Shifting the Health Care Debate from Irate to Ideas

By Ronald E. Bachman 

Americans are clearly angry about the policies and politics of Washington, D.C., and the Tea Party movement has led the way, uniting the silent majority and giving renewed voice to American principles of limited government, personal responsibility, and self-reliance. More people see that the proposals of 2009 were not about health or health care but about centralized power, increased bureaucracies and expanded political control.  

But, being against something is always easier than knowing what to be for. The challenge now is to shift from irate to ideas, from success to significance. “Tea Party Patriots” can remain a movement against selected policies or grow into a movement that promotes common principles and/or specific policies. It need not detail solutions; it could stand ready to choose among ideas. A stronger political position would be to understand the possibilities and direct policy-makers to take specific actions.  

For example, polling indicates that the American public recognizes that there are problems with health and health care, but there is no national consensus on a common vision for going forward. It is now time to lay out basic principles, desired outcomes, and general legislative proposals to deal with real health reform. Reform can be accomplished with a common vision through citizen input, shared values, American ingenuity and bipartisan debate. 

Establishing Basic Principles 

A uniquely American solution must be founded on basic American principles and values. Before any specific policies are promoted, the following are suggested for discussion and debate. Any health reform proposal including private coverage, Medicare, Medicaid, SCHIP, and others aspects of the current health system should be measured against a common set of basic principles:  

1.      Market-based – The U.S. Congress and States should establish a supportive legal and regulatory environment that will allow a creative open competitive entrepreneurial market to develop the health insurance products and services that will meet the needs of every citizen.

2.      Increased competition – Competition in an open, free market among insurers, providers, agents, and other providers and vendors of care is the best solution to lower prices, better services, higher quality, greater convenience and more choices.

  1. Maximize insurance, minimize third-party reimbursements – Third-party reimbursements foster an environment of entitlement and unlimited demand for health-care services. A comprehensive system based on personal responsibility puts financial power in the hands of consumers and can help offer insurance coverage to everyone, regardless of their current or future health status.

4.      Security for the sickest – No one can be left behind. Health insurance is about financial security when sickness or accidents strike. Solutions must help the sickest patients get the best care through financial and information empowerment, not just target the young, healthy and wealthy.

5.      Behavioral change, not cost-shifting – Behavioral change includes wellness, prevention, early intervention, and compliance with proven care and treatments. Providers must deliver evidence- and outcomes value-based care and encourage personal involvement in altering health and health care purchasing behaviors.

6.      Personal responsibility – Information and support tools for increasing self-reliance can help individuals take ownership for good and bad health and health care decisions. Support programs include patient financial involvement with incentives for participation, rewards for compliance, and educational support.

7.      Ownership – Individuals should control key decisions affecting coverage, choice of treatments and selection of providers. Ownership covers financial assets, choice of how to spend personal funds, the right to one’s health information, and ownership of a personal health record.

8.      Portability – Individuals should have continued coverage regardless of employment status and/or job changes. Policies that do not rely on employer-based insurance should be encouraged and expanded.

9.      “Holistic care” – A focus on health recognizes the potential to improve the physical, mental, social and spiritual status of an individual in need regardless of the diagnosis or condition. 

Achievable Outcome

American ingenuity can solve any problem and achieve any goal. By creating supporting policies based upon the above principles, the positive outcomes will include the following:

1.      Empowerment of consumers/patients – Empowerment will come from financial and information sharing. Market-based systems engage consumers in meaningful ways to understand options available to them and the risks and rewards associated with choices. The individual has both rights and responsibilities when it comes to their health and healthcare.

2.      Health care consumerism – Placing economic purchasing power and decision-making in the hands of individuals gives them the information and decision support tools they need, along with financial incentives, rewards and other benefits that encourage personal involvement in improving health and health care purchasing behaviors.

3.      Improving cost and affordability – Affordability is more than the dollars paid as premiums; it’s also health choices and behavior changes. Individuals pay less if they are non-smokers (or quit smoking). Similarly, health care and insurance costs are lowered when individuals maintain healthy metrics for blood pressure, cholesterol and body mass index. Americans with chronic and persistent conditions can earn rewards for adherence to disease management standards or compliance with good lifestyles, diet and exercise standards.

4.      Enhanced access, choice and quality – A choice not to be covered by insurance should be allowed, but getting care (even emergency care) without participation in an available insurance pool will have potential treatment and financial consequences. Once a viable robust market-based system exists, government-based programs of Medicare, Medicaid, and SCHIP should allow individual choice for transitions to market-based alternatives; the increased competition will improve access, choice and quality.

5.      Elimination of diversity in outcomes – Whether it is social, racial, geographic or other categories, the diversity of outcomes will be mitigated once the segmentation of the existing insurance system is eliminated.

6.      Expanded use of technology – The infusion of technology will lower costs, improve efficiency and effectiveness of coverage, and appropriately identify and distribute information. Whether in personal care devices, personal health records, electronic medical records or e-prescribing, the world of health lags in adopting new technologies. Encouraging American ingenuity will advance the use of health care technology to lower costs and improve health.

7.      Movement to a culture of health – A culture of health focuses on wellness and prevention rather than on disease, sickness, and treatments. Health activities should measure and reward participation in wellness assessments, compliance with a condition’s management programs (e.g. taking medications, diet, exercise, office visits), and maintenance of good health characteristics (e.g. blood pressure, cholesterol, nicotine use, body mass index). 

The need and time are here to develop a consensus based on common principles and desired outcomes. Only then can Americans have a rational discussion of ideas such as tort reform, cross-state selling, expanded consumer-driven plans, high-risk pools, federal regulations, coverage mandates, consumer protections, state/federal responsibilities and national insurance.

Ronald E. Bachman FSA, MAAA, is a Senior Fellow at the Georgia Public Policy Foundation, an independent think tank that proposes practical, market-oriented approaches to public policy to improve the lives of Georgians. He is also a Senior Fellow at the Center for Health Transformation, an organization founded by former U.S. House Speaker Newt Gingrich. Mr. Bachman worked as an outside expert with members of Congress and the Clinton administration during the 1993-94 health reform. Nothing written here is to be construed as necessarily reflecting the views of the Foundation or the Center for Health Transformation or as an attempt to aid or hinder the passage of any bill before the U.S. Congress or the Georgia Legislature.

© Georgia Public Policy Foundation (February 5, 2010). Permission to reprint in whole or in part is hereby granted, provided the author and his affiliations are cited.