Most of you know that my main profession, for now, is as a health care finance consultant. Not that this necessarily makes me uniquely qualified to comment on President Obama’s health care plan, per se, but it helps to give me kind of a leg up on what he might be looking to do.

That is, if one can figure out what he’s trying to do. For the life of me, I have had problems trying to find exactly what it is that he wanted to do as it pertained to health care. It’s bothered me because of the dollars I keep hearing being kicked around, upwards of $600 billion to a trillion dollars; ouch! I mean, I came up with my own idea for a health plan, and even talked to a local politician who’s a congressman in Washington, D.C., about it at some event.

I finally found a little something on the WhiteHouse.gov site. No details, mind you, but at least something. In President Obama’s 2010 Fiscal fact sheet, there is this discussion of his ideas on health care, what he’s done so far, and what he hopes to accomplish. This leads us to his basic 8 health care principles, which I’m posting below, along with some commentary.

* Guarantee Choice. The plan should provide Americans a choice of health plans and physicians. People will be allowed to keep their own doctor and their employer-based health plan.

This one is somewhat off, though admirable, yet I don’t see where there’s any cost issue. People who have insurance paid for by their employer will always be stuck with having to make sure their physicians are part of the new plan, otherwise they’ll have to get a new doctor. I’m not sure President Obama has the authority to force insurance companies or doctors to hook up with each other just to satisfy patient’s wishes. I don’t see a cost issue here unless the plan is to pay the money to the doctors who don’t participate with those insurance companies; that can’t be the case.

* Make Health Coverage Affordable. The plan must reduce waste and fraud, high administrative costs, unnecessary tests and services, and other inefficiencies that drive up costs with no added health benefits.

Admirable, but somewhat misinformed. The government is already going after hospitals across the country for waste and fraud with their RAC Audits (recovery audit contractors), and before that, the Office of the Inspector General was doing the same. These have generated billions of dollars for the federal government, so no cost issue there.

Unnecessary tests and services were address by President Obama himself at the American Medical Association conference a couple of months back, where he acknowledged that, with malpractice, physicians may feel the need to do more testing, but that a lot of it is unnecessary and costly. He also said he was against limiting malpractice. You can’t have it both ways, but think of what you’d want if you were the patient. And we’d better start thinking about protecting these physicians in some way.

High administrative costs have always been a part of health care, and will continue, despite his request for limiting it. If the government ever decides to stop tracking so much information from hospitals, and can force all insurances, including Medicaid for each state, to conform to one billing standard, then it might be possible. But it won’t happen because government in general wants all the information they can get, no matter the cost.

Anyway, I assume part of the health care dollars he’s asking for is actually to reform some of this and not provide any care.

* Protect Families’ Financial Health. The plan must reduce the growing premiums and other costs American citizens and businesses pay for health care. People must be protected from bankruptcy due to catastrophic illness.

Once again, admirable, but how can it be done? It would take money to keep premiums from going up, and based on the fact that Congress, at least the Democrats, are looking to tax the wealthy, since President Obama seems to be standing firm on not taxing the middle class or taxing the paid health care benefits from employers (thank goodness; I hope this one holds out), and it would be a misuse of government funds.

Protection from bankruptcy would be a great goal also, but I’m not sure that will work either. Thing is, back in the early to mid 90’s, an outstanding medical bill on a credit report meant nothing to anyone else looking to give you a loan, and now it does, probably because of the instability of the financial situation. Congress could actually vote on and pass this bill without it being attached to health care, per se; after all, though I’m in the medical billing business, no one runs up health care bills willingly, unlike credit card purchases.

* Invest in Prevention and Wellness. The plan must invest in public health measures proven to reduce cost drivers in our system—such as obesity, sedentary lifestyles, and smoking—as well as guarantee access to proven preventive treatments.

Once again, admirable, but unenforceable and unnecessary right now. At least it’s unnecessary as part of the health plan, since the government already puts out a lot of information on these topics, as do state governments. The government can’t force people to change, but maybe a part of this plan is to pay for health club benefits for anyone who decides they want it. I’d like that, but for now, if this is part of the health plan it’s wasteful and unnecessary.

* Provide Portability of Coverage. People should not be locked into their job just to secure health coverage, and no American should be denied coverage because of preexisting conditions.

I full agree with the second part, but I’m not sure about the first part. I’m not sure what it means, since people change jobs all the time and, thus, change insurance plans because it’s what a new employer pays for. Also, I’m not sure how this impacts the cost of the President’s health plan.

* Aim for Universality. The plan must put the United States on a clear path to cover all Americans.

Okay; this sounds nice, but so far there’s been nothing mentioned to say what that coverage entails.

* Improve Patient Safety and Quality Care. The plan must ensure the implementation of proven patient safety measures and provide incentives for changes in the delivery system to reduce unnecessary variability in patient care. It must support the widespread use of health information technology with rigorous privacy protections and the development of data on the effectiveness of medical interventions to improve the quality of care delivered.

This is probably the biggest portion of where the money is supposed to be going. It’s no secret that President Obama is pushing electronic medical records, and I don’t have a problem with that. I do have two thoughts on it, though.

One, I’m not sure it’s the federal government’s prerogative to force physicians into getting themselves set up for electronic medical records. Many physicians are computer illiterate still, which means someone would have to train them and their staff on how to use all this stuff.

Two, it’s actually the federal government getting in the way of itself. One of my fellow local consultants, a guy named Joe Holzer, is working with a Chinese company that has created a free electronic medical records program. The only costs to the clients is for installation and training. However, the Feds require companies to pay over $200,000 for their software to be evaluated by the government, which in actuality what they do is hire someone to look at the software to determine whether it’s valid or not. Anyway, for a company looking to provide free software, this price seems, well, exorbitant for an evaluation fee. Heck, for free software, it would behoove the government to evaluate it for free, sign a $5 million deal with the company to provide it to all physicians, and be done with it; lots of government money saved, and the President gets his wish.

No, things are never that simple, are they? So, it’s going to be costly. Still, how did this just provide any health care benefits?

* Maintain Long-Term Fiscal Sustainability. The plan must pay for itself by reducing the level of cost growth, improving productivity, and dedicating additional sources of revenue.

This one gets a “duh” from me; nothing else I can say about it.

Anything missing here? Yes; what health care benefits will the plan cover? See, I’m back to my main issue, which is having no idea what the President is really going to cover. Preventive medicine, full insurance benefits, dental, long term care, labs, x-rays, surgeries, cancer treatments,… what?

Trust me, I’m not against the President on looking at health care reform; we all know the system is broken. And the public says it wants health care. But once again, it’s being discussed with broad strokes without any details, and there’s nothing being said about what it wants to specifically do for the health of individual patients.

Do you want to take a look at my health plan again?

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