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10 Critical Needs for Implementing Healthcare Reform in 2013

HEALTHCARE POLITICS - To quote House Speaker John Boehner after the November 2012 presidential elections, “ObamaCare is the law of the land.”   Unfortunately, after hearing all the governmental, health care and business experts confess they really don’t know what “ObamaCare means and entails, but that it’s going to have tremendous impact on this nation’s economy, there are only two things we can conclude:
 
We really don’t how our health care landscape will change over the next few years.  
 
And for the smarmy know-it-alls who claim THEY know what it means, perhaps you should change to your tune to what myself and others were taught in medical school and residency:  if you’re not certain about a subject, do NOT swerve from saying “I don’t know.”  Seriously, folks—you really don’t know, even if you think you do.
 
The need to control healthcare costs is vital for every state, county, and household budget, and the only true budget-busters at the federal level are Medicare and Medicaid, with all other spending priorities remaining fairly flat.
 
So the older approach of “let the private sector handle it” or “it’s not my problem, because I’ve got insurance” has rightfully given way to the “dammitall, we’ve got to do something about this!”
 
Here are ten goals, among so many competing goals, for implementing healthcare reform in 2013:
 
1) The election is over:  Stop slapping corporations and employers around, and make sure they’re incentivized to achieve profits while extending health care benefits to their employees.  
 
Whether it’s lowering corporate tax rates to be more competitive with the rest of the world, or linking executive pay and bonuses to providing benefits and bonuses to lower-paid employees, it’s time for a second-term Obama Administration and a divided Congress to team up with the business world to get more employees access to private insurance.
 
2) Preserve the American and capitalist principles of both self-sufficiency and right to pursue happiness by allowing those who want more to work harder and pay for better health care plans.
 
Blame the Republicans for not taxing the rich, blame the Democrats for not cutting entitlement programs, or (better yet) blame the American people for wanting their cake and eating it too, the fiscal cliff is a near-certainty.
 
Payroll taxes and income taxes are going up in 2013, and the option of choosing not to pay for health insurance is also disappearing over the next year.  If it’s good enough for the top 2% then it’s good enough for the rest of us—raising taxes on the top 2% pays for only 8 days of our annual budget, but ending the Bush tax cuts altogether pays for 149 days (tough love, but a big step in the right direction).
 
It’s time for us to help those who can’t work, and demand more from those who can, while incentivizing the fruits of that extra spending and saving towards our own healthcare (we’re not doing that right now).
 
3) Create tax breaks and legally mandate the ability of independent contractors and small businesses to form collectives and get the same lowered group rates that larger employers get from health plans.
 
4) Both the private and public sectors are increasingly enamored with Accountable Care Organizations (ACO’s), and for good reason:  they are incentivized to keep costs down and encourage healthy living.
 
Much discussion has occurred over the past few years about fiscal penalization of the morbidly obese, smokers, substance abusers and those who live unhealthy lifestyles, but an equal emphasis must continue to be placed on doctors and ACO’s to do more (and get paid more) to encourage a healthier lifestyle.
 
More flexible hours of operation, more home phone calls and visits to achieve better outcomes and fewer hospitalizations, coupled with fiscal incentives for patients, can provide a big “win-win” and dramatically reduce society’s health care costs.
 
5)  Consumer “grading” of medical groups, ACO’s and health plans towards affordability, cost-effectiveness and outcomes already exists, but must become more accessible and understandable.
 
6) Lowering the costs of Medicaid and Medicare is critical to preserving  the fiscal health of this nation.
 
No matter how we do this, it’s going to ask more of many (perhaps most) of us, and it’s going to be unpleasant, particularly with respect to Medicaid.  It’s easy to nail Congressman Paul Ryan for his limit-setting budgetary approach, but at least he had the guts to fix this problem.
 
President Obama and all federal and state elected have to show an equal amount of courage, and the need to demand and provide work for young and able-bodied individuals in return for Medicaid and other benefits is as great as it’s ever been.
 
7) Medicaid and indigent health care must be managed to lower costs and cover more people.
 
I’ve seen patients with Medi-Cal (California’s version of Medicaid) in both managed care and fee-for-service settings, and the latter just completely stinks…and promotes increased visits, overbilling, and fraud, to boot.  With a few key exceptions, Medicaid/Medi-Cal patients need to be in HMO’s.
 
Which key exceptions?  Well, those who are made poor by the most efficient method known:  suddenly and unexpectedly becoming sick.  Those who’ve been struck down with rare cancer or degenerative disorders in the prime of life require our moral and fiscal support, as well as a “carved out” and publicly-funded access to specialists.
 
As it stands, while it’s wrong for patients to be denied coverage or specialist access because of a horrible diagnosis, medical groups and health plans understandably don’t want all their profits suddenly destroyed because they “inherited” a handful of patients.  Certain patients require public, not private, management.
 
8) Medical tort reform, and the culture that promotes frivolous lawsuits is ridiculously overdue so why is this not the law of the land as much as is ObamaCare?
 
9) Medicare Part D requires numerous revisions allowing our government to negotiate prices with pharmaceutical companies, and to allow this nation to enjoy a price competitive with that of other advanced nations.
 
The concept of asking pharmaceutical companies to be competitive is as American and capitalistic as any, and the question of why America is paying three times as much for medications as Canada and Europe is as timely as any.
 
Besides, tackling this problem allows us to continue our favorite pastime:  ripping into former President George W. Bush, who started Medicare Part D and who accelerated a trend of healthcare overexpenditures that helped lead to our modern-day healthcare crisis.
 
10) The complex, convoluted reasons for overpriced medications are too involved to blame a single entity—it seems like everyone has gotten into the act, and we’ve yet to confront this problem.
 
The causes of overpriced medications go far, far, far beyond pharmaceutical companies, and extends to generic pharmaceutical companies, FDA-imposed requirements that are too often arbitrary and not scientific…and even your local trusted pharmacy, who may have ulterior motives for switching (and even misrepresenting) your doctor-prescribed medication that most consumers don’t know about.
 
It’s not a pretty picture, but it’s a picture that must be illuminated to the American public if we are truly serious about keeping healthcare costs down.
 
I wish each and every one of my readers a Happy, and certainly a Healthy, New Year in 2013!
 
(Ken Alpern is a Westside Village Zone Director and Boardmember of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee. He is also a Board-Certified Dermatologist who works full-time in an Accountable Care Organization as well as part-time in private practice, and can be reached at This email address is being protected from spambots. You need JavaScript enabled to view it. .   The views expressed in this article are solely those of Mr. Alpern.) 
-cw
 
 
 
 
 
CityWatch
Vol 10 Issue 104
Pub: Dec 28, 2012
 
 
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