By now, everyone has seen the young Google executive, Wael Ghonim – credited with starting the Egyptian revolution via Facebook – proclaiming his willingness to die for the cause. I predict he will not only become an Egyptian national hero, but that one day he will be nominated for the Nobel Peace Prize.
But, where, oh where, is the Wael Ghonim of health care? Who is out there that will proclaim that they will fight to the death (or even fight to a bit of discomfort) for the cause of health reform. I don’t know anyone – right, left or center- that, when speaking honestly and in private, will say that the US health delivery “system” is working for the American people – you remember those folks, the ones we hear about so often during hotly contested political campaigns.
Plenty of people are hurting as a result of our collective failure to rally for the cause of equitable, accessible health care for all. We now have politicians holding hearings on the impact of those supposedly economy- killing regulations, such as environmental protections or workplace safety rules. Oh yeah, guys, protect us from the dangers of mandating safe workplaces and a clean environment, but don’t dare talk how bad it is for everyone – US business included – when the US health insurance industry playbook has run out of options and appears to be entering the “death spiral” phase.
Death spiral? What on earth am I talking about?…let me try to explain. As more and more people opt out or are priced out of coverage, only the really needy – those with high burdens of illness and health care costs– hang on. So people that struggle to stay in insurance pools are sicker and costlier than the general population, and, thus, drive up the costs of coverage. As the cost of insurance goes up, more people make the decision to opt out….and on and on fueling a spiral that will lead inevitably to only a small percentage of people having really, really expensive “insurance.”
Sure there are exceptions to the death spiral scenario. Consider members of Congress – you know those folks, many of whom say the country can’t afford health reform – well they are handsomely insured through the Federal Employees Health Benefits Program (FEHPB)…a relatively rich and reasonably priced insurance program that we should all be so lucky to have.
But let’s face it, the reality for the average guy on the street is drastically different from that of his or her Congressman– Joe Blow and his family, if they are fortunate enough to still have health insurance, are facing higher and higher premiums and deductions every year with less and less of their health needs covered. I found it pretty interesting to hear from a leader in the Centers for Medicaid and Medicare recently that he was shocked to have to fork over a $200 co-payment to his HMO to cover his share of costs for a diagnostic procedure. As a Federal Employee, he probably is covered by FEHBP. If an uninsured person needed the same test, his or her share of the cost would most likely have been in a thousand dollars or more. Let me see…pay the rent? buy the food? Or get the test? Hmmm….
So, where is the outrage? Why are people continuing to put up with the inequity and this broken system without a protest? Michael Millenson, on this blog, summarized it nicely in his post titled, “Why Aren’t The Uninsured Protesting In The Streets Like The Egyptians?” We need folks to speak out even if it is not “politically correct.” We need to stop believing the lies about the dangers of reform and we need to get about the business of fixing a terribly broken, unfair, inadequate system that right now is not doing what a health system is supposed to do – provide care and coverage for “the people.” We need health care reform and perhaps, we need a health care revolution. For sure, need a Wael Ghonim.
Patricia Salber, MD, MBA is Co-Founder and Principal in Zolo Health Solutions, which helps health systems transition into Accountable Care Organizations.