Here is his last paragraph:

“Before we further remove ourselves as direct consumers of healthcare -with all of our beneficial influence on quality, service, and price – let me ask you to consider one more question. Imagine my father’s hospital had to submit the bill for his “care” not to a government bureaucracy but to my grieving mother. Do you really believe the hospital – forced to face the victim of its poor quality service, forced to collect the bill from the real customer – wouldn’t have figured out how to make its doctors wash their hands?”

There are major laws, state by state non-profit tax regulations, and numerous government support programs that make care available to those who find themselves in a difficult financial situation.  The primary law is EMTALA and basically states that a hospital can not turn an emergent patient away before he or she is stabilized.  If you looked at tax regulations in Texas, a not-for-profit healthcare system has to provide at least 4% of its net revenue in some form of charity or financial assistance to keep its non-profit (non-taxable) status.  This just means that all non-profits have programs that provide financial assistance to individuals sometimes all the way up to 500% of the Federal Poverty Level.  Finally, Medicaid and Social Security are there to help people get regular access to care even when they have limited income and assets.

While these programs should not be abused, they are there to support individuals in need and almost everyone who can’t pay for care usually qualifies for some type of assistance.  While the coverage is not automatic, a little bit of legwork can provide someone the “universal coverage” today that so many seek to inject into the US healthcare model of tomorrow.

Does all of this healthcare reform talk have any implications for consumers?  The answer is not yet but it might over the long run.  For the interim, I suspect it will be business as usual because of the huge financial forces keeping the current system in place –  the great “hidden” private insurance tax subsidizing the true cost of government programs.  Medicare and Medicaid pay 25% less than the cost of care and private insurance pays 27% more than the cost of care.  The net 2% is profit for large healthcare system providers which supports growth and ongoing innovation.  This dynamic is known to everyone in government healthcare and private healthcare.  At the end of day, the reality of this huge cross-subsidy and lack of meaningful plans to rebalance the situation will result in a stalemate with any new healthcare legislation that might jeopardize the viability of this industry dynamic – the only reason seniors and those with financial hardship can enjoy the truly comprehensive benefits of government healthcare.

It doesn’t mean that this dynamic is appropriate and should continue.  That is where you as a healthcare consumer can continue to help.  By avoiding the 27% overpayment for healthcare, a consumer puts pressure on the healthcare system one decision at a time to either become more efficient or find new ways to balance and allocate the cost of care.  This is the kind of change I can believe in…

The most I can say about this plan is that it sounds nice.  I want there to be better healthcare technology and affordable health insurance.  It would also make our jobs at Compass easier if hospitals had to disclose true costs and meaningful quality metrics.  Unfortunately, these are all just platitudes and there are no plan specifics as to how these goals would be accomplished or funded.

The reality is that new healthcare technology is overwhelming complex, expensive, and difficult to implement.  Revealing true costs to consumers would be nice if there weren’t confidentiality agreements in place legally preventing costs from being shared.  Healthcare has only become more fragmented as physicians have continued to sub-specialize and open their own surgery centers.  To compete, hospitals have focused on patient experience and service thereby losing focus on what’s necessary to deliver value centric care.

Cost is an entirely different dimension with no mention by Obama how he intends to change the current payment system.  My understanding is that he intends to leave it alone, continuing the hidden tax all regular consumers pay through higher premiums to subsidize Medicare, Medicaid, and the uninsured.  If you leave the hidden tax in place, you simply have to increase taxes somewhere else to pay for what by all accounts sounds like a major and costly – to the tune of 65 Billion - extension of a traditional insurance program (federal blue cross blue shield) to all uninsured Americans.  In a cratering economy, a major healthcare tax increase sounds like a major stretch even for the amazing Obama.

So when people ask me what I think about Obama’s health plan, I tell them not much.  There isn’t much there to actually comment on that would have any basis in today’s reality or be practical in the near-term.  I simply come back to my position that thefastest way to lower cost, extend care, and make a difference is for the everyday individual to become better consumers of healthcare and demand the changes that will truly make a difference.

Since the healthcare system in the US is currently paying for emergent care for everyone, no matter what the ability to pay, and employers are already being “taxed” to cover this cost, why would anyone want to take away the healthcare tax deduction status for employers.  If anything, this status should be extended to individuals to level the playing field and encourage more investment by individuals in their own health.  If you don’t allow this structure to exist, the government is simply going to take the additional tax revenue it collects and plug it back into the healthcare system to meets its goal of universal access to care and offset the decreasing level of healthcare coverage offer by employer.

It is time to have individuals take responsibility for their healthcare, teach them how to be better healthcare consumers, and bring some value based decision-making back to the healthcare process.  This is the one approach that will spur efficiency as providers will be forced to focus on the type and level of care that provides the most value to consumers in order to gain their business.

Drew, President and CEO of the Kaiser Family Foundation, leads one of the most responsible channels for healthcare information today. Within the article Drew contrasted Obama’s health plan that focused on more forced accommodation of the uninsured through traditional insurance organizations with the free market and tax incentive emphasis of McCain’s individual coverage proposal. In the end, the article expectedly stays clear of recommending whether or not individual coverage was better than employer based coverage other than to say it was likely that the average voter would not think so.

In my opinion, both coverage mechanisms have merits and satisfy clear needs. Neither mechanism is better than the other or represents a solution to current healthcare challenges. The important component of these proposals is that they create emphasis on individually driven healthcare decisions. Since only patients can decide what level of care or support is valuable to them, they must have a role in assessing the cost and quality of each healthcare decision they make. Only value based care decisions can bring rationality and cost-effectiveness back to the healthcare system.

Instead of trying to decide for us who should pay for healthcare, politicians should help people get the cost and quality information necessary to make that decision for themselves.