By Jerold Harwood
June 26, 2009 10:55 pm Rep. Pete Hoekstra's health care legislation, H.R. 2925, (referred to by Rep. Dave Camp in a June 19 Forum) represents a small incremental change instead of the sweeping reform needed to address U.S. health care inequity and high cost. Our health care is not equitable: It is not available to the uninsured; and access is hindered by lack of standardization of, and the actuarial nature of, private health benefit plans. Health care cost is a problem: It is the highest of any nation; its outcomes to not justify its cost; and providers charge, and receive, more money than in any other nation. Rep. Hoekstra's plan: -- Doesn't provide universal coverage. The uninsured employed and self-employed are included if the employer elects to participate. No coverage is provided for unemployed uninsured persons. -- Provides no financial support in the form of tax credits or vouchers for premium payments by poverty-level beneficiaries. -- Contains no provision for funding primary care teams and patient education, suggesting care is based entirely on one-on-one primary-care physician-patient transactions. This leaves no time or space for physician follow-up and interim home, office, and electronic communication. The Advanced Medical Home concept being piloted by the Center for Medicare and Medicaid Services provides for such services from nurse practitioners and physician assistants. -- Provides no relief from the cost of private health insurance administration. In fact, it mandates a costly claims-paying system. -- Subjects participants to unregulated cost-sharing in the form of deductibles and co-pays. Health care planners have known since the RAND Health Insurance Experiment of the 1970s of the negative effects of copayments on low-income beneficiaries. -- The basic health benefit provides no care for services not available within the self-determined provider service area and self-selected provider network. Specifically, no emergency or college student out-of-area care is provided. -- No assistance is provided for determination of benefits (and control of costs) by formal effectiveness testing of procedures, medicines and devices. Evidence accumulated over a long period and in many locations indicates up to one-third of health care delivered is unnecessary and/or ineffective. -- AccessHealth of Muskegon, upon which much of this proposal is based, is a remarkable plan characterized more by the stamina of the developers than their ability to craft an equitable, low-cost plan. Development of an actionable plan took five years of intense work, and is more a demonstration of the need for reconstruction of health care as an institution than incremental change. This is not a plan easily replicated elsewhere. These errors and omissions make Hoekstra's proposal a non-starter. There is too much at stake and too many crucial decisions to be made to spend time on this example of what communities are forced to do to provide health care to citizens within a non-system. There is nothing not addressed in the Insurance Exchange provisions of most current reform proposals. Proposals under consideration have some hope of addressing cost and equity issues. Hoekstra shouldn't crowd the playing field with this chestnut. About the author: Dr. Jerold Harwood is medical director of Employed Physicians at Munson Medical Center, where he develops and manages physician compensation plans. He was in clinical practice in Traverse City from 1967 to 1985, was in health plan administration in New York City from 1986 to 1998 and in hospital administration at Munson from 2000 to the present. About the forum: The forum is a periodic column of opinion written by Record-Eagle readers in their areas of interest or expertise. Submissions of 500 words or less may be made by e-mailing letters@record-eagle.com. Please include biographical information and a photo.
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