Humana has added another “educational” to its YouTube series – this one is about “why do we need health reform.”
It’s a good question, and since I’ve been somewhat critical of other Human videos, I feel obligated to say that this one is OK – mostly because it doesn’t contain too much substance, i.e. it’s a mile wide and an inch deep. And I do want to give the writers credit because the video starts by answering the question about what is health reform and why do we need it by stating, “The simple answer is…. Well there is no simple answer.”
But beyond that insight, they gloss over many of the important facets of the problems and possible solutions. For example, in talking about the uninsured, they state that those without insurance have two options: Pay cash or go without care. That is the simple answer, but the reality is that there are many sources of free care (including free medicines) for low income people without insurance. And many of the people without insurance are eligible for free or low cost insurance that they may not be aware of. So in reality, the choices for the uninsured go beyond Humana’s perspective of pay cash or go without care.
US Life Expectancy and Spending
Second, the video notes that the US spends more per person that other countries, but don’t live longer – and they illustrate that point with a figure of a man using a walker. While life expectancy at birth makes the US look much worse than other countries, the data for life expectancy at age 65 is very different. (See chart from Commonwealth Fund below.)
This difference is because, in part, the US has much higher mortality at younger ages due to accidents and violence – including suicides. Also, as the Humana video does depict, our diet and other lifestyle factors lead to poorer health. So it might be that while we are living as long as other countries, we use more intensive healthcare services to treat/manage our greater burden of chronic illnesses brought about by obesity and lack of exercise, etc.
One reform option that Humana mentions is ensuring that people with pre-existing conditions can get insurance coverage. The insurance industry has rallied around that change – as long as it is coupled with changes that ensure everyone has insurance so that people don’t wait until they get sick before buying insurance. This makes sense both for the insurance industry and the country as a whole.
What Insurance Does
The Humana video also presents the concept that insurance is a mechanism for spreading out the costs from a few ill people over a much larger healthy population. This “social insurance” model is what Medicare is based upon and is really the model for most insurance. Another theory of insurance – and one that some insurance products follow – is that insurance is a way to prepay for expected future costs. Some consumer directed health plans with health savings accounts combine these two theories of insurance into one type of policy, i.e. the high deductible insurance policy spreads high costs across a larger group, while the savings accounts enable individuals to put money away for expected future needs.
Competition with a Public Plan
The Humana video glosses over perhaps the biggest reform issue in today’s debate: Creating a public plan to compete with private insurance. The video describes the public plan as “like the one government employees have today.” While the Federal Employees Health Benefit Plan is cited as some as a “government plan,” it is really a lot more like an employer plan, since it provides Federal employees with multiple private insurance plan options. I don’t think this is what most people consider to be a government plan. Rather they are thinking more of something like Medicare or Medicaid, where the government sets the coverage and reimbursement rules and contracts with private organizations to pay physicians, hospitals, etc. for actual healthcare services. And of course the VA is another model for a government health plan, where the government actually owns and runs the hospitals, and the clinicians and staff are government employees, etc. While exactly what the political and policy leaders in Washington are thinking about for a public plan option remains to be seen – there are certainly many options for what this label could become.
The Humana video’s final section is about how to reduce costs. Here they present several current hot-topic options like technology and electronic medical records, giving people more information to compare prices and performance “like they do for everything from new cars to groceries so they might use their money more efficiently,” paying physicians for performance rather than volume, and helping people eat right, exercise more and take better care of themselves. All these are reasonable ideas, but will require considerable investments up from to achieve costs savings in later years.
The Humana video on health reform presents a number of superficial observations about the problems in the US healthcare system and some of the global options for change, but doesn’t delve into how to actually make any changes, and more importantly, the trade-offs that many of these changes would require. So while it might make some people feel they understand the issues better, it really won’t move the debate forward to improve the US healthcare system.
The video also notes that no clear consensus has emerged about what options to pursue, and it suggests that “if you have an idea, call your Member of Congress.” My experience having worked for a Member of Congress makes me wonder if that will really help move the debate forward. It also reminded me of the idea submitted to a newspaper by a reader to answer the question, “How Would You Fix the Economy?”
Pay the 40 million people over 50 in the work force $1 million each in severance with three stipulations:
- They leave their jobs. Forty million job openings – Unemployment fixed.
- They buy NEW American cars. Forty million cars ordered – Auto Industry fixed.
- They either buy a house or pay off their mortgage – Housing Crisis fixed.
All National financial problems fixed!!!
Sounds good, except it would cost $40 Trillion, the Federal budget is about $3 Trillion, and the US GDP is a bit more than $14 Trillion. So I’m not sure the numbers for this “idea” really add up. But it sounds good as long as you don’t care about the facts – which is probably why the newspaper printed it.