HEALTHCARE POSITION PAPER
by Dennis Spivack

As I have traveled up and down the State listening to the people, the overwhelming majority have told me that healthcare, or rather the lack thereof, is the issue with which they are most concerned. Many of the people have voiced their support for universal health care, despite the potential flaws that such a system entails, as seen in England and Canada. Many Delawareans feel that, while our medical care is one of the best in the world, it is oftentimes out of reach for many individuals and families. 

Let me discuss two stories which really hit home. I spoke to one woman who is a single mom and has two children. Despite the fact that she has three jobs, she cannot afford health insurance. She recently had to take one of her children to see a doctor. Since she is not part of a healthcare plan she had to pay the physician’s full cost, rather than the discounted price which would have been negotiated by a healthcare insurer. After paying for the doctor visit, she didn’t have enough money until her next paycheck to meet her other obligations for electricity, gas, and food for her children. In order to stay within her budget and to make sure her children were taken care of and eating properly, she was forced to eat cat food to cut costs. I was appalled and deeply saddened that she had to endure this. I told her that her family might qualify for state-sponsored healthcare and that she should contact the State Insurance Commissioner’s office. This seemed to give her some hope.

At another event, I approached a couple to introduce myself and as I began my introduction, the husband had one of the saddest looks on his face that I had ever seen. I said that I would leave if he didn’t want me to introduce myself. He said no; in fact, he wanted me to sit down when he heard I was a candidate running for US Congress. He and his wife had just enrolled in the Medicare Prescription Drug Plan. He had just paid his electric bill and filled up his car with gas. His wife had a medical condition that required continued medication. He went to his local pharmacy, and he was advised that the deductible had gone up from $7.00 under his old plan to $27.00 under the new prescription drug plan.
 
He just didn’t know what he was going to do. I asked him if he had any family that could help him and he said no, so I gave him the $20.00 he needed. He didn’t want to accept it, and there were tears in his eyes, but then I told him about my experience when I took care of my wife who has had five bouts of cancer during the last 17 years. During many of those years, both my mother and my mother-in-law also suffered from cancer at the same time. I told him that I understood the financial, emotional and mental strain he was going through. I also told him that if it was not for the generosity of certain members of my family, I would not have been able to keep my head above water. I told him to consider the money not as charity, but as someone extending a helping hand to him just like he will do to someone else when he encounters another person in distress.

I’ve also spent a great deal of time talking with retirees who are living on a fixed income. Many of them have told me the same story. They just don’t know what they are going to do to survive. Electric rates have skyrocketed between 60 to 100 percent, and gas prices remain around $3.00 a gallon. If they were covered by health insurance plans from their former employers, the premiums have gone up as well as the deductibles or the plans have been discontinued. The Medicare Prescription Drug Plan has been of no help; there are gaps in coverage, and the plan, as a whole, is unintelligible.

After hearing all of these stories, it is my position that we must begin to find a way to provide coverage because the problem is only going to get worse as the population continues to age. I support the universal health care concept and the current bill, H.R. 626, pending in the House of Representatives, but I think it needs some changes. I want to examine those countries that have a universal health care system already in place so that we can adopt the best of those systems and avoid the worst. Even universal heath care systems can provide different levels of coverage to the “haves” and the “have-nots.” Those who have money are seen almost immediately, while those who do not have money are put on long waiting lists.

Universal health care is not something that will happen overnight. Providing affordable coverage to all Americans, including the 45 million Americans who are currently uninsured (including more than 100,000 Delawareans) is going to be a challenge in terms of (i) getting the votes necessary to pass the legislation, (ii) establishing a fair and equitable program and, most importantly, (iii) funding the program.

Funding is the key issue. I want to make sure that any nationalized healthcare system available to our citizens can be fully funded. Much of the funding can result from savings which can be realized if some of the deficiencies in our current health care system are addressed. I will attempt to set forth my ideas as to how to realize enormous savings in our current healthcare system in the remainder of this Position Paper. Above all, I am committed to working with the people of Delaware and with fellow Democrats and Republicans in Congress to make healthcare coverage for everyone a reality.

Some of the immediate steps we can take now involve focusing upon waste and the costly bureaucracy which currently (i) divert healthcare dollars away from patients to bureaucrats, (ii) restrict care to patients, (iii) avoid timely provider payments, and (iv) reinstitute physical therapy, chiropractic and mental health visits that enable individuals to address health issues without missing work. By focusing upon ways to minimize the waste and costly bureaucracy, billions of dollars could be saved, and those savings could be utilized to expand healthcare services to the uninsured and underinsured.
 
Let me state at the outset that the proposals I offer do not constitute the “solution” to the healthcare crisis, but they do represent responsible first steps. For now, the overall goal is to redirect healthcare dollars away from a bloated bureaucracy and return those dollars back to the bedside.
 
Some of the steps that can be taken by employers, individuals, government, and physicians/hospitals include: (i) making patients the centerpiece of the system, (ii) adding greater accountability throughout the system, and (iii) eliminating wasteful administrative costs and billing inefficiencies, thus freeing up physicians and hospitals so they can concentrate on delivery of care. 

We need to create a consumer – or patient – driven healthcare system as opposed to controlled by private insurers. Congress should establish a system of tax exempt healthcare accounts, and the monies deposited into those accounts by employers and individuals must be used by individuals or families to pay health insurance premiums, deductibles, prescriptions or other healthcare expenses. 

Employers, both large and small, should be free from the business of providing healthcare so they can focus on running their businesses. Removing the primary responsibility of providing health coverage from employers makes sense for a number of reasons. First, employers are more concerned with the cost of employee healthcare, rather than the quality of the care and services provided to their employees. Secondly, employers are less concerned with holding insurance companies accountable for the care or lack of care provided to their employees. Freeing employers from the business of healthcare purchasing reduces their cost which positively impacts the bottom line. A substantial part of such savings should be passed onto employees by way of employer contributions to their employee healthcare accounts.

In a system where the focus would be upon the consumer or patient, the costly requirements for pre-authorizations/referrals for medical services could be eliminated. Patients should have the right to choose and change physicians at any time. In this way, personal medical decisions would be made in a reasonable manner between the patient and the patient’s healthcare provider rather than by bureaucrats, private insurers or the government.

The government plays a central role in this new model. If patients are to be held responsible for choosing their healthcare plans, they must be given correct and easily understood information in order to make informed decisions. The role of the government would be to protect the public’s choice against (i) false and misleading healthcare advertisements, (ii) vague healthcare plans with hidden exclusionary clauses and coverage, and (iii) incompetent and/or fraudulent healthcare providers and insurers. We must avoid repeating the confusion that surrounded the recently implemented Medicare prescription drug program, which was unintelligible and full of pitfalls.

The government can take two critical steps to ensuring health care accountability by creating (i) a truth in healthcare advertisement board and (ii) a national malpractice insurance program. The truth-in-healthcare advertisement board would consist of physicians and experts in media communications and marketing. The main role of this board would be to insure that all advertised healthcare plans are explained concisely and in simple language so patients can make informed decisions. Board members should not have any financial interest or affiliation with any healthcare insurers.

A non-profit national physician malpractice insurance program should be established to control skyrocketing malpractice premiums. Those premiums should not be tied to the performance of the stock market as is currently the case. By removing or reducing the private profit incentive in physician malpractice coverage, premium costs can more accurately reflect physician malpractice activities and claims. The sole goal of the program is to keep the cost of malpractice premiums down.

In addition, we must relieve physicians and hospitals by creating billing and reimbursement procedures that improve efficiency, ensure prompt and fair payment, and reduce bureaucracy and cost-shifting. We must simplify the billing to universally accepted codes. Adopting such codes should remove any excuse by healthcare insurers to pay healthcare providers promptly.

In fact, all provider invoices should be paid promptly within two to three weeks rather than ninety days unless legitimate errors in billing are noted and communicated within that two – to three – week period. The insurer would be required to pay interest on delayed reimbursements if there was no legitimate reason for the delay. If an insurer believes that a legitimate reason exists, a submission would be made to an independent state or other regional board to review and decide the matter promptly. 

If these proposals were adopted, the savings from reducing waste and streamlining the bureaucracy alone would be tremendous. Portions of the taxes collected on such products as cigarettes and alcohol could be dedicated to statewide healthcare accounts. Monies withdrawn from healthcare accounts which were not used for healthcare purposes would be taxed at a penalty rate; those tax penalty revenues would also fund state healthcare accounts. Rolling back the tax cuts on the highest income brackets could also be another revenue source to fund the state healthcare accounts.

As noted at the outset, I do not claim that these proposals are a solution, but they do constitute a real and responsible start. The consumer or patient must be made the primary market force to control not only the quality of physician care but the conduct of third-party insurers. If the focus of the system was upon the patients, then insurers would begin to focus more on the needs of the premium payer rather than the needs of their employers. 
This proposal does not take into account the unemployed or individuals who cannot work. These individuals would require government assistance to be able to purchase affordable healthcare coverage. That is the reason that I advocated the creation of state healthcare accounts. The legislation recently enacted in Massachusetts offers a model as to how those individuals who are unemployed could be covered with the assistance of the states.
It is also vital to recognize that healthcare issues will require joint consultations between the federal government and the states. For example, whenever the federal government cuts Medicaid benefits, states are forced to find ways to cover those shifted costs or cut benefits. In this scenario, the President and Congress look like the “good guys” when they are, in fact, the real culprits. Unfortunately, many congressmen believe they can fool the public by playing this “shell game.” 
Other steps that I would recommend immediately would are: (i) making all Congressmen pay for their health insurance premiums just like the rest of us rather than have those premiums provided at the taxpayers’ expense; (ii) requiring all members of Congress to purchase the same type of healthcare coverage that they legislate for their constituents; (iii) eliminating financial contributions and lobbying effort of members of Congress by healthcare insurers; and (iv) establishing federally mandated licensing requirements for all healthcare insurers.