Last week a Health Care Forum was held at the United Methodist Church of the Resurrection, a very large congregation located near our offices in Leawood, Kan.  In contrast to some recent forums on health care reform, the audience listened respectfully as each of the seven panelists explained their particular point of view. http://www.cor.org/seasonal-special/health-care-forum/

The Rev. Adam Hamilton, pastor of the church, framed the issues from a moral point of view as one would expect.  His point is that 47 million Americans do not have health insurance, and therefore, don’t have access to adequate care. We applaud the civil discourse that dignified this event in contrast to some of the shouting matches that have been held in the name of health care reform, but the real moral issue is not about access.

Ultimately, anyone in America can get necessary care, but too many times that care is delivered in an expensive hospital emergency room and the costs of that care are shifted to all the other people in the country who are covered by insurance. The moral issue is about access to education that enables individuals to make decisions about their health and consequently their own health care.  The problem isn’t lack of access; it is over-utilization of health services by people who are living unhealthy lifestyles.

If we could have a few forums that focus on personal health decisions such as proper nutrition to avoid obesity and diabetes, stress reduction, minimizing environmental pollution, for example, we’d be taking steps toward real morality in our health care system.

Currently, health care consumers don’t have incentives to make proper health care decisions.  Most people get their care through an employer-sponsored health insurance plan. Quite likely, that plan provides a list of providers from which they can choose; but they get no incentives to lead healthy lives.

From what we can see churning through Congress under the rubric of health care reform, the consumer won’t be any more enlightened if any of these proposals actually become law. The government will probably make matters worse by expanding the rolls of the insured by several million without making the public accountable for their own health. We would, in fact, be removing them from all responsibility. And that doesn’t seem moral to us.

The public needs education. People need to know that the every-day decisions they make – consuming junk food, drinking to excess, taking illegal drugs, misusing firearms – all lead to a health care system that is overused. Our company partners with about 2,000 physicians. Most of them routinely provide care to uninsured patients. However, this is care that is delivered in hospital emergency rooms, the most expensive health care venue you can find.

Yes, let’s expand coverage to the uninsured, but not without getting something in return. The free enterprise system rewards those who can identify the wants and needs of their customers and then provide a product or service that meets those needs. We can’t have the government provide a “one-size-fits all” health care plan that will reward bad behavior. Consumers owe something in the bargain and that is a good-faith effort to be healthier. Give them credit for healthy decisions, but don’t make the rest of us pay for their bad ones.

We cannot emphasize enough that President Obama’s aspirations to deliver affordable and universal health care are contingent upon genuine free enterprise rather than more government intervention.

Over and over again we see how true market forces improve the quality of products and services, while bringing prices down for consumers. Here are just a few examples of how that basic concept has played out in other industries:

• The cost of food as a proportion of one’s income is merely a fraction of what it once was.
• Cell phones have advanced from expensive bulky objects to the sleek innovative computers owned by virtually everyone
• Automobiles were once only for the very rich. Today, there are models and price ranges suitable for nearly every American.

One way to let the market perform in health care is to equalize the tax treatment of individuals and businesses. Regina Herzlinger of the Harvard Business School points out that U.S. tax policy for health insurance is fundamentally irrational, regressive and ultimately destructive.

“Current tax policy generally permits employers, but not individuals, to use pre-tax income for buying health insurance,” Herzlinger writes in the National Review.  “Therefore, it is much cheaper to buy insurance through an employer than in the individual market.”

The employer-provided insurance is not portable; workers can’t take it with them when they change jobs. Consequently, people hesitate to leave jobs at big firms to work for small companies that might not provide insurance. “This phenomenon, known as ‘job lock,’ robs small firms of talent and slows U.S. job growth, because small entrepreneurial firms have generated 70 percent of new jobs.”

We agree with Herzlinger that Congress should simply extend the present tax exclusion to all employees and allow them to purchase their own insurance.

In addition:

• Consumers should be permitted to shop across state lines for insurance.
• Encourage the use of health savings accounts, so the consumer is in control.
• Remove obstacles that prevent entrepreneurs from setting up new clinics and surgery centers.

True market reforms will do for health care what they have done for other industries.  Rather than taking a trillion-dollar gamble on everything at once, Congress should fix what’s broken. By starting with the tax-treatment of health insurance, Congress can ultimately achieve true health-care reform, Herzlinger writes. We agree.

That cacophony that you hear rattling throughout the nation this August is the sound of health care reform being debated on the home front.  The noise has become so distracting that it’s hard to imagine that Republicans and Democrats in Congress can agree on anything. Neither the House of Representatives nor the Senate have voted on a bill yet, but various proposals have been cobbled together in the House for a vote in September. But the Senate Finance Committee holds the trump cards in the process, and whatever bill emerges will have that powerful committee’s imprint.

Can the various factions agree on anything? The answer is yes. So if legislation does emerge from this summer’s meat grinder here are three points we can expect to see included:

• There is broad support between Democrats and Republicans for changing the way that physicians are paid, based on the quality of particular patients’ outcomes rather than fee-for-service.

• Likewise, members of both parties want to prevent the denial of insurance coverage to people with pre-existing conditions. Health insurers are also agreeable to this provision as long as everyone, healthy and sick, are included in the risk pool.

• Both sides also agree that a centralized on-line marketing site be developed where consumers can shop and compare the various plans available to them.

The primary point of contention between conservatives and liberals is whether to create a government sponsored public plan to compete against the plans offered by private insurers. President Obama maintains that such an entity will act to keep private insurers honest. The Democratic-backed public option would basically be a huge bureaucracy replicating Medicare, where the government sets the premiums and services. The Republicans hold that a public option will give the government too much control and would be an unfair competitive edge.

We believe that political realities are such that the public option won’t clear Congress, despite Democrat control of both chambers.

Of course another huge flash point is how to pay for it all. The Congressional Budget Office has estimated the cost of Obama’s plan will exceed $1 trillion over 10 years. Democrats would tax the wealthy to cover the costs. Yet the bar to affluence is set a lot lower today than in years past.

Finally, the parties are split over the issue of the employer mandate, that is, will employers be required to provide health care coverage to their employees? Democrats would impose an 8 percent payroll tax toward employees to buy it themselves if the employer doesn’t.

If the House and the Senate can eventually agree on a bill we think it will require heavy regulation of insurance companies and in place of a public option we’ll see regional cooperatives to offer acceptable public programs to compete with private plans.

With Congress in recess throughout August, there’s a lot of speculation and misinformation out there. That’s not surprising because lawmakers are attempting to remake one sixth of the American economy. It’s the most complicated piece of legislation ever undertaken and it will affect everybody. Keep checking back as we keep you apprised of the status of the debate.

Nueterra Healthcare has always been committed to encouraging innovation in health care. For more than a decade we have partnered with physicians, hospitals and health systems to expand choices for patients and opportunities for investors. By relying on market forces, Nueterra has created a model that improves quality and keeps costs in line.

Yet today, Congress is in the process of saddling our country with a government-controlled health care “plan” that will completely distort America’s free-market values. While this is still in a fluid state, we can safely expect that the Democratic-controlled Congress will try to pass some sort of bill that creates an entirely new bureaucracy.

In the legislation being proposed in the House of Representatives there are many rules that dictate the value of a physician’s time and how much physicians will be paid. All doctors would be paid the same, with the government setting value and controlling productivity. How will that not breed mediocrity?

Many clauses of the bill would prohibit hospital ownership and investment by physicians and others, thus restricting economic growth. Why would we restrict growth in any economic endeavor? How can new models come into being?

This country was built on innovation by people who were free to pursue new ideas at their own risk. If the government had restricted the computer industry to mainframes, we would never have the personal computers that have changed all our lives. If the government had restricted the telecommunications industry we would still be using operators and cell phones would be merely a dream. If the government had restricted the publishing industry, we would never have seen the copy machine.

But now the government wants to prohibit the growth of hospitals. What’s more, language throughout the bill allows for more government bureaucracy that will regulate treatments and who gets them, thus inhibiting innovation. The thought of stifling innovation and private investment in health care is difficult to imagine.

We still have the right to contact our Congressmen and Senators. Please do so immediately and express your opinion.  Visit our Public Affairs page for more information.

Welcome to the Nueterra Healthcare blog.  Each week I plan to give Nueterra’s perspective on health care-related issues that are important to patients, providers and our partners.  So I hope that you will come back to this space again and again as the national discussion develops.

Obviously, health care reform is the most important issue facing Nueterra and all health care providers in the country. And judging from President Barack Obama’s recent press conference and the subsequent wrangling in Congress, I couldn’t be more disappointed in the direction the debate is heading.

I see another “non-stimulating stimulus” on the horizon. Just as the president’s economic stimulus plan has yet to produce significant benefits, I am afraid health care reform will result in far less improvement and benefit than is being projected. I believe that the president’s health care reform proposal and other policies his administration is promoting, will have actually hurt our economy by increasing taxes and business mandates while reducing incentives for entrepreneurs and small businesses to create jobs.

The health care incentives are perverse. Why in the world would we want to provide government-sponsored insurance with benefits equal to those provided by the private sector to its employees? Good health benefits should be an incentive for finding and keeping a good job, a reward for honest work.

If we go down this path we are going to take the best health care system in the world and transform it into one with little moral compass and slight regard for fellow human beings.

The president speaks of a health care system that is broken, with spiraling costs that will break the backs of small businesses across the nation. Yet, not once has he mentioned one of the fastest growing expenses – frivolous lawsuits against doctors, which require them to practice “defensive medicine.”  Let’s fix what’s obviously broken first. The increasing cost of medical malpractice insurance dwarfs the growth in pure health care costs. Yet the president and his supporters have fought tort reform every inch of the way.

All of our institutions and organizations, from small family businesses to large corporations, our schools, churches and not-for-profit organizations, provide a structure for the individual achievements of participants. Ultimately, individuals are responsible for their own growth and well being.  The government can’t solve our problems; we have to solve them ourselves.

In fact, private interests have the ability and incentives to solve our health care financing problems, if the government would just get out of the way and let us do it.  We do need reform. But if we are to achieve the goal of universal coverage, we need to let the people and market forces drive it.

Let’s put the decision-making power into the hands of consumers, not take it away as the Obama proposal would do.

Next week: Let Innovators Innovate