I was recently asked to rate the current reform process on a 1 to 10 scale. I paused. Two months have passed since I first published the Healthcare Letter in which I identified four concerns with the current reform process and offered an alternative. Clearly I would have ranked the process and its output on the low end two months ago. But sitting here in mid October, I wanted to do justice to the question so that others would be able to develop their own rating.

On a scale of 1 to 10, I came up with a 1. That ranking even surprised me. Let me explain my logic.

Given that there are approximately 300 million Americans, I began by asking the question, “With the current five bills in Congress waiting to be merged, what will be the most likely impact on Americans if a merged product passes?”

Positive impact would be:

• Improved access to healthcare (i.e. primary care versus ER visit, access to life saving treatments, etc);
• Reduced cost;
• Sustained or improved quality; and
• No less and preferably increased patient choice and control

Easy enough. Now the math. I divided up the population and gave 1 point for every group of 30 million people for whom a positive impact would be created. Positive impact to all 300 million would yield a 10.

Based on the latest legislation to come out of the Senate Finance Committee, the CBO estimates that all but 6% of Americans would have insurance. We started with 15% not having insurance or 45 million. This means that about two-thirds of our uninsured or 30 million people will now get insurance. So that is 1 point for positive impact.

I then paused and asked this, “Should I be allocating points on behalf of the 85% of Americans who have insurance but see the tragedy when their neighbor does not?”  In a recent CBS poll 59% of Americans said they wanted to see people get access. Obviously this speaks to the compassion of the American public. While I may have insurance, it is inconceivable that my neighbor goes without.

But as I began to add points to my rating scale, I had to subtract as I thought about my positive impact criteria.

The bottom line is that for the 85% of Americans, our healthcare costs are still going to increase beyond inflation each year.  For our family, that means that the cost of our insurance will reach close to $20,000 in five years, increasing a predicted 10% each year. The picture unfolds that more and more Americans will need government assistance (i.e. taxpayer assistance) as they are priced out of the private market.

Why? Because the current reform does not address the complexities, inefficiencies and misaligned incentives that drive up healthcare costs.  In fact there are arguments that our costs will increase even faster as a healthcare system with this reform. And it is in this arena that I believe our political leaders have been negligent in their duty to inform the American public, and why I have asked you to become a more engaged citizen in Healthcare Letter to Americans.

For the 85% of our America, the status quo yields a cost trajectory where a more centrally imposed rationing system becomes not an “if” but most likely a “when” for the sole reason that our current structure is not sustainable. This is what every American must understand.

For most, we may not see this overtly right away, especially if our employers pay for our insurance. But it all comes out of our pockets eventually. Even today, just look at the job situation. As the economy improves a little, the hiring isn’t coming back. The employers understand the liabilities that lay ahead including increasing healthcare costs. Salary increases are giving way to hiring and pay freezes as employers deal with escalating healthcare costs and a very uncertain future. Our paychecks aren’t growing if we are lucky to have one.

The drawbacks continue. The smallest estimate for costs to reduce the number of uninsured is $900 billion.  What is so striking is that we are bringing more people on, not by reducing costs for all and therefore making access easier through lower price points, but instead by adding people to the same spiraling cost structure.  Think in contrast of the price pattern realities for flat screen TV’s, cell phones and computers. As volume… and quality went up, prices came down, making them increasingly attractive and affordable to more people.

More importantly, I cannot say that I feel more certain as an American, knowing we have avoided dealing with one of, if not the biggest, economic issues facing our nation’s future. It feels like a false victory. All we will have done is put more people in a life-boat. Are we a country that wants to drift in the ocean hoping for rescue knowing at any moment we might sink?

So based on my “positive change” criteria, on a 1 to 10 scale, I give the current output of this reform process a 1.

Ultimately I am concerned about what this tells us about the state of our governance in general. I believe we should elect leaders who create an environment in which the ideas that are produced score better than a one. Perhaps that is the biggest lesson we are learning today, and one in which each American must take personal responsibility to change.

(1 votes, average: 5.00 out of 5)

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