Guest Column: With election over, leaders must tackle access issues

Last month, we elected a president to lead our great country.

One of the focal points of all parties' campaigns was providing health care for Americans - a proposition that will not only prove to be costly, but also a virtually unachievable goal.

It's important to note that there's a distinct difference in providing health care and health insurance.

Every person in America has access to health care. It may not be the best, the quickest or most affordable, but it is accessible. Health insurance is a different issue.

There are an estimated 43 million uninsured Americans today, and some are uninsured by choice.

Some people look at health insurance as an expense for what they might need if they ever have a problem. These same people usually take the approach that, if they get sick, they have access to care in the emergency room. They might pay the bill - but if they don't, that increases the cost of health care for everyone.

President-elect Barack Obama's plan for health care essentially gives access to the federal employees' plan, of which a very small business will be exempt, although we do not know the definition of very small business, or they can become part of the new National Health Insurance Exchange. The NHIE is a model of the Massachusetts plan that did successfully get thousands covered by insurance, but at budget-busting costs. Access went from bad to miserable, and the cost of care was higher than expected.

Why did this happen? I believe it was because they had no idea what financial impact it would have, and that the stakeholders developing the plan ignored some sound reasoning from health care experts.

The John McCain plan would have left everything in the free market, offering a direct refundable tax credit of $2,500 for singles and up to $5,000 for families to purchase health insurance. That plan would have put the decision squarely in the hands of those purchasing insurance. McCain's plan, which would also have been costly, advocated personal responsibility and choice, and promised some cost controls in delivering the care.

Both Republican and Democratic campaigns called for greater access, portability of coverage, best-practice models for states, transparency of health care quality, disease management, cheaper prescription drug costs and electronic medical records. All of these will have associated costs. Portability of coverage and elimination of pre-existing conditions already exist nationwide as a result of Health Insurance Portability and Accountability Act legislation passed in 1996, though that did increase the cost of health care in America.

Health care quality and disease management also already exists with most insurance companies as they look for ways to control costs. Some companies, such as CIGNA and United Health Care, even have cost estimators on their Web sites for procedures as well as quality indications for many of their network affiliates. Leapfrog is an independent group that gathers data from hospitals so consumers can make informed choices about the care they want. The downfall is there is no mandate for any provider to participate in the Leapfrog program.

Insurance is no different than any other business. The old 80/20 rules exist as 80 percent of the claims are generated by 20 percent of the members. The alarming thing is that of that 20 percent, 5 percent are responsible for 80 percent of the claims in that total.

No doubt health care and health insurance are going to be top-of-the-list issues that the U.S. must address. Our leaders will have to make some tough choices, as will individuals.

There is no easy answer for improving access to health coverage. The best solution, however, will come when everyone takes time to educate themselves about pertinent issues, approach the matter with an open mind and be willing to make the right decisions that can benefit everyone.

Mike Scott is an employee benefits and compliance specialist for Barker Phillips Jackson, an employee-owned insurance company in Springfield. He can be reached at mscott@bpj.com.

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