Facts have been lacking in the 
political debate on health care

By Michael J. Pramenko

Fact’faktn: something that has actual evidence: a piece of information presented as having objective reality.

From my early days studying health reform in Washington D.C. back in 1992, to my present day practice of family medicine, I’m still surprised by the factually challenged health care debate. Many politicians rely on the complex nature of this topic to misinform and misrepresent their own views and that of their opposition. It’s easy. Opportunities abound for oversimplification and misrepresentation.

Indeed, trying to explain the intertwined aspects of health care finance and mechanisms to control costs is akin to explaining organic chemistry to the general public. However, there are some basic principles — facts — that we can all agree on:

✔ Care in the emergency room is much more expensive than at a doctor’s office.

✔ We do not turn people away from the emergency room if they can’t afford the service.

✔ Insurance companies can’t afford to cover pre-existing health conditions without an individual mandate to purchase insurance.

✔ A combination of Medicare cuts and/or increased taxes must be considered to address the costs of the program.

✔ Both presidential candidates have proposed changes that will cut Medicare over a 10 year interval by approximately $700 billion, although Romney’s plan does not start for 10 years.

✔ The United States spends much more on health care than any other country but has similar health outcomes.

Let’s examine the current health reform debate in context with some of these facts.

To begin with, Mitt Romney erroneously told millions of Americans during last Wednesday’s debate that his health care plan would cover pre-existing health conditions. His campaign had to issue a statement following the debate that this statement was incorrect. However, the damage was done. Of the 60 million viewers, how many know that his statement was incorrect?

Certainly, after years of work on his own health reform plan in Massachusetts, Romney understands why an individual mandate is needed to cover pre-existing health conditions. It’s his law in Massachusetts. Was his debate statement a deliberate attempt at misinformation?

Also, recently on “60 Minutes” Romney proudly touted how the United States currently cares for all Americans via access to the emergency room. Apparently, this was an attempt to support his new 2012 belief that all American do not need health insurance. Again, an odd statement from a former governor who explained accurately in the past why a reliance on the emergency room for care of the uninsured is a recipe for fiscal disaster. Does he not remember one of the basic lessons from Health Policy 101?

Finally, we heard a prolonged debate about the IPAB, or Independent Payment Advisory Board, in Obamacare. Indeed, this policy is widely debated and honest people on both sides of the aisle have valid points regarding the function of this new federal board. What can’t be argued is that we are over-utilizing many health care services in the United States while under-utilizing the benefits of personal responsibility and population health. 

If we turned the whole United States health care system over to the private industry tomorrow, health insurance executives and private un-elected “boards” will continue to make decisions about what kind of coverage you can purchase. Indeed, they exist today. For simplicity’s sake, let’s call these “Profit Maintenance Advisory Boards.” For short, we can call them PMABs — the private industry cousins of the IPAB. 

Both Obamacare and a future Romneycare would require the PMABs and an IPAB. Why? Both plans keep elements of private insurance and public plans and both desperately need cost control. Nevertheless, I personally don’t believe corporate and shareholder profits should stem from business decisions that limit our options in health care.

We have a few weeks left in this latest round in the ongoing health care debate. No doubt, there will be more. However, we desperately need more facts and information and less time struggling with politics and misinformation.  We can’t wait ten years for a new way forward. All Americans must accept change and not just the “future seniors currently younger than 55.”

We can build a health care system that Americans can afford. We can deliver high quality health care to all American citizens. We can do this, but we must start with facts. 

 

Michael J. Pramenko, M.D., is the executive director of Primary Care Partners. He serves on the Club 20 Health Care Reform Committee and is the immediate past president of the Colorado Medical Society.


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