Are Any Good Ideas Out There?

The chorus of Republican supporters of healthcare reform was by no means a choir or a repudiation of Republican opposition to the Obama lead healthcare reform efforts.  The airwaves and the tabloids continue to be dominated by discussions and debate related to healthcare reform.  On Wednesday, Peter Suderman published an incredibly gloomy analysisof state-run healthcare in the Wall Street Journal.  He pointed to the state-level results we’ve generated in our nation’s laboratories of democracy, declaring “the reforms have failed.” While the article exposed the flaws of a number of these state healthcare reform experiments, Suderman missed the point in my view.  It seems to me the whole purpose of the laboratories of democracy concept is to embrace the experiments, understand what did and did not work and then, to modify the experiments for the good of the whole union.  Essentially, that’s how Medicare was created. Many of the state initiatives have actually focused a bright and shining light on how we need to move forward with healthcare reform.  In fact, it seems many of the state experiments have offered us a practical environment for how we might proceed with transformation of healthcare across the country.

For example, the Commonwealth of Massachusetts has experienced tremendous results from their experiment.  In the course of only three years, the Bay State enrolled more than 400,000 citizens into a healthcare insurance program. Now, only about 3 percent of the state’s citizens remain uninsured.  Compared to many other states, this is truly impressive.  As an example, New Mexico and Mississippi continue with an uninsured rate of about 1 in every 4 citizens.  While it’s clear the economics of New Mexico are far different than those of Massachusetts, we need to extract the experiences from those states as well as the lessons from both failures and successes.

Another laboratory of democracy example comes from California and Texas.  These two states have led the way in liability reform. While we need to be sensitive to the need for consumers to have access to litigation if something goes amiss, we should also keep physicians focused on making people better and saving lives rather than practicing protective medicine.  In 2003, Texas created caps on noneconomic or so-called “pain and suffering” damages.  The new law forced medical lawsuits to be approved by a panel of experts before they could proceed to the courts.  Since the law passed, premiums have dropped 21 percent, doctors stopped leaving Texas, and 7,000 new practices were established across the state. 

In California, a different approach was adopted which limited the amount of punitive damages.  The effects have been clear. Following the new limits, obstetricians have seen their malpractice costs drop on average to $89,953.  Compare that figure to similar high cost-of-living states as New York and Florida where the same doctor would pay $194,935 and $214,893, respectively for comparable insurance. The current tort system used throughout most of the US is estimated to cost the healthcare system between $100 and $200 billion a year.  The impact of statewide liability reform in the healthcare industry is clear.  Wouldn’t it make sense to adopt some of these “experiments” as national models? It seems Suderman is correct in one sense – there are many flaws in the various attempts at reform throughout the country.  But, let’s not throw out the good with the bad or the maybe.  The real lesson for state healthcare reform is not to stop these attempts but to learn from them and adapt them as part of our nation’s strategy. 

In support of this concept and to broaden the appeal of their initiative, Senate Democrats floated yet another idea this past week.  Senator Thomas Carper (D-DE) suggested that the reform plan should give the states more leverage in deciding how to cover the uninsured populations, including “state-run programs”. Another leading Senate moderate, Senator Ben Nelson (D-NE), responded to the Carper idea saying, “States as a laboratory of democracy probably can find ways to deal with this, and if they do make a mistake, it’s a smaller mistake to correct than at the federal level.” 

David Wessel contributed to the discussion with an interesting articlein last Thursday’s Wall Street Journal, titled, “Wider Health-Care Access Pays Off.”  The article describes the long-term impact of prior healthcare reform efforts on the US population. He points to the health reform efforts included in the Civil Rights Act that forced hospitals to discontinue segregation policies for care delivery.  In the South where segregation was dominant, the post-natal mortality rate of African-Americans plummeted while those living in the North where access was generally not segregated post-natal mortality rates remained stagnant. Wessel’s argument is that as we focus on the healthcare reform debate, we must remember the past and look towards the future.

At the end of the day, the question, as it seems me, is – are we going far enough, fast enough? Can we really “break the curve” of expenditures and costs (see hyperlink for New England Journal of Medicine article on the topic) that are clearly moving in a direction where someday soon we will exceed the nation’s economic capacity to support healthcare as we have come to know it and expect it?  Is the quality of care up to the standards we expect?  The debate continues across the board.

The views and opinions expressed herein are my own and do not necessarily represent the views and opinions of Dell Services or its affiliates.