The healthcare disconnect

July 10, 2009

Darrell West— Darrell West is vice president and director of governance studies at the Brookings Institution and the author of Digital Medicine: Health Care in the Internet Era. The views expressed are his own. —

It is not the first time Washington has been disconnected from the general public, but recent discussions over healthcare reform reveal a D.C. establishment fixated on arguments not central to the general public.

The air waves are filled with clashing claims over the so-called public option whereby Medicare would be expanded to include more Americans. Proponents claim this is the best way to cover most Americans currently without coverage and drive down costs by creating competition for private insurance companies.

Opponents complain about a “government-run” health system and bureaucrats coming between physicians and patients.

According to pollster Geoffrey Garin, though, voters do not have a big problem with the public option, or employer or individual mandates requiring coverage. A recent New York Times/CBS News survey found that 72 percent of Americans support a “government administered health insurance plan” similar to Medicare and 59 percent believe the government would do a better job than private insurance companies in holding down health care costs.

The problem, from the voter standpoint, is how to pay for reform. With costs estimated to top $1 trillion and federal budget deficits already having sky-rocketed, people want to know who pays and how changes will affect their personal medical care. It matters to them whether the bill for coverage expansion comes in the form of higher taxes on sodas, alcohol, tobacco, or employer benefits or reduced spending on physicians, hospitals, and other health providers. With personal finances under great strain due to the recession, the public is not in a particularly generous mood.

The greatest fear people have, according to public opinion experts, is that their current care will suffer. Seventy-seven percent of Americans are satisfied with the medical coverage they currently receive. While they are interested in expanding coverage, they don’t want to do so if it is really expensive or endangers their own treatment.

The best thing President Barack Obama can do is remind people that if they like their current care, they get to keep it. No one will be forced into a public plan. People can keep physicians they like. If they worry about government-run health care, they can stick with private insurance.

The biggest change from 15 years ago, when the Clinton administration attempted health care reform, is that now people worry as much about mistreatment from private insurance companies as government-sponsored health plans. The bureaucrat they fear is not just a government employee making policy decisions affecting health care, but the commercial insurer that denies claims, demands extensive paperwork and removes people from coverage due to pre-existing conditions. From the voter’s perspective, the playing field between the public and private sectors is more level than in earlier reform efforts.

New technologies furthermore give consumers greater control over medical information and treatment. Regardless of what policy decisions Washington makes, America is moving towards “consumer-directed” health care that will transform the practice of medicine. The monopoly over medical treatment held by physicians and hospitals is eroding. In the future, people will use remote sensors to monitor glucose levels and blood pressure; electronic medical records will be utilized for storing information. Information technology will produce the real long-term revolution in health care.


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The creative route is largely untapped and undeveloped. This is when software with biometric technology can, through the use of sophisticated models, diagnose symptoms and evaluate the progression of chronic health conditions. I guess it would be a different type of doctor – one that doesn’t currently exist.

In terms of the holistic approach, tracking the use of medication using information technology, that can also provide a bounty for researchers. My main concern – and I’m sure others would share it – is the privacy of medical data. Insurance companies will take every opportunity not to pay out. Of course insurance companies have proven themselves to be well managed by competent individuals (cough – not). A mandatory plan that covers all people would be the way to go.

Posted by Don | Report as abusive

Before we go any further down the road of health insurance we need to look at insurance and what it means. One gives money to a company for 1 year and that company invests the money keeps the profits and only if you need to pay a doctor or? does that company pay up. At the end of the year the company looks for more money and this is where we have to look. Why more money and not the same money they got last year? if one doesn’t claim their money is gone. Now the answer of course from the insurance company will have have several hundred reasons why this is so but one should not believe them. Take a good look around and see what’s happening, all our problems are coming from this industry? Don’t believe me but do take a good look at your life and the influence insurance companies have on it.

Posted by Donal Jackson | Report as abusive

A simple doctors’ exam doesn’t take too much technology and I think that the percentage of unsatisfied health care patients is actually much higher than Darrell West claims. This abuse of attention given to high end technology when the basic knowledge and technology in medical care is the basis of treatment of the general pool of patients is diverting the real issue: can the health of the overall population be put at risk simply for economic factors, and when will the pervasiveness of punishment of the poor for living in a wealthy country actually cease to influence US politics in Washington, D.C.?

After WWII, the european countries involved managed to create a public health care system out of the ashes of war, with far less resources than the ones available to the US today and they did it with borrowed money from the US. They have succeeded.
I guess it takes a severe trauma to make things happen, not money, after all.

Posted by Danny Breakfast | Report as abusive

The health insurance industry is only part of the problem. The other is the high cost of medical care itself. Any solution, which addresses only how we pay for service, and does not significantly reduce cost of service, will fail.

Posted by Paul Bartholow | Report as abusive

The discussions around the healthcare industry have centered on leveraging a universal insurance model to provide accessibility.

What is far more important is to manage the rising cost of healthcare while providing consistency in the quality across the entire country.

There is a large disparity in the delivery of healthcare within the United States and this disparity is not a reflection on the cost.

In many cases the best healthcare in our country is not the most expensive.

For example the leading healthcare institutions tend to operate differently. Best practices in areas ranging from sterilization techniques to pre and post operation processes can deliver better quality of healthcare at a lower cost.

On the insurance side, the current thinking around legislation has many specifics on raising money through taxes to provide insurance for people who don’t have it; however it lacks anything specific on how to manage the rate of change in health costs.

The taxes are a surtax on people with high income. This is good to cover expenses this year; however it assumes that the income levels of the taxed people will rise in direct proportion to the rise in health care costs. Without specific measures to manage costs in the healthcare industry, this system will break in less than 10 years.

Posted by TomG | Report as abusive

The primary disconnect is that our government is focusing on expanding the access of healthcare without addressing the healthcare (quantity/quality) itself.

Our healthcare system is running close to full capacity. Doctors and hospitals are already providing the amount of healthcare that they can. Offering more healthcare coverage does not result in more care being provided. The effect is more competing interests for the same healthcare services, in essence resulting in “rationing of healthcare” and increasing either the healthcare costs and/or reducing the quality of healthcare provided.

The primary problem is not universal health care, it is the astronomical health care costs. The primary cause of these costs is simply demand for health care exceeds available supply of health care. Public-run health insurance does not address the cause of the problem .

Posted by Hank Wang | Report as abusive

I implore the American People; Do Not Allow Government Controlled Health Care! I am an Honorably Discharged Disabled Veteran of The United States Navy. The Veterans Administration Health Care System is a window to the future of what will be if this is allowed. For instance; I lost my glasses at work yesterday in rough terrain. Today I went to the VA Hospital in Minneapolis, MN. My Disability is for a Service connected eye impairment. The Government controlled VA had; 5 years ago, outsourced eye exams to a local optician. The VA in Minneapolis MN. has an optician but they first said I would have to wait until I had an appointment in 32 days. I told the desk that my disability was Service Connected for a visual impairment and that I am a priority case as such. “Nothing we can do” was the answer. Then my wife pointed to a sign on the wall that I obviously couldn’t read which read “Please allow 6 weeks for delivery on glasses”. Oh yes, let me not forget the hour that I waited on the phone this morning hearing the repeated message that my call was important, asking me to hold on the line. I later found out that no one was manning the phones so I would have waited forever on the long distance call to nobody. Help yourselves but I’m just warning you – you must never become ill or have a heart attack because the service you will receive may be worse than having a good friend take you out to the woods and relieve your suffering with a bullet.
USN Disabled Veteran
Blind in one eye – can’t see out of the other!

Posted by James | Report as abusive

Someday soon people need to figure out that any program run/administered by our government will be costly, bloated and fail. Look at the past for endless examples.

Posted by Bruce S. Mitizak | Report as abusive

If you think IT is going to solve health care finances, you’re wrong. Most Americans don’t have the scientific knowledge or access to evolving medical information to understand their medical illnesses. One of the roles of doctors, nurses, and other health care providers is to provide and interpret information in the context of the individual’s life.

Posted by Shelley Binkley | Report as abusive

“Opponents complain about a “government-run” health system and bureaucrats coming between physicians and patients.

As opposed to what? The current way of for-profit health insurance companies coming between physicians and patients?

Posted by Petunia McIntyre | Report as abusive

It could very well degenerate into a “two health care worlds”! Like many countries that have the “well to do” visiting the costly private clinics and hospitals and the rest having to depend on goverment run hospitals that are mostly “run down”!

Posted by Thomas George Walsh | Report as abusive

Has anybody tried to address the huge difference between what providers charge and what they actually accept from some insurance companies? For some tests, the lab bills several hundred dollars, but because they are “participating providers”, they accept my insurance company’s payment – often a small fraction of the “sticker price”. Presumably, the uninsured pay full price. And what about insurance companies who provide coverage based on “reasonable and customary” charges? (I had that kind of coverage 25 years ago – I don’t know what it would cost today!) Unless a reform plan addresses this issue, we won’t know whose cost estimates to believe!

Posted by Richard Woytowich | Report as abusive

A very well written opinions peice Darrell. Having personally come from a universal health care system to the US system, I prefer the universal health care system. Despite it’s flaws. It is true, the general standard of living is lower due to higher income taxes, the wait lists for hostpitals are long, however the average doctor visit where you wait to be seen is in fact shorter where I was from than here and you pay zero or much less out of pocket and probably less overall. Private and public systems CAN co-exist side by side if you don’t wish a lower quality service. There is much misinformation concerning universal health care that is being circulated right now. My hope is that they look at serious reform of both insurance and the healthcare industry.

Posted by Working Mom | Report as abusive

“After WWII, the european countries involved managed to create a public health care system out of the ashes of war, with far less resources than the ones available to the US today and they did it with borrowed money from the US. They have succeeded.” – Danny Breakfast

Really? Then why is it that so many of these countries have gone to great lengths to cut back on these systems if they are working so well? Answer: The economics of the situation right after WWII were quite different than the current economics in these countries. This was largely due to the fact that there was a smaller population right after WWII, the life expectancy was much lower, and people were having more children. So they had a sustainable system as long as their children continued to have the same life expectancy and had as many children as their parents did as well as continuing to earn at the same rate as their parents (adjusted for inflation). This obviously has not been the case. Instead they have a population that is growing by basically living longer but having less children to support those who are dependent on the system and they are earning less than their parents did. So they have two basic options at this point: cutting care (in a variety of ways including reducing the amount of procedures that are covered, changing the age of eligibility for coverage, etc.) or increasing taxation.

Posted by John Wilson | Report as abusive

How can any intellegent person beleive that state run healthcare will be better and cost less? Does anyone really beleive that higher taxes to the rich are the answer? Does anyone want to add to our trillion dollar deficit? Aren’t we still involved in two wars? Why is national healthcare more important? If a woman has breast cancer, her chances of survival are much, much, much greater in the U.S. than countries that offer universal. This is a fact. Listen to the veterans who have experienced “national care” from VA hospitals. Timeliness is the most important factor when it comes to healthcare.

Posted by Cecilia | Report as abusive

How will we pay for healthcare over hall?? Get out of Iraqu and stop giving 10 billion dollars a MONTH to Dick Cheney’s companies that are not using any of that money to take care of our soldiers!!!!! Thats how, pretty simple actually!!

Posted by Hello | Report as abusive