Former Surgeon General C. Everett Koop told members of the Class of 2000 last night health care reform in the immediate future could lead to either a successful merger of the best aspects of previous health care systems or lead to a system that will collapse in 30 to 35 years.
In a speech titled "Will Your Parents' Medical Bills Threaten Your Financial Security?" delivered to about 115 freshmen in Spaulding Auditorium, Koop described the evolution of health care since the start of the Clinton Administration and the possible outcomes of health care systems in the future.
"If things were bad when Clinton came on board, they have gotten no better and in many instances they have gotten worse," Koop said.
America in the near future could see a system based on greed with soaring health care costs, a merging of the best aspects of managed care and fee-for-service health care. It could also produce a government-controlled health care system, which if history proves correct would fall apart within three decades, Koop said.
Koop's speech explained the recent metamorphosis of managed care systems and health maintenance organizations that have replaced many fee-for-service plans.
He said in the past citizens with insurance went to doctors, received their bills and sent them to the insurance company under previous fee-for-service systems.
But he said in the years leading up to the Clinton Administration hospitals and insurance companies began shifting the growing costs generated by uninsured patients at hospitals to the insured "people, like your parents" by inflating the price of their services Koop said.
This trend led to the rise HMOs, which provide coverage to members but do not charge more to help defray costs of the uninsured, he said.
But Koop said such practices negatively affected health care in the United States. "The working poor ... now are absolutely out in the cold," Koop said.
Uninsured patients are now treated later and with less quality than insured patients, he said. Koop quoted studies showing death rates up to three times as high for uninsured patients as compared with insured patients with the same affliction.
Koop said another problem with HMOs is the amount of coverage their members receive may not be sufficient.
"HMOs dramatically restructure financing and delivery" of health care, Koop said. "HMO members usually pay an annual fee," he said, and in return the HMO provides what care it deems necessary.
Koop said cutting costs has now become more important to many HMOs than providing health care.
"Many HMOs limit the time a patient may spend with their doctor to 14 minutes," Koop said. Some HMOs also prevent their patients from seeing their doctor of choice, he said.
But Koop also said HMOs could alter the health care industry for the better.
"No doubt there will be good HMOs and bad HMOs just as there are good doctors in America and bad doctors in America," Koop said.
Managed care is another recent health care development that limits the amount of medical care patients receive, Koop said.
He said managed care can make it profitable for doctors to withhold treatment, which damages the important doctor-patient relationship.
Koop also stressed the importance of training doctors to stay abreast of current medical information.
Teaching doctors to study in the 30 to 40 years after their residency is more important than teaching them to study for medical exams, he said.
He also discussed the role of new technology in the medical industry and described how the information superhighway could connect every hospital and doctor's office in the country, providing instant access to medical records and information.
Koop is the Elizabeth DeCamp McInerny Professor of Surgery and the Senior Scholar of the C. Everett Koop Institute at Dartmouth.
