I have been traveling around the country these last two weeks, and it astonishes me to see how soon the dialogue which might begin as a literary one or a medical one turns to health care and health care reform. Health care is not just filling pages of newsprint. It is causing heartburn in Middle America, it's clearly triggering insomnia, and it is occupying significant worry space in the cerebral hemispheres. Whatever momentum there was for reform in the summer of last year seems to have vanished. My worst fear is that we emerge with tiny fixes which will wind up being worse than no fixes. Or else, we expand coverage (as was done in Massachusetts) without reforming payment schemes, which will be a disaster.
So here is a third option (that is to say neither Democratic nor Republican) that is certain to be effective and it's also effortless. It is simply to do nothing. Doing nothing (which comes naturally if you think about) is a brilliant plan and will result in the following:
- Health care costs will continue to rise (that and death and taxes are the things we can bank on in this life).
- Rising health care costs will cause employers to opt out of providing health insurance benefits, even if they get a tax break for doing so.
- Employers will increasingly shift the burden to employees who will now have to ante up more money to pay for health insurance.
- We, the great masses of employees, will be forced to choose whether to pay for our health insurance or for our mortgage.
- Unemployment will rise, mortgage defaults will rise, the number of the uninsured will rise from the present paltry number of 46 million (with about 200,000 deaths per year that the Institute of Medicine believes is directly attributable to lack of insurance) to some figure that catches our attention.
- Meanwhile insurance companies such as Anthem Blue Cross will raise rates by 39% on individual plans. (By the way, for all the protests and grandstanding by elected officials, there is absolutely no legal reason that insurance companies can't raise their prices--I mean, let's not forget they are not in the business of insuring your health but in the business of making a profit for shareholders.)
- Ultimately, if we are patient enough, the only people left with any decent insurance will be members of Congress.
- Meanwhile we must continue with present fee-for-service reimbursement model, which ensures that doctors, hospitals and every player in the industry will keep trying to generate more service to get more fees.
- Without payment reform, graduating medical students will continue to be driven to choose procedure driven specialties (the ROAD to success as students see it, ROAD being Radiology, Ophthalmology, Anesthesiology and Dermatology), because you get more fee for that service, for doing to a patient than for talking to a patient. This will guarantee we will have even fewer primary care physicians, but take heart that if you are in a theater and have a skin emergency, there will always be a dermatologist in the house.
- Allow all the above ingredients to cook and simmer, stirring occasionally with inflation, stock-market collapse, and scandal.
THEN, at long last, the masses will start protesting outside their elected representatives' offices, they will march on Washington. The only question will be who they hold responsible for the inaction: the Democrats or Republicans or the president?
OK, so call my Third Option cynical. But you know it's already happening. We just need to stay the course.