Is it Health Care Reform or Health Insurance Reform?

by AdminJ on August 12, 2009

All over twitter people are talking about how mad they are that Health Care Reform is now called Health Insurance Reform. Health Care and Health Insurance are two totally different things. It was only a matter of time until slowly the name turned into Health Insurance Reform. Health Care will never happen in this country but Reform can happen with our Health Insurance.


President Barack Obama and his team have made a subtle but significant shift in the language they are using in the health reform debate. Where once Obama talked about a massive transformation of the nation’s dysfunctional health care system that would rein in rapidly escalating costs, now he almost exclusively refers to “health insurance reform.”

Obama’s visit today to a town hall meeting in Portsmouth, NH was billed by the White House as a “Health Insurance Reform Town Hall.” But back in March, the conference that kicked off the President’s campaign to overhaul the nation’s health care system was titled the “White House Forum on Health Reform.”

The change worries lots of health care experts, because it seems to signal that Obama has tabled efforts to bring exploding health care costs under control, and instead will settle for only expanding coverage to the uninsured. Economists are almost all in agreement that covering the uninsured without addressing cost controls will create an even larger fiscal mess. “I think we’ve lost the plot on health reform,” says David Knott, head of Booz & Co’s global health practice. “The debate started out as a fulsome discussion of all the issues, but now we’ve just punted on the affordability issue. They are kicking that can down the road.”

The difference between Obama’s language now and then is striking. In New Hampshire today, he told the crowd:

Health insurance reform is one of those pillars that we need to build up that new foundation. I don’t have to explain to you that nearly 46 million Americans don’t have health insurance coverage today…But it’s just as important that we accomplish health insurance reform for the Americans who do have health insurance, because right now we have a health care system that too often works better for the insurance industry than it does for the American people.

Contrast those remarks with the President’s speech at the health reform summit on March 5:

If we want to create jobs and rebuild our economy, then we must address the crushing cost of health care this year, in this administration. Making investments in reform now, investments that will dramatically lower costs, won’t add to our budget deficits in the long-term – rather, it is one of the best ways to reduce them.

What changed? For one thing, Congress has not been willing to overhaul the fee-for-service method now in place for paying doctors and hospitals, which rewards health care providers for quantity, not quality. Given that hospitals and physicians together account for two-thirds of the nation’s health spending, taking a hands off approach to their payments doesn’t leave the legislators with a lot of other places to find significant savings. In fact, legislators have already proposed giving doctors a $245 billion “raise” in their Medicare reimbursements over the next 10 years to insure their support for health reform.

The legislators’ reluctance can be chalked up to the fact that hospitals are the largest employers in many congressional districts, giving them enormous political clout. And the public regularly rates doctors among the most admired professions. Insurers, however, are wildly unpopular with the public, making them a much easier target, despite their lobbying power.

There is an argument to be made, and many are making it, for passing universal coverage now, which voters generally support, and worrying about politically difficult cost cutting changes later. That’s what Massachusetts did in 2006 when it passed a state wide universal coverage law in 2006. Now, faced with rapidly escalating costs, the state is considering an overhaul of the doctor fee structure. Such a strategy would be tougher to follow on a nationwide basis, where health care spending is on track to consume a crippling 20% of GDP by 2017 if nothing is done to change current cost trends.

Health insurance consultant Robert Laszewski recently took note of the change in Obama’s language in his blog Health Care Policy and Market Review, writing:

For months I have been saying that the health care bills in the Congress have not been health care reform bills but expansions of the health insurance entitlement with some cost containment “lite”…I believe we need a lot more than health insurance reform—we desperately need health care reform—for all the reasons the President said we did when he first opened this debate. But at least he’s now calling it what it is.


This was only a matter of time until the country saw what was really going to go on. There is really no logical way to have a Universal Health Care. We would lose all the good doctors, medical centers and hospital right along with it. There are already too many people in this country who do not pay taxes and get free health care.


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