Second year medical student Juan Garces listens as U.S. Sen. Roland Burris, D-Ill. outlines his position
on proposed changes to the way health care is provide in America
as he speaks at Stroger Hospital, Monday, Nov. 2, 2009 in Chicago.
(AP Photo/M. Spencer Green)
Six basic questions must be addressed before a rational discussion on health delivery reform can ever begin. The Democrat majority in Congress has moved the needle on health care reform and will probably get some reform accomplished, but will they have answered the fundamental questions?
Basic Questions:
o Is basic health care a right or a privilege?
o Why should all U.S. residents be forced to carry basic insurance?
o How are health care services going to be funded?
o How can medical debt personal bankruptcies be avoided?
o How can health outcomes in America be improved?
o How can the ratio between health expense and GDP be reduced without compromising patient care?
Others have kept the health care monster at bay:
Other advanced developed countries have successfully faced these questions. The United States is the only developed nation that does not recognize a right to basic health care. A survey across these nations finds there is more than one way to successfully fund health care. Very few have socialized medicine. Many, but not all, have short waiting periods for service. Medical debt caused bankruptcies are almost unknown. Health metrics often surpass America. And costs are on average half what they are in America.
Right or privilege:
The notion basic health care is a privilege only afforded to those who can pay is fundamentally repugnant to most people. One logical alternative allows people with curable conditions in stressed economic times to suffer and/or die. Unacceptable!
Mandate:
The notion of all insurance assumes shared risk. Regardless of our present health, we will all need medical care sometime. With hospital trips costing thousands of dollars a day, who among us can afford to truly self insure? Even someone with millions in assets is overwhelmed in just weeks.
More importantly, shared risk demands that all risk pool members participate. Some will use their insurance. Others will remain well. If only those most likely to draw on pooled premiums contribute, then the cost becomes unaffordable to individuals or the premium pool runs dry.
Funding:
Three basic funding models operate internationally. A U.K. style system offers true socialized medicine. The Canadian system operates government run insurance companies on a province by province basis paying mostly private providers. The third system, named for Otto Von Bismarck, requires private payment of premiums to insurers who fund private providers. Insurers operate geographically. Government may function as a transfer agent in some countries.
All systems require universal access to care. All systems offer affordable basic coverage. Care prices are negotiated between providers and insurers regionally. Coverage is not related to employment. Basic policies are standardized. Government assists low wage workers.
Medical Bankruptcies:
Medical debt caused bankruptcies are mostly unknown outside the United States.
Improved outcomes:
Although there is much that can be done to encourage healthy lifestyles, the significant difference between America and other similar countries is just access to care.
Cutting the cost:
The United States is the only advanced country that allows its for-profit insurers on basic policies. Instead, foreign companies in the Bismarck model countries compete on service. Profit is allowed through sale of ancillary policies that reduce out of pocket expenses, provide for private rooms in hospitals, offer dental coverage, and other services. These are roughly equivalent to our Medigap policies.
American health insurance revenue streams break down to about 75 percent paying for care and about 25 percent for other purposes. They call their patient care expenses “medical loss.” Each company uses different payment guidelines and forms. This process takes a lot of people as each company tries to minimize their medical losses.
Exacerbating the challenge is the parallel structure of similar size that exists in all provider business offices only to deal with the insurers. America is spending roughly 40 percent more on health care expense than other similar nations mainly to push this paper around.
Most developed countries spend around 10 percent of GDP on health care. America spends about 18 percent.
Simply by fixing the paper chase and leveling the playing field, America’s cost of medical care drops by about $1 trillion annually; roughly in line with other countries.
It wouldn’t be fair to ignore that people would be thrown out of work by fixing what ails the system. On the other hand, all clinical specialties are crying for more people. And while this has been a rather gross macro-analysis, many other savings exist to be harvested if America is smart about how it goes about its planning.
Al Portner is a former daily newspaper editor and publisher in seven states and author of the forthcoming “Mark Twain and the Tale of Grant’s Memoir.” He can be reached at alanportner@gmail.com
Next: Other ways to save on health care:
For more info:
The Healing of America
The Swiss model for health care
McConnell misrepresents Canadian wait times
How America Compares
For Profit Insurers add to cost
Health care administration may cost $1 Trillion annually
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