Health Care Reform, Part 2: The Devil's in the Details

I'll be out of town for the next couple of days -- a quick trip to New Hampshire -- which seems appropriate, in a cosmic kind of way. Spending a couple of days in the Live Free or Die state, while Congress works on health insurance reform, just seems like the right thing to do. Especially since, when they're done, we're not likely to be living free and in fact we may be dying sooner, or dying more, or something like that. I'm guessing the devil's in the details. And as usual, getting the details is proving to be a devil of a chore.

One version of a draft bill is over 1000 pages. Pretty safe to say that most of the folks in the House or Senate, whichever version this is, will not even read much less understand what's included at anything more than a 500,000 foot level. And I will say right from the get-go that I have no idea what's included in the bill either - I can only read, and listen, and try to learn. Naturally, anyone I want to read, listen to or learn from will have a partisan opinion, so there are not a lot of options for normal folks like us to really get a straight view of things.

That being said, here are some of the things that I'm catching wind of, through a whole host of outlets:

• Congress apparently is excluding themselves from the proposed government option. If you ask me, this is a bad sign. Not an uncommon one, I think, but a bad one.


• The House plan may prevent new private health insurance policies to be written after the full legislation is effective. Hmm... if the point is to merely offer a government option to promote competition, why does it sound like that may be the only option?


• Many of the people chiming in on the conversation have indicated that we need to stop having insurance company bean counters making health care decisions. Yet, if we listen to the President himself, he's looking for a plan that will not pay for multiple tests when one test will do; he's also looking to incent docs and other health care providers to provide 'the best care' not 'the most care'. If that's not 'bean counter' language, I don't know what is.


• We have heard a lot about the 'insurance exchange' where many different options will be available either for companies or even individuals. What I don't know is, how do we offer that marketplace of carriers, when each state has their own labyrinth of laws governing what carriers can offer coverage in which jurisdiction?


• End of life care is another hot topic without a lot of detail. What really will happen to older, sicker Americans? Is someone going to be doing a cost-benefit analysis on their care?

There are a number of questions that need to be asked, and answered, before anyone votes on a bill for health care reform. All of us need to be educated, so that we understand how whatever the end result is impacts our insurance coverage, our taxes, our benefits, and our livelihoods. If you have insurance, or you don't; if you work for an insurance carrier like I do, or a small business; if you make gads of money or something less than gads - you're going to be impacted by this legislation.

Clearly there are opportunities for reform - and I do support reform, even thought I work for an evil health insurance company. There's lot of room for improvement in costs, in quality, and in coverage. But if you think for a minute that we are going to get reform without having to pay for it, or if you think that reform will come free from painful cost-containment decisions, including denial of care under some circumstances, you're fooling yourselves.

The devil's in the details, and we have to make sure someone's paying attention to them. Why not have that someone be you?