What would a good-faith bipartisan conversation on health reform look like? Here’s a start.
Genuine conversation between Americans with different political views has become a rare commodity these days. In this piece, we sought to buck that trend by asking two Americans with different political philosophies who work within the U.S. health care industry to discuss their views on the current health reform debate.
Karissa Loper is the deputy bureau chief for the Nevada Department of Health and Human Services, and identifies as an independent, with liberal leanings. Brenda Massey is an account executive for Hibbs-Hallmark & Company, an insurance agency in Texas. Massey identifies as an independent, with conservative leanings.
The following exchange conducted via email has been edited for length and clarity.
Q: Do you think either the Affordable Care Act (ACA) or the American Health Care Act (AHCA) get to the core problems with the U.S. health care system? What, if anything, does each bill fail to address in improving our system?
Massey: I think each health plan addresses some of the core problems of our health care system, such as greater access for people with preexisting conditions, but ultimately neither one fully addresses the main problem: the cost of health care. The AHCA attempts to address the cost of insurance by bringing the insurance marketplace back to a free market. However, that doesn’t address the actual prices being charged by health care providers. Health pricing is currently not transparent and the price for the same procedure can vary widely between providers and between insurance contracts.
Loper: I agree with Brenda's point on the core issue being the cost of receiving health care, and would also go further to say the ACA made an effort to get the industry to focus on prevention, as opposed to a treatment-centered and reactive form of care. The U.S. health care system has traditionally focused on treatment, which is understandable from the physician or caregiver perspective. From a public health and government perspective, we want to ensure the foundation for good health for all Americans — we want to prevent as much disease, injury, and disability as we can. This is a case of big upfront costs for long-term results, and Congress is often reluctant to make those decisions.
I don't think either bill addresses a core question I have: Do Americans have a right to receive medical care regardless of their financial ability to pay? If the answer is yes, then we need to do more to ensure people can access basic services without any form of insurance — and that out of pocket costs are truly reasonable.
Loper: I consider myself politically independent with Democratic Party leanings, but I get very tired of the rhetoric regarding “liberalism,” and how those with liberal leanings must all be lazy and looking for a handout. I have had very little simply handed to me in my life, but I was born with certain opportunities and connections because of the work my family has put in, plus my own intelligence and determination. I recognize, probably because of my small-town Texas upbringing, others did not receive the same opportunities despite the fact they are my same age and from the same town
Therefore, I think our taxes should be used to help those unable to help themselves, and to let people start from the same place of opportunity. I think the clear majority of people want to work and are looking for work, or are actively working in low-skilled jobs, but we are telling them — with this message of health care as a privilege — that your health care is not worth society’s investment or expense, because you don’t have a “valuable” job, since it does not provide you with health insurance or the ability to pay for health insurance on your own. And I will not even address the seeming endless discretion insurers are given to decide what counts as a preexisting condition.
I think if we just decided all Americans are entitled to receive health care services, if we really made that ideological decision between the two parties, then we could focus on the work needed to make that vision a reality. We could probably even do it with much of the existing infrastructure and insurance networks, and be successful. Now that would be American exceptionalism!
But no matter what the Yahoo commenters say about other Western health care systems, ours still costs the most and delivers subpar outcomes in many measures.
Massey: Karissa, I admire your passion to help people. I hold all of the same ideals that everyone should have access to help and opportunity. I am a conservative independent with Republican leanings, but the Republican Party is no longer “my” Republican Party. I see our elected officials in Washington drawing lines in the sand, and they seem to be focused on their own reputations, rather than being invested in actually solving problems.
In this case, the problem is equal access to health care. The question of whether health care is a privilege or a right is the crux of the entire matter. That a 30-second blurb from Miss America or Jimmy Kimmel or anyone else can cause such controversy and discussion speaks volumes.
The solution ultimately lies in a combination of personal responsibility and societal support. But, there should also be a willingness on the part of the health care providers to go back to their roots: when doctors and hospitals existed to help people, to cure people, and not to be mega-conglomerate profit centers. I realize there are still doctors who adhere to these values, but for the most part, I think doctors have become hostage to the machine of health care as a business.
Another solution would be to eliminate the artificial controls in insurance plans called “managed care.” If insurance companies would do away with PPOs and HMOs and go back to simple indemnity coverage, then every provider could set their fees based on the actual cost of care, rather than artificial fees based on the highest possible pricing a provider can get the insurer to agree to. Provider fees should be transparent, allowing the health consumer to “shop” and have more control over how they spend their dollars.
Yes, society as a whole does have a responsibility to help those who can’t help themselves. I just don’t think this can or should be accomplished entirely or even mostly through our federal government. Where we differ is this: I think this can and should be done on a local level, not by the federal government. Many communities and states already do a good job of this. They provide community health centers with fees based on income, free clinics, and county hospitals. Many hospitals offer free or low-cost services to low-income patients.
I’m just an insurance agent, not a government official, and recognize that I don’t have all the answers or insights. However, I strongly believe that when we give the government control over our health care, we give them control over our health care decisions and our lives. As an individual, I think that my local community and my state are better suited to determine what is needed to help me obtain health care.
[Image: Hillary/ Flickr]