Reform or Refinance

Which Are We Getting

by Dr. Bob Braile

Rarely a newscast goes by, or a newspaper printed, that does not carry a story on the health care reforms being proposed by the President, the Republicans, or individual states. Certainly the hottest topic of the day for the next few months will continue to be health care reform. Panels of so-called experts have already started appearing on many news talk shows to bandy about the Clinton plan or the Republican response. There is even a series of television commercials airing designed to scare the general public about these changes.

But, the one noticeable thing about all of this hoopla is that very little talk of actual health care reform is going on. Most of the talk is about refinancing. The basis of all the plans being offered today is how to rearrange the payment for care, so that it costs less. Forming purchasing alliances, HMO's, and other managed care groups doesn't change the way health care itself is delivered to the individual patient. These systems just change the way the doctor gets paid for rendering the care.

If we are truly interested in reforming health care, we must examine health care itself. One of the problems that has been identified in our present system is that it is profit motivated. I've seen experts on talk shows say that the doctor's desire to make a profit drives him or her to perform extra tests and procedures in order to increase fees. Some of these experts go on to say that a socialized or managed system would cure this problem by limiting what procedures the doctor can get paid for. Unfortunately, if you could take the profit out of health care, it would only serve to force a lot of good people out of the field. The Soviet Union fell apart because their whole society had no profit motive or reason to produce.

In order for us to reform our health care delivery system, while retaining the profit motive for the doctors, we must restructure the system of incentives. At present, the system of incentives is based on sickness. This means that doctors and the entire medical industry make money on sick patients. The more sick patients, the more money to be made. The sicker the patients, the more money to be made. Now, I'm not suggesting that doctors or medical corporations conspire to keep people sick, but something is wrong with the incentives when the profits of hospitals are based on their ratio of occupied beds. In reality, would it not be better if the occupancy rate was very low meaning that no one was sick enough to require a hospital stay?

Changing our incentives in health care is the only reform that will ultimately help the patient, our budgets, and keep the doctors happy. We must reward doctors and patients for wellness, instead of paying all the big bucks for sickness. A whole new direction would emerge in health care if it became more profitable to keep people healthy than to treat them when they're sick. The entire health care industry would adapt from sickness care to prevention and wellness care if that's where the money was. This concept is not untested. Today we see the remnants of the entire defense industry changing from production of war goods to consumer goods.

The question ultimately comes down to this, do we really want reform? Are we willing to change the incentives of our health care system? Do we want a consumer that demands health, and is willing to pay for it, or the current system of patients demanding that someone else pay for their sickness treatment? These changes will not come easy because they require a change in the way doctors, patients, insurance companies and the government view health care. But, if we can make these changes, we can produce a health care system that is geared toward keeping people healthy, instead of paying huge amounts for treatments when they're sick. If we want to improve the quality of our lives we must insist, we want Reform, not just Refinance.