Health Care Reform: A Healthy Skepticism? (pt 2)

Fox Valley Candidates Discuss This Year’s Most Controversial Issue. By Paul Stukel

Ethan Hastert, R-Elburn
Ethan Hastert begins to lay out his vision for health care reform by adopting the famous physicians’ principle:  First, do no harm.

“My approach begins with some basic principles. First, don’t do anything to degrade the current level of health care service American receive.  Second, don’t do anything to reduce consumer choice.  Third, don’t do anything to get in between doctors and their patients.  Fourth, don’t increase the cost.”

Hastert is no fan of the public option.  “In the first place, we as a nation can’t afford the public option.  But more importantly, the idea of the government inserting itself into the health care decisions of millions of Americans is, to me, improper.”

There is no question that significant problems exist in the American health care system, Hastert recognizes.  “Where I come from, insurance is too expensive.  It’s too expensive for individuals, too expensive for employers, too expensive for employees.  And there are too many people with no insurance.”

Hastert focuses on several fundamental issues.  “Tort reform [litigation reform] is essential, and it’s not mentioned in the current proposals.  We should look to Texas and California as test cases,” he says. “We also need to increase the effectiveness of the free market by opening up the ability of consumer to purchase insurance across state lines.  Along those lines, we need to allow the formation of large “insurance blocs” that provide a much larger pool for insurers, which would drive down risk and, therefore, costs.”

Portability, or the ability to retain one’s insurance when changing jobs or life conditions, is also high on Hastert’s priority list.  “By removing barriers from insurers selling across state lines and creating large insurance pools, we can enhance the ability of consumers to achieve significant portability.  Also, increased utilization of Health Savings Accounts is important in this respect, since they’re by nature portable.”

“We also need to increase the transparency of health care providers,” he continues.  “We need to provide more tools for consumers to educate themselves on their options.  For instance, if I’m shopping for a dentist, I should be able to know how much treatment will cost and what kind of quality is available.  It’s true for insurance providers as well.  What’s covered?  What are the options?  You’ve got to increase the knowledge of the consumer.”

Hastert is “philosophically opposed” to an individual mandate, even as a means to deal with the issue of pre-existing conditions.  “I think the issue of pre-existing conditions can be dealt with through a ‘surgical fix.’  If someone has had insurance and has done all the right things, but for whatever reason gets ‘caught’ without insurance at a bad time, we should be able to deal with that using public resources.  But again, it’s a surgical fix.”

Mark Vargas, R-Elgin
Having spent 16 months during 2007-2008 travelling back and forth to Iraq working on economic development for the State Department, Mark Vargas certainly brings a unique perspective to the health care issue.  And his thoughts are fairly stark: “Nationalizing health care is going to turn into a nightmare.  Just look at the “Cash for Clunkers” program.  It was supposed to cost $1 billion and last for three months.  Within three weeks the money was gone, and it ended up costing three times as much as originally estimated.  That’s just what will happen with nationalized health care.”

Like his fellow Republican candidates, Vargas believes in the primacy of market forces over government solutions.  “Everybody should have access [to basic health care], we all agree on that,” he says, “but government control isn’t necessary for that to happen.  Increased competition between private insurers will drive down cost, and that’s where we need to be focused.”

Vargas points out that there are over 1000 health insurance providers in the country, yet in some states there are but one or two providers competing.  Vargas attributes this to the rococo nature of state regulations and mandates that stifle the ability of consumers to reach across state lines to choose the right policy for them.  “Every person has a unique need,” he asserts, “and a ‘one-size-fits-all’ approach just won’t work.  We have to allow consumers more choice to find the policy that works for them, and that means opening up competition nationwide.  That will drive down costs considerably, and will provide more choice and opportunity for consumers.”

Litigation reform is also central to Vargas’ vision.  “You simply can’t talk about health care without addressing litigation reform,” he says.  “The costs of medical malpractice and, more significantly, the expensive practice of ‘defensive medicine’ add considerable inefficiencies and cost to the system.  We have to address this in any kind of health care solution.”

When asked about the issue of pre-existing conditions, Vargas recognizes that “the current system leaves a lot of people out in the cold.”  But again he stresses individual circumstances.  “It’s a problem, but we need to assess this on an individual basis,” he says. “We need to allow people to choose what’s right for them, be it supplemental insurance like AFLAC, or other, market-driven policies.  But the government shouldn’t be mandating these things.”

“I don’t have all the answers,” he says. “I plan, during the campaign, to host about a dozen health care “workshops” around the district, involving experts in the field, providers and consumers.  I want to run a solutions-based campaign, and have the voters walk away with something tangible as a result.  The fact is that 85% of the American people are reasonably satisfied with their current health care arrangements. I want to find solutions to dealing with the remaining 15%.”

Brian Griffin, Communications Director, Delnor Community Hospital
We spoke with Brian Griffin of Delnor Community Hospital to get a health care provider’s view of reform issues.  While Griffin was understandably reticent about addressing the more political elements of the discussion, pointing out that “there are just so many proposals out there, we don’t want to comment on specifics at this time,” he did lay out the hospital’s four core tenets in terms of what is desirable.

1) Expand access to health care while maintaining coverage for those who are satisfied with their current arrangements. 

“We support proposals that expand coverage to the uninsured,” Griffin says.  “We believe that a large portion of the problem is the inefficiency of using the emergency room as a primary care option [which is what most uninsured people do].  Providing effective and efficient health care is often a matter of ‘right time, right place,’ meaning that if those who choose to go to the emergency room for basic health care needs were to have access to primary care, the cost savings would be significant.  So expanded coverage is very important.”

2) Focus on improving quality.

Griffin emphasizes that the quality of health care can be improved by several means currently available to providers. 

“Greater transparency is key,” he says.  “We here at Delnor have been early adopters of processes that gather information on quality of care and making that available to prospective patients.  That allows for consumers to make informed decisions on which provider is most effective for them.”  Griffin also urges the expansion of patient access to electronic medical records in this respect.

Finally, basic “best practices” protocols are crucial to enhancing quality of care.  “Delnor was also an early-adopter of what are called ‘evidence-based methodologies’ in providing care.  The Institute for Health Care Improvement is a non-profit organization dedicated to identifying and disseminating practices and procedures designed to reduce errors and enhance quality.  Delnor has worked closely with this organization to improve its procedures, with significant results.”

3) Appropriately control costs.

“One of the ways we’ve managed our costs at Delnor is through the adoption of LEAN principles, which are management techniques that involve bringing together all elements of our processes  - doctors, patients, vendors, etc. – to assess and implement ways to reduce excess costs through process change,”  Griffin says. “As an example of the success we’ve achieved, we recently avoided a multi-million dollar expansion that we thought was necessary due to higher volumes of patients.  By altering our procedures and making them more efficient, we not only found that our current capacity was adequate, but we also increased patient satisfaction.”

Griffin also reiterated the fact that “right time, right place” treatment was essential for controlling costs.  In addition, he cited litigation reform as crucial for eliminating defensive medicine and reducing excessive medical malpractice premiums.

4) Protect reimbursements for Medicare and Medicaid.

“We feel strongly that reimbursements for Medicare and Medicaid must not be cut back,” Griffin says. “We are already in a situation where these programs typically don’t even cover us for our costs, and when we do get paid, it’s usually after a long delay.”  Griffin emphasized the need for proposals that reflect all of the stakeholders in the process, urging a more collaborative approach to dealing with this issue.

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