Recently a colleague sent me a link to a Slideshare presentation entitled “Healthcare Napkins for All”. The presentation created by Dan Roam and Anthony Jones depicts a simplistic and yet fairly accurate description of our healthcare reform efforts to date. The napkin presentation provides an amusing, yet straight-forward illustration of how the American taxpayer resides squarely in the middle, squeezed by the healthcare insurance companies and the healthcare provider system, while politicians continue to develop alternative plans to “improve” the failing healthcare system at the taxpayers’ expense.
A major point that the presentation makes is that we are not reforming healthcare, but only the insurance side of the equation and this approach will have serious opposition considering the deep pockets and lobbying capacity of the insurance companies. This type of approach is especially troubling if you listened to President Obama’s recent address to Congress and the Nation where he indicated that not one red cent would be added to the cost of the healthcare reform plan. If that is true (which is very doubtful), then where will the money come from other than from the direct out-of-pocket costs levied on the American consumer? It certainly won’t come from the huge savings from Medicare and Medicaid savings (reductions?). I also doubt that the funding will come from the Insurance Exchange or Government option which is supposed to cover the uninsured Americans that can’t afford or obtain private or employer insurance and who may be our most vulnerable population in terms of illness. Most insurance companies do not want to cover individuals that have poor health and have little or no income to pay for care without some steep outside incentives or subsidies. That’s just not good business and if it was, they would have provided it long ago.
Let’s face the reality that to provide better care for all Americans, both the ones now insured and the ones not currently insured, you must consider the huge costs to the system. You can’t simply wave a magic wand and create fictitious savings. Even if we could save some reasonable amount of money from over utilization or bureaucratic administrative wastes (and this is also very doubtful considering our history concerning vast administrative costs of Medicare, Medicaid, and other government run programs), it would not begin to cover the major increase of additional care (primary & preventive) that would be needed by so many individuals. If the savings come from the perceived overtreatment in the form of increased rationing of care currently provided under private insurance plans, then this approach will also meet strong opposition. To make an expanded program work without extensive rationing, it will most assuredly need to be subsidized by someone - most likely the American taxpayer.