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The Elephant in the Room’ Is Not Being Discussed

2009 will be the year health care reform will finally become a reality. President Barack Obama and the Congressional leadership have made it clear that this is the top agenda item for the country.

[IMGCAP(1)]Although Washington, D.C., will be the center of action, health care reform will have a significant, lasting impact well beyond the Beltway, with communities big and small affected by the outcome.

The president has said repeatedly that if you like your health plan today — and research shows that most of us do — you’ll be able to keep it. But will all of the benefits, options and disease management programs you receive today remain in place after the reform debate is complete? What will be the cost to taxpayers, and how much more will each American be expected to pay under a reformed system?

Don’t let the rush to reform health care deter you from becoming informed and involved.

The Medicare system has been held up as a model for the government option. While Medicare and Medicaid serve an important role in providing low-cost or no-cost health insurance to those who truly cannot afford it, those programs are riddled with problems — from the inability to eliminate poor-quality providers to underpayment of doctors and hospitals, which in turn shifts this additional cost to the private insurance companies.

Unfortunately, the elephant in the room is the impact a broad government option will have on the average American if implemented. With private insurers currently subsidizing both Medicare and Medicaid to keep those programs affordable for low-income Americans, the true cost of a broad government option is underestimated. Who will pick up the tab? You, the American taxpayer.

This is similar to the situation Ford Motor Co. finds itself in. Ford chose not to take government funds as it restructures, while GM and Chrysler did and now have access to funds at a zero percent interest rate. Without access to such a low rate, Ford is already behind the eight ball as compared to its competitors.

We can expect a similar scenario in health care. Although the president has said he favors including a government plan because it will spur competition and keep the private insurance companies honest, the opposite is true. A government plan will force out private plans because they will not be able to operate within the price structures the government would enjoy. That means less competition — the one thing that we all know will increase cost and decrease quality.

Ultimately, that will lead to higher health care costs and rationed care. Why? Not enough doctors and hospitals will be able to afford to stay in business. Consumer demand will quickly outpace the public plan’s ability to supply care, as we’ve seen in Britain with the National Health Service, which has had to rely on the private sector to add capacity for the government-run NHS.

Private insurance is not without its flaws, too. The big question is what is the solution? Unfortunately, there is no silver bullet, and anyone who suggests there is, is not truly informed. What is certain is that any reformed system must provide coverage for all Americans, expand the current health care safety net by eliminating pre-existing conditions, streamline the exchange of clinical and administrative patient data, and eliminate frivolous lawsuits against doctors.

Reforming health care will strain the imagination and skills of our Representatives on both sides of the aisle and stakeholders from throughout our industry. Each of them has a vested interest in achieving reform on their terms. And so should you.

The final reforms will affect our nation for generations to come. Ensuring continued access to critical medical services provided by the best doctors and hospitals is something each of us has a stake in. And each American needs to take this responsibility seriously. Because when you or a loved one needs access to the best medical care available the outcome of this debate will be your only option. Now is the time to do your homework and make your voice heard.

Karen Greenrose is president and CEO of the American Association of Preferred Provider Organizations.

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