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Editor's Page: National Healthcare Challenges

Editor's Page: National Healthcare Challenges

Healthcare — its costs, outcomes, insurance, and politics — are everywhere in the news these days, and not only because President Obama wants reform.

At a time when budget deficits are on everyone's mind, the festering issue of unfunded Medicare and Medicaid obligations is growing too large to ignore, especially with the imminent retirement of the baby boom generation. And anyone who thinks that the nation can put off dealing with such concerns for another decade, as we did the last time around, is delusional. The issues and costs are real, the need for a national consensus on how we will deal with them is great, and the time surely is now, before we enter a period in which congressional and presidential election politics makes consensus impossible.

Those in our audience who work in healthcare know the cost of providing care to the indigent and uncollectible is top of mind for every healthcare administrator. In the end, the rest of us pay these costs in our insurance rates or with our taxes because there is no where else they can be shifted. Those who say we cannot afford to insure everyone miss the point. To a large degree we do afford it — the costs just aren't clearly accounted for.

By nature, I am a free marketer. As Thoreau famously said, that government governs best that governs least. But there are times when a free market seems incapable of addressing our communal needs, and healthcare insurance certainly seems to fall into that category. That's because in a free market, insurance companies would seek to avoid insuring those who are already ill (it does), to terminate coverage of those who become ill (it does) and to ignore the issue of covering the indigent who can not pay (it does).

That indeed is our reality today.

For the most part, the insurance industry has not done very well at helping to control healthcare costs either. It has done well at cost shifting: for example, negotiating lower treatment costs for those who have insurance than those billed to patients who don't.

And when small businesses, like restaurants, try to extend healthcare benefits to employees, they often find they'll have to bear insurance costs much higher than those obtained by corporate and institutional entities. In my mind, there is no reason an employer of 200,000 should be able to negotiate lower healthcare insurance rates than an employer of 20. Delivering healthcare services is not like delivering a carload of potatoes.

When such inequities exist, they also tend only to shift the true costs elsewhere. The aggregate system costs remain as high as they were, and still must be paid somehow.

This is not to say I agree with those who think a government-run healthcare system is inevitable or the best way to address the challenge. Monopolies — and especially government monopolies — have never been in the public's best interest for long.

As Obama rightly points out, we need to look harder at those healthcare service providers — like Geisinger, featured elsewhere in this issue — which have managed healthcare costs, quality and outcomes more effectively within the competitive marketplace we do have. There is much we can learn from them.

To make competition work in our national interest, we need to level those parts of the healthcare playing field that today let cost-shifting substitute for strategy. That — along with fairness to taxpayers and employers as well to those on the lower rungs of our social ladders — should be our goal.

Yes, the costs are great and they must be managed. But they will be there, and will likely be even higher, if we do not face up to the challenge.

What we need is not a government takeover, but government policy. And those politicians who work only to spread fear about the former need instead to help us develop the latter.

It is time for elected officials to face the fact that it's their job to help us reach a national consensus on this issue. When they allow political positioning, partisan squabbling and simple irresponsibility to win out, they fail us. And in the matter of a national healthcare policy, Washington has failed us for too long.

If you agree with me on this, make your voice heard.

Elsewhere in this issue you will find a feature recognizing FM's Best Concept Award winners. It's always been our position that there is much more creative thinking and innovation in onsite foodservice than it gets credit for, and our goal is to point out examples of that innovation and share them with others.

We'll be celebrating our winners' successes with a banquet in their honor at the FM IDEAS Conference in September. (For more information, go to

We invite you to join us there and in recognizing this year's winners. And to this year's winners: Congratulations from those of us on Food Management!

TAGS: Healthcare
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