The voluminous healthcare bill  passed by the House of Representatives last week overlooks several of the most egregious problems in our dysfunctional system.  Among them:

 Lack of meaningful oversight of the hugely expansive and expensive private insurance industry bureaucracy, resulting in rate increases that do not go to patient care. The most recent memorandum from the board of the group health insurance plan associated with my workplace shows double digit increases in the rate history of the medical plans provided by this group.  These are increases above inflation and cost of living and above the rate of any raises received by the average American. 

 Interestingly, some of the largest increases came in 2009, as health insurance reform started to move forward (from 12.4 to 28%, depending on the plan). Insurers are not stupid. They know how to make a fast killing as reform creeps forward and there is nothing to mandate that such actions do not continue into any reform era.      

 Tiered prescription and prescription precertification. Insurers are making medical decisions.  Insurance companies are mandating increasing numbers of medications must be pre-certified.  Insurance companies, not physicians, will tell you whether you are allowed to take the drug prescribed by your physician.  This is happening now and nothing in the legislation will prevent more of this in the future.

 Who will investigate the subversive practices that are emerging, such as demanding precertification for an ever-expanding list  of procedures and then denying payment (a practice that is growing at a startling speed)?  

 Will Congress now make a change and ensure strong oversight of this industry?  Who will monitor the rate increases?  What will be the penalities?  Who will enforce the law? Too many in the Congress have conflicts of interest when it comes to the industry–whether through contributions or spouses sitting on boards or lobbying for the industry. 

 The insurance companies have been emboldened by the ineffectiveness of Congress on health reform.  Until Congress can push back and ask the hard questions of the companies that over the last decade increased rates well beyond any cost of living or national standard, we will have no real reform.