Can the House Always Win?

The House has passed a health care bill! Let’s celebrate! It only took over a year and won by a very slim margin in a Democrat dominated House, but it passed, so healthcare reform must be around the corner. Right? I said, right? Wrong. It will still be stalled and the system will still be flawed and we will still bitch and moan about it. Why? Because we are flawed at every level from the people utilizing healthcare to the people providing health care to the people moving money for healthcare to the people legislating healthcare. That’s four groups of people debating. If the government and its three groups (White House, Senate, and the House, really, but executive, legislative, and judicial for you hopelessly optimistic in the system) cannot pass most bills easily, imagine how much harder it is with four groups. Let’s look at the four groups.

People utilizing healthcare. Or as some call them, the patients. Nearly everyone falls into this category at one time or another, and so the disharmony among this group is by far the worst. This group will only agree on one thing and one thing only. That the healthcare system is flawed. That’s it. Not even everyone believes that the healthcare system needs a complete overhaul. Those people exist, and Katie Couric or Michael Moore have already found and hounded them. Because not everyone even agrees on what parts of the healthcare system are flawed, there is no agreement on how to fix the system or structure a new one. And not only that, this group of people, while the largest of the four groups, has the least amount of influence over healthcare changes anyways. They have no say as to what goes into a healthcare bill, or how costs are contained, or who will be covered. Sure, they elected the President, and sure, they elected their politicians. But that is where it all ends because they did not elect their politicians’ friends in the healthcare industry. They also did not elect the lobbyists wining and dining their politicians. So what is this group left to do? The only thing they can do is what they already do best. Complain to anyone that will listen, and elect a Democrat when a Republican has failed them and vice versa.

People providing healthcare. This is still a large group of people, including not only doctors, but nurses, techs, secretaries, drug company personnel, biomedical manufacturing personnel, and all people working for medical facilities. Though the peripheral people in this group, such as secretaries and hospital valet services may not feel like they are in this group, they are because their financial livelihood is tied to their employer’s financial livelihood. This group is also divided, though not quite as severely as the first. Healthcare has morphed significantly over the decades. The days of prestige and personal fulfillment from practicing medicine are gone. Ninety nine percent of people going into the medical field do not enter the field because they “enjoy helping people”, but because they see the financial stability in a vocation in which they are or could be proficient. And changes to the system will invariably attack that financial stability. But of course, the disharmony comes from many aspects. First, many simply do not understand how they could be affected. There are many nurses and techs, for instance, that do not think their pay could be cut, or benefits stripped, or even jobs laid off. It is an unfortunate ignorance that will be their rude awakening one day. Others are not dependent on their healthcare jobs for financial stability, and so default to their “people utilizing healthcare” stance. Other opposed groups are those between the private practice doctors and the academic doctors, and the old school and the new school. The AMA (American Medical Association) and the Sermo are example of this, as they have differing views on healthcare reform. One thing is certain—half of this group will be very unhappy if healthcare reform hangs the providers out to dry. The question is if they will be unhappy enough to leave and make the question of healthcare reform moot and the question of who will provide healthcare very real.

People moving money for healthcare. I almost called these people the ones who pay for healthcare, and that would have been a gigantic faux pas. This group includes all the insurers as well as the government. While the government is motivated by its need to stem the Medicare and even Medicaid bleed, all other insurers are motivated by their need to make money, and for some, make money for their stockholders. This means that both need to make a profit—the government to stop losing money and keep Medicare viable, and the private insurers to stay in business. The strategies are somewhat different for each one. Medicare will essentially cover anyone with enough work credits in their lifetime and meet certain age or medical condition criteria. It is difficult to be excluded from Medicare. That means that the way to change loss into profit will be to increase revenue with more taxes, or reduce costs by cutting reimbursements, denying some drug coverage and diagnostic testing, and denying more procedures. For private insurers, much of their edge was derived from their ability to deny coverage based on preexisting conditions. This, however, is being targeted by healthcare reform. That means that the private insurers will also need to resort to the same cost cutting techniques the government will use. No longer will they be able to offer more brand name drugs or allow more testing than Medicare because they spend less money on healthier patients. In the insurance world, it is split down the line. Private insurers benefit and profit from the current system. The government and Medicare are bleeding and losing money from the current system. But only one of the two has lobbyists.

The people who legislate on healthcare. These are your politicians. The shifty, unreliable, tunnel visioned egoists you thought were idealists when you elected them. This group has battled over a public option healthcare with a devastatingly enormous amount of wasted time. This group has the most power over healthcare reform but is also the most internally conflicted. They have to listen to the other three groups to determine what to do. And when you are listening to a lot of noise, you end up producing rubbish. The other thing you do when you listen to a lot of noise is daydream and think about what you what to think about, much as a weed smoking teen does in history class. This is how we end up with six thousand little pet projects attached to the healthcare bill. This is also how we end up with a President that has to make the statement, “Now it falls on the United States Senate to take the baton and bring this effort to the finish line on behalf of the American people.” Congratulations to the legislative branch. You’ve forced the President to be your schoolmarm. Apparently, no one has considered passing healthcare reform the same way that Medicare ended up where it is today—by piecemeal. Sure, Medicare started with a band in the 1960s, but there have been many small changes over time. And this way you know exactly with what each shifty politician is taking issue. But then, where is the glory is writing a bill that makes only one change in Medicare? You can’t run for your fifteenth reelection on that feather in your cap.

So what do we have when you add it all up? You have a public made up mostly of people who care only about themselves and not the future or public good. You have healthcare providers that depend on the system they love to hate (frenemies). You have insurers profiting off the public’s medical testing obsession. You have politicians who certainly do not understand the healthcare system any more than most people trying to get their cut of the cash cow that is the healthcare reform process. What does that equal? A perfect example of bureaucracy minus understanding and direction. At this point we would be just as better off if we put the healthcare bill to a national vote and literally let it be decided on the majority of individual votes. That or flip a coin. But I’m sure the politicians would have something to say about which coin is used and who would flip it and where it is flipped and how many times it is flipped…