By Jamie Court for the Huffington Post

“Prevention” was the word of morning at the White House Western forum on health care reform in downtown LA.

Led by Oprah’s Dr. Oz, Governor Arnold Schwarzenegger and Washington State Governor Chris Gregoire, the assembled “stakeholders” rattled off how prevention pays in health care.

20% of the patients account for 80% of the costs. 75% of the costs spring from four conditions. The most expensive medicine is bad medicine It’s no doubt true, but keeping kids out of McDonalds, treating heart disease preventively, and making sure Grandma takes her medicine isn’t going to get us where we need to go in health care reform.

We need to rein in the charges of the medical-insurance complex. And that’s a subject the politicians, hospitals, insurers, doctors and health care professionals assembled today didn’t want to acknowledge.

Well, it’s true, health care reform boils down to regulation of medical charges, which is hardly popular with the medical establishment. None of the two hours set aside today in largely scripted testimony dealt with the public option to the private market or mandatory health insurance and how to make it affordable.

The kumbaya spirit was encouraging, but the reality is standardization of medical insurance charges and costs is going to determine whether there is enough money in the health care system to cover everyone. The Obama Administration largely listened today, but Schwarzeneggeer was selling three essentials in health care reform: 1) getting all the stakeholders together 2) mandatory health care 3) prevention. Only #3, prevention, will have a positive impact on reform. To please the stakeholders with consensus risks letting their out of control costs remain out of control. Making health insurance mandatory on its own won’t bring costs down, and Americans are losing coverage today because they cannot afford it. Schwarzenegger refused to regulate premiums in his failed 2007-2008 effort and Capitol Hill is not likely to do better.

The California Nurses Association brought nearly one thousand nurses and activists to a rally on the street outside the forum. Their calls for a Medicare For All system weren’t heard in the auditorium, but guests couldn’t miss the message as we entered the auditorium. The testimonials from patients inside were heart breaking, but none of the answers from so-called stakeholders inside were compelling. None of the solutions dealt with how patients who lost coverage would be able to afford it again under an overhaul where the only cost savings come from medical prevention.

At some point the White House is going to need to get tough on health care and insurance charges, in addition to trying to pay for performance through “comparative effectiveness,” which Obama has promoted. A truly public option like Medicare offers the best hope to drive down costs and force the insurers to compete. Recently, Senate health reform architect Senator Max Baucus seemed to suggest the public option was not really needed. In the absence of health care cost standardization and regulation, a genuine public option may be national health care reform’s main saving grace. Let’s just hope Obama isn’t in as much as denial about the need for cost regulation as the assembled potentates today.

3 Comments

  1. Terry Brauer on April 8, 2009 at 6:06 pm

    Paradigm shift time! New prism needed for Jamie and other journalists. If they continue to believe that what they witness is actually what they are witnessing, they have forfeited the license to understand.

    The ECONOMIC stakeholders are simply economic stakeholders. They are not fighters for healthcare purchasers and healthcare consumers. If what journalists expect is for those with serious, indeed awesome, financial interests in the outcome of ‘reform’ …. to act in the broader public interest, then Bernard Madoff should be released from prison and appointed to the Federal Reserve Board … and Andy Fastow should be pardoned and appointed to the SEC.

    Economic stakeholders today … or any other day … didn’t announce that they are willing to take less. They didn’t suggest that single-payer … or the public insurance option … was the road to true cost containment. There were a hundred or more other ‘cost containment’ recommendations bandied about in the course of ECONOMIC stakeholders’ meetings to date. None of the recommendations, please note, gored the oxen of those making them.

    The only White House spokesman to tout COST CONTROL recently was Peter Orszag. Peter is looking to save $700 Billion by reducing unnecessary medical procedures … a tough sell to most surgeons, radiologists, pathologists, oncologists, cardiologists, dermatologists, etc. etc. etc.

    Bulletin for Journalists: The people in the room are playing in the game. That’s why they are in the room. Those who should morally and logically be evicted from the room for past and current, gross, egregious business practices, inflicting pain and suffering, and massive fraud … have effectively thrown down the gauntlet and placed America’s healthcare crises on the backs of patients, lifestyle habits, and plaintiffs’ attorneys — none of whom are in the room.

    HEALTHCARE CRISES ARE ALWAYS THE FAULT OF PEOPLE AND ABSTRACTIONS NOT IN THE ROOM! The folks in the room (it doesn’t matter if the room is in L.A., The White House, or Charlotte) are the nation’s saviours.

    To date, the White House and Congress have filled the various rooms with economic stakeholders. The beneficiaries, payers, and most adversely affected victims of ‘reform’ remain primarily observers.

    Got it? Get it? Good!



  2. ACarroll on April 8, 2009 at 6:34 pm

    It’s not called LA-LA LAND for nothing…



  3. Stephen Schimpff, MD on April 9, 2009 at 2:42 pm

    Illnesses have changed from what we called acute problems to today’s complex chronic diseases that tend to last a lifetime such as diabetes and heart failure. These have become common because the population is aging [old parts wear out] and because of our adverse health behaviors such as smoking, obesity, poor nutrition and lack of exercise. So we truly do need prevention. But we also need efforts – now – to bring down the costs of care for these diseases which consume over 70% of health care expenditures. One of the biggest problems is that care of these chronic diseases is not coordinated well among the myriad doctors and others involved. The result is excess physician visits, tests, X-rays, procedures and hospitalizations. Good care coordination would bring down the costs substantially and deliver much better quality and much safer care. Those leading reform efforts need to take this into account.