Colleen Conway-Welch
Nursing professor

Colleen Conway-Welch

Colleen Conway-Welch, RN, is the dean of Vanderbilt University’s School of Nursing.

Haven't We Learned Our Lesson?

The logical answer is no, a public option is not necessary. The federal government should be doing only the 20 activities specified by the Constitution -- and health care is not one of them. Today, actually, more that 50 percent of health care is already delivered by the federal government, if one adds together Medicare, Medicaid, the Veteran's Administration, the military, employees of the federal government, etc. And yet all those are fraught with problems (not unlike "civilian health care"). So why would anyone believe a public option would solve problems, control costs and "keep insurers honest"? Haven't we learned our lessons from "managed" care, the postal system and the rail system regarding cost containment by the federal government?

A major answer to the health care dilemma is not imposing a public option but organizing care delivery into integrated systems and providing incentives so that people and organizations don't feel it necessary to "game the system" because the "rules" are conflicting and ambiguous.

One of the many reasons that our health care is so expensive is the massive administrative expense embedded in it. Does anyone seriously think that a government option would be a model of administrative leanness? The public option would still need to document, bill and pay for services just like any other insurance company and physicians are opting out of Medicare and Medicaid now because the reimbursement does not cover their costs. We do not need another "government option." We need to cut costs by reducing variability, streamlining administrative burdens, establishing a nationwide standardized electronic medical record and encouraging physicians to stop providing unnecessary care and tests in order to avoid frivolous lawsuits.

By Colleen Conway-Welch  |  August 6, 2009; 1:17 PM ET  | Category:  Health costs , Public option Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati  
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"provide for the common Defence and general Welfare" - US Constitution

If health care isn't general welfare, I don't know what is.

You say, "One of the many reasons that our health care is so expensive is the massive administrative expense embedded in it."

You hit the nail right on the head, but practically all of the waste is in for profit insurance. They have Medical Loss Ratios of 70% - 80% which means 20% - 30% of premiums are spent in other ways than medical benefits. The MLR for the Federal part of Medicare is 98%; Canada's is 98.7%. In fact, the government run plans in other countries all have MLR's over 98%.

In addition, private insurers inundate our physicians with complicated forms and cause them to spend hours trying to get their patients paid the benefits they deserve. Medicare is much simpler. France has a fee for service system, but there is a simple one page form that they use for all visits.

If you want to lower administrative costs, get rid of for profit insurance companies. Support HR676. Medicare for All.

Posted by: lensch | August 7, 2009 12:14 PM
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