Thursday, May 24, 2007

Hypocrite Series: Clinton on Health Care Reform

As we all know, Senator Clinton has a checkered past with the U.S. Health Care system. I honestly have no idea what she proposed during President Clinton's term in office. I just know that everyone, Democrats included, seemed to dislike it. Whatever the case may have been, a blog post this morning promotes her new agenda for lowering health care costs:

Hillary Clinton Announces Agenda to Lower Health Care Costs and Improve Value for All Americans (PDF)

Where John Edwards gave us some big and, dare I say, sensible changes to the Health Care system as it stands now, Senator Clinton seems more inclined to nibble at the edges and play it safe. It's a 7-step strategy:

  1. Create a Groundbreaking National Prevention Initiative to Reduce the Incidence of Such Diseases as Diabetes and Cancer that Impose Huge Human and Financial Costs

  2. Institute a New “Paperless” Health Information Technology System

  3. Transform Care of Today’s Chronically Ill Population to Improve Outcomes and Decrease Costs

  4. End Insurance Discrimination to Help Reduce Administrative Costs

  5. Create an Independent "Best Practices Institute to Empower Consumers, Providers and Health Plans to Make the Right Care Choices

  6. Implement Smart Purchasing Initiatives to Constrain Excess Prescription Drug and Managed Care Expenditures

  7. Put in Place Common-Sense Medical Malpractice Reforms

As you can see just reading the overview, this is really a mixed bag of political mumbo-jumbo and actual changes. A groundbreaking what? When you have to tag market-speak onto your initiative, it probably means there's not much to it. Best Practices Institute? Is this Marketing Ed 101 or what? Smart purchasing initiatives? Thanks for clarifying they wouldn't be dumb. Of course, in her defense on the last one, most government purchasing initiatives are pretty dumb, aren't they? Strike that one...good clarification there.

Anyway, let's move on a discuss some of the good and bad points we have here. Senator Clinton seems most interested in addressing cost. In step 1, she wants to reduce the incidence of diseases like diabetes and cancer. This groundbreaking initiative is implemented in two ways.

  1. All insurers must participate in federal prevention programs which would include eliminating copays on high-priority prevention services.

  2. Spend money through some stupid beauracracy...I'm paraphrasing here.

Focusing on prevention really isn't a bad idea for reigning in costs, but what do her proposals really accomplish? Just because my insurer offers a free Colonoscopy doesn't mean I'm going to take it. And, if my Doctor doesn't tell me I need a physical, I'm not going to volunteer just because it's free. As far as spending money, do we really believe a few million more through Department of Waste My Hard Earned Money is going to accomplish anything? Pushing money through an agency is just a feel-good way for politicians to pretend like they accomplished something. What's more, all of these arguments ignore the fact that the federal government is not meant to act as my damn caregiver.

Moving on...let's talk about Senator Clinton's paperless IT system. Everyone seems to be on this bandwagon which surprises me since they probably aren't in the trenches handling any health care paperwork. Needless to say, though, the system is ridiculously antiquated and overly burdensome to operate. The problem is that you have to walk the right-to-privacy vs. efficiency lines.

What I want to see, though, is a Doctor's office who can tell me how much I owe when I leave my appointment. I shouldn't have to wait 2 months to find out how much the Doctor discounted for the insurance company or how much the insurance company covered. I should be able to plop down my money at the end of the appointment and neither the Doctor nor I worry about invoicing and payment down the line. I'm not sure if Senator Clinton's proposal wants to go this far, but whatever the approach, we need more and better IT behind health care to reduce costs and reduce headaches for all involved.

Senator Clinton's chronic care initiative sounds like market-speak even in the details section. There's very little substance to it, and it's probably put there just to win some Senior votes.

Step-4 would end insurance discrimination to help reduce administrative costs. Now, I do like what this would accomplish as my wife would be insurable, and we would have more options for how to live our lives. However, I really don't like the fact that she said the purpose was to "reduce administrative costs". Maybe they're trying to win over the insurers with this (I doubt it), but I want it to say "end insurance discrimination because it's stupid" or something along those lines.

Okay, so now we're at blah-blah-Best Practices-blah-blah. Not even worth my time to read...

In step-6, Senator Clinton wants to constrain prescription drug expenses. It would be nice if this section included some sort of patent system reform, but unfortunately, it doesn't. It does, however, hint at some possible patent reform in attempting to remove barriers to generic competition by removing loopholes exploited by prescription drug companies to prevent generic competition. Since prescription drug companies typically abuse the patent system to keep out competition, I'm going to assume Senator Clinton wants to fix that but just doesn't want to say that's how she's fixing it. Sneaky...

The rest of this section is just marketing b.s. with the exception of letting Medicare negotiate prices. This must only be an issue due to campaign contributions, bribes, lobbying, and who knows what other underhanded dealings between politicians and the drug industrty. Medicare constrains costs on everything except prescription drugs. It's high time the government constrain prescription drug costs.

And last but not least, Senator Clinton wants to put in place malpractice reform. Of course, she doesn't want to admit Republicans were right about this in the previous election, but I'm sure she's studied health care enough to know malpractice insurance is a major burden for Doctors. Reforming the system would be a good thing for Doctors, but I'm not sure her "National Medical Error Disclosure and Compensation Act" will work. Regardless, I'll give her the benefit of the doubt and call it an okay idea.

That about sums it up. It's not great, but it's not terrible either. It's a far cry from the kind of socialized health care system a lot of us expected, and it does solve a couple of very basic problems in the system as it exists now. Compared to Edwards' plan, I think it's a loser, but picking between Clinton's and maintaining the status quo, I'll choose Senator Clinton's plan.

Now, as to the rest of the candidates save Ron Paul (who I'm sure would want to eliminate federal involvement in health care), let's hear some real proposals instead of campaign speak. Clinton and Edwards have given us details so put up or shut up.

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