The doctor’s prescription

He’s got good ideas but no overarching solution

Jeff Lobosky says he thinks it’s “ironic” that the health-care-reform law is called “Obamacare,” since much of what candidate Obama proposed is no longer part of it. Obama, he says, gave away some of the bill’s best parts—particularly the public option and the ability for Medicare to negotiate the cost of drugs—in order to get it passed.

“I was disappointed,” he said. “The original bill was a step in the right direction.” He believes the public would have stood behind the president if he’d fought for the public option.

Interviewed three weeks before the Supreme Court was scheduled to issue its opinion on Obamacare, Lobosky said that, even if the court ruled the individual mandate constitutional and left the package alone, “it won’t address or solve the problem.”

To mention just one of several flaws Lobosky sees: It moves millions of low-income people into Medicaid, but there aren’t enough doctors for current Medicaid patients. “It will get them a card,” he said, “but it won’t get them care.”

And without the individual mandate, he said, Obamacare simply won’t work.

Now, Lobosky’s biggest worry is that the failure of Obamacare will “kill any hope for reform for years,” which would be a truly monumental disaster on many levels.

So what’s the alternative?

Not single-payer, or “Medicare for all,” as it’s often called, though Lobosky believes it “makes a lot of sense” and is infinitely more efficient and fair than the current system. It’s just not politically viable at this point, despite its popularity in the polls, he says: “You can be sure that the major special-interest groups will all oppose it,” beginning with the all-powerful insurance industry, which stands to lose everything if single-payer is adopted.

And yet, he says, “we must fix health care if we hold out any hope of continuing as a nation of prosperity and providing an admirable quality of life for our children and grandchildren….

“If we agree that a single-payer system is unrealistic, a public option is untenable, and the status quo is unacceptable, how do we craft a solution that provides universal coverage and universal access while controlling costs?”

Here are just some of the good doctor’s recommendations:

• Make insurance regulations federal, not state-based, and establish minimum standards of coverage that include all reasonable treatments derived from evidence-based medical studies.

• Create state-instituted insurance co-ops to purchase policies at volume rates for people not covered by their employers. Trigger a “public option” if the insurance companies don’t cooperate.

• Require everyone to provide proof of health insurance when they file their income taxes. Be tough on those who opt out—make them pay cash for care, and stick to it.

• Require a copayment, however small, for every service provided to discourage overuse.

• Set an appropriate fee schedule for both private and governmental insurers.

• Create a system designed to establish which treatments have the best outcomes and pay only for those.

• Allocate resources that will preserve not just lives, but also quality lives.

• Institute a representative “Task Force for Effective Care” to analyze medical data to determine which treatments have the best outcomes under a variety of conditions.

• Set reasonable caps (say, $500,000) on malpractice judgments for non-economic losses (i.e., pain and suffering).

• Bring down the “wall of silence” by which doctors protect the incompetent among them.

• Place greater emphasis on staying healthy and less on treatment. Spend more on health club memberships and less on cardiac bypasses.

Ultimately, though, any overarching solution rests with Congress, and Congress, Lobosky says, has been bought and sold. It will be up to the American people to rise up and demand reform, beginning with congressional term limits and campaign financing reform.

Unfortunately, both proposals would require a constitutional amendment, and that’s beyond unlikely in the current polarized climate. But Lobosky’s other suggestions are good ones, and he’s right about another thing: We should take a good look at single-payer. As he says, it makes a lot of sense.