The following "In My Opinion" column ran in the Portland Oregonian newspaper on Thursday, December 23, 1999. It is reprinted here with permission of the author, Stephen A. Gregg, an Associate of Cascade Policy Institute.
Thursday, December 23, 1999
Let's start over on our national health-care debate
By Stephen A. Gregg
Here we go again! More health care reform lies ahead.
Tensions continue to build surrounding health-care issues. Reports of escalating numbers of uninsured; legislative reforms designed to curb managed care; a very unhappy physician community and the return to double-digit increases of health-care costs are some of the presenting symptoms.
Is the renewed outcry from some quarters for a national health-care system a fix or an additional complication to a system with more fundamental problems?
On the positive side is the resolution of a heartfelt need to help the uninsured. The downside is a monumental infusion of new cash into a health-care system that has an uncontrolled appetite for more services and money.
Several years ago, we decided as a matter of public policy to dismantle conventional health insurance and encourage a nationwide conversion to "managed care." A deal was cut between the health-care system and its targeted HMO subscribers - you, the public. Our government encouraged the deal.
The system said, "We will give you a generous benefit design with a promise that you will not need to give a personal twit about the underlying costs of health care. In addition, you should feel an implied right to an endless list of services commensurate with state-of-the-art technology.
"You, in return, will agree to follow the rules irrespective of whether the rules meet your needs at any given moment. You will be compliant and do as instructed for the benefit of the whole.
"The mutual understanding will be that society's money, and not your money, supports your health-care requirements. You are to understand that your health plan will do what it can to treat you as an individual, but its greater priority is to manage the collective interests of all members of the plan.
"Your personal physician will no longer be reimbursed specifically for services rendered to you but will be paid a monthly allowance for a defined population of patients irrespective of the services rendered."
Guess what? The deal is breaking down.
Increases in premium costs are returning to record levels; distrust among and between doctors, patients, hospitals and health plans is breaking out all over. And we are left with the slim comfort that more regulation and lawsuits will offer substantive correction. This is not a happy environment or a sound strategy.
Honestly, are we really surprised? Look at the deal.
We must consider whether this historical contract can be fixed with modest tweaking or must be recast in its fundamentals. Are we willing to exchange the entitlement benefits of selected populations - those covered by insurance - for a more modest safety net for everyone? Would we be willing to reintroduce personal financial risk and reward in exchange for freedom of choice and personal responsibility? Should we presume patients to be too limited in knowledge and untrustworthy to exercise personal responsibility
What are the right questions to ask that will give us a working understanding of the challenge ahead? We clearly need a vastly improved alignment of the interests of patients, health plans and providers. The current deal is not going to get us there.
It is time to reconsider the disrupted health-care system in all of its dimensions. We cannot sustain a "spare no expense - get someone else to pay - it's not my responsibility" culture.