Eight easy fixes to the health care system!
First and foremost, the solutions are political. Totally!
Not because politicians don’t know how to fix them, but because they are being paid not to. With campaign contributions coming from every direction – insurance companies, agents, hospitals, physicians, clinics, nursing homes and lawyers – it’s pretty hard for them to keep their “public protector” hat on.
So what would these politicians do if cash were not flowing into their campaign coffers? They’d fix the system, but let’s look at how and who would object. We’ll abbreviate the opponents I, A, H, P, C and N.
1) Systemic:
This is the biggest and most obvious fix needed. Instead of sending wasted health care dollars to the insurance industry, they should change the system to bypass this bureaucratic nightmare. Hospitals and doctors would remain private, but they’d be paid by a collective pool of all citizens through the Medicare-for-all proposal.
No, it’s not socialized medicine, it’s public-private like Medicare is today. It’s the same kind of pool that funds our roads and other vital services. (Opposition: I,A,H,N)
2) Certificate of Need:
Politicians would restore this committee that they disbanded years ago after pressure from their contributors. All hospitals, physicians, clinics and nursing homes would henceforth be required to seek CON approval before expanding in beds or expensive technology and services. (Opposition: H,P,C,N)
3) Hospitals:
They’d prohibit the building of duplicative hospitals or adding beds in areas already adequately served. They’d not be able to expand to provide, say, heart surgery, without a community need and CON approval. They’d not be able to hire their own physician referral staff, who then are obligated (and sometimes pressured or rewarded) to fill empty beds and order unnecessary tests so they can pay for the expensive technology they’ve invested in. (Opposition: H)
4) Physicians/Clinics:
They would not be able to add expensive testing equipment or services that are adequately provided by area hospitals. They not only draw revenues away from hospitals, they become cash cows for the clinics. According to a recent McKinsey report, physicians who have such ownership are up to eight times more likely to order tests than physicians without such conflicts of interest. (Opposition: C,P)
5) Nursing Homes:
They’d have more oversight. They’ve been known to sit patients in front of a TV set and bill Medicare for a therapy session, or sit them in a coffee clutch and bill for “group therapy.” (Opposition: N)
6) Medical Liability:
It’s a problem, and though minor when compared to all else, it should still be fixed. We need a three-judge medical court rather than a 12 man jury with no medical expertise. Lawyers should have three strikes and then start paying defendant’s legal fees when they bring frivolous cases. Punitive damages (if awarded) should go to the healthcare fund rather than to plaintiffs that have already received damages. (Opposition: Lawyers)
7) Fraud/Abuse oversight:
All medical providers should be required to educate employees on what medical fraud is, how to report it, and make them aware of the whistle-blowing laws and rewards. Once employees are aware of fraud rules we’ll see them providing the oversight government has failed to provide in the past. (Opposition: H,P,C,N)
8 ) Political system
What else would you expect? Of course health care is not the only area of government that has been destroyed by our corrupt political system. We pay enormous taxes to offset the unnecessary spending by politicians receiving cash contributions from special interests. Tax breaks, subsidies, no-bid contracts and the giveaway of other taxpayer assets amounts to $1300 per taxpayer per year at the state level and $4000 each at the federal level. (Yes, our politicians are costing us dearly.)
The solution is obvious. If politicians are to be beholden to the taxpayers, the taxpayers must fund their elections. And at $5 per taxpayer per year ($10 at the federal level) it’d be one terrific bargain.
Why would politicians not like this? Because it levels the playing field and they don’t like level playing fields. So they argue that it will “increase taxes” even when it will do just the opposite. And they’ll make other pathetic claims just to keep the fat cats alive and well, and themselves in office.
And oh, 15% of the lawmakers should lose their health care benefits, another 15% should be underfunded, and the balance should be forced into health savings accounts. Then let’s see how long it takes to fix the system.
– Lohman is a retired business owner from Colgate and operates http://MoneyedPoliticians.net. He authored “Politicians - Owned and Operated by Corporate America” and can be reached at jlohman@execpc.com.
December 8th, 2007 at 8:04 am
[…] autwh had some great ideas on this topic.You can read a snippet of the post here.Instead of sending wasted health care dollars to the insurance industry, they’d change the system to bypass this bureaucratic nightmare. […]
December 8th, 2007 at 12:49 pm
Ever notice how most of the “problems” with our economy occur in areas of “concentration of power”? (a.k.a. corporate consolidation, and government interference with overregulation, and corporate fascism -combining the two)
We’re talking energy, food, medicine, immigration, productivity. Jackasses in ivory towers are the problem. They all think they can solve problems from the top down with their plans.
December 8th, 2007 at 1:17 pm
So you think a government bureaucracy will be able to provide cheaper, more efficient health care administration than the free market? Medicare’s supposed cheaper cost of administration is only on a balance sheet that does not allocate for direct costs of capital investment , government labor costs for appointed administration and staff, costs of oversight and fraud and indirect costs of legislation. Add those up—and the costs of Medicare rivals if not exceeds private enterprise but with less responsiveness to the actual provision of health care. The cost of health care has escalated precisely because of government interference and a bigger, more expensive bureaucracy will be the only result of your “fixes” for health care.
http://www.americanthinker.com/2007/11/when_politicians_decide_health.html
When Politicians Decide Healthcare
The Democratic-controlled Congress has been working all year to determine how to allocate an estimated $390 billion dollars to cover more than 40 million seniors and other recipients. The process is byzantine, as the legislative process tends to be. It involves everything from possible changes to Medicare Advantage to physician fees to reimbursements for a host of treatments and therapies housed in this mammoth program.
What the process isn’t principally about is the best healthcare for Medicare recipients. Foremost, this is a political process with political ends in mind. And therein is a cautionary note for voters who are flirting with the idea of socialized or universal healthcare, or some lesser proposal that is a Trojan horse in all but name.
Senator John D. Rockefeller (D-WV) and Representative Charles Rangel (D-NY), key committee chairs who are playing major roles in the outcome of Medicare funding, may, in their ways, be conscientious public servants, but they are politicians, meaning that along with 533 colleagues, they are making rather complicated calculations as to how to curry favor with, entice, placate or punish special interests. The same goes for their constituents, less the punishment.
More specifically, it’s about protecting home state businesses that count on Medicare revenue for the products they manufacture or keeping jobs at local hospitals. It’s about keeping older voters and other important voting blocs happy or quiet, or about trying to offload the pain of funding cuts on other members’ districts or states (preferably, the opposition’s). It’s about allocating money away from Medicare to fund other, non-healthcare programs, or taking money away from Medicare to help pay for SCHIP expansion. And, finally, it’s about campaign contributions, favorable publicity, votes and re-election, among other parochial considerations.
Our healthcare system is indeed in need of reform but not by a government that has proven itself inefficient, wasteful and untrustworthy.
December 8th, 2007 at 1:45 pm
I believe the solutions are political and on a federal level, including a federal- not state-controlled CON. However, how do you force the politicians to make change? I think this is the key component for a meaninful solution. The voters in America have to en masse make it clear to the politicians that reform is mandatory–not rhetoric but real fundamental reform, which benefits all of us. How can that happen? The voters themselves will first have to change. Americans will have to understand the following, make the changes in their own mind and lifestyle, and then force the politicians to acquiesce with the power of the ballot box:
1. that health care is not a business;
2. that health care is a sound, ongoing doctor—patient relationship, which requires specific work input from the patient as well as from the doctor;
3. that sound, ongoing doctor—patient relationships have to become the new bottom line for our health care system as opposed to the almighty dollar bill;
3. that our health care businesses and therefore payment for their services and product must be restructured so that their primary goal is the penetration of sound, ongoing doctor—patient relationships into every community in America and so that their profit margins, which nevertheless must be taken into account, become a secondary issue. This will require a concept of managed capitalism between a federal single payer and individual businesses;
4. that Americans cease with their ridiculous presumption of immediate achievement of unattainable perfection from doctors;
5. that doctors improve their act on at least three levels: a. knowledge and competency requirements,
b. altruism,
c. work ethic, i.e., accessibilty in a manner that maintains continuity.
I discuss mechanisms for achieving all of this and more in my book, EQUAL HEALTH CARE FOR ALL.
R. Garth Kirkwood M.D.
http://www.equalhealthcareforall.com
doctork@equalhealthcareforall.com
December 8th, 2007 at 2:11 pm
First a disclosure: I retired 4 years ago after spending 35 years in the healthcare industry and the last 25 as a Medicare provider. I owned a cardiac monitoring lab and contracted to physicians and hospitals and billed Medicare directly. I am now a Medicare patient under their *traditional* program. I thought Medicare reimbursements were fair and preferred them to the privates.
Medicare has two divisions: public (traditional) that covers 81% of seniors, and Medicare Advantage which 19% of seniors have opted into. Advantage (Medicare HMOs) are run by private insurers and costs taxpayers 20% more than those patients under traditional Medicare. So much for private being more efficient than public. As well, traditional Medicare is fee-for-service and “Advantage” are capitated (they are paid by Medicare a fixed $$$ amount per patient), thus the biggest complaint is that they make money whenever they deny care to a patient. They have to increase the spread between income and outgo, and avoiding tests and living on the edge is to the company’s advantage.
The reason there is a lot going on is simple. Private “Advantage” providers can give campaign contributions and government entities cannot. So Bush set out to cut physician payments IN HALF over a five year period, with the first 10% coming early next year. Bush wants doctors to abandon traditional Medicare patients and force them into “Advantage” programs. Well I wonder why? Could it have anything to do with campaign contributions? You bet.
Is Medicare perfect? No. But it is better than private coverage. And the privates have more abuse and fraud because the federal violations often involve jail time. And traditional Medicare does not have marketing costs, broker commissions, actuarial costs, high executive salaries and bonuses, and ever-increasing shareholder profits. And they also have high lobbying and campaign contributions that they have to offset by passing those costs on to the patients. And they way they can is to cut back on patient care.
So yes, I prefer the single-pool Medicare system that works beautifully.
And I disagree. It is the free market that took over health care with Newt Gingrich in 1994 that has driven the costs so high. There is no such thing as competition in health care. Patients will not seek out the lowest bidder, and most likely will go to the more expensive provider. The cheapest doctor is usually perceived as not being able to attract patients and the cheaper hospitals as those who skimp on technology and cleanliness.
There are some things the government can do better than private, and Medicare is one of them. Also providing police and fire security and building roads. If you really want to see how well “private” works, take a look at the Medicare Drug program versus the Canadian system of price controls. And before you give me the argument that profits are needed to fund research, remember that the pharmaceutical industry is the most profitable in the world, even AFTER deducting for their high R&D and executive salaries and shareholder profit deductions. Over 80% of the drugs they do R&D on are “me-too” drugs (old drugs slightly changed to extend the warranty).
And no, Medicare is not socialized medicine. The government collects money through taxes and then passes it on to state administrators (in Wisconsin it is the privately owned WPS under contract to Medicare). Then they reimburse private doctors and hospitals.
SCHIP was to be funded by tobacco taxes. Ask Philip Morris how much campaign money that one cost them.
December 8th, 2007 at 2:21 pm
Thanks, Doctor K. You are absolutely right that healthcare should not be a for-profit business. But of course, that then means that the “free market” is a bad model for it. Medicine is not a commodity, and the fact that ours is virtually the only non-universal system in the world is driving companies and jobs and resources out of the country. Free market medicine will kill free market businesses.
How do you fix the political system? Vote them ALL out and create a 100% turnover in congress. And if the newbies fail to fix it, kick them out too.
December 8th, 2007 at 4:05 pm
The further removed the patient is from the actual payments, the higher the costs become. Routing money from individuals up to Washington and back down to the states to be divvied up among the healthcare providers adds how many layers of markup? so that $10 in taxes from the individual results in $2 reaching the healthcare provider, requiring hundreds more tax dollars from individuals to make sure that local provider receives his $50 for the 10-minute visit with his patient. Strip the bureaucracy out of the system and put the patient face to face with his doctor, from the appointment to the payment, then you’ll see the actual costs of healthcare drop for everybody.
December 8th, 2007 at 4:44 pm
Dr. Kirkwood,
With all due respect, “equal” care for all is not measurable, achievable or even desirable and is a sure fire path to less healthcare and less quality health care for all.
First of all, you want to confiscate the skills and services of physicians and healthcare providers and mandate that they provide service in exchange for whatever the government decides to pay them. All we need do is look at the quality of public education to see how well a government controlled healthcare system will work.
While I do agree that a patient-doctor relationship and continuity of care is important to achieving positive health outcomes, there are indeed areas of medicine where skill, education, technology “trump” relationship. Patients do need a health system advocate and overseer and this falls on the primary physician. This model however, does not operate within most areas of specialized medicine where procedures and treatments are episodic. If I am in need of a complicated treatment or surgery, I want the most highly trained technologically advanced care available. Your system will ensure that the quality of health care specialties will decline along with the research and innovation health care specialties generate in this country. But it seems that is your goal if “equal” healthcare is to be achieved–more basic healthcare for all, less specialty healthcare for all. We will all be willing to suffer together as long as everyone receives the same.
And then you make the huge assumption that once doctors/providers/suppliers see the light and realize they have a duty to provide their products and services to the general public at whatever the government can afford to pay them, the general public will do their part and not pursue unnecessary or expensive medical treatment (as defined by the now government employee doctor) and will now follow doctor’s orders to achieve their best possible health care outcome. It will be one big collective symbiotic society where everyone does their part for the greater good.
No thanks.
The problem here is you fail to grasp the reality that healthcare outcomes are the result of a multitude of issues within our culture that cannot be solved by government mandates and altruism.
December 8th, 2007 at 5:52 pm
Mr Lohman,
The government got into the business of health care in 1965 with Medicare and that was the start of perpetual health care inflation. Government now accounts for almost 2/3 of health care costs as it is so more government health care control, regulation or benefits is not the answer.
December 8th, 2007 at 7:08 pm
Government + health = a cancer on society. Let them do the basics like defending the border and building roads and bridges. Of course I realize it’s not very exciting. My answer is SO WHAT!!!!!!!!!!!!!!!!!!!!!!!
December 8th, 2007 at 7:30 pm
Response to Chris #7,
Response to hoads #8:
Thanks for the rhetoric designed to maintain the status quo.
December 8th, 2007 at 8:56 pm
http://youtube.com/watch?v=gGoiWWjEEhA
December 8th, 2007 at 9:06 pm
Lohman & Kirkwood: Great posts. Please keep ‘em coming. Very informative.
December 8th, 2007 at 9:08 pm
Thanks for the comments, guys, though I don’t buy into some comments.
Chris, Medicare is an automatic deduction from payroll, with next to zero handling costs. Then paid to state administrators (one bank transfer per month). 20 cents on the dollar is just nowhere correct. Medicare’s total administration costs are 3.5%.The fact is, for the same 16% of GDP we are spending to cover 85% of the people we could provide first-class care to 100%.
Hoads, surveys of physicians show 64% approval of Medicare-for-all. That they can cut office staff by half and get 100% payment with no bad debt or collection costs, translates to a pretty good deal. The American College of Physicians just came out in support and so does the American Medical Students Association. These people are not dummies. The only people to be hurt by Medicare-for-all is the insurance industry.
And wait a minute: “If I am in need of a complicated treatment or surgery, I want the most highly trained technologically advanced care available.”???? I thought people wanted to go to the lowest bidder?
The government accounts for a higher ratio of costs because they cover almost exclusively seniors that require more care, end-of-lifers, and the handicapped. Fold in all of the younger generation and the “average” then becomes lower than what most people pay today.
On Mercola… Hogwash!
December 8th, 2007 at 10:20 pm
History shows that “control freaks” and “central planners” are usually a “destructive force” in society. If the “planners and pontificators” were really productive members of society then they wouldn’t have time to “ramble on” about the virtues of “government regulation”.
December 8th, 2007 at 10:43 pm
Think about health care financing like pensions: the choice is defined benefit or defined contribution.
Then, have a look at the long-term viability of defined benefit schemes.
Finally, square that particular circle and go collect the prize.
December 8th, 2007 at 11:49 pm
We must have a system that promotes preventive medicine! The cost savings is 10 to1! Also we must eliminate all exclusions!
December 9th, 2007 at 6:49 am
At 70, Bill, all I have is time…. and I think a decent overview of the healthcare problem and where the unfair profit-taking is occurring. People are dying as a result, and we have an obligation to fix it. Unless, that is, those dying are not our own.
And I agree, John. Preventive medicine is needed (though getting people to eat right and quit smoking is not easy).
December 9th, 2007 at 7:44 am
I’d also add that we need a national database of patient data. The patient would fill out a complete one-time questionnaire, the stats are compared with the database and the physician views what other docs have done in similar cases.
Of course the patients could keep their names secure, unless they are traveling and seek care. But it would also compare medications and flag the physician when ordering conflicting meds.
This would ultimately lead to transparency on the basis of quality of care rather than price.
December 9th, 2007 at 12:46 pm
Jack
And with that in mind:
Some of my more “heated” comments are all in fun.
re: “I’d also add that we need a national database of patient data.”
Yeah I’ll bet you would doc. This desire for “data” on the public is a classical “symptom” of the mindset with the “Orwellian” types. Why don’t we all just go in and get a bar code stamped on our forehead? You first.
December 9th, 2007 at 1:01 pm
Bill, you can opt out. That’s what a free society is all about. Then when your new or remote doctor needs to look at your records to save your life, you are screwed. But it’s you being screwed and not me. I’m okay with that.
The national database would not have names attached, just diseases, how they were treated, and the results and side effects.
But again, you and your family can opt out.
For that matter I would happily put my DNA on record to add some level of protection to your family and mine. But there again, I am not of the suspicious type. More pragmatic perhaps. Or maybe just Orwellian.
December 9th, 2007 at 5:13 pm
Remember the military’s $60 hammers and $300 toilet seats? That’s the exact same bureaucratic process that brings you $100 aspirin and $300 doctor visits. Why would the government spend $60 on a hammer, especially buying in bulk like they were, when you can run down to Ace and get one for $10-15? Because the government can’t manage money effectively, and an entire supply chain industry exists solely to make a profit on each layer of markup getting those hammers from one location to another. Put the customer - the end user - in direct contact with the supplier - the manufacturer - and the multiple markups disappear and costs drop to the floor. The exact same principle applies to products and services in the healthcare industry. The more the government’s involved, the higher the prices.
December 9th, 2007 at 5:40 pm
Chris, The medical field is NOT the military, though I can understand why people might want to make the connection.
When I was in the medical field one of the services we provided was mobile echocardiography. My $60K per year technicians would drive a $75K van to a physician office, unload our $150K echocardiography system, spend 30-45 minutes performing the heart scan and turn the results over for his interpretation. We did 95% of the work and billed him $300. Medicare reimbursed $400, giving him a $100 profit. However, when he billed private insurers for the same procedure it was in the area of $1800. Why? Because he could! There was no oversight in the private arena.
There were no $300 toilet seats in the Medicare system and it should not be burdened with the defense department’s reputation.
Read #5 paragraph two above. “Private” is 20% higher than public, and they’d be a hell of a lot higher if they could be.
I repeat what I said above….. “There is no such thing as competition in health care. Patients will not seek out the lowest bidder, and most likely will go to the more expensive provider. The cheapest doctor is usually perceived as not being able to attract patients and the cheaper hospitals as those who skimp on technology and cleanliness.”
>>>> Chris: “Put the customer - the end user - in direct contact with the supplier - the manufacturer - and the multiple markups disappear and costs drop to the floor.”
Not true, though I wish you were right. Health Savings Accounts and High-Deductible Health Plans are an example: The Bell Policy Center found that “HSAs coupled with high-deductible health plans increase cost-consciousness among enrollees, but have little effect on overall health care costs.” Source: http://www.thebell.org/PUBS/IssBrf/2007/08-HSAs.php
December 9th, 2007 at 5:45 pm
Correction: We billed Medicare $300 and the $100 was his interpretation fee.
December 9th, 2007 at 5:48 pm
And incidentally, $100 aspirin’s are only billed to private insurers. Hospitals are paid a flat rate by Medicare (which includes all aspirins).
December 9th, 2007 at 6:02 pm
You’re absolutely wrong regarding healthcare competition. The primary reason Walmart is opening in-store clinics is to provide health services at a lower cost than is currently available to their target market. As far as I know it’s a cash service with no medicaid-medicare billing whatsoever. I believe the average doctor visit will be around $30, and they take walk-ins. Talk about unhindered access to healthcare, here’s one answer blossoming right before your eyes.
More people are seeking alternative health solutions than ever before precisely because of the costs involved with “traditional” medicine, all perceptions of quality care considered. Just look at the growth of the alternative medical industry over the last two decades, and try to explain why there is such enormous growth.
People are using garage and basement unlicensed doctors and dentists because it’s cheaper for them, so there go your concerns about the perception of quality. There have been several raids of these kinds of services just this year alone.
People are traveling to the Phillipines and Taiwan and Mexico for less expensive care for debilitating illnesses, cancer, and surgeries precisely because the costs are dramatically lower, even taking into account the travel and accommodations costs.
There most certainly is a demand for lower cost services, quality perceptions or no, that the traditional American healthcare industry has completely choked out of existence with the complete aid and comfort of our government.
December 9th, 2007 at 6:20 pm
I support Walmart getting into it, but I wouldn’t go there for anything much beyond a cold or flu. They likely will only attract the low-end docs that weren’t popular in the clinic setting.
I won’t argue about the growth of alternative care, and believe patients should have that alternative for their own care. I am a bit troubled when uninformed parents start taking their kids there, but they ARE their kids.
Yes, some folks go to Mexico out of desperation when they’ve learned they have a terminal disease. Don’t blame them, I’d do the same. But they have no better outcomes, and I wouldn’t trust them for primary care.
Do as you wish, Chris, and I understand that Super 8 has rooms for under $50.
December 9th, 2007 at 6:40 pm
So when you say “There is no such thing as competition in health care. Patients will not seek out the lowest bidder, and most likely will go to the more expensive provider. The cheapest doctor is usually perceived as not being able to attract patients and the cheaper hospitals as those who skimp on technology and cleanliness.”
You really mean the right kind of patients won’t use lower cost services. Maybe you can define what the right kind of patients are, in your book.
December 9th, 2007 at 6:43 pm
Me! In my mind I am the right kind of patient and I will not seek out the lowest bidder. You can, but I know how they got there.
December 9th, 2007 at 6:57 pm
I understand that Super 8 has rooms for under $50.
You bring up another interesting and relevant point. Where did all the Katrina evacuees stay when they got to Georgia? The Marriott, in $180/night rooms. Why? Because the government was paying for it.
December 9th, 2007 at 7:04 pm
Well, I agree with you on the Katrina issue, but we can thank Bush and Brownie for that. And they left several thousand mobile homes empty.
But with all due respect, Chris, that doesn’t make Medicare bad. I have it, I love it. I get sick, I get care, and the caregiver gets paid. Pretty simple. Very efficient.
December 10th, 2007 at 7:36 am
Trying to “control” health care from the top down is another case of “squeezing jello”. I don’t know of any case throughout history where a sector of the economy attempted to depart from the free market with anything resembling success. What you get is death and/or black market activity.
December 10th, 2007 at 7:54 am
Bill, Medicare has been working quite well for 50 years. So much so that it is the last thing in the world insurance companies want to see and are treating it as their greatest enemy. To me that indicates that it’s the right thing to do.
But aside from that, look at the other public-private ventures like the building of roads, and the pure public solutions like providing fire and police protection. They all work quite well.
Passing a Medicare-for-all system is not irreversible if it doesn’t work.
The sad part of this is that we are already paying for it, but we aren’t getting it. Over $700 billion per year is wasted and not going to patient care. You and others not on Medicare are getting screwed.
December 10th, 2007 at 7:59 am
[…] Check it out! While looking through the blogosphere we stumbled on an interesting post today.Here’s a quick excerpt First and foremost, the solutions are political. Totally! Not because politicians don’t know how to fix them, but because they are being paid not to. With campaign contributions coming from every direction – insurance companies, agents, hospitals, physicians, clinics, nursing homes and lawyers – it’s pretty hard for them to keep their “public protector” hat on. So what would these politicians do if cash were not flowing into their campaign coffers? They’d fix the system, but let’s look at how […]
December 10th, 2007 at 12:57 pm
Medicare is unsustainable and is predicted to outpace revenues by 2020. Medicare has a history of positive patient satisfaction because it is just now being hit with the impact of our aging patient population which has not yet reached full fruition. But, as the elderly continue to require more and more health care, bureaucrats will continue to slash provider reimbursements and benefits and more and more health care providers will opt out of the system. This is already the case with Medicaid, whose reimbursements are often lower than the costs to provide the services resulting in less providers willing to accept Medicaid patients.
Most Medicare recipients purchase private Medicare supplemental policies because of the gaps in Medicare coverage. Current retirees are getting a sweet deal that will not be available to future generations especially if we move towards “Medicare for all”.
When everyone is on the dole, you can bet, the conversation will turn to limiting “heroic” end of life health care measures. And the definition of “heroic” will be defined by politicians who will determine age criteria for certain health treatments. What may be “heroic” one day becomes mainline over time as the technology progresses and costs come down. But with government, there will be a delay in passing legislation to capture the latest in health research and technology as compared with the private sector.
The UK and Canada utilize less diligent preventative care measures than does the US. They receive less mammograms and less follow-up of abnormal lab results and exams and why? Because health care must be rationed. People do die while waiting for follow-ups of their disease processes. And again, what constitutes “preventative” health care is constantly changing with advances in research and technology but, these advances will have to endure the rigors of a government bureacracy before they can become mainline treatment and in the interim–people will die or endure illness needlessly.
Bureaucrats making policy decisions about health care are worse than insurance companies making decisions about health care benefits. Read my article in post #3 which describes the chaos and politics involved when politicians decide healthcare. Bottom line, lobbyists and special interests earn the ear of our politicians and the voice of the consumer is drowned out.
A government controlled single-payer system will only add layer upon layer of bureaucracy who will be even less accountable to health care consumers than are current system and dangerously susceptible to making health care decisions that will effect the entire population based upon the squeeky wheels.
I want to keep the line between me and my health care providers as short as possible and am not willing to give the government the benefit of the doubt.
December 10th, 2007 at 1:42 pm
Mr Lohman,
The gap between private health insurance reimbursements and Medicare has narrowed tremendously over the years. In fact, private insurers use Medicare rates as their basis for determining reimbursements and rarely do private insurers reimburse more than 10-20% over Medicare rates.
In your post #14-
“And wait a minute: “If I am in need of a complicated treatment or surgery, I want the most highly trained technologically advanced care available.”???? I thought people wanted to go to the lowest bidder?”
This is the primary culprit in our health care system—consumers are insulated from the cost of healthcare and the concept of “lowest bidder” has never applied. Only when consumers are in control of their health expenditures will we have a healthcare system responsive to demand/ price scenarios. A government single payer system controls costs by rationing, not by lowering costs.
The problem I have with jumping on the government single-payer bandwagon is that we have done nothing to address the fragmentation and duplication within our current health care system. A federal mandate to standardize healthcare IT systems is projected to reduce the actual annual costs of health care by 5% or 77 Billion per year.
There are many areas of healthcare that are experimenting with telemedicine which has the potential to produce substantial cost savings.
You can bash pharmaceuticals all you want but, the pharmaceutical industry has attributed much to the quality and longevity of life for millions and has reduced the costs of health care by reducing the need for expensive treatments and hospital stays.
Real health care reform that reduces costs while maintaining quality can only come from the private sector albeit, minimal government interference such as federal mandates for business compliance, establishing standards for IT and establishing a health care database that monitors health care costs/benefits based on science.
December 10th, 2007 at 4:32 pm
Hoads, let me argue with you a little on these:
>>> “Medicare is unsustainable and is predicted to outpace revenues by 2020.”
You have to quit looking at these claims. Our total health care costs are 16% of GDP, spent in dozens of different programs (Medicare, Medicaid, BadgerCare, workers comp, employer benefits, and on and on and on). And it is being paid for in a myriad of different ways (employers, taxes, bankruptcies, cost shifting, etc). But the fact is we are all paying the bill, in many ways, if only via higher product prices. If we got rid of all of the crap and had everybody on Medicare, got rid of Medicaid and the unemployed and the freebies in the ER and etc, we could provide first class care to 100% of the population. Yes we’d pay for it in higher taxes, but we’d see lower product prices.
Medicaid is lower in reimbursements because they are cost-shifting the bill to those who can pay. Yes, some providers will not accept Medicaid and the patients go elsewhere and we still pick up their costs.
>>>>> “Most Medicare recipients purchase private Medicare supplemental policies because of the gaps in Medicare coverage….”
Yes. I pay a 20% co-pay but have the option to pay for service with Gap insurance.
>>>>> “Current retirees are getting a sweet deal that will not be available to future generations especially if we move towards “Medicare for all”…..
If it’s not available to future generations, it will be because the current generation has fallen for the insurance industry BS. The only thing that will save Medicare in the future is Medicare-for-all today.
>>>> “When everyone is on the dole, you can bet, the conversation will turn to limiting “heroic” end of life health care measures. And the definition of “heroic” will be defined by politicians who will determine age criteria for certain health treatments.”
Only if the voters today let the politicians continue ripping them off. Medicare-for-all should also include all politicians. But our voters are not very smart. They should term limit them all at the voting booth.
That said, I support an automatic no-code on everybody over 90 unless the family is willing and able to pick up future costs. That ought to sit well with conservatives.
>>>>>> “The UK and Canada utilize less diligent preventative care measures than does the US.”
That’s not correct. They have better outcomes there than we do here. Their wait times could be eliminated if they’d spend 16% of GDP rather than the 8-10% they are spending now. If they pulled one out of every six people out of their waiting lines, as we have done in the US, they’d not have wait times either.
>>>>> “Bureaucrats making policy decisions about health care are worse than insurance companies making decisions about health care benefits.”
Bureaucrats don’t make my healthcare decisions, my doctor does.
>>>>>> “Bottom line, lobbyists and special interests earn the ear of our politicians and the voice of the consumer is drowned out.”
Absolutely. That’s why we need full public funding of campaigns. If they are going to work for us, then we must fund their campaigns.
>>>>>> “A government controlled single-payer system will only add layer upon layer of bureaucracy…..”
Not true Hoads. Medicare is the simplest system we have, except for the socialized VA and Armed forces systems. You are seeing the costs of the insurance bureaucracy if the 16% of GDP we are currently paying. You haven’t thought it through.
>>>>>> “I want to keep the line between me and my health care providers as short as possible and am not willing to give the government the benefit of the doubt.”
Then keep paying and quit complaining. Incidentally, are you in the health care or insurance field?
December 10th, 2007 at 5:50 pm
If the gap has narrowed it is because private insurers pick-and-choose who they cover, and they know full well that if you get sick they can increase your rates or simply cancel you. They can fire their customers, while Medicare can’t. They take 100% of all comers and do not terminate the costly ones. But they will never match Medicare rates. They can’t and still provide the same service because they have too much fat in their system.
>>>>>> “Only when consumers are in control of their health expenditures will we have a healthcare system responsive to demand/price scenarios.”
You must like Health Savings Accounts and High-Deductible Health Plans: “HSAs coupled with high-deductible health plans increase cost-consciousness among enrollees, but have little effect on overall health care costs.” According to The Bell Policy Center http://www.thebell.org/PUBS/IssBrf/2007/08-HSAs.php
>>>>>>> “You can bash pharmaceuticals all you want but, the pharmaceutical industry has attributed much to the quality and longevity of life for millions and has reduced the costs of health care by reducing the need for expensive treatments and hospital stays.”
Absolutely correct. But they also screw the taxpayers on the side. We pay for 33% of all R&D and then give the patents to the drug companies so they can charge outlandish prices for the next 20 year patent life. Read Marcia Angells book “The Truth About the Drug Companies: How They Deceive Us and What to Do About It.”
>>>>> “Real health care reform that reduces costs while maintaining quality can only come from the private sector …”
We disagree. But that’s what our country is all about.
And hoads, I’ve got no dog in this race. I have Medicare and love it. I’m covered. I’m now working on behalf of my kids and perhaps yours.
December 11th, 2007 at 1:07 am
>>>>> “The gap between private health insurance reimbursements and Medicare has narrowed tremendously over the years. In fact, private insurers use Medicare rates as their basis for determining reimbursements and rarely do private insurers reimburse more than 10-20% over Medicare rates.”
Wait a minute guys. A while ago you were telling me government-run medicine was horrendously expensive, and now you’re telling me private is only 10-20% higher????
I’ll stick with Medicare, thank you.
December 11th, 2007 at 3:06 pm
What are you guys? Retarded??? The problem with health care is that the government is already too involved.
December 11th, 2007 at 5:35 pm
I’m retarded, Fred. I see Medicare as our only savior, but politicians too much in the pocket to make nonconflicted decisions.
December 12th, 2007 at 10:43 pm
Jack
Medicare has always existed alongside the free market. Not a good example. In fact if it were examined closer I think people would be horrified at the rampant corruption and ineptitude.
December 13th, 2007 at 4:58 am
Yes, there is Medicare fraud, though in Canada it represents less that 1% of the total and the perps go to jail. There is far more fraud on the private side, however, because the penalties are not federal and generally do not include jail time.
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