Healthcare reform: The more I know, the less I understand

The healthcare reform law is indisputably an emotionally charged, complicated piece of legislation that can thwart even the best intellects and intentions.

Just take LifeScience Alley’s seminar on how the law will impact Minnesota’s healthcare industry. I witnessed an unfortunate analogy, two Freudian slips and an ill-conceived attempt at humor… I think.

We’ll start with the keynote speaker, Sen. Amy Klobuchar, Minnesota’s senior representative in the U.S. Senate. Unlike most of her colleagues, Klobuchar has largely avoided obsessing over the law’s more notable features, such as requiring everyone to purchase insurance or prohibiting insurers from denying coverage based on pre-existing conditions.

Instead, Klobuchar has consistently focused on the less-sexy aspects of reform: the creation of the Patient Centered Outcomes Outreach Institute, comparative effectiveness research, payment bundling, and measuring the quality and cost of care through a national Value Index.

In short, she concentrates on the parts of the bill that try to lower costs by reforming a dysfunctional payment system that rewards volume over outcomes. In Klobuchar’s eyes, Minnesota gets penalized because it offers superior, affordable care — most Medicare money goes to states that don’t.

Through well-designed cash incentives, Klobuchar says we can change the culture of healthcare to promote quality and value. But here’s where Klobuchar veers off track.

Citing a piece in Atlantic Monthly, Klobuchar compares healthcare to agriculture. In the early 1900s, food production was inefficient and expensive, consuming nearly 40 percent of a family’s budget. So the government stepped in, offering farmers cash to rotate crops and share comparative data to raise yields. Today, food makes up 8 percent of a family’s budget.

Klobuchar needs to work on her historical analogies. Yes, food is inexpensive today, mostly thanks to the billions of dollars of questionable subsidies Uncle Sam bestows on farmers every year. Such subsidies not only break the bank but also cause tension with global trading partners. And thanks to low food prices, obesity and diabetes run rampant in the United States: a major reason behind… wait for it… escalating healthcare costs.

Socialized medicine? What about socialized agriculture? If Klobuchar is trying to promote healthcare reform, perhaps comparing it to a bloated, outdated system that gorges on government money is not the best way to do it.

At least Klobuchar made it clear she supported the reform law. I wasn’t so sure with Roger Green, vice president of strategy, policy and communications with the HealthEast Care system.

“For the record, I support Obamacare,” Green said.

Hmmm. “ObamaCare” is a term normally used by critics to deride the healthcare law. There’s a reason why even President Obama won’t call it ObamaCare.

Google Obamacare and this is what you get: “ObamaCare Watch,” “The Truth about ObamaCare: What the Liberal Media Aren’t Telling You About Obama’s Healthcare Plans,” and a Time magazine piece titled: “The Fatal Flaw of Obamacare.” (Apparently, the law is so divisive, we can’t even agree on whether to capitalize the “c” in Obamacare.)

Green fired off another Freudian slip.

“The implications of this mess… this mess?” said Green, not quite believing what he just said. “I supported it!”

Green criticized the law for cutting Medicare payments to doctors and forcing greater Internal Revenue Service scrutiny of not-for-profit hospitals’ tax status.

I was still waiting to hear why Green supported the law. He eventually got to that — additional federal funds for information technology, greater collaboration between hospitals and doctors, and a focus on transparency and costs controls.

Ah, okay.

I’m not sure if Donna Zimmerman, senior vice president of government and community relations for HealthPartners, was trying to be funny. But after two hours, the crowd was sure not in a laughing mood.

Zimmerman correctly observed that passing the healthcare law was just the beginning. The real battle will be how interpreting and implementing the complex legislation over the next several years — a job tailor-made for lobbyists like herself.

“It’s a great time to be in government relations,” she said, beaming. “Work is good if you’re in government relations.”

With all of the stress and complexities of healthcare reform, I doubt the audience shared Zimmerman’s joy about lawyers and lobbyists being gainfully employed for a long, long time to come.

But heck, at least somebody’s happy.