Barrett Rainey's Second Thoughts

A lot a folks these days are bandying about words like “universal healthcare” and “Medicare/Medicaid for all” and similar popular phrases.

Sounds good. Sounds positive. Sounds hopeful. And chances for any to materialize nationally in the near future are slim to none. Like lots of things we want to fix in our lives, the distance between “want” and “get” is a country mile. Or two.

In November, large majorities of voters in Idaho and Utah said they wanted expanded Medicaid programs to take care of hundreds of thousands of uninsured. Referendums in both states passed with significant numbers. In the old days, the legislatures would have heard the call and gotten right to work fulfilling the will of citizens.

Today, not so much. Majority political parties in each state tried their damndest to ignore those voices. Bills were introduced to cut benefits of anything eventually adopted. In Idaho, there was a “poison pill” measure in committee to kill eventual expansion if the feds ever change the funding ratio. In Utah, they tried to flat out stop expansion. Period!

If voters in those states want to see their dreams of more insured folks, they’re going to need a second election to get rid of the naysayers. Maybe even a third and fourth.

Looking to Congress for help is an even more daunting – and certainly doomed – task in the near future. While large numbers of us want significant improvements, too many denizens of that swamp won’t lift a finger. There’s all that lobbying money from insurance companies, the folks making pharmaceuticals and dozens of other interests wanting to keep the status quo.

It’s not as if “universal” care or federal medical programs won’t be expanded or that our payment system for services won’t be improved. All that can – and likely will – happen. But, given the obstacles, those politicians promising such in the near future are blowing smoke.

For those too young to remember, we went through such efforts in the ‘60’s with creating Medicare. Even with favorable majorities in Congress, Lyndon Johnson had to push, pull, promise, horse-trade and literally threaten the political futures of some in both parties to get it. The fight today is way more uphill. The aforementioned drug and insurance outfits and their friends are making it so. Whatever the outcome, it’ll start with political and business decisions – not consumer need. A basic issue that must be solved is how those entities can survive and in what form.

Proof of that is how physicians and hospitals have radically changed business models in the last decade to stay in business with Medicare. Many now use step-down intermediate care to get patients out of the more expensive hospital stays. They’ve hired salaried doctors and “hospitalists” on staff, opened their own related care facilities such as rehab centers and lower-level extended care centers. Many ancillary services previously farmed out have been incorporated into the overall structure.

Physicians have reorganized for Medicare, too. Often, they create a partnership of several specialities, open in-house labs, manage their own testing such as EEG and similar exams and limit nearly all patient visits to 15-minute appointments. Many docs have hired specialty physician assistants so more patients can be seen, spreading the load but not the costs.

Insurance companies started “Medigap” programs which, given the amount of advertising to attract new customers, must have proven profitable. They’ve also changed other aspects of their business models to streamline coverage while assuring income.

In all likelihood, we’re heading to some sort of single-payer system in this country. Call it “Universal” or “expanded Medicaid” or any other popular name. The plain fact is we can’t continue to operate under a system that eats so much of our national resources, is priced out of reach of millions and causes bankruptcies in the thousands each year.

But, to realize a goal of “healthcare for everyone,” the political and business issues must be solved first. If availability and cost containment are the goals, then assuring the survival – in some form – of the medical, pharmaceutical and insurance providers who make up that system must be addressed up front.

No one entity has the answer. And you won’t have traditional quality healthcare of any reliable sort without them. As businesses and corporations, they’ll need to survive or none of us will live to see significant changes.

Politicians who make it sound like we can achieve all that by simply electing them and they’ll make it happen, are glossing over the massive work to get it done.

Healthcare is, after all, a business.
 

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