Tuesday, March 23, 2010

Health Care Changes, Here to Stay?

Obama has done it. He has signed national healthcare reform into action, now he can claim to have done something big and significant as part of his presidency. I was concerned that I wouldn't like the reform at all. My family is spoiled in that we have a great insurance plan and I don't want it tampered with in any way. I realize that I am in the minority of Americans in this regard. Much of the reform will actually be helpful to my job. Especially the part that won't let insurance companies deny coverage for a pre-existing condition in children. I am very disappointed that there isn't more reform in regards to mental health care which is in a perfectly deplorable state in this country. Having navigated the ins and outs of mental health coverage, or lack thereof, with a friend of mine trying to get services for her mentally ill husband, I know more about the need for reform in this area because I have seen the paucity of it first hand.

I must say that I am not overly thrilled with the notion of people being penalized for not having health insurance and I am wondering if health care providers will be required to provide services for those on less than premium plans. As far as I can tell, this new bill makes no provision for what health care providers are required to provide and not provide. Whether we like it or not, health care is a for profit industry and if the government plan does not provide good monetary returns, there are undoubtedly many health care providers who will be unwilling to provide for those with such coverage. Molina and DSHS are good examples of that now. As far as I know, the private rehabilitation clinic that I work in is the only one in this vicinity to provide care for Molina patients. Even at that, we don't take on too many. At a 33% reimbursement for services, most private companies can't afford to.

The other concern that I have is the cut back in medicare payments to hospitals, home health agencies, and skilled nursing facilities. In skilled nursing facilities especially, it is quite challenging to find quality help that stays employed with the facility for any length of time. Reducing medicare payments to hospitals may result in more "drive through" care for the elderly. While it is true that we need to reduce costs and spending, it is also true that the elderly get sick more than the rest of the population and often require the most in terms of health care. Any cut backs in this area concern me because the aged and infirm are some of the most vulnerable of our population.

Although this may be a good start, in some ways, for a full-system overhaul, it still leaves many loop holes and, I think, opportunities for health care providers to mismanage and short change care in an effort to make the bottom line. Some of my biggest complaints with our current system are that health insurance companies are often in charge of medical decisions and these decisions are made only in terms of cost, the job of insurance companies at present seems to be avoiding payment for services, CEO's and managers in the insurance system are, in my opinion, overpaid when compared to those providing direct health care, COBRA payments following loss of employment are astronomically ridiculous, and too many middle class workers cannot afford or qualify to receive benefits. Additionally, with the new healthcare legislation, I see the Cadillac taxation policy on higher end insurance plans having a negative effect on union employees who desperately need good plans. There is also the potential issue of employers providing better and better benefits in lieu of salary increases.

Representatives across the country are already revved up to fight the new legislation based on constitutional concerns. If one part of the new legislation were to change or be removed, the entire plan will topple so it is kind of a house of cards at the moment. Meanwhile I will be waiting to see if this landmark legislation does anything to improve the morals of the insurance industry, if that happens, I won't be disappointed.

1 comment:

Kristine said...

We're following these news here in Norway too. Not only us US-connected people, but Norwegian news-broadcasters, newspapers etc. I really hope this baby step can lead to something good.
Seen from here, it has alway been difficult to understand why a western country don't have normal healthcare for everybody... For us that is very "dark ages". But, on the same time, I totally see the fear of many Americans, the fear of not being able to choose. That's a huge question here in Norway, actually. Traditionally, you're forced to deal with one hospital, but now we have got "free hospital choice", which I think is great.