Healthcare Reform or Health Insurance Reform?

September 12th, 2009 by Nick Jacobs Leave a reply »

President Obama’s eloquent address to Congress on his proposed changes to the U.S. healthcare system was fraught with ambiguous issues that will certainly provide a feeding frenzy for opponents. When the President stated that “This country’s failure to meet this challenge year after year, decade after decade has lead us to a breaking point,” he was exactly correct. We are the only industrialized nation in the world that has not addressed this challenge.

There are too many people without coverage of any kind who use emergency rooms as their primary care physician. Unfortunately, the difference in cost between a visit to your emergency room vs. a visit to a physician’s office is exponentially different.

Q-tipsIf we, as a country, do not believe that we are paying for these patients in some real way, then we are not cognizant of how the system is being contorted in order to allow hospitals to remain solvent. When you hear individuals complain about the high cost of Q-tips in a hospital, it’s because they are being priced to help cover the losses being incurred from the millions of uninsured.

So, what is it that we must address? When the President said, “Under the present system, due to job loss or illness, many could lose their coverage,” he was totally accurate. Unfortunately, millions of Americans have come to experience this phenomena first hand, and could lose their homes, investments, and their possessions because they have no insurance. So, as President Obama appropriately questioned, “What is the best solution that is both moral and practical and best reflects the ideals and freedoms upon which our country is based?” He was clear to explain that implementation of either a Canadian-style system or an individual based system would both be a radical shift, and each represents extreme positions that would completely change the way healthcare is delivered in this country.


So, if we eliminate the extremes and concentrate on compromise, we begin to see signs of conciliation that might be embraced. For example, there appear to be very few people who would argue against providing “more security and stability to those who have health insurance.” The majority of Americans also seem to embrace the concept of providing some type of coverage for those who currently have none.

What the President and most of our elected representatives are avoiding in the conversation is talk about quality, safety, end of life care, wellness, prevention and outcome data.

David B. Nash, MD

I had the fortuitous opportunity to hear David B. Nash, MD, MBA and Dean of the Jefferson School of Population Health’s presentation on Population Health. At the risk of misquoting Dr. Nash, I will carefully attempt to touch on only a few of the facts, figures, and points that he made in his analysis of what it would take to fix the system.

One of the most profound points that Dr. Nash made was in seeking the answer to the following question:

What percent of adult Americans do all the following?

  1. Exercise 20 minutes 3x a week
  2. Don’t smoke
  3. Eat fruits and vegetables regularly
  4. Wear seatbelts regularly
  5. Are at appropriate BMI (Body Mass Index)

The answer surprised even this writer. Only 3% of American adults are following all five of these wellness and prevention guidelines, and 40% of deaths are the result of smoking, unhealthy diet, physical inactivity and alcohol use. In an interesting analysis of the President’s healthcare speech, finance author  J. André Weisbrod writes: “I see it as a Darwin Awards kind of issue. You are free to be stupid and I am free to not have to pay for your stupidity…”

Bundled payments, end-of-life counseling, evidence-based medicine, an emphasis on quality and systemic approaches to ensuring safety are only a few of the myriad suggestions recommended in Dr. Nash’s presentation.  Bottom line? The third rail of politics is limiting honest, open dialogue regarding reform, and time is running out.



  1. Carl says:

    The debate over increasing the health of the population and it resulting in reducing health care costs has been tossed around many times in the past. Changing behavior is one of the hardest things to do, ask any therapist. Our culture does not “reward” healthy behaviors. When it comes to our health, unless we are sick, we are in deniel that we will ever get sick. Combine that with the ecomomics of health care and the cost of health care, and you may be fighting an unwinable battle.

    There was a study out a few years ago that showed raising the tobacco tax cut the number of people who smoked more than 75%. The thought was that this would save health care money. However, what they found was that these people lived longer and required more health costs later in life that exceded the cost of health care they would have received if they continued to smoke and died early.

    So where does that leave health care reform? Not in the hands of the consumers. It does not seem to matter if we are a healthy or unhealthy country, the solution really depends on how we pay for our health care. Insurance for everyone seems like a positive step in that direction.


  2. Stephanie says:

    I was prepared to tell you that after hearing Dr. Nash speak recently, I began to look at things a bit differently. For example, my first thought when I walk through the group of employees taking a smoking break outside of my building is: ‘How much is this costing us?’ Or my best girlfriend, who continues to smoke despite my nagging and her children’s badgering. I think differently about the obese guy sitting next to me (but really somewhat on me) at the Phillies game. After reading Carl’s response, maybe I need an attitude adjustment. Perhaps instead of wishing these folks would change their detrimental ways, I should be wishing them a happy, but very short life.

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