On Healthcare
Tue, 07/21/2009 - 16:26 — indymike
I'm a little pissed off right now. Our politicians just don't get it. When it comes to healthcare, it's not real complicated. I want:
Security: To be able to get medical care without fear of being bankrupted or losing their life savings.
Stafety: A system that "does no harm."
Freedom: The ability to make choices and select providers.
Obama's plan fails to deliver any of the above. It is overly complex, has too many layers of bureacracy and would strip protections from negligence. Obama's bill flat out should not be passed, ever. The Republicans on the other hand don't get it either. Their "resist Obama at any cost" strategy leaves us with more of the same, except different in the same way. Maybe the time has come for our lawmakers to stop delegating all the details to staffers, special interests and passing thousand page laws without reading them. Here are a few suggestions for fixing health care that might make a real difference:
Force providers to disclose costs prior to delivering care to the consumer and insurance company. This allows the you to leverage competition to get better prices.
Fix adverse selection by shifting the cost for expensive long term, chronic conditions to the Federal Government. This keeps annual premiums low and healthy people in the system. Annual premiums are set by assessing risk in a group being insured. Chronic conditions like diabetes or cancer aren't a risk, they are a certainty for the insurer to pay for and they mark up the group's insurance to cover. Adverse selection is where healthy people opt out of health insurance because it costs to much and they don't need it.
Provide an incentive for employers to provide on-site clinics and allow smaller employers to create co-op clinics for primary care. Getting treated at the emergency room costs five times more than the doctor's office. On site clinics fix this problem and another: the cost of routine doctor's office visits.
Copyright 2008, Mike Seidle.
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Comments
National Healthcare - No Thanks
One thing I rarely hear mentioned when people complain about spiraling healthcare costs is the growing number on "medical conditions" that various government agencies mandate be covered (acupuncture, hair transplants, in vitro fertilization, etc.) Obviously, health insurance providers must raise premiums in order to cover these expensive, elective procedures.
While I'm no expert on all the nuances of the current debate, I'm instinctively opposed to the federal government taking over anything as critical as healthcare. I'm well aware of the rationing of "nationalized" care in both the UK and Canada, and of the exploding costs of both Massachusetts' and Hawaii's state-run healthcare programs. Thus, I question whether Obama's proposed plan will reduce costs while improving care.
My experience is that the primary objective of any bureaucracy is to grow that bureaucracy (regardless of the service level provided to people it serves), and the primary objective of any politician is the furthering of his or her political career (regardless of the damage caused to his or her constituents). So, if adding expensive, non-essential medical treatments will grow the bureaucracy, and if demonizing insurance companies will buy votes, so be it.
As vilified as Corporate America is, I ask you which "motive" does the most good for the most people ... the "profit motive", or the "re-election motive"?
Modifications
* Tort reform: The problem is balancing the fact that medical mistakes often do end up permanently damaging people's lives, and capping the payout for that is ludicrous. If you permanently disable a 20 year old by accident, you could easily prevent them from millions of dollars of earnings over a career and put them on government rolls (disability, Medicare, etc) for the rest of their lives. Yet a cap on malpractice would essentially prevent the victim from receiving enough in a lawsuit to cover costs of getting used to a new disability, much less cover lost income, etc.
* Cost disclosure: Not all medical costs are incurred when the patient has time to shop around, and there is no guarantee that the prescribed care won't have additional costs incurred due to unforeseen circumstances. Perhaps an insurance solution would be to require cost disclosure, and then offer the patient the choice: accept the stated cost but accept that further costs may come out of pocket, or pay a higher cost that will automatically cover any further costs due to unforeseen circumstances (which doctors cover with an insurance package of their own). Doctors with a proven track record will be able to offer lower costs.
* On-site clinics: For this to work, employers must have immunity from damages, and employees must have assurances that the clinics do not actually report to their company. Having it run by a company like MinuteClinic would be an ideal solution. I wonder if someone could rig up a MinuteClinic-type operation in a bus for something like this...
As a note: the flowchart shown is...no more complicated than what we already have, either on the government or private insurance side. No matter who is paying the initial or final bill, health care is and will remain complicated.
There are other necessities:
* Provide comprehensive support, then penalize people for not taking care of chronic conditions. Reform must include sticks along with carrots, and one of the key drivers of cost are people not properly managing their chronic health issues (diabetes is a good example here).
* Refuse to cover self-inflicted injuries. If you refuse to wear a seat belt, and get thrown out of a car, then it's your own fault, and you should pay for the costs of treatment. A doctor should have every right to only provide the absolute minimum of care unless you can cover the costs of additional treatment. If you burn down your own house, your insurance company won't pay - same principle.
* Expand S-CHIP to allow credits that would help reduce the cost of company Family insurance plans based on income. Lowering prices on family plans for low/middle income families will help increase the number of insured adults, and it would move people off the government plan and free up slots that doctors usually have filled.
* Remove state mandates for care. For the most part, they're completely wasteful. Obama's idea of having this handled by a committee of experts only works if the states have to butt out.
Great Comment... BUT
Ed - Great comments... and some great ideas:
Tort Reform - Right now, the threat of lawsuit is the only real protection a consumer has. Health care providers always seem to want to address malpractice costs as a solution, but as a whole, people are very afraid of what would happen if you take away the only real protection they have. This can be addressed, but only if it's fair - there has to be something the consumer is getting in return for changing this.
Cost Disclosure - Sure, some costs are emergency care. But most care from lab tests to surgery could easily be shopped if customers knew prices. Cell phones are everywhere.
Self Inflicted Death Sentences -The idea of not covering self inflicted injuries leads to some very arbitrary life or death decision and probably isn't a good idea. Who rules on what is self inflicted? Does someone deserve a death sentence because they ate too many whoppers or jay walked? I do not believe so
The problem with a system like what you are advocating is that it strips away freedom and creates more situations where the government is using providing or withholding care as a means of forcing compliance (btw - this is the opposite of freedom).
Tort Reform - Exactly. Cost
Tort Reform - Exactly.
Cost Disclosure - I'm sure an iPhone app that did this would be quite popular. :)
Self Inflicted Death Sentences - Note I said injury, not condition. Eating too many whoppers is fundamentally different (and subjective) than injuries caused by not wearing a seat belt, using fireworks improperly, or accidents following the words, "Hold my beer and watch this!". Your note about jaywalking, however is not an issue of freedom - if they were jaywalking, they are committing a crime. A minimum amount of care to save the patient is one thing - but anything outside that minimum should come out of the patient's pocket, not insurance or government.
With freedom comes responsibility - a person has the right to be an idiot, but what happens afterward is their responsibility.
Mike: I agree with you that
Mike:
I agree with you that all of us have made health care unduly complicated. And the reason is simple. We refuse to admit that the only simple solution is national health care with the government as the primary provider. The simple truth is that health care does not lend itself to free market mechanisms.
Every other advanced society in the world offers some form of nationalized health care. And that health care is cheaper than our health care. Life expectancy is also greater.
Will nationalized health care mean some inconvenience or sacrifice? Undoubtedly. But in cost benefit terms it is simply a no brainer.
Posibly
Dick - I think the current healthcare business model is about the same as a crack house: sell something at ridiculous, confiscatory prices because the buyers will suffer or die without it. Here's a question we keep failing to ask - is health care a right or not?
One thing I would add: tort
One thing I would add: tort reform. Any healthcare reform package must lower the cost of obtaining care, and discouraging abuse of the legal system is a great place to start. Lessening the burdens doctors carry in the form of malpractice insurance is savings that will be passed on to the patient.
While the president has said his primary objective is to lower costs, virtually every honest assessment of his plan does just the opposite, as you note.
I agree.
@Andy - Tort reform would make a difference, too. There's just so much that needs fixed.
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