Political, market solutions needed to fix health care

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By Sherry Robinson

Martin Hickey has been around the quadrangle in healthcare, working in public institutions (Indian Health Service and the VA) and private.
He’s best known here as former CEO of Lovelace Health Systems, although he worked outside the state for three other companies.
Now he runs New Mexico Health Connections, a nonprofit health insurance cooperative founded in response to the Affordable Care Act.
In a talk before New Mexico Press Women last week, Hickey was frank about doctors, hospitals, and the healthcare system.
“Money has rained down on top of it,” he said, referring to healthcare, and yet outcomes are worse than cheaper systems in other industrial nations. We don’t have real competition between doctors or hospitals, and hospitals are money machines.
A physician, Hickey said he took his last exam in 1981, but he can still hang out a shingle anywhere. You may like your doctor, but you really don’t know how skilled he or she is because they’re never measured.
Some healthcare organizations have gotten better at measuring doctors, but the only people who know the results are other doctors, so “you have physicians working with other physicians, and most of the high-cost doctors will get better or leave.” Still, he thinks all doctors should undergo a yearly simulator test.
A hospital’s “primary purpose is money,” Hickey said. “We’ve gone crazy for murals and four kinds of marble in the lobby. Who’s paying for that? You are.”
And don’t assume for a second that nonprofit hospitals are kinder than for-profits. Nonprofit hospitals will be just as mean when they come after you for money owed.
Hickey describes a free-wheeling system with no real competition, no cost control and no oversight.
“Healthcare can generate its own demand. As a doctor, I can write an order and a procedure gets done,” he said. “The system has evolved where if you do more procedures you make more money. Pharmaceutical companies can simply raise their prices.” What regulation we have is “convoluted and not well thought out.”
Hickey said: “We’ve never had a coherent healthcare policy in the United States – ever.
We need to figure out a way to get costs under control and get everybody covered.”
As he sees it, there are political solutions and market solutions. Which brings us to Obamacare.
Attempts to repeal the Affordable Care Act failed, and political solutions are out of reach because members of Congress are unable or unwilling to compromise.
That leaves the market, but as he already explained, a lack of competition removes the usual mechanisms of supply and demand and consumer judgment.
One of the flaws in ACA is the mandate that everybody must buy insurance.
“Twenty-something men are not going to buy insurance,” he said, because they believe they’re invincible, if not immortal. The penalty was not high enough to make them buy in, he said, and without them, the plan is unbalanced by sicker and sicker people, which raises the cost.
“We’ve got to enforce individual mandates,” Hickey said. “We did it with car insurance, we can do it with health insurance.”
He adds that ACA always had design flaws leading to rising rates. “Had it been set up like Medicare, we would have gone back to Congress for repeated fixes,” he said.
Hickey would like to see employers speak up and say, “No, I’m not going to take it anymore.” He describes employers who grew tired of paying more and more for health insurance and created workplace programs for exercise, weight loss and smoking cessation.
The solution, he said, is a market mechanism with regulation. “We’re also going to have to have political solutions.”
Hickey says he makes himself available to talk to politicians of all stripes about healthcare. Let’s hope they take him up on that.