Opinion: Health care reform talks beg question of funding overhaul

The juxtaposition of widespread agreement and dissent with regard to ongoing health care reform talks makes it clear that the U.S. health care system is on the minds of Americans nationwide.

Most can agree that something needs to be done to improve U.S. health care, and most recognize that whatever the solution, it's not going to come without great cost, as most proposals are in the trillion-dollar range.

But the dissension comes when it's time to figure out what would be the best fix for American health care.

On Aug. 26, I was among the roughly 35 people gathered at Springfield's Twin Oaks Country Club for UMB Healthcare Services' Breakfast Forum, where CEO Dennis Triplett shared his perspectives on the current state of health care costs and what ongoing reform discussions might mean in terms of health insurance.

Triplett's track record puts him in prime position to address this important issue. He's considered an architect of the Archer medical savings account that was introduced in the mid-1990s; he has chaired the national health savings account committee for America's Health Insurance Plans; and he's a charter member of the HSA Council of the American Bankers Association.

One thing Triplett made clear is that America is going to have to take a hard look at the amount we spend on health care.

Consider this, for example: In 2009, health care is expected to comprise 17.9 percent of the gross domestic product, at $2.4 trillion. And by 2017, it's anticipated that health care will comprise 19.5 percent of the GDP, at $4.3 trillion.

"That means we have to look at how can we be effective and competitive globally when we spend that much on health care," Triplett said. "More care does not mean better care."

Also disconcerting in the health care arena is a continued lack of access to care for Americans.

Triplett noted statistics that showed some 45 million uninsured Americans in 2008, and he estimates that number to be closer to 50 million today. In March alone, he said some 8.9 million people dropped out of employer-sponsored health plans, due in part to layoffs. While some of those people transitioned to government-sponsored coverage, a large number likely joined the ranks of the uninsured.

One point President Barack Obama has made repeatedly in his push for reform is that people who have insurance they like can keep those plans in place, but Triplett rightly noted that the question then becomes, "How do you get there?" That's a particularly puzzling question when some politicians stand firm that they won't approve a reform plan that has a public component, while others say they won't support one with out it.

Reform talks also circle around an individual mandate that everybody should have health insurance, which sounds like a good idea, but isn't likely a cure-all for what ails our health care system. Triplett notes that there are, after all, laws that require auto insurance coverage, and yet some reports still show that there are roughly 12 percent of drivers without it.

"It's a nice goal to have, but it might be difficult to enforce," Triplett said of the individual mandate.

Of particular concern to employers are the possible tax implications of whatever shape health care reform ultimately takes. Multiple aggregate amounts, including $25,000 per employee per year, have been bandied about, and could result in companies having benefits packages that are considered "too rich," Triplett said. One issue that drew questions was what could happen if reform mandates that all employers offer health insurance. Triplett said the likely result would be a "pay or play" mindset, whereby companies would pay into a coverage pool at a rate based on payroll if such coverage isn't provided.

John Gentry, president of Positronic Industries, asked what would happen if all companies just opted to pay the presumably lower cost of the pool instead of paying for coverage, and while Triplett didn't have a concrete answer, he agreed that the gap between the funds put into the pool and the cost of care would have to come from somewhere.

Perhaps the most often-heard question amid the health care debates is what it would mean if the government were to start determining who receives care.

While concerns in that vein touch on end-of-life issues and care rationing as seen in other nations, Triplett said the granddaddy of all questions remains, "How do you pay for all this?"

It's not likely that there is a single answer to that question, and we as a nation will have to wait for legislators to hammer out a prescription for change. Only time will tell if the solution offered will be a Band-Aid or a long-term cure.[[In-content Ad]]