Health Care Reform Treating Symptoms But Repeal Unlikely

Today the Republican-controlled House of Representatives passed a measure, widely considered symbolic, repealing the health care reform bill enacted by the previous Congress and signed into law by President Obama. There is little chance the Democratic-controlled Senate will bring the measure to the floor for debate, let alone a vote.  Beyond that, there is even less chance that President Obama would sign a repeal of his signature domestic achievement.  He would almost certainly veto such an effort if it would reach his desk.

There was much public debate regarding the bill which will not soon be forgotten.  The main focus of the proponents of the healthcare reform bill was to attempt to build public support through the demonizing of the insurance industry, mostly with a focus on pre-existing condition exclusions.  It was an interesting situation, where on one hand Democrats told of the "evils" of the insurance industry, while on the other hand pushed for the expansion of insurance to more Americans.  Secondary to expanded coverage was the idea of cost controls, though much more muted than the outspoken attacks upon commercial insurers.

The Obama Administration and Congressional Democrats continue to extole the virtues of the law.  Even yesterday, in advance of the House vote on repeal, Health and Human Services (HHS) released a report that claims up to 129 million Americans are threatened by repeal of the health care reform law's protections against denials of coverage for pre-existing conditions.  It's an interesting report, but is clearly partisan in its authors' bias and should be considered thinly veiled propaganda.

What has unfortunately been lost in all the hoopla is the really necessary change to the health care landscape in America.  (Yes, I DO mean health care, not health insurance)  Health insurance and the associated socially distasteful practices that Democrats "fixed" are merely symptoms, and the fixes leave the root issue (the underlying pre-existing condition) untreated.

The root issue in health care in the United States today is cost.  Overall cost, driven by a great many things, including increased utilization of new  and continuously improving technology (which is *shock* expensive when new and novel), increases in the diagnosis of previously not understood or rarely recognized conditions, impacts of social/cultural choices (super size my fries please...), and the embedded cost of care for those without means to pay (which is spread across the remaining payers in the system), includes to rise, and eat up more and more of the country's GDP.  It's unsustainable to continue to grow health care expense faster than the growth of GDP.

But the health care reform law did little to curb the overall growing expense.  In fact, the expansion of coverage (especially Medicaid-like coverage which is generous in comparison to most private coverage) will potentially grow health care costs, by encouraging utilization.  And the American taxpayer will foot the bill.

Insurance practices such as pre-existing condition exclusions (there are many less well known approaches) are a reaction by insurers as well as employer clients to the incredible, and unsustainable increases in overall medical expenses related to care.  It's actually a natural, business-based reaction.  It's not friendly, but it is good business.

Insurance companies make money by insuring people.  If you fix the underlying issue of cost escalation, and prices/premiums are allowed to normalize, you would likely see the insurance industry focus on efforts to further increase enrollments, covering more people, not less. In the end, addressing costs (disease) versus industry practices (symptoms) would likely be much more efficient, allowing the symptoms to improve or resolve on their own.