Additional Comments/Solutions for Health Care Crisis
-----------------------------------------------------------------------
Your Health Care Solution Editorial was enlightening and added perspective to many of the issues
related to the problem of expanding the availability of health care to those currently not insured.
Considering the cost of record keeping and the automated medical records is such a large part of the
health care costs, it would be logical to have a "standardized" automated system, however I shy away from
the idea of a single "government owned and run system". I say that from the perspective of privacy and a
bit of trepidation at the prospect of an inept government bureaucracy handling sensitive personal information.
Still, a single system that meets the needs of the majority of medical practices would reduce some of the overall
costs. I believe it would be far cheaper to have an interoperability standard which would make automated record
keeping systems compatible, than creating a brand new government system from top to bottom.
I also believe the current health care proposal of the administration is one of a massive replacement of the
system in place now. Perhaps that may be an overstatement, but I don't think it is too far off the mark.
It is as if we have a huge apartment complex that is not serving everyone, so we are going to completely tear
it down to the ground, and rebuild in its place, a new larger complex to replace it. The new complex will
be under a single remote manager who is far removed from the actual complex, and have a single record keeping
system. That sounds good and well but I don't think it necessary. Why not just add twenty percent more
capacity to the apartment complex. Using the qualified non-MD providers for a laundry list of appropriate
and approved services for the non-insured would be a good start in cutting costs.
Adding 40 million new patients to the current health care delivery structure might be better accomplished
by a modification of two things. A standardized cost schedule, which of course you already described, and payment
methodology that is based on a tax credit for the medical provider who actually provides the service to the
non-insured patient. This provides an incentive for the medical practice to accept patients who have no insurance.
A detailed study of the appropriate services that should be provided for the uninsured patient would need to be
done, and a list of those approved services publicized.
Since each area of the country is unique as to population demographics and doctor/patient ratios, the planning
for implementation should include county inputs to States, and State inputs to the National level prior to
implementation. I think it would be prudent to have the responsibility for patient care remain where it is now,
and not in the hands of a federal health care czar. Perhaps that would mean that the tax credit for services
provided to uninsured patients be primarily at the state income tax office of responsibility and not the IRS,
except in those cases where there is no state income tax. In that case, the tax credit could be at the IRS level.
Normally, the closer the management apparatus is to the site of service, the more efficient the management is
likely to be. For that reason, the management of Health Care should remain with the State Boards of Medicine
and not the federal government.
The solution to the health care "crisis" must involve the incentive of a tax credit for service provided. That
is the key to expanding delivery capacity. The use of non-MD providers for medical procedures that do not require
the skill or training of an MD would help reduce overall costs to a manageable level, and that would benefit
all the patients. Increased service capacity should come directly from investment of savings into that capacity.
To rebuild the system from the ground up, and develop a completely new automatic records system is not necessary,
nor is it advisable economically, given the already astronomical level of debt being carried on the backs of
two generations of Americans.
I believe the way to get universal health care coverage, without destroying what is left of the economy, and
what little is left of the taxpayer is to simultaneously cut costs and incrementally build service capacity
as cost savings are realized. There is not a health care "crisis" in the US, but there is cost growth
that must be stopped while service capacity is increased.
Your fifteen point program is a very good starting point for study and implementation.
Two items which are big drivers of health care cost must be addressed for potential savings. First is
Health Care fraud which is estimated to be about $800 Billion a year, or a third of annual health care costs.
The second item highlights two opposing forces. That item is the issue of defensive medicine costs. Added tests
and paperwork to avoid malpractice suits is a big cost driver. Unless some limitation to malpractice suits is
enacted, the cost of malpractice insurance will remain astronomical. Of course the opposing force in this issue
remains the lawyers who do not want such limitations enacted. This is a an area of conflict that must be resolved.
If all fifteen of your recommended areas of cost reduction were addressed in a systematic manner with
appropriate reduction of fraud and costs associated with the defensive medicine costs, it is probable
that the savings would pay for an expansion of service delivery without the trillion dollar cost to taxpayers
and without the imposition of a government funded insurance option.
The government funded insurance option would ultimately drive the current insurance companies out of the market
adding to unemployment and a reduction in the number of people seeking careers in the medical profession.
The end result would be rationed health care that is the cost the American citizen can ill afford.
James Newman
-----------------------------------------------------------------------
From Debbie K:
Thank you for your editorial. I fully agree. I am an L.V.N. who
has not practiced in years but, when I did, I most always acted in
an R.N. position. I sadly used this to rationalize not going back to
school. I also second assisted on C-Sections, Abdominal and Vaginal
Surgeries while the M.D. who was assigned the case, sat in the doctors
lounge for liability purposes. I worked at Methodist Hospital taking
care of Dr. DeBakey's (Heart Surgeon in Houston TX) post-operative open
heart surgery patients and know the nurses are the ones who wrote all
the prescriptions and orders for those patients for the medical students.
When I worked as an office nurse for a busy OB-GYN, I would treat all the
patients with prescriptions for their complaints they would call in with
as I knew the treatment for their symptoms.
The problem is, I am sure this is still happening there is just no adjustment
of the fees as the doctors make all the money and the nurses get so little
pay. I do not see M.D.'s giving up fees to "inferior" ranked staff
regardless the fact that they are in fact doing their work. Their ego's are
in the way. The fact that Medical Students have to work for minimum wage is
a disgrace.
Secondly, I am an independent business owner with a company who markets
Dental and Health Discount Plans to those who simply cannot afford insurance,
have been denied insurance or dropped due to medical illness. This company
is 13 years old and has saved over a million Americans over a billion
dollars on their Dental and Health services. This not being insurance
does not carry the restrictions that insurance does. This is something
companies can afford to offer their employees
-----------------------------------------------------------------------
** Health Care Vouchers **
From Don Stenberg, Jr.:
In point 15 you recommend going to high-deductible only healthcare,
and that is a very good idea for restoring good market principles to
healthcare. There is, however, another way.
What if instead of insurance covering your expenses (beyond a point)
regardless of the cost, they gave you a healthcare voucher in an amount
based on your diagnosis. You would be able to spend this voucher at any of
the medical facilities listed in your article, and you would be able to
personally pocket between 20%-40% of the value of the voucher if you were
able to find providers who would treat you that inexpensively. Of course,
if you wanted more expensive (and theoretically better) health care than
covered by the voucher, you would have to come up with the difference
yourself. Insurance companies would probably also have the incentive to
give you 'check-up vouchers' to catch problems early, when they are much
cheaper to deal with.
A perhaps slightly more radical version of this idea is to use it as the
basis of a government-funded healthcare system. With the government funding
vouchers, you get the ultimate in medical choice, market forces are still at
work reducing the cost of treatment, and no one is uninsured.
-----------------------------------------------------------------------
From "Concerned":
I thought that you had some good ideas and some bad ones. It's pretty
late but I had to comment on your last suggestion of "*Design new
insurance plans that shift more costs from premiums to out-of-pocket
costs."
*Joe, this would never be good as this would so enormously hurt those
who need the medical field the most....those who have severe illnesses.
It is already very difficult for them in life and most of these people,
due to their severe health, have little income and usually do without
more than most as it is. They already have to pay so much more in the
existing out-of-pocket due to more medical visits, tests, procedures,
drugs, etc.
Of course there are also just those who have little income and can not
afford the increased out-of-pocket you are talking about. This is why
so many low income (those who fall between the cracks and don't meet the
very low poverty requirements to qualify for any type of medical
assistance) are usually the most unhealthy or more likely to die due to
inability to pay the deductables and co-payments as it is and therefore
don't get the important screenings that are advised along with waiting
to see if they get well without going to the doctor or hospital or
getting that test. Many people who can't afford the out of pocket as it
is will try to wait chest pains out, or severe head and neck pains that
just don't seem to go away like the more common pains. Also women who
feel lumps in their breast will just hope that the lumps are non
cancerous and hope that their going without pap smears and other
important check ups will not end up a deadly choice to either pay for
such or pay the oil bill. Joe, this is already going on due to such
people hardly being able to pay the present out-of-pocket charges....if
they're lucky enough to even have enough money to have a policy.
What your suggestion would accomplish is to make it even more difficult
for those who are very limited as it is and basically would mean that
only those with higher incomes could afford to have an insurance policy.
Again, there are also those with severe illnesses and who require much
medical care which your suggestion would put so much more burden on them
than they already have with the hardships including extra expenses and
these people would just not be able to pay for such and would become
worse or die. Remember, this group already is in general, forced to pay
more as it is because they have a serious illness and their payouts to
insurance is much steeper let alone all that their illness costs them
that insurance refuses to pay for.
Some may respond to the above as, well life just isn't fair. But most
people would have something else to say, I'm sure, if they suddenly
found themselves severly ill or injured or one of life's other surprises
that you never plan for or expect.
I do believe that I have some good solutions but these would be
unpopular with those who make millions in outragious saleries and fringe
benefits, along with those who like to fraud taxpayers and ......
-----------------------------------------------------------------------
From TIM R:
You have very interesting Ideas. I have one idea I
know will work for all americans. We create a national bid board system in which
qualified insurance companies would bid on your district to provide coverage for
everyone in your district working or not. Every family would have a family plan
and every single person would have a single plan. Everyone who works would pay a
premium as we most do now. Every buisness would pay a health care tax. We would
need to regulate the health care industry with health care standards like we do
with our defense military specifications. Every hospital every clinic would
follow these standards. For heavens sake if we can regulate the paint we use on
a military vehicle, weapons and so on, we can regulate health care.