Election could bring health care reform

As an estimated 47 million in the United States remain uninsured and health care costs continue to rise, Americans are becoming increasingly concerned about access to affordable, quality health care. Presidential candidates are talking about reforming the health care system, although few details are forthcoming. For the first time since the early 1990s, the U.S. political environment offers the real possibility of fundamental health system reform. When it comes to the comparative importance of different issues in deciding their vote, health care has consistently been among the top three issues chosen by American voters. Numerous voter polls indicate that the majority of Americans would like to transform health care to minimize inefficiencies, but there is no broad consensus on a fix. Compared to other industries providing products of similar sophistication, health care delivery is extremely fragmented in both structure and process, resulting in high costs and lapses in care quality. There are numerous causes of this fragmentation. Number one on the list is the framework used to administer a fee-for-service payment system whereby health care encounters are unbundled and separate charges are billed for each individual aspect of care. This system encourages misalignment of incentives and, even under the best of circumstances, does not create strong, systematic incentives to deliver efficient high quality care. Disjointed health care is also caused by lack of integration and communication between systems and providers. For example, a diabetic may concurrently receive health care services from a clinic, home care service, hemodialysis unit and a hospital. If a low blood sugar noted during dialysis treatment is not communicated to the clinic, the diabetic may require extra home health visits or a preventable hospitalization.

The two major political parties have extremely different views about the issue of providing access to coverage to serve the 47 million people without insurance. The Republican candidate advocates a shift from employer to individual health plans, de-regulation that would allow cross-state shopping for insurance and establishing high-risk pools offering insurance benefits to individuals with pre-existing health problems.

The Democratic side supports employer “pay or play,” in which nearly all employers either contribute to providing coverage or pay a tax to a publicly funded plan. Coverage for all children and a national health insurance exchange – including choice of private plans, public plan options, benefits like Federal plans and guaranteed access – are also included.

The good news for Americans who care about health care is that the 2008 presidential election has begun a much-needed dialog about health reform. It remains to be seen whether it will continue to be a top issue after the general election. While both parties take divergent approaches for overall health reform, and the media and ad campaigns critique and dispute the details of the plans, the real challenge starts in 2009 and will depend on whether the new president makes health care a top priority. There is already a health care reform proposal sponsored by Sen. Ron Wyden, D-Ore., and Sen. Bob Bennett, R-Utah, waiting for the new president. The Healthy Americans Act, a bi-partisan bill, is radical when compared to the Republican candidate’s reform plan and seems to go further than plans promoted by Democrats.

When all is said and done, health care reform will happen only if Congress engages in effectual health reform debates, can find a way to pay for it – and can compromise on ideological differences.

– Lori A. Loan, ’82, Ph.D., RNC, is a hospital executive and health services researcher as well as an affiliate faculty member in the School of Nursing at Pacific Lutheran University. She believes there is no secret formula for health care reform in America. Photo by University Photographer Jordan Hartman ‘02