From The Middle

Health Care Reform

America! Please Stop! My Ears Are Hurting!

The screaming from both sides of the spectrum on health care reform is hurting my ears, and my heart. Is this how we solve problems in America now? I don’t think so, Scooter. Can’t we try a little reasoned, common sense approach?

Do we really have the best health care system in the world?

1. Costs are rising faster than any other country, faster than inflation, faster than our incomes;
2. Infant mortality in the U.S. is now 28^th in the world (there are 27 other countries who have better infant mortality rates than our 6.37/1000 births);
3. Life expectancy in the U.S. is declining – we are now #42 in the world. That means that people live longer in 41 other countries;
4. Graduating from college, changing or losing a job (which happened to how many millions in the last 2 years) can mean losing health care coverage.
5. There are 40-50 million people in the U.S. with no health care coverage.

From this I believe that we can conclude that while we once had the best health care system in the world, we have lost that ranking and have some problems to solve.

The first step in solving a problem is to identify the cause(s) of the problem.

CAUSES

#1. WHY are the costs of health care in America skyrocketing?

1. Malpractice. The fear of malpractice lawsuits causes doctors to prescribe more tests than might be necessary just to protect their butts. It is also why we have so few General Practitioners (GP’s) coming out of medical schools – they need to be specialists to be able to afford the premiums. In addition, according to the October, 2009, issue of Scientific American, we are now down to 5 companies that manufacture vaccines of all kinds from the 25 that existed in the 1970′s due to liability concerns. Why is there nothing in either the House or Senate bills addressing tort reform?
2. Medical Training. Medical students in America are, for the most part, trained as human Maytag repairmen and women. They are mechanics, trained to repair you, not to keep you healthy. This is where the GP’s used to fit in as the ones trying to keep you healthy when they were not busy fixing someone.
3. Insurance Reimbursement Programs. Insurance plans pay doctors and hospitals for procedures performed. The more procedures performed, the more they get paid. This is also tied to the malpractice issue because the doctors will put you through procedures you may not need in order to protect their butts from liability, and, they get paid more for doing it. This same system supports the “fix you – not keep you well” approach to medicine. Doctors and hospitals don’t make money if you don’t need to be fixed.
4. Drugs. The U.S. has the highest prescription drug prices in the world. About 10 million U.S. citizens bring in medications from other countries annually. Drugs that are over-the-counter in other countries are prescription here (= more expensive) because U.S. patents last 20 years and the pharmaceutical companies have found loopholes to extend those patents even longer.
5. Paperwork. One average-sized hospital in Phoenix, AZ, has over 300 people on their payroll JUST TO PROCESS INSURANCE AND BILLING PAPERWORK!
6. Fraud. Drug runners have traded that business for fraudulent medicare treatment and supply companies because it is easier to make more money!.  Estimates are that we are paying $47 to 60  Billion per year!

#2. WHY are we 28^th in the world in infant mortality?

1. The main reason for the high rate is pre-term delivery, and there was a 10 percent increase in such births from 2000 to 2006, according to recent figures from the Centers for Disease Control and Prevention. The cause(s) for this are unknown.
2. I would suggest that the fact that 25% of the children born this year will be born to single, stressed mothers may have something to do with it. I have no facts to support this, but, the medical profession has no better suggestions.

#3. WHY are we now 42^nd in life expectancy?

1. High uninsured rate among the population (people are not getting help until it is too late);
2. Rising obesity rates;
3. Racial disparities in life expectancy. Black U.S. residents have a shorter life span, at 73.3 years, than whites;
4. The U.S. also has a high infant mortality rate compared with other industrialized nations, with 40 countries having lower infant mortality rates than the U.S. in 2004.

#4. WHY are 40-50 million people in America without health care coverage?

1. They are unemployed – 6.2 million. Those who lost their jobs or have just graduated college and are unable to find a job with health care benefits.
2. They are underemployed – 12 million who work for minimum wages for companies that either do not provide healthcare, or, it is so expensive the employee can not afford it.
3. They are illegal – 10-12 million
4. They are children of the un- or underemployed – 12-14 million

SOLUTIONS

1. Tort Reform – Limit liability awards to reasonable levels.
2. Focus on keeping people healthy
   1. Train medical professionals how to keep people healthy as opposed to fixing them (they will still have to learn how to fix people, it’s just the emphasis shift)
   2. Pay for health – reimburse doctors and hospitals for keeping people healthy
   3. Charge higher premiums for unhealthy life choices like smoking, illegal drug use, obesity, etc., but no more exclusions of pre-existing medical conditions.
   4. Reimburse for successful outcomes resulting from the team approach where a primary physician works together with specialists to get a patient healthy quicker.
3. Reduce the number of children born to single mothers.
4. Subsidize drug research in return for reducing drug prices to levels consistent with other countries.
5. Provide affordable portability. If you lose your job, the COBRA option is normally too expensive for anyone. There must be a means to maintain the same coverage during the gap between old and new employment.
6. Automate medical and insurance record keeping

I would like to offer an “out of the box” proposal for discussion.

We are all paying for medical coverage for all of America.  We are not just paying for our own coverage.  When we buy anything, a car, insurance, clothing, food, anything, somewhere between 10 and 20% of what we pay goes to pay for the benefits for the employees at the company that sold us the product.  Where do you think the money your employer kicks in for your health insurance comes from?  The premium you pay, comes out of your salary that your employer pays you.  They have to pay you enough to cover that with some left over or no one would work there.  They set the prices for whatever they sell based in part on your wages.

The premiums we are charged, and the prices at hospitals, are based on their costs, plus, the costs of providing care to the uninsured – it has to be paid for somehow.  So, the average annual premiums for a family of four of $13,400 (according to the National Coalition on Health Care www.nchc.org//facts/cost) are really paying for everyone – you just get to decide which doctors you go to.

My proposal is a MIDDLE position between the current system that clearly has faults and the possibility of  “national health care”.

How about letting the people who should be most interested in our health other than ourselves – the doctors – be in charge?

Recognizing that we need some kind of organization to manage this, I propose that we remake the current major health insurance companies into state-by-state companies governed by a board of directors that must have a majority of licensed medical practitioners.  The reason for the state-by-state division is to account for the differences in health care needs by areas of the country – the facts show that health care needs are not the same across the country.  These companies may affiliate with each other for economies of scale, but, their charter is to see to the care of the citizens of their state.

All premiums and co-pays, just as they are today – no changes – would go to these entities.  These companies  would then pay the medical providers as follows:

1. Pay doctors a flat fee per registered patient per month.  You register with whatever doctor you want.  He/she is paid a flat fee every month in return for being in charge of your health care.  (The bean counters would have to figure out the fees.)

2.  Pay hospitals a flat fee per Emergency Room patient seen and for patients admitted per day.  (Again, the bean counters, which insurance companies have armies of, would determine the figure.)

3.  Both providers would be paid “bonuses” for keeping people healthy and penalties for negative outcomes (such as hospital re-admittances for the same ailment or infections obtained while in the hospital).

In terms of the currently uninsured, we are already paying the highest possible prices for what health care they get, because they wait until they have to go to an emergency room that can not deny them treatment.  Suppose we take the same approach to this that we take with education.

Nowhere in the Constitution does it say our kids are entitled to a free education (free of course excludes taxes), but we do it anyway.  But, those who have worked hard and are able to afford to send their children to private schools can do so.  My proposal includes taking a portion of the premiums brought in, along with current state health care dollars, and providing a minimum level of health care to all Americans – immunizations, checkups, basic medical services – in order to keep them from jamming the ER’s when they are extremely ill.  The doctors would receive separate payments for caring for them.

I know that there are a million details that would have to be worked out, but, something along these lines would provide:

A.  Choice

B.  Portability

C.  Health incentives vs. repair incentives

D.  Health care dollars staying in the state

I welcome calm reasoned discussion on this topic.

REQUIREMENTS

1. The health care reform package that is finally voted on must include the members of Congress and the White House and their staffs. No more “elite programs” for the “Lords and Ladies”.
2. Related to #1, all federal workers will be enrolled in the Social Security system, again, no more “elite programs” for the upper class.
3. If this is “the most important legislation of our time” then implementation  will begin within 12 months of it being signed into law – not after the next elections.

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