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Not a day goes by without hearing of new momentum in the fight for the various health insurance reform bills advancing through Congress. The Obama Administration is on the attack against their attackers. Democrats have gotten their token Republican supporter. A bill has made it out of committee. Pundits are predicting that Congress will pass a strong health insurance reform bill before the end of the year which will probably include some form of public insurance plan.
Health insurance reform is making progress. But where is our health care reform? Getting all Americans covered by insurance in a wonderful thing. Increasing the insured pool sizes will do much to reduce the price we all pay for insurance. It will reduce the costs further by introducing preventative medicine to those whose idea of a regular doctor is whoever happens to be staffing the ER (and ICU!).
But it will not address the systemic problems that cause much of the costs that make up our premiums.
Fully 40% of all health care bills to insurers are for duplicate tests, unnecessary procedures, cover-your-backside defensive medicine and outright fraud. Even worse, the structure of our health care delivery system provides no incentive to reduce costs. Patients, providers, and insurers are all perversely incented to spend more money, not less. Even worse, we do nothing to track the effectiveness of the money we spend.
Patients neglect basic care of themselves like proper exercise and diet, and then demand miracle cures from doctors who get paid by the procedure, visit and pill. These same doctors deliver care in excess to ensure that patients see they are going above and beyond to avoid getting sued for bad outcomes that can be predicted like the rising sun. Why not? The insurance companies pay for everything anyway.
Our health care system has been neglected for the past 40 years, and it is naive to believe it can be fixed in the space of one huge reform bill. Insurance reform needs to be the step of this journey, not the destination.
The next stops in this journey include:
1. Moving from a fee-for-service model to an annual patient budget model for given classes of patient (i.e. young adult, children, chronic asthma sufferers, cardiac patients). End of year reviews will review effectiveness and examine any unexpected outcomes or changes in health and provide the basis for the next year's action.
2. Simplifying regulations! The patchwork of rules from state to state is a nightmare. It acts as a weight on the entire system. Regulations between states need to be aligned. Regulations need to be crafted no only to protect us, but to provide incentives to all players to improve.
3. Systematic effectiveness measurements. We cannot fix it if we do not know what it broken and what it not. We need to introduce system-wide measurements of effectiveness in every sector.
Comments
Jon,
It seems to me, and many others who are deeply concerned about this subject, that if you really want to talk about getting to the root of the problem then health care must be talked about as a basic, human right. Not a commodity. Not a profit making scheme. Not a lucrative industry. And not even superficially, pretending some legislation here and there will solve it. It's an ethical/spiritual dilemma, not mere politics.
People are demanding economic justice around the world. The idea that only some people should get most of the pie and others left with very small bites, if anything, is absurd. People will not put up with this forever. So the ultimate answer surely will be - ensuring (not insuring!) that all humans are covered in some way, if we care about all fellow Americans, to have basic treatment. Until then, we live in a primitive society where people are dying of preventable disease and lack of care, all for the sake of excessive profits and greed.
Thanks for your insights Stephen. I completely agree.
Or, people can quit beng lazy, get off there but's and work for something. True, there are some people out there that can't help themselves.
However, I wonder how many millions of people are out there claiming to have "health care as a right" and saying "I can't afford it", while they are making payments on a new $30,000 car, wearing $100 sneakers, spending $150 per months on cigarettes, $100 a month on cell phone coverage.
BS!
One word...priorities!
"Getting all Americans covered by insurance in a wonderful thing. Increasing the insured pool sizes will do much to reduce the price we all pay for insurance."
Not going to happen...the Baucus bill reduced the tax or fee for people who do not get coverage. Health people (who would help reduce the cost in the pool) would rather pay the tax/fee until they get sick, then buy. Result...the sicker people get coverage, thus INCREASING the cost.
Thank Max for that one.
"Fully 40% of all health care bills to insurers are for duplicate tests, unnecessary procedures"
You got it...and most health care providers agree that "tort reform" would eliminate a major (not all) of this problem.
"Not going to happen...the Baucus bill reduced the tax or fee for people who do not get coverage"
While the penalties in the bill for non-insured have in fact been reduced from the original proposal, they are still quite substantial. When factored in with the expected drop in premiums, the cost for not being insured is predicted to be around 90% of getting insured. We will have to see how this ends up turning out and make adjustments.
"You got it...and most health care providers agree that "tort reform" would eliminate a major (not all) of this problem. "
A study commissioned by the Bush Administration found that tort reform would product around 1.5% savings. That's not huge, but works out to about $9 in savings in the annual Medicare budget. Definately worth pursuring as long as we don't expect it to be a silver bullet.
"BS! One word...priorities! "
Agreed! Thanks for your feedback Jess.
" but works out to about $9 in savings "
This should be
" but works out to about $9 BILLION in savings "... a >slight< difference =)
Jon,
As a mother, your shared theory concerns me greatly. If high profits can not be made, then who is going to provide the cost for "inovation" of new medicines, treatments therapies? Why is that our country leads the world in new medicines? Profit! Take that away, and more people will suffer, when it could have been prohibited.
I agree with something that Jess said, as I am sure you can figure it out.
I am a single mother, with little to no child support. I could milk the system, stay home and receive a decent check from uncle sam, while watching Oprah, days of our lives, etc. Years down the road, I would be in the same place.
However, I choose to work, make my way and strive to better myself for the sake of my children. I drive a beat up care, live in a mobile home, and make just a little bit more than what I got get off of welfare and others government hand-outs. I could have a nicer car, better cloths and by name brand products, but health insurance is my priorit
Continued:
I hate to say it, but many of my friends (we all work at the same place) are in the same boat that I am. However, they do have the nicer things, but most of them complain about the not having "affordable" health insurance.
Our government should be giving hand "ups" as in pointing us in the right direction, not hand "out" to buy us off and get us "out" of the way.
Also, here is something from Sarah Palin :
"However, the maximum fine for those who refuse to purchase health insurance is $750. [2] Even factoring in government subsidies, the cost of purchasing a plan is much more than $750. The result: many people, especially the young and healthy, will simply not buy coverage, choosing to pay the fine instead. They’ll wait until they’re sick to buy health insurance, confident in the knowledge that insurance companies can’t deny them coverage. Such a scenario is a perfect storm for increasing the cost of health care and creating an unsustainable mandate program."
"If high profits can not be made, then who is going to provide the cost for "inovation" of new medicines, treatments therapies?"
The "high profits" are the reason our system of medicine is designed to treat illness, not cure it. Healthy patients do not provide revenue.
As for innovation, I would support incentives to companies that innovate in the form of a commission paid based on savings. If some new miracle machine produces a better, healthier patient then they should be rewarded with a percentage of the savings to us all.
"However, the maximum fine for those who refuse to purchase health insurance is $750."
The level of fines for non-participation is all over the map, and I expect it to grow much higher in the reconciliation with the House bills. I agree that the fine must be on par with the cost of insurance, but also that the cost of insurance must drop prior to the fines ratcheting up. In many ways it is a catch-22 situation.
"I hate to say it, but many of my friends (we all work at the same place) are in the same boat that I am. However, they do have the nicer things, but most of them complain about the not having "affordable" health insurance."
Unfortunately, you are paying for the health care for your friend's children. It is wrong that a responsible person such as yourself must do this.
It is also unfortunate that so many people must choose between the health of their children and some of the nicer things in life. No such much on a moral basis, but a simple basis of American competitiveness.
When our American companies much shoulder the burden of health care, it puts us at a disadvantage with all of the other countries that share these costs across the population as a whole.
Thanks for your feedback Concerned American! I really do value it and try to incorporate it into my writing.
I wonder, will you then write an article on the Baucus plan, where as the deficit cuts he claims, only come from the fact that we will be paying for it for 3 years before it even goes into effect, as far as coverage is concerned? Sooner or later, the 3 year cushion of cash will be gone, and the deficit will soar. It's like robbing Peter to pay Paul. unfortunately, Peter will come back to collect...with interest!
And, your wrong, this health care plan will cut into innovation, research and develop. And those innovation inncentives you speak, well, were would that money come from...the tax payer of course.
Keep on going down that slippery slope until you hit terminal velocity!
Hi Jon - I have a question for you...kinda on of those "food for thought" issues.
One of the arguments for pushing the democrats health care plan through is the claim to make it "a RIGHT to have health insurance". Okay, my main argument is that everyone does have the right, they may not elect to get it, or even afford it. But that is a different issue.
But, for sake of that argument with the plan being pushed, how can it be a right to have it, when it will not be a right to choose NOT to have it...without a fine or tax being imposed? How can you claim something to be a right, when you have to pay for not using it?
Fair question?
Thanks
"I wonder, will you then write an article on the Baucus plan, where as the deficit cuts he claims"
I already have. See my "Pay Now, Benefit later" article.
"And, your wrong, this health care plan will cut into innovation, research and develop. And those innovation inncentives you speak, well, were would that money come from...the tax payer of course."
We shall see... and the incentive money would come from the savings produced by such devices. I've got an article in the works are a section of Part III of my "Only solutions..." series.
"But, for sake of that argument with the plan being pushed, how can ... when you have to pay for not using it?"
Chet, great question! I think it can form the basis for a whole article. My quick thoughts: The question of a "right to insurance" is really more of a moral argument, since we don't have anything in our Bill of Rights that explicitly says this -- although some would argue that Article I, Section 8 would cover this under the "general welfare" provision. Some constitutions -- like the new Iraqi one -- explicitly guarantee health care.
Anyway, just because we have a right to something doesn't mean we have a right to get it for free -- we have a right to bear arms, but the government doesn't hand out guns. At the same time, the state of Alaska requires that anyone going out into the wilderness be armed with a rifle.
I really appreciate the feedback; I'm going to give this some more thought. If you want to send me an email we can discuss more (I'm hitting the character li
"Anyway, just because we have a right to something doesn't mean we have a right to get it for free"
I think we can agree on that one!
But, I would have to disagree with the "general Welfare" argument (is it safe to assume that you don not totally agree with that one, since you didn't say you agree you agree with the argument?)
I find it hard to stomach that "welfare" meant that same thing back then, than it does today.
If you have not read them, I suggest "The Federalist Papers". Since it is written straight from 3 of our founding fathers, you get a point of view about the contitution that no politicain can give you. It changed a lot of my views.
Anyway..good day to you!
"But, I would have to disagree with the "general Welfare" argument (is it safe to assume that you don not totally agree with that one, since you didn't say you agree you agree with the argument?)"
I was so intrigued by the question I wrote an article on it... see "Do we have a right to health care".
In short, there is not airtight case either for or against since the Framers deliberately chose ambiguous wording. You are right about the meaning of "welfare". Back then it was understood to be about the well-meaning and happiness of the people, not a government handout.
"If you have not read them, I suggest "The Federalist Papers"."
I've read them many times, and I tend to agree with them. However, it is important to remember that this view was held only by about half of the Framers, with the other half being strongly supportive of a strong central government.
It should also be noted that Madison changed his tune markedly once he became President...
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