Health Care In My Head

In the health care debate I think something very significant has been overlooked: the fact that we have no money to pay for it! This link explains it so eloquently that I need to say nothing else on the subject. It was a story that ran during the excessive spending of the Bush administration and we are digging a bigger hole now.

http://www.youtube.com/watch?v=OS2fI2p9iVs

Ok, now that you have seen that, we can discuss the problem of health care in America. I know that a lot of other countries have universal health care, some successfully. Many of those countries have much smaller population and much higher taxes. In France (who is held up as having an excellent health care system), health care is bankrupting the country, to the point that they are starting to shut down clinics in smaller populated areas, which ultimately causes rationing of care. They tried requiring co-pays and the population had a collective meltdown. I think we need to take our next steps carefully and while I think everyone agrees that we need to make a change, the change we choose could have some far-reaching consequences.

First off I have to admit that I am anti-entitlement and think that the New Deal was one of the worst financial mistakes that could’ve ever happened to this country (besides the fact that it just made the Great Depression last seven years longer according to a study by UCLA). That is so you already know where I stand and that I am crazy. It is not a leap for me to despise Medicare and the way it is run. (I think anyone giving an opinion should tell where their political affiliations are, so you can read their piece more objectively.)

With foreign officials openly laughing at press conferences where our treasury secretary says "Don't worry. US treasury bonds are still of value continue to buy them," we have limited options of where to get all this magical money from the sky that is going to fund these programs. We need to get real. There are many reasons why I am not in favor of a public option, besides the fact that there is simply no money to pay for it and you already heard that argument so let me go to the others. I have yet to see a government program run anything efficiently and humanely… which I think people were looking for in a government sponsored insurance. For example, the way our wounded vets are treated when they are injured. It is no secret that it has been an absolute scandal the way these men and women who were injured in the name of our country were treated…. or not treated… in sub-standard facilities, not getting the tests, care, and attention they needed. It was like the government didn’t expect servicemen and women to be actually wounded in a war. Every single one of them was on government insurance.

The American auto industry was kept alive by government money for the past two decades. Instead of letting failing companies fail and letting new innovative ones take their place, we kept them on life support while they continued to fail. Foreign car companies came in and made better cars… and here is the kicker… for MORE money and people bought them because they were better cars. Americans were pushed out of the auto industry because the government wouldn’t allow us to fail. No amount of government money will ensure any kind of success no matter how many committees we put in charge of them. The government throws more and more money at education every year and the test scores are worse…. so we lower test standards. Absurd! Instead of having the guts to change the system, we throw more money that we don’t have at it and call it “doing something.”

Then, of course, there is Fannie Mae and Freddie Mac which I give the distinction of causing, or contributing greatly, to the current economic crisis since it was mandated by Congress that through Fannie and Freddie we would finance all those lovely sub-prime mortgages that ultimately no one could actually afford. Barney Frank, since he provided the Congressional oversight, was celebrating that home ownership was up right until the moment that he couldn’t deny that the system was crashing around all of us. That is the point where we decided to spend MORE money to fix the problem that the government helped create! Ok, I am done with the list of governmental sins. I just wanted to establish WHY I don’t trust the government with health care.

The big assumption made by most right now in this debate and the point that is largely ignored is that government health care is available. Almost any child in any state has a health care plan available to them, if needed. If you can't afford health care, there is usually a state-run health care plan that you can get already.

The root of the healthcare problem is that, as I read to eloquently last week, we want it now and we want it perfect. If a doctor messes up, we sue him. We don’t allow for any kind of human error without financial restitution. So doctors, nurses and hospitals need expensive malpractice insurance. The FDA takes 15 years to approve drugs which drive up the cost of pharmaceuticals, BIG TIME. Since we all must have the latest and greatest pill that was advertised on television, we cost our insurance companies more because the generic isn’t available yet. Don’t forget that 15 years we still not enough time to approve the drug since some particularly vicious side-effects were not known until it was let loose on the public. Make way for another lawsuit… where you can only sue the company who made it not the FDA who approved it for use. If we overhaul the system it has got to be from the fundamentals up, or we are just masking the problems that created the mess in the first place.

Another point that is never mentioned is that America leads the world in medical and pharmaceutical breakthroughs, the cost of which is passed on to Americans. These breakthroughs benefit the world… I guess the question is: Are we willing to do without them? It is quite the Catch-22. We don’t want to pay for it, but we want the latest and greatest. I submit that the companies creating these breakthroughs would not be the world leaders if their innovation was not closely ties to their pocketbooks.

Ok, so we know the problems and since I am obviously not in favor of a public option what do we do? I have been thinking of some ideas that could at least make health care affordable to most. (I say most, because I could never say ALL and be honest about it.) Some of these were literally thought up today while I was doing dishes, so I am sure they are full of holes, but the idea I think is to reform the industry itself, not create another government money pit. So here it goes:

First, insurance is too complicated. Hospitals and private practices alike pay teams of lawyers and insurance billers to interpret codes, coverage, etc. and the insurance companies themselves employ teams of lawyers and other staff to find ways to get out of paying, interpret policies, look for insurance fraud, etc. We change all of that a save both side a ton of money by requiring insurance companies to only sell policies that pay certain percentages of coverage. For example, if you want 100% coverage you pay a higher premium that the person who chose the plan that paid 60% coverage. That is it. (Actually, I would include a contingent policy that would include paying for alternative and experimental treatments that you would have to pay extra for if you wanted that, because I know that would be an issue.) The insurance companies would pay for any test or treatment deemed necessary by the doctor. No refusal of coverage. Now keep in mind, both sides should be saving money by not having teams of coverage interpreters, so hospital bills should be lower and insurance companies are not spending as much on employee salaries and benefits. If an insurance company thinks a doctor or hospital orders too many unnecessary tests or provides unnecessary treatments than they can choose not to have them be one of their care providers, which keeps costs down also.

There are clinics out there that do not accept insurance at all, to keep costs down and I think I remember that a doctor’s visit was $20-$30. That is a huge difference from what my doctor now charges an insurance company (around $85 for the visit alone)!

I also submit that this would further cut down on costs because of the emergency room factor. I have seen a lot of struggling and self-employed couples around here carry the emergency room only insurance. So what do they do when their child has 104 degree fever? They take them to the ER even though it is not an emergency. The trip costs $2000 instead of the $150 it would cost to go to the doctor. This happens way too much. It is called and EMERGENCY room for a reason, but it has become a source of primary care for too many. This insurance coverage change would greatly increase preventative care also and if diseases are caught earlier they are easier to treat and therefore cheaper.

Next, we cap how much a hospital and private practitioners can be sued for. This cuts down on malpractice insurance costs and settlement costs which, ultimately, we pay for. As an alternative, I suggest, since we don’t want the terrible doctors to stay in business, we provide a patient feedback database. This would be a private company (or companies) that could function much like 1-800-dentist, with on-line or over the phone reviews of doctors including histories of complaint, positive feedback, if they have been deemed negligent in any court proceedings, etc. I know these are already in existence to some extent, but I am thinking of a more far-reaching and comprehensive database that would include which insurance they would accept and whether they are accepting patients. Since it would be privatized, you would have to pay a small fee, maybe $3-$5 for a family search. I am sure there would be competing companies, which would improve the ease of service and thoroughness of information provided.

I also propose independent oversight of the drug companies. We provide a government contract (I’d guarantee they would function on half the money the FDA functions on) that would be responsible for the drug companies FDA approval of drugs. I am still wondering about this idea myself, but hear me out. This company would function on 3-5 year contracts and if significant lacks of oversight, like drugs passing through that were harmful, the drug company and the oversight company would be held responsible. The oversight company’s contract would go somewhere else, so they would have to be diligent in making sure they were doing their job. The FDA is not held responsible, individuals in the FDA take kick-backs from the drug companies themselves and they will never be put out of business for making a horrible call. This would change all of that. They take kick-backs… they are gone. In addition to that I would halt all drug companies’ advertisements of their new drugs on television and in magazines. This, theoretically, saves the drug company money, lessens the need the newest and greatest, which would allow for the proper amount of time for a smaller group of people to see what the drug does (instead of the huge amounts now) and allow time for a generic alternative. I would like to outlaw all those damn pens and mouse pads that all the drug reps push on the doctors to save cost, but that is going a bit far I guess. Perhaps limit the ways a drug rep can contact a medical facility. I would hesitate at that action as well, but I you can see where I am going with this. They have to still make enough of a profit though for them to stay in the business, so I don’t know. Half of the drug companies’ problem is government paperwork… we need to streamline the system and make it easier for all involved and lower costs.

Last, and least popular, I would announce that anyone 35 and under will not be receiving Medicare benefits when they come of age. Unfortunately, they will be paying for it, either way we would’ve been anyway… now at least they are upfront about our need to prepare to not be covered and to save and plan accordingly. There will still be Medicaid available to the lower income brackets, but for the majority of Americans, it will not be made available. This is drastic, but seeing as we cannot actually pay for the program anyway it is, at least, honest. I would fit into the under 35 category here, so I am not choosing the age so I will get under the wire. I just think 35 is still enough time to save for alternative means. I am willing to pay for a benefit I will not receive; I do that all the time through taxes anyway, if it means that my country will be fiscally sound in the future. Hopefully, by that time, we have reformed the system to be more affordable and cost-efficient.

Again, I know these ideas probably have holes all over the place, but this is just what I thought of at my kitchen sink! Surely others should have ideas that would be even better and more efficient than just throwing money we don’t have at the problem. We need REAL reform, not a band-aid! Let’s get the conversations started!