Why Obama’s Plan Won’t Be Able to Cut Health Care Costs

As I woke up this morning, I realized one of the reasons why the Obama health plan — if something entirely watered down doesn’t replace a public plan and other measures — won’t be sustainable.  Because of the way it has been formulated — from the tippy top of a very large elite Titanic like iceberg, the kind that brought the unsinkable ship down — it is guaranteed not to address any of the cost escalators that keep health care costs snowballing in this country.  No I don’t mean only insurance company costs, marketing, CEO salaries,  and all those other huge cost escalators that the plan doesn’t even approach.  What I mean are the cost escalators that ratchet up our health care bill every day at the ground level of where health care is delivered.  The problem with the Obama plan is that it has been constructed and replicates the very problems that have created the most inefficient health care system in the industrialized world.  To create his plan, Obama focuses on elite corporate and medical actors — he talks about and with the execs of big Pharma, hospital CEOs and the American Hospital Associations and doctors.  He never mentions nurses or anyone who actually delivers health care at the ground level.  He has talked to the American Nurses Association ( a group that largely represents nursing management, ie hospital management).  By failing to do that — talk to the people who deliver the care– he ignores one of the most critical patient safety and efficiency measures that we have come to value today — teamwork.  The Obama plan is the anti-thesis of teamwork.  It’s a plan designed at the top, for the top,and by the top.  The problem is that health care costs don’t only escalate at the top — which they definitely do.  They also escalate at the bottom — because there is not teamwork at the bottom of the health care edifice where care is actually delivered.

Take end of life care — which we know is one of the highest ticket items in all of the health care delivery system.  We know the depressing figures that we spend more on people during the last days of their life than on anything else.  Why?  Of course, that’s because that’s when people are the sickest.  But it’s also because there is no teamwork at the end of a patient’s life when they are hospitalized.  Physicians drag out their biggest guns and with all good intentions aim them at the patient.  Nurses are often concerned about why patients are being given futile, toxic, expensive care.  Hospice could be involved but usually isn’t, until two or three days before a patient is about to die.  Docs are supposed to have discussions about code status (i.e DNR) as soon as a patient enters a hospital, but most don’t do it because they find the conversation uncomfortable, so families can’t plan intelligently and patients may not even understand how dire their situation is.  Where in the Obama plan do we see any evidence that anyone understands this problem?  Where are nurses in the genesis of this plan?  Or any other category of health care worker or professional other than docs?  What do you think about this?  Let me know!

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4 Comments

  1. Yes of course! What you are saying here is very right-on, the status quo is a symptom of a very sick system…docs make more money when they bring out the big guns, don’t they…

    we have to get realistic, with a step-by-step approach to resolving this gargantuan problem…

    I think we need to start at the bottom of the heap…the patient, the family, the worker, and the small business owner, most of whom cannot afford fully “loaded” health insurance policies that are mandated by more and more states (e.g. family of 4 in Massachusetts HMO $1,200 – $1,600 per month..YIKES!!!).

    Step one… lower premiums by standardizing a minium credible coverage policy at the Federal level. Raise deductibles ONLY on major medical events, the least likely yet most costly benefit of any policy. And have the ability to customize policies for the individual instead of a one size fits all- the current approach).

    Step 2:
    Have the government(s) subsidize the deductibles instead of the premiums.

    Most middle class people can afford a $5,000 deductible if it happens only once or twice in a lifetime, Most hospitals will discount deductibles according to financial need. Hospital bills of $100K receive $95k from the insurance company, $5,000 is only 5% of the total. I’ve been a businessman for 30 years and a 5% discount is always a “given”.

    People in need will not have to worry about the deductible either by discount or fed or state subsidies.

    Health care is business unlike any other in a capitalist society. But here it is driven, as you say, by the top of the food chain and not the market, and by the fearful consumer who worries that a $15 copay will break the bank.

    Members of Congress are typically lawyers, not businesspeople, and it shows. It’s time we taught them how!

    Thanks for your thoughts,

    Mark Rosen
    Licensed Massachusetts Health Insurance Agent
    20 Fair St
    Newburyport, MA 01950
    978-764-4364

  2. And thanks for yours.
    Suzanne

  3. First off, I have to say that response above above me is so bloody typical of what I see insurers spamming the internet discussions on health care reform with: “Give us MORE subsidies, we want you to put us on the DOLE permanently, so we can continue making profits of your tax dollars AND your premiums!!!”
    I swear, I don’t think I’ve ever had so many conversations with insurance people than I have over the last month or two; the internet is completely FULL of them now, behaving like cornered animals. Anyway…

    I’d agree that there has been little attention paid to the important people whom are actually delivering the health care, no doubt about it. Most unfortunately, that is the way most of governed institutions manage these things, on an industrial model, from the top. Just look at our educational system, it is ALL about administrative decisions, and no input from teachers – in fact, there’s manufactured distrust of teachers designed to keep them OUT of the debate! That aside…

    I agree with you about the conflict of best interests coming from the IMO too, it’s the same thing going on with the AMA; more interested in profits, less interested in addressing medical professionals’ issues. I went to the IMO website, and the first thing I noticed is they are in biomedical and equipment: the two biggest industries opposed to reform! It’s my understanding that they may have the most to lose profit-wise too.

    There are in fact some unions which are addressing this health care reform from the bottom up, and the California Nurses Association is doing precisely that! I especially like their study on Single Payer, showing it would create a MASSIVE economic boost for the entire country! Creating over 2.6 million new jobs and $317 billion in new revenues for both private & public.

  4. My sentiments are with you. I am a nurse too. I think you are referring to modern management theory. Indeed, it would have been better if the President started from bottom to top. That is, talking first with those who deliver the care directly and more closely to the clients. Who better than the nurses, right? I know the ANA represents the nursing professionals but it is not an entire representative of the whole nursing population. By this, I mean the ANA does not represent all the nurses’ concerns regarding patient care delivery system. There are a lot of issues concerning healthcare. I hope they give these matters more attention. Thanks for the post!

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