Look to the States for Reform
Look to the states for meaningful health care reform
Dr. Joe Jarvis, Salt Lake Tribune
First published July 2009
If you are among those who remain hopeful that President Obama and the Congress are seriously working at solving our nation's health care crisis, then allow me to sell you Alaska's "bridge to nowhere." Whatever health care bills are passed and signed this year will not forestall the coming health system meltdown for at least three reasons.
First, Congress is debating how to cover the uninsured, as if that is the principal problem of our health system. Should we have a public plan option? Should we expand Medicare? Medicaid? Should there be a mandate to buy health insurance? Obama believes that health system reform will require a massive infusion of tax money to cover the uninsured, also his primary issue. Both Congress and Obama are wrong. The issue is not coverage, it is cost control, or more specifically, waste elimination. Per-capita taxation for health care is higher in the U.S. than anywhere else in the world. More than one-third of the $4 trillion collected in state and federal taxes this year will go to health care.
If we limited health spending to just those tax dollars we would be spending more than any other nation on health care. Yet we add another $1 trillion to our health spending through private payment of employer premiums and family co-payments. Per-capita health spending is twice as high as it is in any other nation, and rising faster, because we waste half our health spending on inefficiency and poor quality.
For example,overhead in American hospitals is five times higher than in other first-world nations and post-operative wound infections occur up to 10 times more often than should be the case, at an average cost of $14,000 per case. Wasteful health system spending is the direct and inherent result of the business models of American health corporations. What I call waste they call profit. These corporations spend $1 million per member of Congress per year on lobbying to defend their business models.
Nobody has dared challenge them. Until they do, no amount of additional health spending will ever sustainably cover the uninsured, because half of each additional dollar will be wasted.
Second, Obama frequently states that reform should build on what works, meaning health insurance. Those with insurance can keep the health benefits to which they currently cling. This is the premise of current American health system reform. Trouble is, the whole system is dysfunctional.
Former Health and Human Services chief Mike Leavitt has his own oft-repeated phrase: Medicare is only good at writing checks. He means this as a disparaging retort to those promoting "Medicare for all," but this is actually a tacit admission that, other than efficient claims payment, Medicare is no better than private sector payers in promoting quality and containing cost.
Which means that Obama's premise is wrong, employee health benefits are riddled with faults, including poor quality, rising costs, inadequate coverage and ridiculously massive overhead. One of our nation's leaders in health system quality, Dr. Brent James of Intermountain Health Care, recently testifying before Congress, said the American health system pays doctors to harm patients. How does that leave any room to argue that we should be building on "what works"?
Third, why are we even having this debate in Washington? More importantly, why should Utahns embrace a federal system after building a higher quality health care system with the lowest per-capita costs in the nation?
Congress could legitimately legislate (and fund) a minimum-standard health program while allowing any state the option of creating a better system, thereby earning exemption from federal rules and regulations.
States unwilling or unable to excel in health care could get the federal plan. States able to experiment with improved health system performance would become the laboratories of democracy, leading the nation toward improved health system quality at a lower price. Where is the Patrick Henry Caucus when you need them?
If you have been hopefully anticipating sustainable health system reform in our nation's capital, beat the rush and wallow in frustration now. When you get over it, join me in making sustainable health system reform happen right here in Utah.
Dr. Joseph Jarvis is chairman of the Utah Healthcare Initiative. He lives in Salt Lake City.