Thoughts on ‘Reform’

February 1, 2010
Bob Keaveney

Read editorial director Bob Keaveney’s thoughts on the recent upheaval in the U.S. Senate, and the now cloudy future of healthcare reform.


The election of a Republican to the Senate on Jan. 19, a health “reform” bill that had been considered a fait accompli was suddenly cloudy. At this writing, Jan. 20, it wasn’t clear what would happen. I’m as much a proponent of real reform as anyone, but if the Massachusetts shocker leads to the collapse of what the Senate passed in December, that would be a good thing, even it if means, alas, not reform at all, because the bill:

Does not reform healthcare. The point of reform is to lower costs while increasing access to care and improving outcomes. That means moving from an episode-based sick-care system to a case-management system where providers are rewarded for doing the right things (as opposed to just doing everything) and patients are discouraged from demanding unnecessary tests and procedures.

The current employer- and government-based coverage system obscures the true costs by spreading them around. President Obama’s early decision to preserve this system - because changing it, he said, would be “too disruptive” - torpedoed any hope of meaningful reform.

Does not reform the insurance industry. Around midyear the administration realized, if the press hadn’t, that it was not attempting meaningful healthcare reform. So it began referring instead to “health insurance reform,” because insurers would be forbidden from denying or rescinding coverage based on a person’s health status. Such actions have long been illegal in the group-insurance market, which is where most Americans get their coverage. In exchange, the industry will get millions of new customers - most of them young, healthy, and profitable - conscripted into purchasing their overpriced, junky products. This is insurance reform?

Does not include tort reform. The trial bar is, essentially, the Democratic Party’s employer, so tort reform was never likely. Still, one purpose of the bill is to reduce the cost of healthcare in the long run. What better way to cut costs without cutting healthcare quality than by reducing the fear of lawsuits that so often leads to the ordering of unnecessary tests and procedures? Patients genuinely harmed by malpractice could be compensated fairly within a reformed tort system. Only the lawyers would take a haircut. Which is why it never stood a chance.

Is not fair to younger and lower-income people. The individual mandate, as outlined in the bill, is an outrage. Not merely because there is no “public option” (real reform would not have required one), but because there is no meaningful insurance reform. It is wrong to make people buy a product that they can’t afford, and perverse to do so without at least reforming the industry producing the product. Yet the mandate is what the bill’s defenders are referring to when they proudly claim it “covers” 30 million uninsured Americans. It is the biggest, most corrupt, most shameless government giveaway to corporate interests I’ve ever seen.

Democrats are bitterly disappointed that they lost a Senate seat they thought they owned. But if its loss leads to a restart on healthcare reform, it will have saved them from their worst enemy - their legislation.

Bob Keaveney is editorial director for Physicians Practice. He can be contacted via e-mail at bob.keaveney@cmpmedica.com.

This article originally appeared in the February 2010 issue of Physicians Practice.