Sunday, October 01, 2006

No easy fix to health care crisis

Friday, September 29, 2006
No easy fix to health care crisis
Medical, business leaders agonize over slow pace of reform
Ron French The Detroit News / The Detroit News

WASHINGTON -- Bruce Bradley stood on a podium in a Washington hotel after giving yet another PowerPoint presentation on problems in the U.S. health care system.

Few in the audience of medical professionals and business leaders disagreed with the reforms proposed by General Motors Corp.'s director of health care policy. But a hospital administrator from Maryland had one question for Bradley:

Who's going to pay for it?

It's the question that, more than any other, stymies reform of arguably the sloppiest and most costly health care system in the world. Americans spend more on health care yet are sick longer and die younger. Medical bills are the leading cause of personal bankruptcy and are hobbling companies like General Motors Corp., which pays the medical bills of nearly 1.1 million people.

Yet there has been little meaningful national reform of the system, frustrating companies like GM and baffling even politicians familiar with the trench warfare of Washington.

"This is baloney to keep delaying this," said Newt Gingrich, the former speaker of the House of Representatives who now runs the Center for Health Transformation. "How many more people do you want to die before you get it fixed?"

For every potential fix there is a powerful interest group and political backlash waiting in the shadows. Even incremental changes can take years to wind their way through Congress, Gingrich said.

For every dollar the auto industry spent lobbying in 2004, the health care industry spent nine, according to the Center for Public Integrity. The pharmaceutical industry alone has nearly three lobbyists for every member of Congress.

Out-gunned and outspent, GM must pick its health care battles carefully. The automaker has lobbied for measures to computerize medical records and increase public access to price and quality data. Those efforts could trim hundreds of millions from GM's medical bill, but will not spark the seismic change that U.S. business leaders say they need.

"I bet management at GM has spent more time on health care reform than the members of Congress and the administration," said Jim Tallon, president of United Hospital Fund in New York, a research and philanthropic organization. "Businesses are facing a clear and present danger, but this is back burner in Washington."

President Bush has postponed a meeting with the automakers four times, most recently saying he won't meet with Big Three executives until after November's midterm elections. To meet before then, Bush said, would politicize the issue.

"Someone is going to have to take the lead and find a solution for our health care system," Tallon said. "How the devil are you going to be the dominant economy of the 21st century when 20 percent of your people have no health coverage?"

Bradley is optimistic. More data on the cost and quality of health care will be available to the public in the coming years. Hospitals are using more information technology to reduce errors.

"We're still losing (the health care war) if we're comparing to other countries," Bradley said.

"But we're winning if you look at the progress we're making."

Here's a rundown of health care reforms and their status.

National health care

Proposals range from a national health system similar to that of other nations to catastrophic medical expense coverage, in which the government pays bills greater than a set amount.

Pro: All Americans would have health coverage. GM and other U.S. companies would save billions.

The system likely would reduce overall costs.

Con: Another huge government bureaucracy; fears of long waits for elective surgeries like in Canada. A single-payer system also might weaken the economy by taking money -- and jobs -- away from the health care industry, which employs 13.5 million Americans.

Status: Highly unlikely in the near future. Politicians still remember how then-first lady Hillary Clinton was vilified by health industry interest groups when she pushed unsuccessfully for national health care in 1993.

Personal responsibility

Some economists, politicians and many businessmen believe Americans use so much health care because most of the cost is borne by the government and employers.

Pro: If people have to pay for medical care out of their own pockets, they'll be more frugal -- asking for generic versions of brand-name drugs and looking for doctors and hospitals that charge less. This might force the medical industry to lower prices to compete.

Con: Studies show that those without insurance -- who already pay their own medical bills -- tend to scrimp on preventive health care, leading to larger, more costly health problems.

Status: Some businesses are creating health savings accounts while trimming traditional health insurance, making employees take more responsibility for how they spend their health dollars.


Transparency allows the public to window-shop for health care much as it would other services or consumer goods. Laws would require hospitals, drug companies and doctors to provide the cost of services, as well as quality of services.

Pro: Once the public can go online to see which hospitals have the best survival rate for open-heart surgery or which doctors charge least for an office visit, the medical industry will be forced to improve.

Con: Statistics on quality can be misleading because of differences in patient mix.

Status: In August, President Bush signed a measure ordering federal agencies to share more information on the cost and quality of medical care with the public. The measure forces agencies that administer Medicaid, Medicare and Veterans Affairs facilities to pool data and find a way to make it accessible to the public.

Similar efforts are under way in a few communities. GM convinced Dayton, Ohio-area hospitals two years ago to share mortality and morbidity rates for various medical conditions. That information will be available on the Internet next year.

Electronic medical records

Computer record-keeping and sharing is slowly making its way into hospitals.

Pro: EMR reduces prescription errors and makes it easier to transfer medical records between hospitals.

Con: It's expensive. Hospitals, businesses and Washington are fighting over who should pay for technology that is funded by governments in other countries.

Status: Congress established interoperability standards for EMR this year, the first step toward making patient records easily transferable between health facilities. Hospitals are slowly installing EMR systems in their patient wards.

You can reach Ron French at (313) 222-2175 or

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