The health care reform law is more than a year old now. What do you see happening next with reform?
“The price of health care is two or three times the general inflation rate, and as a population, we can’t keep going that way. Both political parties say it’s unsustainable — everybody agrees on that, just not on what to do with it. The political system is so gridlocked that I just don’t see us able to deal with this in any effective way. … It’s possible someday that the gridlock will be so intense and the public so disgusted that from out of this whole thing we’ll get turned over to a commission that will make the tough decisions, but I honestly don’t see that happening. I think what’s going to happen is that we face bankruptcy and, at some point, kind of throw up our hands for what to make of the crisis. And the public will say ‘do something,’ and we’ll probably expand Medicare to cover everybody.”
What role do insurance companies play in reform?
“I used to think of insurance companies as totally evil. Now I realize that they’re sort of the middlemen caught in the middle. And we’ll probably have to get rid of them someday for cost reasons because they consume money that doesn’t go to health. Which is why a government single-payer is going to be less costly. The overhead for Medicare is about 1.3 percent, and the overhead for private insurance is about 11.7 percent. That costs a lot of money. Inevitably, I think we’re going to have to get rid of insurance companies, but I have some sympathy for them.”
What are the keys to health care reform?
“There are four things you have to have in place to get true reform. We have to change the system from fee-for-service where we simply pay for doing whether or not it’s needed to payments that are based on outcomes and results. We have to have a national information technology system so your medical records can be with you and go with you anywhere you go. Once that computer system is in place, we need to have comparative data that we as providers can literally look up what really works, what’s best in any given situation. And all of that will work only with the fourth thing, which is to have good primary care available to everybody, meaning a place where you can go to or at least call 24 hours a day, seven days a week when you think you’ve got a problem and they can advise you.”
Does the health care reform law begin to tackle those four things?
“It does, because part of the law on the Medicare side provides for these innovation reform centers, and they’re now under way. I would have preferred Medicare for all right now to get everything in one place, but politically I know that’s not possible. So no, I don’t think it’s a perfect law by any means. What they’re doing, the heart of the Obama proposal, is the exchanges, the state exchanges, which is really modeled on the current federal employees benefits plan, sometimes called the congressional plan. Federal employees every year, including members of Congress, get a list of insurance companies in their area where they live that have been vetted by the government in many ways so they can sit down and choose from this list. The lists are all done in the same way so you’re comparing apples to apples. The plans have feedback from other people who have used them, so you can pick a plan that seems right for you or your family and know exactly what you’re getting and what you’re not getting. And if you don’t like it at the end of the year, you can drop it and choose another plan.”
What are your thoughts about the employer health insurance mandate that kicks in by 2014?
“I have sympathy for small-business owners who are worrying how they’re going to pay for it. But I also believe in mandates — that is somehow making sure that everybody gets covered and that’s one way to accomplish it in one segment of the population. There are two reasons why we need mandates. One is, the whole theory of insurance is the more people you have in the insurance pool, the cheaper it is for everybody. We have all these young people who don’t buy insurance because they don’t think they need it. But when they get sick, of course, they expect to be taken care of. It’s not fair. So mandates create a sound insurance policy and make things fair.”