"Like Sand through an Hourglass..."

With apologies to all of you soap opera lovers - “Like sand through an hourglass so are the days of Health Care Reform.” Since 1994 I’ve used the hour glass as a metaphor for our Health Care (HC) and HC Financing (HCF) systems.

In the next few months the TV lobbying / advertising drama (being played out in one minute snippets by the reformers and the status quo advocates) will resemble soap operas. So like the days our lives - will be the days of Health Care Reform.

Experience indicates that most people believe we have two health care systems - one for the poor, underserved, aged, and needy and the other for the folks with individual and / or group insurance coverage - this is the rich, the employed, and folks with “resources” and / or good luck. I disagree - I believe ours is one system.

Visualize an hourglass. Equalize the sand on both sides and then lay the hour glass on its side. In this metaphor the sand is people and dollars. On one side is the “public sector” - Medicare, Medicaid, the VA, state / charity hospital systems, etc. On this side the costs of care provided are paid by taxes and out of pocket monies.

On the other end of the hourglass is the private sector. This is the insured population - those individuals that have bought their own policies or have been provided coverage (and sometimes premium subsidies) through their employers, association, or other group mechanism. On this side of the equation costs of care are paid by premium dollars and out of pocket monies.

Now before you scream that my visual is as flawed as the current systems since I have ignored 40 - 50 million people who are uninsured, I encourage you to hear “the rest of the story.” The uninsured can get care - they don’t get insurance.

When individuals in the public sector and the uninsured use services that are not covered by a public or government plans, these folks run to the private side - where they obtain services needed at their own cost or they use the private sector on a “free” (to them) and uncompensated (to the provider) basis.

When the government does not adequately compensate providers - the share of uncompensated costs are shifted to private side resulting in premium increases - in effect a “tax” on these plans (some project this cost to be 15 - 20% of premiums). When the public sector offers increasing services or demand for services increase - the hourglass is flipped over and tax dollars flow from the private to the public side.

It is a fact that Medicare and Medicaid are now underfunded in the short term to providers and unsustainable in the long term. A public plan that pays full costs for services will not be competitive and a public plan that does not pay full costs will force the private sector plans into a non-competitive position and ultimately bankruptcy. So as you can see - Health Care Reform is like “sand in an hourglass.”

Copyright - Michael G. Manes (July 2009)
All rights reserved