an idiot’s guide to fixing healthcare

Now that the leaders of our executive and legislative branches are, thanks to the freshman Senator from Mass., being forced to actually turn to their constituents on the health care issue I thought I would add my two cents…okay, maybe I’m up to 4 or 6.

If you have been following this blog, you know I am opposed to the current House and Senate Health Care plans. I think positive reform (which is what we are going for, not complete reconstruction) can be made with relatively little maneuvering and with far less money required from the tax-payer.

While I am not suggesting there is a ’silver bullet’, I think one thing could go a great distance in fixing what ails our country’s broken, but still envious health care system. (I am sure you noticed that as health care got closer to being changed, more and more people said ‘just leave it alone!’ That is because, when it gets down to it, most American’s health care is not nearly as bad as everyone is telling them it is). So what is this idiot’s key to drastically improving our nation’s health care?

Reduce the COST of health care. It seems in all of this crazy math, finger-pointing and empty promises, our elected leaders have come out fixated on increasing the AVAILABILITY of health care, with little concern for the cost. I would suggest that the lack of availability is due, at least in part, to the unreasonable cost of health care.

Much of this legislation moose-knuckles employers, insurance companies and health care providers into providing health care for everyone, but does not reduce costs. That is why we hear the ridiculous numbers we hear, which we can rest assured are under-estimates. We don’t seem to have learned from the housing mess that moose-knuckling companies into doing things they shouldn’t is a bad idea. As big and bad as insurance and drug companies supposedly are, I really don’t think we want to push them out of business and let Uncle Sam take care of all our boo boos…or have to bail them out later because they are ‘too big to fail’.

So how to reduce costs? 1) Court reform 2) Emphasize primary care 3) Reduce government involvement.

1) Court Reform ~ While, again, it isn’t a silver bullet, one ’sure-fire’ way of lowering the overall cost of health care is to reign in medical malpractice lawsuits. First off, the medicine doctors practice has been forced to radically change in order to prevent lawsuits. This kind of ‘CYA (cover your hinnie) medicine’, involves spending lots of money the physician is almost sure is unnecessary, but he/she cannot afford to risk not doing it for fear of litigation. Also, we know, first hand, the amount of money a physician is required to spend on malpractice and ‘tail’ coverage. Inevitably, this expense, like any imposed on a provider, is passed on to the patient. The cost of these insurances are ridiculous! Why? Because the amount of money these companies spend on fighting (or most likely just settling) court disputes is no small sum. Sometimes, the care was negligent. However, it is often the case that a patient is taking advantage of a well-known flaw in our health care system that makes it cheaper for insurance companies to settle these cases. So how do you reign in these costs without taking away a patient’s ability to be compensated when negligent care is provided?  Texas took a step in the right direction by limiting the damages for ‘pain and suffering.’ Another approach is a bill (HR 3076) Dr. Ron Paul supported.

“The bill provides a dollar-for-dollar tax credit that permits consumers to purchase “negative outcomes” insurance prior to undergoing surgery or other serious medical treatments. Negative outcomes insurance is a novel approach that guarantees those harmed receive fair compensation, while reducing the burden of costly malpractice litigation on the health care system. Patients receive this insurance payout without having to endure lengthy lawsuits, and without having to give away a large portion of their award to a trial lawyer. This also drastically reduces the costs imposed on physicians and hospitals by malpractice litigation. Under HR 3076, individuals can purchase negative outcomes insurance at essentially no cost.”
Read Dr. Paul’s full 1996 essay entitled “Lowering the Cost of Health Care”

There are likely many ways to decrease frivolous lawsuits and thus lower these costs. Our litigious society is getting the logical outworking of its entitlement mindset. This needs to be reversed on all levels, but if it were at least done with medical care it would have a positive effect on the cost of health care.

2) Emphasize primary care. ~ (Disclosure: Yep, I am married to an F.P. Regardless, it is just common sense.) If you can find a way to get patients to go to a doctors office for non-emergent injuries, instead of an ER, the cost of the care is drastically reduced…and the quality of the care is likely increased. In general, Americans are too impatient. (I can say this now that I have observed non-Americans for over a year…and because I am an American). We rush to the ER or costly specialists, skipping a trained family practice doc who could correctly triage our problem, which in may just need some sleep, ibuprofen, Tums or time. Instead, our insurances premiums and tax dollars are being spent on thousands of needless ER visits, ambulance rides and trips to a specialist. It should be noted, that this is one aspect the current health care legislation addresses. However, under the current plan, you may not have an FP as your front line care, it may be an FNP or PA.

3) Reduce government involvement. ~ As was the case with housing, the problem is not lack of government involvement, it was an excess of federal control. If you ask anyone who manages a health care provider (especially one unfortunate enough to accept Medicare, Medicaid or any other federal support) what is their biggest hassle, they will likely tell you: collecting from the federal government for services rendered. As a result of the red-tape and hoops that the government requires in order to get paid for helping a government ‘cared-for’ patient, the provider often does not receive full payment, if they receive payment at all. So what happens? You guessed it! Those of us who pay for private insurance end up paying an inflated cost in order to allow the health care provider to collect an amount that averages out the others underpayment.

Also, we need to remember that we can thank the federal government for the nonsensical idea of tying health care coverage to employment. This system, which spells disaster for the unemployed, can be traced back to the HMO Act of 1973. Dr. Paul reminds us:

“Many in Congress are happy to criticize HMOs today, the public never hears how the present system was imposed upon the American people by federal law. As usual, government intervention in the private market failed to deliver the promised benefits and caused unintended consequences, but Congress never blames itself for the problems created by bad laws. Instead, we are told more government – in the form of “universal coverage” – is the answer. But government already is involved in roughly two-thirds of all health care spending, through Medicare, Medicaid, and other programs.

These three simple (compared to the three-ring acts going on now) steps would go a long way to fixing health care. Unfortunately, Washington doesn’t have a great track record when it comes to removing itself as an obstacle to positive change.