Eva Mor on Healthcare Reform |
OurBlook interview with Dr. Eva Mor, author of the new book “Making the Golden Years Golden.” President Obama has made it clear he isn’t working to set up a precursor to a single-payer health care system. Meanwhile, the insurance industry says that any version of a public plan will kill private industry. Is there any precedent for a public/private partnership in health insurance? If not, how could this experiment be structured?EM: There are precedents of public/private partnerships in other countries that seem to work. Each has some shortcomings, but in general they work and provide health services of high quality. In Israel, for an example, every Israeli is provided with health insurance coverage from the day they are born until the day they die. The health services are provided through four large HMOs, each an entity of its own. Each HMO has clinics throughout the country, and each person can choose an HMO and switch to another if desired. Each HMO has specialists and provides the full range of medical services and is interconnected with local hospitals. Payment for insurance is in the form of deductions from your earned gross income to the tune of 4 percent. For the elderly and unemployed, the government pays from this budget. There are direct payments to insurance companies from individuals who are self-employed. And one can buy additional coverage above the universal one. If we had in this country from five to 10 large health insurance companies that would absorb the smaller insurance companies, unify services, as well as charge rates for said services that are uniform, it would make it easier to provide health coverage for most of the population, including the uninsured with the addition of a public plan. Proponents of a public plan insist such a program is necessary to create competition to stop the skyrocketing costs of health. Why is our current market-based system unable to cut costs without government competition? Are there other forms of regulation that fall short of creating a new government program that could rein in costs? EM: The costs keep rising because the health care system is profit driven. The competition at this time is driven by bottom lines, not the quality of service or even consideration of consumer needs. The administration of the existing health delivery system is bloated with waste and unnecessary cost. If information was shared by all providers of health services and all insurers by using computerized systems to store all medical records, it would cut costs and reduce errors that would save and improve lives. What we need in a health system is uniformity in pricing for procedures and services and modalities of provision of testing and procedures for diagnosis and treatment. By providing coverage to the uninsured, which initially will cost the taxpayer, it eventually will save us hundreds of millions of dollars. As of today, we are paying through our health insurance and our taxes for their care. When the uninsured seek health care, they come to the emergency room, either acutely ill due to waiting too long before seeking help, or bringing in a child with a runny nose and a cough. This is the most expensive mode of health care delivery. If those people were cared for by family doctors, it would cost the system much less. As a gerontologist, do you see any special impacts in this debate on the Boomer generation and older? Are there any particular provisions you would like to see put in a bill? EM: Preventive care is a must. It will make our population healthier and with little or no need of expensive chronic illness care. It will be a great investment for the young generations, saving billions of dollars over the years. The baby boomer should be also provided with accessible and affordable long-term care insurance. This will protect them, allow them to remain independent as long as possible, and protect their assets. It would be extremely helpful to Medicare recipients if the doughnut hole was closed and all medication for the elderly were covered through Medicare part D. As of today, it puts a great deal of hardship on them, forcing them many times make decisions of forgoing of taking their medications or cutting on food. The last health care debate, a la Hillary Clinton, was met by an immediate backlash from health care providers and insurance companies. This year, the debate began with a ‘strange bedfellows’ meeting on cost cutting measures at the White House. The proposal of a public plan seems to be fracturing this fragile bipartisan atmosphere. Do you think there is any room for compromise now that detailed legislation is about to be debated publicly? Will we see Harry and Louise return? EM: The main difference between the last health care debate and the current one is that the majority of Americans support changes in the health care system. This will force both political parties to eventually support some plan, and take credit for its implementation. I hope we will not see Harry and Louise return. Harry and Louise will be the first to benefit if the current health system is overhauled. I think all parties involved … insurance companies, providers of health services, such as doctors, hospitals, etc. as well as consumers and government … realize that the system as it is functioning now cannot continue. We just cannot afford it. I think that if the insurance companies will feel less threatened and reassured that they will be part of the future health system, they will spend less energy and dollars to fight the changes. Opponents of a public plan have decried a potential government program as “socialism” and “rationing.” Yet, Medicare is one of the most consistently popular programs in our history. From your perspective, do you think that people relate the two? Do you think a public plan gives too much control to the government? EM: There is a misunderstanding of the role the government plays in a health care system. We elect the government to represent the people, keep us safe, provide education to our children, build infrastructure, etc. Why is it a given that if the government establishes a health care system, it will be rationing provision of services and deficient in quality? When Medicare was established, there were plenty of people fighting it, with pretty much the same reasoning, yet the program has proven itself, and is a life saver, literally, for so many of our seniors. I would give more credit to my fellow citizens, that they would not tolerate governmental abuse of power in controlling health care provision. What do you think of the more controversial Medicaid program? Do any substantial changes need to be made or keep it basically as is? EM: Medicaid is a complex program and if any of the programs needs to be revamped, Medicaid figures high on the list. We may need to revisit the guidelines for qualifying for entitlement and establish better controls to reduce fraud and abuse. Medicaid may be better controlled if it is broken up into two or three agencies, each providing different services. One agency may deal with the older population, focused on their specific needs. The other may deal with the poor and the needy, etc. David Leonhardt, an economist and New York Times columnist, writes that rationing is already an unfortunate reality in health care, but mostly because of the way scarce resources are allocated, such as the high costs paid for experimental or unproven treatments that could be going to preventative care. Do you think there’s any reform that could increase the number of Americans covered without rationing? EM: I am not an economist, but I can see Mr. Leonhardt’s point, but I think it will be a mistake to withhold resources for experimental treatments. This is how scientists have made advancements in medicine, finding treatments and saving lives. I totally agree that preventive medicine is a must. Through practicing preventive medical care, we will be healthier and reduce costs by decreasing chronic illnesses which are so prevalent in the elderly today. The Obama plan is still evolving and it will still take a great deal of negotiations, give and take between all the different parties, political and otherwise, until we see the final plan. What role do you see small business owners playing in the debate? The major players in the debate so far represent powerful interests such as drug companies and doctors, but small business plays a vital economic role in any discussion of costs to employers. EM: Small businesses are such an important component of the American economy, and should be part of the debate, but personally I think that the overhaul of the health care system could ease their pain in carrying the burden of paying the high premiums of health coverage for their employees. Do you feel that a public plan is necessary if reforms include mandated health coverage? EM: A public plan may force the health insurance companies to take notice and compete for the consumer by providing better coverage, better services at a lower cost. Without a public plan, the insurance companies, even if mandated to make changes, will soon revert to old practices and high cost. Health care reform has been on the table in Congress before, but the resulting reforms, once they meet the President’s desk, are often more tweaks then overhauls. How do you see the debate on health care reform playing out in Congress this year? Do you think we will see sweeping reform at the end of the day when these proposals are negotiated? Do you see any Republicans crossing the aisle to support a public plan? Do you see any Democrats crossing the aisle to oppose one? EM: We are at a unique point of time. We are a population of 300 million Americans, 77 million of whom will become 55 and over in the next 10 years. With such big chunk of population aging and requiring more health services, and 47 million uninsured Americans, we can ill afford watered-down plans. There is no question that we will see an overhaul of the health system. The question to ask is: to what extent, and will it be enough? Dr. Mor was born in Poland to parents who were Holocaust survivors. Both sets of her grandparents were killed by the Nazis. She has an M.A. in gerontology and health administration from New School in New York and a Ph.D. in epidemiology from the School of Public Health Trackback(0)
Comments (2)
  written by DrDavidMcNeil, October 10, 2009
Dr. Mor seems very well intentioned, but also very naive regarding the healthcare reform proposals currently before Congress.
Re: "If information was shared by all providers of health services and all insurers by using computerized systems to store all medical records, it would cut costs and reduce errors that would save and improve lives." -- Well, if wishes were horses, then beggars would ride (or something like that). I mean she is jumping over one HUGE "if". It is prohibitively expensive. It would establish privacy problems that no one even wants to think about. Re: "The costs keep rising because the health care system is profit driven." -- In most sectors, the pursuit of profits drives costs DOWNWARD. Sally Pipes, in her book, The Top 10 Myths of American Health Care, explains increased costs as a result of greater marginal disposable income, technological advance, bureaucratic reporting requirements, and other factors. I would like to see Dr. Mor's evidencethat profits are driving the cost increases. Re: "What we need in a health system is uniformity in pricing for procedures and services. . ." By providing coverage to the uninsured, which initially will cost the taxpayer, it eventually will save us hundreds of millions of dollars." -- I agree with both points, although I would argue we need efficiency in pricing, not uniformity. For example, an MRI in the hinterlands of Alaska might cost more than one in downtown DesMoines, and asserting uniformity would be inappropriate. Our current system of artificial prices is the consequence of overregulation in the marketplace. Single payer or public option will worsen the situation. Freeing the markets (to some extent, at least) will help. Health Savings Accounts exert market forces to bend cost curves downward. However, they are outlawed in all bills currently before Congress. Similarly, if we bring the uninsured into the marketplace, sustainable success is likely. Tax credits for Health Savings Accounts have been shown to work in pilot studies. On the other hand, Public Options go bankrupt and bust - requiring draconian rationing when they are in their death throes.
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-- If wishes were . . . We don't have enough family doctors. We need more. We need to pay them more, not less. We need to get bureaucrats off their back, not a whole phalanx of more from the Public Option.
Re: "Preventive care is a must."
--Can't argue that. Everyone should eat right, exercise, and avoid unhealthy habits. On the other hand, paying for preventive medical services costs much more money than it saves. I would support selective preventive interventions in selective at-risk populations for specific conditions. I wish I knew more.
Re: "Why is it a given that if the government establishes a health care system, it will be rationing provision of services and deficient in quality?"
-- Please read the bills. H.R. 3200 designs a public option that will, in short order, per force lead to a single payer system. The Baucus Bill will do the same via more subtle mechanisms and over longer time. (See my blog posting "BaucusCare Approximates SIngle Payer" at the website above.)
Re: "I would give more credit to my fellow citizens, that they would not tolerate governmental abuse of power in controlling health care provision."
-- Not to put too fine a point on it, but please read the bills and pertinent analyses. Our fellow citizens and we ourselves are not going to have a lot to say about this once things are set in motion. This is not my paranoia. Read the bills.
Re: "Do you think there’s any reform that could increase the number of Americans covered without rationing?" (This was a question that went unanswered.)
-- There is nearly infinite demand chasing limited resources. There will have to be some way of sorting out who gets what. The only two possible are modified free markets and government dictates. The first is called allocation; the second is called rationing. At least with free markets, individuals are in the position to make decisions for themselves. For example, in England, a medication proven to halt macular degeneration will not be made available, even if the would-be purchaser has ready cash to pay for it, until there is already blindness in one eye. Does that seem reasonable? If it were available, even a poor person could decide to take on a second job, beseech relatives, forego other expenses, etc. to save his or her eyesight. But the individual would decide. If someone has money, shouldn't they be allowed to spend it on their health?
Health Care Reforms that would make services much more affordable, cover a much higher percentage of the population (remember, ObamaCare leaves at least 25 million uninsured), not tax away people's benefits, and, in fact, not cost taxpayers a penny include:
- Health Savings Accounts
- Eliminate State Mandates
- Allow deductibility of individual premium payments
- Allow risk pooling for individuals (this would include coverage for people with pre-existing conditions)
- Tort reform
- Special care organizations and service delivery for common, chronic conditions (e.g. diabetes).
See my blog entry, There are Ideas That Work; Here are Some.