I am a healthcare consultant with 10 years experience working with the most dysfunctional healthcare organizations in the country, and years of experience prior to that working for those organizations. I am also someone with a lifelong chronic condition plus a recent severe back injury.

All this makes me uninsurable on the individual market and acutely aware of the major changes necessary to enable affordable, safe, quality care. So I watch healthcare reform developments carefully as I pay for my extremely expensive, limited benefit small business insurance.

Political Maneuvering

Thinking through all of the last few months’ complex political maneuvering and dizzying arrays of healthcare reform bills, proposals etc., I suddenly saw the writing on the wall for the near future of US healthcare (or is it health care-less?).

Observe:

· AMA’s surprising and nonsensical support of expanding private insurance

· Insurer’s careful responses during Congressional hearings (No, we will not limit recission—cancelling medical coverage—to only cases of intentional fraud)

· Insurer’s uncharacteristically altruistic concessions (Yes, we will begin covering those with pre-existing conditions and won’t charge more for women)

· MoveOn.org’s amusing call-outs of anti-public plan congressional representatives with major insurer funding (”Will Mary Landrieu sell out Louisiana for $1.6 million?”)

Outcomes Analysis

Here’s what I believe will play out if we don’t take action:

Since the public option is essentially in critical condition, small group cooperatives will spring up (thank you, Senator Conrad) to address the insurance gap. With no scale, clout, or experience in insurance operations or the incredibly complex US healthcare landscape, these cooperatives will fail (see: Cerner’s Healthe Exchange, the bane of its employee’s existence).

Private insurance will, as usual, become the only option available to the majority of Americans. Employers will continue to cut back group coverage availability and features due to expense. The Wild West of the individual private insurance market will flourish.

Rack rates (read: Prada retail price) for most providers will opportunistically increase, as there are less uninsured patients to pay them and more insurance beaurocracy to navigate. AMA member rack rates will be even higher, as they have suddenly received higher network rates from the major insurers (thanks for supporting us guys, here’s your fee!) and feel they are worth more, period.

Those with pre-existing conditions will be accepted into private plans, albeit at exorbitant premiums. Premium cap regulations will only be created reactively, after years of continued insurer abuse. Member’s plans won’t cover the pre-existing conditions for which they need insurance in the first place.

Members who rack up too many claims, or those who develop expensive conditions, will suddenly be terminated from their plans due to “irregularities and fraud” on their applications (read: recission). These unlucky individuals will then be liable for the entire rack rate of all services provided under the plan, as all covered claims at network discounts become null and void. Personal bankruptcies will explode for a number of years while private insurer profits soar (does this sound familiar?).

Languishing Reform Initiatives

Electronic medical record (EMR) adoption will remain in critical condition, with half-finished implementations littering the physician office and hospital landscapes. EMR vendors rejoice, as license fees must be paid regardless.

Comparative effectiveness research of medical treatments will be confined to the White House dungeon. Pharmaceutical and medical device companies will rejoice as they continue to trot out expensive and unproven miracle products (with direct-to-consumer advertising campaigns, of course). No healthcare savings will be realized (I know this surprises everyone).

Political hot air about personal responsibility for healthcare will expand with congressmen’s subsidies from insurers, sure to increase as recission incidence skyrockets. Too late, the government will get serious about a public plan, which will only be implemented in a minor role after many more years of political wrangling. Any attempt to create a “healthcare system” will continue to be in the political crosshairs.

Take Action For Alternative Choices

None of this seems like reform, does it? In fact it seems nothing but an escalated extension of our current state healthcare disaster.

But it doesn’t have to be this way. A public plan, whether as an option or single payer, can still become a reality if enough of us make our voices heard. Contact your congressional representatives today and let them know anything other than a public plan option is unacceptable. Or join a pro-public plan campaign through groups like:

Move On.org
Health Care For America Now
Stand With Dr. Dean
Campaign For America’s Future
Single Payer Action
…or many others!

Make your vote count and let’s create an American health system for the first time in history.

© 2009, Actively Fused LLC