Letter to Joe Courtney, US Representative from Connecticut - Health Care Solutions

Letter

Dear Congressman Courtney,

At Tuesday night's debate at The Garde in New London you complained that Republicans are big on criticisms of the Affordable Care Act (aka Obamacare), but never offered any solutions. You challenged Lori Hopkins-Cavanagh to offer a solution. Having been excluded from the debate, I was not able to offer a response at the time--but I have one.

Let me begin by briefly reviewing the problems with our current system and the ACA, many of which you acknowledge. Our system is so complicated that it is a burden on all and an impediment to those the ACA most sought to serve. Emergency room visits (the most expensive, but easiest to understand health care--you just show up) are rising. Full time jobs are being converted to part time jobs as employers seek to avoid new burdens.

The incentives are still not right. Providers being compensated for treating us instead of for keeping us healthy (driving up treatments, operations, visits, etc.) and patients have little incentive to make healthy choices. All of this has resulted in US health care costs per person being 50% higher than those of any other country, while our health outcomes are chronically among the lowest of developed nations.

Components of the solution we need are,

1) Providers should be compensated for keeping us healthy. Public and private models for this exist in the US and in other countries.

2) Patients should have incentives to adopt healthy lifestyles (diet, exercise, regular checkups, etc.)

3) A simple, universal health care system.

Regarding the last of these, some have argued that health care is a basic human right, but I disagree. It is hard to argue that anyone has a right to something that must be produced by someone else.

But we all agree that universal K-12 education should be universally provided because of what Nobel Prize winning free-market economist Milton Friedman called the "neighborhood effect." Friedman recognized that an educated population is critical to our democracy and our economy, meaning that the education of any of us is valuable to all of us (we benefit from the education of our "neighbors").

Economists recognize that the same is true for health care. Whether it is in controlling epidemics or reducing absenteeism, the health of any of us is important to the well-being of all of us. As such, the same reasoning that supports universal K-12 education supports Universal Health Care.

It is critical, however, that patients must continue to have choices. The state might be the single payer, but it should not be the provider--the market should do that. Competition is key to controlling costs and improving outcomes. And patients should still be allowed to purchase private insurance for additional coverage if they wanted it. That is common in other countries with Universal Health Care.

Let me reiterate that it is important that we move away from the "fee-for-service" model, which drives providers to increase procedures in search of revenue. New payment models, such as Direct Primary Care and the New York Delivery System Reform Incentive Payment (DSRIP) Program compensate providers for maintaining the health of their patients over time instead of for doing operations, tests, and other procedures, which may not be necessary. Our new health care system should do that too. The net effect of these changes would be significantly lower costs with better health outcomes for all. I am happy to talk about this more if your have time and are interested.

Best regards,

Bill Clyde

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