Richard Hermann: Health care reform itself not very healthy

Richard Hermann

I had three contacts with the health care reform roll-out (aka "Obamacare") this month that I want to share because they are insightful concerning how far we still have to go to devise a rational health care system:

First, I had my annual physical and watched in fascination as my doctor — a Larry David look-alike — sat in front of a computer terminal for half-an-hour coding in hundreds of information bits about me. Meanwhile, he complained to me that, prompted by health insurers, his practice had engaged a health care computer firm to digitize patient records around the time that health care reform was enacted. The necessary hardware, software, training and transition cost $70,000.

Once the U.S. Department of Health and Human Services (HHS) became involved in implementing the electronic records provisions of the law, his practice had to scrap the new system and purchase another one that cost in the low six figures. However, he said that the new system is so complex that only the doctors in the practice can do the coding.

Finally, the technological demands of digitizing have reduced the number of patients he is able to see in a day from 24 to 16. One could say that health care reform has curbed his enthusiasm.

Watching him geeking, I wondered how a primary care physician could possibly assess his patient’s affect and overall health if he no longer is able to look at him or her while fixated on a computer screen. I could see that one of the few Affordable Care Act provisions that addressed healthcare costs isn’t working.

Second, one of the central criticisms of the Affordable Care Act is that it does not permit Americans to purchase health insurance across state lines, which would, according to the critics, increase competition and lower costs. My knowledgeable and experienced insurance agent (and good friend, who occupies a position on the ideological spectrum to the right of Ethelred the Unready) explained to me why this could never work.

Every state posits different coverage requirements for health plans that can vary dramatically from state to state. If a Texas insurance company, for example, sells a New York resident health insurance, it is likely the company would not meet the standard policy coverage requirements mandated by the New York State Insurance Department. As long as we retain a system of 51 state regulators, we will not be able to overcome this problem.

In fact, even if permitted by law, insurance companies probably would not sell policies to out-of-state residents because of the regulatory quagmire into which they would fall. To make this work, a single national regulator would be required, a reform abhorrent to the very same critics.

Third, I listened to an hourlong interview with HHS Secretary Kathleen Sebelius about the first full year of health care reform. Callers posed questions to her about their families’ health care circumstances. In all but one case, she responded that the Affordable Care Act did not address their issues. Although she did not appear as knowledgeable about the Act and its nuances as one would hope the chief implementer would be, this might be understandable, given the monumental complexity of the 2,000-plus page law.

Unfortunately, President Obama left the drafting of the law up to the Senate and House Democratic leadership rather than putting forth his own ideas and leading on this issue.

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