One by one the presidential aspirants in both parties are starting to share their thoughts on how to revamp our health care delivery system. All are looking for a needle in the haystack. The needle, of course, being a metaphor for an elusive solution to the vexing problem and hiding in an unlikely place. So far, in my judgment, all have missed the boat. Not every haystack has a needle–but some do, if you are willing to look hard enough.
The problem with the solutions revealed so far is that the focus is on the wrong part of our health care system. In one way or another all suggestions deal with the way we finance health care rather than the delivery system itself. The real problem is not so much “how” we finance, but “what” we finance. I do not believe we will ever reach a satisfactory solution until the system has been dissected and its component parts examined to see if there aren’t some needles that could show the way to a more effective and lower cost mechanism to deliver our health care–rather than continuous tinkering with the financing of the system as it is. There are such needles out there, if we have the courage to look for them. A few examples may serve to make the point (no pun intended).
Needle #1: Re-examine the way we cover (or finance) maternity benefits. Maternity does not meet all the tests of an insurable risk and was not fully covered in early health plans. It was treated as a loading factor and a benefit of $150 to $250 was added to the plan for maternity to essentially provide a benefit for younger workers who, through their premiums, were financing more serious illnesses of older workers.
But then came the mandates for various coverages, including maternity, and full coverage had to be provided. Is it a coincidence that since the advent of the mandated coverage, costs for maternity care have skyrocketed? I don’t think so. The option of a C-section delivery has multiplied, adding to the cost. Further complicating this picture is the prevalence of malpractice suits that has reduced, drastically in some areas, the number of practitioners.
Maternity is the one medical treatment where a person has time to plan and save for it. There must be a better way to handle this expense. The needle is out there.