According to the news, there will be a vote this week on healthcare reform. Regardless of whether a bill makes it to the floor of the House, I thought I would chime in on this topic for posterity.
First, I must admit, I have not read all 2,000 plus pages of the bill. That in itself should signal something (about both the bill and me). One bill to solve the issues. Couldn't they break this down a bit and vote on specific areas that need improvement and deal with them separately?
If the goal of the bill is to improve access to healthcare for everyone, I do not see the current piece of legislation achieving that goal. I would prefer to see the government offering incentives to the industry so that more sources of care (hospitals, clinics, physicians, nurses, etc.) are created. If there is a greater supply of caregivers, it follows that prices would fall and access improve.
In its current form, there is very little incentive for people to enter the healthcare profession. In fact, the case can be made that with the government essentially controlling what doctors can charge for services, I anticipate the wait time to see a doctor will simply increase as doctors realize there is a ceiling to what they can make and no real reason to improve the quality of care. Additionally, those doctors with thriving practices will form “private” practices" (like they are already doing). You will pay cash, pay extra (a little more) in order to get the care that you want.
If the government offers a plan that provides greater assistance to those currently not covered without offering some sort of incentive for service/supply expansion, two things are sure to happen:
1) Prices will go up as demand increases
2) Premiums will go up. This may be counterintuitive. Some lawmakers are stating the case that with more people in the “pool” of premium-paying consumers, premiums should fall. This may be the short term effect. However, long term, premiums will increase reflecting the nature of people to have unlimited demand for services that are relatively low-cost.
Partly troubling to me is the notion that the government will force everyone into a plan - if you do not have coverage. It is sort of a Miranda Rights approach to healthcare: “if you do not have coverage…coverage will be appointed for you…” There are people in this country who, for what ever reason, have chosen not to purchase insurance. They should be free to make this choice. At the same time, the larger healthcare industry should not have to treat them and you and I should not have to pay for that treatment.
For those of us with concerns for these people, we can donate money to support the creation of clinics to provide basic healthcare services.
The real question is: as a society, should we offer basic healthcare services to everyone, especially those in need of care who cannot afford it.
While it is easy to shoot holes in someone else’s ideas, I do believe it is important to offer an alternative solution at the same time. Here are my suggestions as to how to “reform” healthcare:
Before implementing a massive overhaul of the entire healthcare industry:
a. Prove to the citizens that the government can run Medicaid/Medicare within budgetary expectations and pay for it. Eliminating waste in this area alone would be a huge win for everyone. If the government cannot effectively run what they are already responsible for (which some say is in excess of 25% of the US healthcare market), why would we think they could run something larger. Medicare alone is a $400 Billion program and Kim Brandt who heads up the Medicare Fraud task force (Director of Program Integrity) estimates that annual fraud within the current plan is between $60 - 80 Billion annually.
b. Pass Medical Tort reform (see more below).
c. You first. Be leaders. If you think it is good for the citizens, it should be good for the Congress, Federal & State workers, and military/veterans (they deserve better – not sure about this). Start there. If you can control costs with that segment, then go to step d…
d. Ask a state or two to volunteer into the proposed plan (I volunteer Mass – do it for Teddy… they have a plan that is close to this – if they want in, it is a bad sign, cause they already have one that is pretty darn close to this – you would think they would want their own plan, which Mitt Romney enacted while governor). If it works for them, roll it out for the rest. If it does not work for them, we will be saved from a poorly designed plan.
e. Education: I work in an industry that basically serves the top 10% of wage earners. Actuarially, we can prove that this segment of the population understands the importance of regular check-ups, proper nutrition, exercise, etc. They have access to information, access to healthcare and they use both. The government is in a unique position to get information into the hands of the general population: They find us at tax time. They know where my boys are for selective service. And the Post Service can take the time to leave me a note telling me to move the snow a little further back. They are really good at this when they want to be.
f. Lastly, any solution should integrate illegal immigrants in some way. In certain parts of the country, illegal immigrants are a serious burden to the healthcare system. Let me be clear, I am all for legal immigration. But, illegal immigrants… we need some way to either encourage them to go home and re-enter the country legally; or, we need to integrate them fully into our society. They need to be paying into the system so that services can be provided (payroll taxes, income taxes, etc.) and they are paying their fair share for not just healthcare, but also education.
Lest you think me hard-hearted, I will readily agree that it is a sad state of affairs when the wealthiest country on Earth cannot provide a basic level of care for those who cannot care for themselves. It is my thought (and I sincerely hope that it is true – I just do not know to what degree) that hospitals rarely turn away anyone in need of care. In fact, I would think they would lose their license to operate if they did. Let me be clear, I do think there should be a safety-net.
The safety net should include:
- government run programs. Some of these already exist: Medicaid/Medicare
- quasi-government sponsored/supported programs (WIC, planned parenthood, etc.)
- Third-party / faith-based clinics:
o Sponsored by churches, synagogues, mosques, YMCAs, Boys and Girls Clubs of America, Tom Cruise
o In return for a half-day-every other week of service, Doctors/nurses could repay education loans backed by the government. This might result in increasing the supply of doctors and thus lower costs (supply and demand – it is a natural law and cannot be avoided). I am thinking 5 – 7 years, at 48 weeks per year might work out about right: 5 hours X 26 days per year X 5 Years @ $350 per hour = $227,500 (with no interest assessed) and also take some of the burden off of the healthcare system (don’t take your child to the emergency room with a cold/fever… take them to the neighborhood clinic).
o Investment – another way to lower costs is to encourage investment and innovation to improve care/production. Not sure how to do it, but I am thinking some type of Medical R & D/innovation/technology tax credit be the right incentive to compel improvements.
Back to Tort reform for a moment… In talking with a lawyer friend of mine about this a few years ago and a Dr. friend of mine, they both felt there was room (the lawyer takes on large class-action lawsuits, primarily against the auto industry; and the Dr. had moved his practice out of Baltimore City due to adverse court rulings to his fellow physicians and the resulting mal practice premium increases). Whether it is an award cap, I don’t know, but there should be something built-in to any tort reform that:
- punishes repeat offenders (1% of the doctors are costing us all: patients, doctors, hospitals, etc. – get rid of the quacks)
- punishes negligence – If someone/or an entity (HMO) does not approve something just to delay a treatment and it results in protracted care/severe injury, and it is institutional (system-wide), that practice should bear consequences.
- justice is difficult to streamline. But when the court case is John Q vs. Humana, Humana can run them into the ground… force them to spend a lot of money on legal fees, time, etc. There should be an incentive (rather dis-incentive) for companies NOT to delay resolution.
- Like-wise, there should be a dis-incentive for people to bring frivolous lawsuits against doctors, hospitals, nurses, etc. Maybe they would be forced to watch endless replays of the Penn State Iowa Football game from a few years ago that ended 6 – 4 (two field goals and two safeties – it was like watching paint dry).
Comprehensive healthcare reform, while desirable and a legacy cornerstone for any administration, will be difficult. Any solution will impact a large segment of both our population and economy. The hardest part is: if there is an entitlement aspect to it... it will be costly and difficult to take away.
2 comments:
I must respectfully disagree with your statement that individuals should be allowed to not have health insurance if that is their choice...the point of the reform program was to universalize care so that no one had to do without because they couldn't pay for it, and to control the costs associated with postponing care. Those that CHOOSE not to have insurance are inevitably the ones that get sick later and then expect to get the coverage to control their costs, not having contributed to it the entire time. The uninsured are an ongoing drag on emergency services/rescue squads and hospital emergency rooms (which cannot turn them away).
The logic of allowing exceptions is like saying it's okay not to wear a motorcycle helmet if you would rather. But then folks expect to be scraped up off the side of the road where they crashed and flown to the trauma center, and eventually land in and be maintained in a nursing home with the traumatic brain injury that resulted from the crash.
Real world costs flow from those decisions, and if you declare universal insurance a societal priority with the intention to control those costs, you should not allow exceptions.
Dawn Nakroshis (ECN-1040-XE01H)
Dawn, thank you for your post. You make some excellent points. I think the point here is that some people Choose not to have health care... the self-insure. Others cetainly may not be able to aford the care that they want.
By government mandating care, initially it may be affordable, but in the end, costs will rise even more because the government will cause inefficiencies.
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