EDITORIAL: The Fight Continues

We agree that the bill is a good first step but falls short on controlling costs
March 25, 2010 -- When The Lund Report began almost a full year ago in April 2009, the national healthcare debate had just started to boil over. Throughout the summer and into the fall we covered angry town hall meetings, street protests and arrests.
We also uncovered stories about profits and financial interests that helped fuel some of these demonstrations.
But even the most cynical among us have trouble condemning the entire bill signed by President Obama into law on Tuesday, and so do we, because in this legislation marks the end to the most destructive and unjust practices in the health insurance industry that got so many of us into this fight to begin with.
Just like that, a woman will never be denied chemotherapy because she lied about her weight on an insurance application. A father will never again put off going to the doctor in fear of losing his health insurance because of a pre-existing condition. Americans will never again be shackled to a job they hate because it’s the only way to get health insurance. And because the law prohibits insurers from putting lifetime dollar limits on policies, we should see far fewer Americans declaring medical bankruptcy.
Now a year later, the healthcare bill has finally passed without the public option that had embroiled so much debate, while a critical component – controlling costs of the health care system itself – has virtually been ignored. It’s almost as if the insurance industry is expected to wave a magic wand over the marketplace. 
As Rep. Mitch Greenlick so aptly said, we need to start tackling the cost of healthcare services – otherwise we’ll be unable to bend the cost curve in a significant way. He suggests that Oregon lead the way by establishing a global hospital budget where all payers – Medicare, Medicaid, the new health exchanges -- would establish a rational budget to pool both outpatient and inpatient hospital costs. Hopefully more lawmakers and public policy officials will rally around that call. You can read more about this proposal in a related article.
There is still much that is broken about our healthcare system. Our rural communities are starving for primary care physicians, our hospital wards need nurses and our hospital facilities and drug companies continue to expand and gobble up an ever-larger percentage of our healthcare resources
Just as backers of President Obama didn’t wipe their hands after the election and rest on their laurels, those who care about making healthcare a right and not a privilege must stay vigilant to make sure the reforms enacted in the law become reality and that future laws go further to expand healthcare access at an affordable price to all Americans.
As this legislation unfolds, we know that our work at The Lund Report and other watchdog journalists will be in greater demand. The journey has just begun.


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Here are my fears: Devastating strategic mistake to have legislated a solution for the uninsured part of the reform problem while deferring on a credible strategy to control costs. A commitment to "affordability" is a rhetorical demand for more subsidy and subsidies are generally inflationary to costs. What was passed will clearly increase the total cash flow to the health care industry, or who would assume the AMA would have supported the legislation? What has been passed at the Federal level is a "more money" solution and "gee, we must get after this cost problem sometime". When does feeding the monster more meat satisfy its appetite? We will now enter a second phase of tepid reform, where we will likely chase the cost issue with unproven assumptions, and a greatly expanded public bureaucracy with its own aspirations for growth. Those who were only interested in universal coverage, will walk on the tough decisions related to costs. Politicians will subsidize and cost shift to avoid the heat and pick the next player in its exercise of evilization and shifting the blame. Most of us will pay more than we should or be subsidized. Some States will dance to this music, others will break away perhaps shaping future winners and losers. People and companies will move. Is Oregon positioning itself as a state to move to, or move away from? As long as more money flows, most of the commentary will be, "good start", "bend the curve", and an emperor wears no clothes agreement among folks who know better. The State which had the capacity to alter the rules of insurance all along in Oregon will seek to optimize its own vested interests as if they were the same as its citizens. A commitment to state controlled global budgets fits that agenda, while presuming the money I spend on health care is the State's money and not mine. Let's be honest, for hospitals, they might as well turn over the keys. Ask how a State controlled by public unions will effectively control the operating costs of hospitals when 60+ percent of those costs are payroll related? We face a giant case of denial, deferral, and vested interest striking at the core of governance and the prospects for success.

I agree with you about the cost factor. I work in healthcare and I know without any doubt that the AMA went along with it because if everybody is now insured it means more revenue. Potentially much more revenue. Just because everybody is insured it does not mean anyone will lower prices for procedures, office visits, tests etc. Where is the incentive? If the money is flowing in people in healthcare are not so big hearted as to turn down a windfall. I think transparency, competition and cost control at all levels should have been one of the first goals. Then work on getting every body covered somehow.