Editor's Note

Creating Options

Health reform must source coverage from both the private and public sector.

• By David Kopf
• Aug 01, 2009

I’m not sure if what I’m going to say is going to be popular or not, but here goes: if the United States is going to successfully reform its healthcare system, it needs a public option.

Talking heads and pundits can drone on and on about how a public option would be “socialized” medicine, or the “terrors” of healthcare in Britain or Canada (rhetoric that is highly debatable), but all that wailing and gnashing of teeth is truly a much ado about nothing, because the current healthcare reform package is hardly “socialized” medicine.

So far, what has been coming into focus is a healthcare landscape that looks a lot more like what Switzerland and the Netherlands have: a compulsory government healthcare system that works with various private payor insurance firms to provide the nation’s healthcare under the governance of a large public healthcare agency that controls the process.

At press time, the Obama administration has only toyed with whether or not it would it wouldn’t even be amenable to the notion of including a public entity, such as Medicare, that provided public healthcare coverage, but it certainly hadn’t made that a necessary component of the healthcare reform it is trying to build.

To me, that’s exchanging one unworkable scenario for another. As we have seen with Medicare, public agencies do not grasp what it takes to provide decent healthcare (hence competitive bidding and the 36-month oxygen rental cap, for example). However, I think it is fair to say we have also seen that insurance companies are not as invested in quality patient care as we would like, either, as they try to maintain margins while the cost of hospital care goes sky high.

However, if we created a system that sourced its healthcare coverage from both the private and the public sector, I believe we could create a system that truly kept prices at a reasonable level while fostering quality of care. The public entity would keep the private sources in check by constantly focusing on protecting the taxpayers, while at the same time, the private sources would be forced to differentiate themselves through quality of care, thus pushing care standards higher. Moreover, I believe that HME providers and the rest of the homecare industry would be key players in such a landscape given their ability to help ensure quality care at a cost far below that of hospital care.

Ultimately, what we need is balance, which is how we approach our government anyway. So why not do the same for our healthcare? Besides, what I’m describing is not unlike what the U.S. government provides to Federal employees. Why not expand it to function as a national system? Cost-efficiency and quality care: those are the goals.

In fact, Congress and the Obama administration could learn a thing or two from the HME industry when it comes to striking that balance between price and quality. No other component of the healthcare industry has been forced to undergo the revenue pressures that HME providers have, while continuing to stay committed to delivering high-quality care to patients that need it. That’s why we’ve devoted this month’s cover story, “Your Pot of Gold” to discussing how providers can leverage their HME software systems to optimize their billing and maintain cash flow.

Speaking of cash flow, my biggest issue with healthcare reform is that I can’t tell if the timing is right for it from a cost perspective. Legislatively, we couldn’t ask for a more fertile lawmaking environment. However, as we all know, the Baby Boom is entering retirement, and its members will increasingly need more healthcare as they age. Creating a system that efficiently delivers cost-efficient quality care to a demographic of 78.2 million people — along with the rest of the nation — is a great idea, but how can the nation pay for it using a tax base that’s mired in a down economy? I hope I’m not the only one asking that question. …

This article originally appeared in the August 2009 issue of HME Business.