How is the health reform going to pan out?
The question these days, on everybody’s mind is ‘How is the health reform going to pan out?’
With the passage of the bill in the house (though surprisingly narrowly) and with a clear democratic majority in the senate, the issue is not of ‘If’ but more of ‘When’ and ‘In what shape’ the bill will come into being. Now that we have pretty much moved beyond that point, the foremost question becomes what will be the ultimate impact of the reforms on three primary stakeholders, namely the patients, the providers and the payers.
Let’s speculate…
Today we will talk about the patients, that least cared for community despite all the promises about ‘patient centric focus’. Under the new bill, with the definitive advent of healthcare exchanges and possibility (however remote) of a public plan down the pike, the benefits seem tremendous for the uninsured and the underinsured. With a choice beyond the employer sponsored plans and possibility of designer plans (I guess a true Consumer Directed Health Plan scenario), even the currently insured seem to have a lot more freedom of choice. After-all, isn’t that what the free-market economy is all about?
But, and yes there is a ‘But’ with a capital ‘B’, with choice comes responsibility, a heck of a lot of it. Do we think that the common American ready to make complex decisions regarding their health coverage based on highly complex set of data points that are clinical in nature as well as mired in legal jargon of a contract? How many of us actually understand the exact definition of life-time benefit caps with their multitude of ingrained caveats? How does one determine the amount of copay we want to incur for medication for chronic asthma? Rating engines can definitely provide guidance towards selecting the right provider, but can they ensure that the ‘Right doctor’ is a part of the network belonging to the ‘Right plan’? And if not, what is the recourse.
Yes, I know, the freedom of choice activists are already sharpening their knives for me but I just want to produce one evidence in support of my case and that too not from healthcare industry. See what happened to millions of home-owners who were given the freedom of choice regarding their mortgages without a real tight control by a set of people who were well versed with the inherent shenanigans of the financial systems. We have unprecedented foreclosure rates in the country despite all the incentives that the government is providing and historical low finance rates. At least in this situation people just got hit financially. Imagine what could happen if similar catastrophe hits on the medical side. Now we are talking serious impacts, having to do with life and nascent quality of it.
Enough with the nay saying though. Let’s look at the positive aspects of it. There are many of those too. For example, open and transparent competition through a wide-spread and pervasive medium such as Internet could only help to increase the awareness among common Americans. After all, lendingtree.com and progressive.com have only helped in making Americans better prepared for mortgages and auto insurance respectively.
The ‘Exchange’ concept will also bring about better awareness of one’s health and its associated cost, hopefully leading to a society that is much more health conscious and proactive about managing its own health. The concept could (and I strongly believe, it would) lead to much faster adoption of electronic health record, especially in public domain (a la Healthvault and GoogleHealth) and that can’t be bad for an industry that is practically deprived of business intelligence and its associated benefits due to lack of electronic data.
This could definitely be a step in right direction towards building of a society that is more health conscious and is actually competent enough to make solid and rational decisions regarding its own health scenario (may be in 5-10 years) but let’s not forget there are always two sides to the coin and unless and until you are in Vegas, chances are the two sides do not have the same picture.
So what’s my final opinion… I guess I have not firmed up one yet (I am sure you could see that from my flip-flopping content in this blog till now). My head tells me that something drastically has to happen if we need to steer this rudderless ship called ‘Healthcare’ in the right direction and this new reform bill could definitely be that steering wheel. At the same time, I have this gut-wrenching feeling, deep in my stomach that ‘Are we chewing off way too much way too fast’. I don’t know. For a change, I am going to deviate from my ‘usually opinionated’ self and sit this one by. Let the test s of time make their own judgment on this one.
