We are Americans. We want our solutions quick, total, and now. So every four years we corner our presidential candidates into a series of fast-fix promises almost destined for disappointment.

Typically, our candidates always have such solutions in ready supply. But in the current race, when it comes to the complex issue of healthcare, it appears as if both the candidates and the public are seeking some deep and major overhauls.

With 47 million uninsured Americans, spiraling care costs, and both workers and employers unable to handle the premiums, healthcare is truly a problem no sincere candidate can ignore. To determine exactly how the election may spotlight and alter our current system, the Human Resource Management Association has invited attorney Henry Fader of Pepper Hamilton to speak on “A Presidential Year and Healthcare: A Good Mix?” This HRMA breakfast seminar takes place on Friday, September 26, at 8:30 a.m. at Pepper Hamilton’s Princeton office, 301 Carnegie Center. Cost: $20. Visit ww.hrma.org.

Despite being Philadelphia-based Pepper Hamilton’s head of healthcare practices, Fader insists that he fell into the whole specialty. A native of Long Island, Fader attended the Rochester Institute of Technology, graduating in l968, before earning his law degree from Syracuse. He then centered himself in Philadelphia, working for Fox Rothschild, and later Schnader Harrison.

During these early years in the l970s hospitals and insurance coverage were expanding. Fader was serving on Pennsylvania’s State Chamber of Business which sought a dialogue between insurance firms and government. “What I quickly discovered was that these two entities really did not know how to talk with each other,” says Fader. Thus he was drawn into taking a liaison role, and has remained a healthcare specialist ever since.

Fader has served on the Pennsylvania Cost Containment Council, which collects data on the state’s hospitals. “Actually, I must say that since the 1980s, in most hospitals, the nursing staff has gotten better and doctors have become much more willing to work as team players,” Fader says.

However frightening healthcare costs may seem today, Fader assures us, we haven’t seen anything yet. “There is no indication in any foreseeable future that patient and hospital costs will get controlled,” he says. “The increase in building costs, the new technology, larger volumes of testing, all point to higher treatment costs.”

Promises v. hopes. Over the last eight years the percentage of uninsured Americans has climbed double digits annually. Today one out of six voters have only their own wallets when they enter a hospital, physician’s office, or drug store. Politically, such a problem cannot be sidestepped.

Fader notes that, traditionally, the Republicans have sought solutions based on personal responsibility while Democrats have fostered ideas of change within government for new controls. Each has its problems.

In l992 Bill Clinton took the Democratic presidential nomination with a proposal of broad healthcare reforms, hinting at some kind of overall government system. Republicans briefly countered that such “government pork barrel spending” was unnecessary; existent private healthcare needed no fixing. Public response was immediate and outraged. Within a few weeks, Republican leaders had come up with a similar, federal aid-based program that claimed to cut costs and be more inclusive.

Clearly, the public is calling for some federal help. At the same time, having the government handle healthcare is a truly daunting task. “Innovative work in government is a hard thing,” says Fader. He notes that most major government efforts in this country are contracted out to private industries in some form anyway.

“We’ve been headed this way a long time. If any politician says he can turn the battleship in six months he is just wrong,” says Fader. “In the end, I see that our next administration will end up tweaking the healthcare system, but not really being able to overhaul it.” It might include a changing of Medicare to a sliding scale, so the wealthy don’t get a free ride. Yet at the same time, healthcare has become a party plank equal to war and education in the current campaigning.

Patients’ plight. As the situation stands, the 47 million uninsured are not gathering great political sympathy in all corners. Pennsylvania Governor Ed Rendell, a Democrat, has referred to the uninsured as “the free riders” who are not paying their fair share of the nation’s healthcare tab. Solutions have ranged from the distribution of mandatory insurance cards to every citizen, to the less drastic Obama proposal which aims to be more inclusive through subsidy.

However, these uninsured may not be a whole lot worse off than those covered. The great dream of consumer-driven healthcare, in which participants set aside certain portions of income for individualized healthcare treatment, seems fading. Fader notes that, like many plans, it brings little aid to the lower socioeconomic groups who tend to hold back on healthcare dollars while the wealthier can afford to be hypochondriacs.

“Surveys continually show that our healthcare level is not up to where we want to convince ourselves it is,” says Fader. Increasingly, insurance companies are denying payment for correction of erroneous hospital treatments. A botched procedure or accidental burn incurred during surgery? No coverage. Additionally, the hospitals must take in all comers, including the uninsured whose bills get negotiated with the insurance providers.

The hospital’s portion comes out of its budget, meaning less service for the patient. The insurance company’s portion of non-payer’s bills gets merrily passed onto the payers as higher premiums. Either way, the patient loses and the public pays.

Insurer v. hospital. Meanwhile, Fader points out, the crunch is on. Plunging financial markets have lessened insurers’ capitalization and given employers less money for healthcare premiums. To fend off premium cost spirals, insurers have begun drastically reducing payment amounts to physicians and hospitals. In most cases the recipients of this short change wince and take it. Most, but not all.

“If it is a known hospital, or one with a renowned specialty, they have some clout,” notes Fader. “The hospital can refuse the proposed payment cut and say, ‘We won’t accept your people at our hospital for that price.’” The insurer then gets pressured to the negotiating table by his clients, demanding that this name hospital be on their list. Hospital and insurer sit down and decide what patients they will take for what price. Thus, there is a little bit of elbow room and often the patient wins.

It is in the expansion of these connective workings that most politicians find their hope for change. Collaboration between healthcare and insurance providers, overseen by government (and its potential funding) is at the heart of most proposed plans. Yet whatever the promises and whatever the actual deliverable improvements, healthcare has become real election dealbreaker. As Fader puts it, “the candidate who wins will be the one who can truly find a way to enroll in state healthcare plans those who can currently not afford it.”

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