nation — which is currently killing lots more people every year than 9-11 ever did — and now conservatives are outraged about privacy issues.”

My answer led me to reach back to something I had previously written to him. An intrinsic fear of government runs deep in the roots of all Americans. Yet, when Republicans are in power, conservatives tend to forget this fear, and when Democrats are in power, liberals tend to forget this fear. The result is that the establishment always wins. The power of government to own us, control us and destroy us increases. It happens regardless of which party is in power.

Americans should be very concerned about how this health-care bill is yet another blow to the right to privacy. If you donʼt believe me, check out the bill for yourself and take a close look at Section 431(a), Section 245(b)(2))A) and Section 1801(a). It will get you started on the track at least. This is an unprecedented, mandated collection of personal, financial and medical data by the federal government. Thousands of federal employees would have real-time access to information regarding transactions from your credit cards and checking account.

If a Republican were in the White House, I imagine Dr. Khan would oppose such measures. Many of my conservative friends were silent on the infringements of the Bush White House on personal privacy.

One of the biggest points of division at our town-hall meeting was whether a person would rather go to battle against a private insurance company or the federal government. Honestly, I have no desire to do battle with either. But the worst my insurance company can do is deny a claim and send me a bill. The federal government can and will not hesitate to absolutely destroy me. Take my house. Send me to prison. Destroy.

Whatʼs missing from the reform package?

First, we need litigation reform. It is consumers — patients — who inevitably must pay the cost that doctors and the medical community face because they are forced to carry expensive insurance to cover themselves from the threat of frivolous lawsuits. Currently, a doctor can’t even use the words “Iʼm sorry” without it potentially being used against them as evidence of implication. Tort reform is essential to real health-care reform.

Second, we need to go after those cheating the system. Earlier this year, Malcolm Sparrow, a Harvard professor and author of License to Steal, testified before the Senate Judiciary Committee and said: “The units of measure for losses due to health-care fraud and abuse in this country are hundreds of billions of dollars per year. We just donʼt know the first digit. It might be as low as $100 billion — more likely two or three, possibly four or five (hundred billion dollars).”

But these issues are still on the periphery. We must enact tort reform and beef up efforts to eliminate fraud, but this is only a tinkering with the system. The greatest single contributor to skyrocketing health-care costs is the gap. It is the wedge between the person who receives a service and the person who pays for a service.

Until two years ago, I rarely thought about the cost of the health care I received. As an employee, I had an employer-sponsored health plan. I never considered the cost of the plan or the value of the plan based on what my employer was paying for the plan. That all changed when I started my own business and was responsible for paying my health-care premiums. Suddenly, I was very interested in value.

Whole Foods CEO John Mackeyʼs Wall Street Journal piece on health care last month had seven practical suggestions for health-care reform. Two of his suggestions dealt directly with this issue.

He wrote:

» Equalize the tax laws so that employer-provided health insurance and individually owned health insurance have the same tax benefits. Now, employer health-insurance benefits are fully tax deductible, but individual health insurance is not. This is unfair.

» Make costs transparent so that consumers understand what health-care treatments cost. How many people know the total cost of their last doctor’s visit and how that total breaks down? What other goods or services do we buy without knowing how much they will cost?

Consumers who are spending their own money on health care will demand value. Arthur Laffer weighed in on this issue, writing in the Wall Street Journal that “when the government spends money on health care, the patient does not. The patient is then separated from the transaction in the sense that costs are no longer his concern. And when the patient doesnʼt care about costs, only those who want higher costs — like doctors and drug companies — care.”

He continues: “According to research I performed for the Texas Public Policy Foundation, a $1 trillion increase in federal government health subsidies will accelerate health-care inflation, lead to continued growth in health-care expenditures and diminish our economic growth even further. Despite these costs, some 30 million people will remain uninsured.”

The health-care packages on the table actually widen the wedge between the person who pays for health care and the person who receives the service. The plan would eliminate — completely eliminate — co-payments by patients on a wide range of health care. That means that consumers have no financial responsibility whatsoever. This can only lead to overuse and a burdening of the system.

President Obama has repeated over and over that opponents of his plan would have us do nothing. That simply is not true. We all know our system is unsustainable and plain maddening. But doing nothing is actually better than the prescription prescribed by Obama.

While I believe that the vast majority of Americans understand this common-sense approach to health-care reform, I have little hope that Washington gets it. Thatʼs why a recent Rasmussen poll showed that 42 percent of Americans think we would get a better Congress if we randomly selected names out of a phone book. Frustration with Washington is mounting.

From my vantage point, I see no sign that a change to the business-as-usual approach is on the horizon.

— Clark Vandeventer is a social entrepreneur and is the founder and chairman of The Vandeventer Group. He’s committed to developing practical ideas that make government work and make government work for us.

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