Health Care Reform

Of course, no one knows what the future of health care reform will be. The plan is being created even as I write this.

However, the nature of the problem is clear: We have 50 million people uninsured. We probably have an equal number of people who are under-insured (they have insurance but it excludes coverage for serious pre-existing problems). Yet we have a health care delivery system that costs twice as much per person as Europe, with worse outcomes regarding life expectancy and infant mortality.

The goal is to extend coverage to the uninsured, improve coverage for the under-insured, enhance the quality of outcomes while eventually cutting costs in half. That's a tall order and there are only a few solutions that can work.

Therefore, as I gaze into my crystal ball, here are my predictions:

1. Universal Coverage. Everyone who wants insurance will be able to get it. Insurance companies will be mandated to issue a policy to everyone who applies. That is the only way to solve the problem of the uninsured. Many of these people are uninsured because they are already sick and no one will sell them a policy they can afford.

2. Price Controls. The cost of health insurance will somehow be regulated. The cost of a policy has to be affordable or health insurance reform is impossible. Insurance most people can't afford is worthless as a solution. Expect tax credits to help the poor cover the costs. The rest of us will get insurance from our employer or will buy a private policy for a reasonable rate.

3. Incentives. There will be some way to encourage you to get insurance. The government can't create a situation where people can wait until they get sick before buying coverage. That would bankrupt all insurance companies. Either, everyone will be required to buy insurance, or insurance companies will be allowed to exclude pre-existing conditions from coverage temporarily so that people, in self-protection, will pay for a policy even when they are healthy.

4. Capitation. This is the aspect no one is talking about because everyone knows it will be unpopular. The only way to bring health costs under control is to somehow limit payments to physicians and hospitals. The old "fee-for-service" model encourages providers to render more "services" (such as unnecessary tests) in order to get more fees. The only way to prevent this is to move to a "per incident" model where the health care system gets paid a specific amount for each patient who is ill with a specific illness. In this way physicians and hospitals will make more if they conserve. They will make nothing or will lose money if they over-treat. The downside is that you will no longer be able to get all the care you want. There will be a cap after which treatment stops, and people are allowed to cope, suffer or die. Americans will hate this. However, it is what the rest of the world does, and it's the only way to control cost. There are different ways to do capitation. Some forms are explicit and obvious (HMOs, medical homes, etc.), some are only obvious to the provider (strict policy limits, pay-for-performance, etc), but capitation will be unavoidable. There is no other mechanism to control cost.

5. Tort Reform. If you want hospitals and physicians to stop ordering unnecessary and expensive tests, you have to regulate the courtroom so they can't be sued for skipping an expensive test that is unnecessary most of the time. Otherwise the courts will jam with malpractice cases, and medical providers will be in the untenable position having to roll the legal dice every time they say "no" to a treatment or test that is probably unneeded.

6. Efficiency. There is waste in the current medical care delivery system. Much of this can be overcome using technology. Medical providers will move to Electronic Medical Records, and citizens will be encouraged to have Personal Electronic Health Records (such as Google Health). However the savings that will come from this innovation will not show up for many years, and so it will not be much help in controlling costs in the near-term.

The good news is that this will be better than what we have now. People who get sick will no longer be wiped out. People will not stay in jobs they hate because they can't get insurance if they leave, and people will not stay in bad marriages because they need a health insurance policy they can get no other way. Medical providers will do okay. They will get less per patient, but there will be more patients because the uninsured will now be covered.

What does it bode for alternative and complementary care providers such as myself? We will prosper, just as we have in Europe. The reason is capitation.

People will no longer be able to expect their insurance policy to provide all the care they want. Insurance will only provide a basic level of care and then capitation kicks in to limit care. If people want more, they will find it available on a private-pay basis. Throughout Europe and Asia there is a network of prospering private hospitals and physicians who provide the "extra" care many people want. We will soon develop the same thing.

Those who find private medicine too expensive will turn to alternatives to supplement what they can get from their insurance policy. If they can't afford private hospitals, they can afford acupuncture, herbs, hypnotism, chiropractic, bodywork and energy work. Capitation will create a demand for the reassuring additional care people want in order to feel safer.

Consulting Hypnotists like myself do a form of hypnotism intended to make the care received from a physician more effective. Research shows that it works, and that people who do hypnotism in addition to standard medical care have better outcomes.

In a world where the care received from a physician will be caped by insurance limits, making the care one can get more effective will become very important. Additionally, we can help in other ways, such as encouraging a positive attitude and the management of discomfort. These are valuable services and the value will be obvious in a world where healthcare is, de-facto, rationed.