BY THE TIME YOU READ THIS, American voters will have chosen a new president.
But no matter whether that next president is Barack Obama or John McCain, the challenges confronting him after inauguration day are immense, most particularly in the field of healthcare.
The United States has approximately 45 million residents without health insurance, and the current economic downturn has led some families that do have insurance to delay treatment or avoid filling prescriptions. The final Election 2008 Kaiser Health Tracking Poll in October revealed that nearly half (47 percent) of the public reported someone in their family skipping pills, postponing or cutting back on medical care they said they needed in the past year due to the cost of care.
Things aren’t much better for healthcare providers. Given the crisis in the credit markets, hospitals are delaying or canceling capital improvement plans. Nonprofit hospitals that rely on bond financing for such projects are being hit especially hard.
Hospitals will also have to deal with an increasing amount of bad debt, as more people fall into the ranks of the uninsured – or underinsured – and are unable to pay their medical bills.
Physician practices continue to see reimbursement rates threatened with cuts. The American Medical Association and other physician advocacy groups fight an annual battle to have Congress avert fee cuts mandated by the Medicare Sustainable Growth Rate formula. Doctors say they can’t absorb continual cuts in Medicare fees and maintain the viability of their practices.
I recently attended the 2008 Annual Conference of the Medical Group Management Association, where talk of managing collections and running leaner operations seemed to be on every practice executive’s lips.
The MGMA’s president, William Jessee, MD, said the healthcare reform plans proposed by both Obama and McCain are inadequate, in that they did not address the fundamental financial problem in U.S. healthcare. That problem, according to Jessee, is that the healthcare payment system makes no sense.
“In our system, it pays more to let people get sick and then treat them, rather than to keep them healthy,” Jessee said. He noted that the current path to profit in U.S. healthcare is to perform as many procedures as possible on unhealthy people. The buttoned-down MGMA chief sounded downright radical when he called for “universal coverage” and “total payment system reform.”
I tend to agree with Jessee that payment reform is the central issue in transforming U.S. healthcare. But, as Jessee also wondered, will the new president and Congress have the political courage to alienate those industry players who profit from the current system?
Given past attempts at healthcare reform, perhaps not, but political leaders would do well to focus more intently on public frustration with the high cost of healthcare than on the resistance of some prominent industry players. For if politicians ignore calls for reform, how long before the current healthcare system becomes economically and politically unsustainable?
If that happens, then the reform that follows will almost certainly be more jarring, and most likely less considered, than anything proposed by either Barack Obama or John McCain.