I sat and watched tonight's Charlie Rose interviews with Peter Orszag, called the strongest voice in Obama's ear on healthcare, and Denis Cortese, CEO of the Mayo Clinic. Fascinating. Instructive. Somewhat reassuring.
One question, though....
The impression I get is that removing nuts and bolts healthcare decisions from Congress and putting it under the Executive branch through the creation of an ongoing oversight body called IMAC is designed to create a system going forward that will help streamline healthcare delivery and give it a structure we don't currently have.
Cortese summed it up: The healthcare system is not broken; we don't have a healthcare system. He used his experience at the Mayo Clinic, which is recognized for its ability to provide high-value care at low costs, as a springboard from which to launch into a discussion of building the kind of system that doesn't currently exist -- a system of valuation of healthcare, essentially, and of making sure people get what they pay for.
Orszag's presentation gave me the impression that the Obama administration would rather realign insurance from the delivery side, by starving the insurance industry of funds for unnecessary and redundant tests and so on through streamlining the system. It was a very high-tech sort of presentation from a guy who seemed genuinely concerned with finding answers to our shituation.
I was left with a single question.
Both gentlemen seemed to assume the involvement of private insurance as a given, and since Rose never asked them what "value" the health insurers brought to the table in exchange for their 30 percent, I was left with the impression that the highly-efficient, streamlined system they are seeking to build would be at best 70 percent efficient and would go down inexorably from there.
Is the question so impertinent? Why is nobody asking it?
What value do health insurers provide for the percentage of healthcare dollars they siphon off right up front in the lobby? Their only value, near as I can tell, is to discourage overuse of healthcare delivery. Unfortunately, that has gone increasingly awry as the demands of the bottom line dictate the use of every available mechanism, and even some outside the law, to deny payment when its customers most need them.
Death by spreadsheet is the new reality.
I understand the reluctance of Congress to ask existential questions of the insurance industry, since that industry is one of Congress' larger corporate investors.
But surely the insurance industry must be eager to trumpet its advantages over simply having the government collect the money and pay it out to healthcare providers directly. On the Hannity website, one conservative dared answer the question:
"Choices, options and competition."
That's it. That was the answer when someone asked what value health insurers add to the equation. Really?
Choices? Of what? My employer offers a small variety of plans and options from a single insurer for me as an individual and my family. Unfortunately, I'm not in a position to take a 25 percent reduction in my weekly pay in exchange for coverage that, in my first 40 years, I'd scarcely have used. Am I paying for future care? Possibly...unless they can figure out a way to get my ass off the rolls as soon as i get sick or have an accident. I obviously can't afford a private plan at 3X to 4X the rate I'd pay through my employer, nevermind the increased risk of a private, individual plan as opposed to a group plan. I have no choice. Options? Competition? Are you kidding?
I can't afford to gamble on paying for insurance.
I'm just not seeing it. I'd appreciate hearing from the other side on this issue. What does the health insurance industry add in exchange for the percentage of healthcare dollars spent that it receives?
Just ask the question.