The current healthcare debate seemed to first center on healthcare reform.  As the details and the “weight” of the bills as drafted became known, the administration began to discuss health insurance reform.  The thinking here was that by changing the terminology the electorate would settle down.

Of course, we know the result – further degradation in the numbers and an angrier electorate.  And now, we find the Democrats calling for reform in context of  “Teddy Kennedy” – the new rallying cry.  Can you imagine, the very guy that used all of his money and power to stay alive is now going to be the posthumous sponsor of a bill that would limit choice, limit treatment and limit life!  In fact, Kennedy loved life so much that he sacrificed a young woman’s life by leaving her in a car in the water, later discovering she had ripped the liner of the car while likely surviving the accident – that is until her air bubble collapsed.  Maybe the Kennedy association would be appropriate for those it would leave “behind” through rationing and allocation of resources.

However, I have a different view that I would offer.  It is essentially based on “five pillars” of health insurance reform – and socialists need not apply.  These pillars or regulatory changes incorporate the best of our private insurance with existing programs and reform that is working.  The key elements are: 

• Transportability
• Pre-Existing Conditions
• Pooling
• Cafeteria Selection
• Tort Reform 

So let’s look at why these regulatory reforms would help solve much of the problem. 

First, transportability is a requirement that will allow anyone with a policy to retain that policy should they change jobs, move to a new market or suffer a job loss over time.  Transportability would ensure that those people who purchase their own policy can retain that policy whether they work for another company or entity that may or may not provide health insurance.

Second, pre-existing conditions must be covered by any newpolicy holder, period.  The idea is that most corporate plans allow for pre-existing conditions to be covered, such as high blood pressure, pregnancy, etc.  This model could be applied through the same reform and ensure that all people who desire to be covered can be covered. Critical to this effort is the need for pooling.

Third, pooling will allow for the further spreading of risk across a larger group of insured.  Texas does this in the state and is looking for the ability to do pooling across state lines.  This is currently limited by federal law.  In addition, pooling is one way the Federal government is able to balance its risk for Federal employee benefits.  If it works for the government plan it should be allowed for the privately insured.

Fourth, a “cafeteria” approach to insurance would allow for selection of different levels of benefits, much as auto insurance or homeowners insurance does today.  The approach would further allow for people who prefer a minimum level of insurance to make that decision, taking this out of the government’s hands.  Further, a cafeteria option would allow for selective insurance based on gender or family situation – essentially reducing the expense for those people who today may be paying for a “blended” policy.

Finally, tort reform must be part of an overall reform package.  Tort reform has been proven to enhance medical care through improved delivery and a reduction of costs related to lawsuits, generally.  It is instructive that the administration has done little to advance this option and has ignored the results in Texas which have clearly demonstrated its success.  It is importantl to note that capping non-economic damages does NOT reduce the payment for economic damages relating to the inability of the affected patient to work or make a living.

And given the scant discussion of tort reform, the Texas model provides an instructive review of its actual benefits to a patient community, those practicing medicine, those manufacturing pharmaceuticals and medical devices and finally the actual cost of insurance generally. The discussion below, presented by Governor Rick Perry of Texas, provides a remarkable picture: 

The state of Texas capped non-economic damages at $250,000 per defendant, or up to $750,000 per incident, while placing no cap on more easily determined economic damages, such as lost wages or cost of medical care due to injury. This ended the practice of allowing baseless, but expensive, lawsuits to drag on indefinitely, requiring plaintiffsto provide expert witness reports to support their claims within four months of filing suit or drop the case. 

These measures were supported by the people of Texas, who in September of 2003 approved a ballot measure, Proposition 12, authorizing all of these changes. Changes were seen immediately, and continue to be felt. All major liability insurers cut their rates upon passage of these reforms, with most of those cuts ranging in the double digits. 

More than 10 new insurance carriers entered the Texas market, increasing competition and further lowering costs. As a result, Texas doctors have seen their insurance rates decline by, on average, 27 percent. 

The number of doctors applying to practice medicine in Texas has skyrocketed by 57 percent. In 2008, the Texas Medical Board received 4,023 licensure applications and issued a record 3,621 new licenses. 

In all, in just the first five years after reforms passed, 14,498 doctors either returned to practice in Texas or began practicing there for the first time. And the reforms finally brought critical specialties to underserved areas. The number of obstetricians practicing in rural Texas is up by 27 percent, and 12 counties that previously had no obstetricians now have at least one.  The statistics show major gains in fields like orthopedic surgery, pediatrics, neurosurgery and emergency medicine. 

The Rio Grande Valley has seen an 18 percent growth in applications to practice medicine, adding about 200 doctors to this critically underserved area. 

And what about the money that used to go to defending all those frivolous lawsuits?  You can find it in budgets for upgraded equipment, expanded emergency rooms, patient safety programs and improved primary and charity care.

Success stories like Texas need to be told and need to be remembered as we continue this national debate. Instead of handing down "one size fits all" mandates on how it's going to be, Washington should be enabling states to set their own agendas, and solve their own problems when it comes to health care.  And of course, these “pillars of reform” do not require the wholesale takeover of our healthcare system by an administration that has been unable to gain the trust of the people by promoting its current agenda.  Again, Socialists need not apply!