Stay the Course: Why Doing Nothing Is Best Strategy For Lasting Health Care Reform

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In an earlier post I wrote about the "Third Option" in health care reform, which was simply to do nothing. It was, I will confess, somewhat tongue-in-cheek, but doing nothing (and perhaps this is the only thing truly predictable in health care reform) will result in:

  • Health care costs rising
  • Employers will opt out of providing health insurance benefits
  • Employees will ante up more for health insurance.
  • Unemployment, mortgage defaults and the number of the uninsured will all rise
  • Insurance companies such as California's Anthem Blue Cross will try to raise rates by 39 percent
  • States will find Medicaid patient rosters growing astronomically and will cut eligibility

Since I wrote that a week ago, I have been delighted to find in subsequent days other commentators expressing similar opinions:

  • Yesterday Nicholas Kristof's op-ed in The New York Times was titled Do We Really Want the Status Quo on Health Care? (Yes, Nic, we do. It is the only way for the flames to grow to the point where folks in Congress are ready to abandon entrenched positions paid for by lobbyists. When your pants are on fire, most everyone looks for water rather than debating the flammability of the material.)
  • Today Paul Krugman writes about California's Death Spiral  referring to how insurance company rate increases are inevitable without reform.

But what I think has been the most significant development, guaranteed to get the attention of the discussants at President Obama's Bipartisan Healthcare Summit scheduled for Feb 25th is the fact that state governments are about to drastically cut and tighten Medicaid eligibility--they have no choice.

Here's why the pressure on Medicaid might ultimately bring about reform:

  • Medicaid enrollment is up by 3.3 million, a surge not seen since the earliest days of Medicaid in the late 1960s and it is going to get worse. This reflects unemployment; indeed it lags behind unemployment.
  • States are cutting Medicaid coverage from everything from adult day care to the numbers of diapers supplied to the incontinent.
  • States will slash further what Medicaid reimburses physicians; more and more physicians will opt out of Medicaid because it already means losing money. We'll have fewer primary care physicians to see Medicaid patients.
  • More patients will wind up in emergency rooms which is the most expensive kind of primary care.
  • The stimulus package Medicaid money which kept a band-aid on this crisis is running out.

The "Do Nothing" strategy guarantees that the upcoming Governor's Conference which begins tomorrow in DC will have only one significant agenda item: health care reform. I predict the Governors at the end of their conference will signal their frustration with Congress and their recommendations will have little to do with their Republican or Democratic roots.

Then comes President' Obamas Bipartisan Health Summit on February 25th--the timing could not be better! Mind you, this crisis has been brewing since before Nixon, but it will have reached a new height on February 25th (an easy prediction since the problem keeps growing every day).

I do have one suggestion Mr. President; just before your meeting on Feb 25th, make an executive decision to do away with the television cameras. (Really, we have heard enough from everyone at this point). Lock the doors. Get down to business. Don't let anyone out till you have a solution.

If you won't do that, then do nothing.
 
It's working.

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Abraham Verghese is an author, physician and med school professor. He is the author of Cutting for Stone and his writing has appeared in many major publications. More

Abraham Verghese is a physician and writer. His third book and first novel, Cutting for Stone, was published by Knopf in 2009. He is also known for two acclaimed non-fiction works, My Own Country, which was based on his experiences working with persons living with HIV in Johnson City, Tennessee; that book was a finalist for the National Book Critics Circle award and was made into a movie. He followed that with The Tennis Partner, also a New York Times notable book and a national bestseller. His writing has appeared in The Atlantic, The New Yorker, The New York Times , The New York Times Magazine, Sports Illustrated, and The Wall Street Journal as well as many medical journals. Verghese is board-certified in internal medicine, pulmonary medicine and infectious diseases. He attended the Iowa Writers Workshop at the University of Iowa where he earned his MFA. He currently practices and teaches at Stanford University School of Medicine where he is a tenured Professor and Senior Associate Chair for the Theory and Practice of Medicine in the Department of Internal Medicine.
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