It’s a good time to talk about the saga of health care reform

It seems a good time to talk about the saga of health care reform and the move afoot to allegedly repeal/replace/rename/tinker with the Affordable Care Act.

Getting rid of this deceased seagull hung around the neck of the American health care system has been a priority and talking point for Republicans since 2009 but now that they control all levers of power, discovering a solution to the problems piling up from the ACA are still in the theoretical stage.

That’s partly due to the fact that many entrenched legislative potentates expected Hillary Clinton to win the election and they could continue to complain without offering much in the way of solutions.

The health-care system, after all, is an extremely complicated and challenging topic that forces individuals to confront their mortality and inevitably superimposes some sort of cost-benefit analysis on providing and paying for medical services, a practice which exists in every health-care system the world over where third parties are compensated.

I’m naturally skeptical of all large systems that attempt to provide individualized services. This is especially true with the health-care industry since I’ve discovered some of my friends who are providers refuse to acknowledge that beef jerky is the perfect food or that donut holes and Red Bull are the foundation of the morning meal.

On the practical front however, no matter how we arrived at this point, the more health care becomes centralized in administration, the less efficient it becomes in delivery.

This is apparent in the removal of health insurers nationwide from various markets where costs continue to exceed revenue as was the case of the recently absorbed Rocky Mountain Health Plans, which could no longer meet expenses, even with rapidly escalating premiums.

Despite the complexity of the Affordable Care Act, its anticipated result seems easy to ascertain — a collapse of the present system under a blitzkrieg of regulation and rulemaking that is at times at odds even with its own stated goals.

For instance, simplifying access to medical records through electronic record retention. This might seem like a good idea until one realizes the time and difficulty of placing records into an accessible system or assigning a staggering increase in diagnostic codes for medical practices. This attempt to make compensation more mechanical actually created a torturous and expensive process for providers because they have to sift through the myriad codes to unearth the most accurate match of procedure and compensation.

I suspect the goal was to push this bedraggled system to a breaking point at which time there would be little choice than to lurched toward a taxpayer supported single-payer system administered directly or indirectly by the federal government.

The beginning of this was the contortion of Medicaid, originally intended for the neediest that were unable to participate in the workforce, to a default program for otherwise healthy and non-disabled individuals. Colorado was one of the states that expanded Medicaid financial eligibility to roughly 138 percent of the poverty level to meet ACA requirements.

This resulted in a surge of covered parties far beyond estimates. As former state treasurer Mark Hillman has pointed out, there was a 196-percent increase in the number of residents of the state participating in Medicaid between 2009 and 2016 which means the number of residents in the program went from 1 in 12 in 2008 to 1 in 4 in 2016 and the department which administers Medicaid now consumes more than 26 percent of the state budget.

While the federal government wrestles with trying to unwind the Gordian knot of Obamacare, Colorado should adopt a more workable solution as a stopgap measure to prevent the unbalancing of the state budget.

The best solution to head back from the brink seems to be that which has been adopted by the state of Arkansas in the form of a program called “Arkansas Works,” which has adopted a hybrid public-private program that does not continuously expand Medicaid but instead uses federal Medicaid dollars to buy private insurance for qualifying individuals. Make no mistake, this program carries troubling exercises of state power by requiring persons over the age of 21 to enroll in some type of insurance if it is provided by their employer with the program picking up the tab for premiums and co-pays at qualifying income levels.

The program seems to be having better results than the pure Medicaid expansion used in Colorado and has a private component. We should consider trying it until a better solution is hammered out.

Rick Wagner is a Grand Junction attorney who maintains a political blog, The War on Wrong. He can be reached at .(JavaScript must be enabled to view this email address).


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Like many so-called “conservatives” Mr. Wagner does not see the problems of healthcare delivery as a humanitarian problem, but purely as an economic one;  i.e. a matter of money.  Perhaps the gentleman should re-orient his thinking, from materialism to humanism.

He states that the number of codes the physician or medical practitioner has to deal with is the fault of the government.  He should do much more research.  If he did, he might well find that doctors and other health care providers, all too frequently have to struggle with private insurers as well, and on a daily basis.  However, he (just as do many others) totally neglect that part of it.

Some of us are old enough to have gone through many types of health insurance programs. 

We went from systems where we merely submitted our insurance card, were treated, and concerned ourselves no further. 

Then we went to HMO, which was presented as the answer to “culling out” those who abused the system.  Unfortunately, those who were charged with screening, ended up being incentivized for denying patient care, thus making those HMO organizations more profitable and efficient, and quite frequently at the expense of some patients.

Today we have reached the stage where so-called “claims adjusters” are dressing in surgical garb and following physicians into pre-op and looking over the physicians shoulder and questioning his/her every move.  They are not physicians but are nevertheless prescribing.  Perhaps counting down the last “stich”.

Some of us, when we go to a physician or other medical care provider, do not want anyone else second-guessing that individual, be it the “government” or some insurance company.  Neither do we want that physician to be concerned about anything but us and what is best for us as a patient.  Not only should the patient demand that nobody “butt in” when receiving medical care, but so should those in the medical profession when they are providing that care.

If those in the medical profession have a problem with some of their fellow practitioners, they should raise their standards and make certain to either correct those individual and/or revoke their credentials to practice, and “kick them out of the profession”, not only within one state, but nationwide.  Their are far too many incidents of physicians and other medical care professionals having their credentials revoked in one state, then moving on to another State and doing the same thing all over again.

Their are always financial considerations when dealing with almost anything, even medical care and neither I nor society can afford everything. But, far too many are placing financial considerations (usually their own)as either the sole or primary concern, in making decisions which affect not only them but others.

Are you adding health care consultant to your resume now?

Mr. Bacon:
    The only thing I have on my resume, and at the very top of it, is that I (just like everyone else) is first and foremost, but a human being. Too many, are so busy being so many other things, that they forget that.  They should not.  What they should do instead is keep reminding themselves of it, and on a regular basis.
    Human civilization is about human beings, and as such, no matter what, our concerns here (and at this time) are humanitarian concerns, and what happens to other human beings.  It is when people forget that, usually in what they believe is some “noble” cause, that human beings and humanity get into trouble and is what leads to what are referred to as “crimes against humanity”. 
    Being a human being is the one thing we all have in common, no matter what we do, or what station we may have in life.  What I have presented in my post is nothing new, just something which most (for whatever reason) have chosen to ignore.

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