Clinton Health Care Reform

October 30, 1993

HEALTH CARE – We all want it, wish to pay as little as possible, and most have at least one horror story about our current system. As President Clinton’s self-imposed deadline that a comprehensive reform bill be passed before the November elections the political rhetoric is reaching deafening proportions. With that rhetoric I find one of my basic human emotions getting stronger: FEAR. And, from this writer’s perspective, well founded fear.

The early 1980’s saw Medicare hospital expenditures rising at alarming rates. In usual Washington fashion, a long brewing problem was labeled an immediate crisis, the “experts” were called in, and the healthcare system was turned on its ear. In one sweeping “reform” bill, hospitals were no longer reimbursed their COST for treating Medicare patients, but rather paid a FLAT FEE per patient’s diagnosis. If a hospital’s cost to treat a Medicare patient was less than the flat fee (Diagnosis Related Group payment) it kept the difference, (made a profit). If cost was greater, the hospital had to absorb the difference, (take a loss). Guidelines were even established as to the estimated length of stay that a patient should stay in the hospital for any given diagnosis. It doesn’t take a rocket scientist to figure out that the government’s solution for cost control was to put the hospital and ultimately the patient at risk.

The rhetoric was, hospitals were the problem. The reality was, physicians controlled utilization (Admissions, lengths of stay, tests and procedures ordered, etc..etc..). The rhetoric was, physicians would still have control of their patients care. The reality was, Hospital Administrators were forced to explain to their medical staffs that if practice patterns didn’t change (order as few tests as possible and discharge the patient as early as possible), losses from treating Medicare patients would put the hospital itself in financial jeopardy. The rhetoric was, it was an equitable way to reimburse for care. The reality was, there were huge gaps between urban and rural rates. Many rural hospitals were forced to close and thousands of others have been left on the edge of financial disaster.

The rhetoric is, it has been a resounding success and saved the Federal Government hundreds of millions of dollars. The reality is, urban hospital have shifted losses to commercial insurance carriers, while rural hospitals (usually 70% Medicare utilization and above) have been forced to shift the losses to the taxpayers in their local community. When you add in the pitiful Medicaid rates (another wonderful Government program), the underlying reason for high commercial insurance premiums and the so called “Health Care Crisis” is the government itself. Due to the millions of people it insures, (Medicare and Medicaid recipients) the Federal Government has the power to dictate what rates it will pay whether it covers the cost of that care or not. Does the term Employer Mandates come to mind at this time? If a private insurance company tried the same unfair practice, it would find itself without a hospital willing to treat their insured patients.

Hence, in this writer’s opinion, it is the Federal Government itself who is the cause of the by now highly touted crisis. It has forced cost shifting to other payers, which in turn, forces commercial carriers to pay higher prices, which ultimately forces the insurance premiums through the roof. The only reason quality of care has not suffered (Medicare and Medicaid) is because the private sector has been picking up the tab for what government doesn’t want to pay.

It is this history that makes me so fearful of the future. Whether it be complete government takeover (single payer system) or large, regional purchasing alliances, the Clinton plan shifts power from many to a few. Those few will then be dictating to the many. The rhetoric is, it will lower costs, improve access, maintain choice, increase quality, etc…etc…etc… The reality is, it’s just rhetoric.

Yes, there are problems in health care today. Would not the prudent solution be to tackle each, one at a time, step by step, correcting along the way? Unfortunately, Mr. and Mrs. Clinton appear more worried about the politics than fixing the problem. They have unilaterally decided they know what’s best for the rest of us. The rhetoric is, they do. The reality is, they’re dangerous.

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