Brainstorm of Ideas, Methods, and Techniques for Lowering National Health Care Costs
Barack Obama's health care law passed in 2009 is only the beginning in what appears to be a long battle over the United States health care. Whatever plan is eventually implemented, it will fail miserably unless long-term costs are brought down. This article lists a brainstorm of ideas for lowering health care costs. Each idea may have other advantages and disadvantages, but cost to the individual and society is the main focus of the ideas.
- De-regulate the medical profession by allowing less-educated individuals to perform work currently limited to doctors.
Medicine and the human body may be the most complex of subjects to learn in existence. A medical doctor must go through 8 years of rigorous, grueling intense
higher education training. Then, he or she must go through 4 years of internship & residency that includes exhausting 80+ hour weeks. During all this training, doctors
usually accumulate over $100,000 of debt. And all this torture is limited to those who have the GPA and MCAT scores that are good enough to even get accepted into
the programs. No wonder we have such a shortage of doctors, and the ones we do have are so expensive! Nurses, physician's assistants, paramedics, and other medical
professionals don't have to go through that rigorous of training, but the education they do have to go through is still expensive, time-consuming, and incredibly
complex. Each professional has a range of skills that are developed through the years. Unfortunately, politicians and government officials with minimum, if
any, medical training are setting rules for what can be done by who, and how
much training they must have. In other words, they pass laws that so-and-so must be done by M.D.'s, so-and-so can only be done
by registered nurse training levels, etc. It's time the government ease restrictions on who can do what in medicine. Does it make sense that someone who wants
to perform heart surgery has to go through the same amount of education as someone who wants to set broken bones and prescribe infection remedies?
Does it make sense that 3rd-year med students are allowed to perform medical tasks that a nurse with 30 years of experience can't? Does it make sense
that a Ph.D. psychologist can't prescribe Zoloft or Prozac but a psychiatrist who can prescribe the drugs must go through 8 years of education almost
completed unrelated to psychology? Medicine is probably the most complex subject in existence; still, the vast majority of medical tasks don't require
someone with 12 years of tortuous training. Health care costs are so high because tasks that could often be performed by nurses,
physicians assistants, paramedics, and CNA's are restricted to fully-licensed doctors.
De-regulation would reduce costs in three ways: 1) Routine tasks can be billed out at the much cheaper rates
of lesser-trained professionals; 2) Doctor salaries would fall
since they wouldn't have to handle the same case load and pressures; and 3) Competition would increase, which always leads to lower prices and better
quality. Doctors would also have more time to devote to the tougher cases, and you'd draw more students to medicine since they'd be able to do more
meaningful work without having to devote the time and money of becoming a full physician.
Yes, we want and need an elite class of physicians, but given the dire situation, maybe we need to open certain tasks to lesser-trained individuals. Some may worry that this opens the door to more medical mistakes. Yes, lesser-trained individuals will make more mistakes, but remember, people have a choice. If they want to save some money and possibly take a little more risk (which may be more perception than reality), they'll choose a nurse or other lesser-trained individual. The overall risk may actually decrease, since doctors will be able to spread the workload rather than try to keep up with the overwhelming patient load.† If it's a more complex problem, patients can go to a fully-licensed physician. Think about how many doctors refer their patients to specialists anyway. What difference does it make if the first cog in the machinery is a nurse, nurse practitioner, or physician's assistant? Also remember that a medical professional always has the threat of a lawsuit if he or she screws up.
- Create a range of new medical training levels and specialties.
Despite the vast number of medical problems, there are specialties and training
levels are somewhat limited.
Sure, there are specialties, but most at the doctor level. It takes
almost a superhuman to get through the rigorous training requirements we have
for our physicians. Each student must spend an average of $160,000 and devote 8
years to a grueling education program. Then, he or she must complete a
slave-labor 4-year residency with 80+ hour workweeks. This is just to
start their medical career. Almost anyone in medicine will agree that
while a solid base of knowledge is important, you don't really know what you're
doing until you've accumulated years working on real cases. Think about it. If
you had a certain medical problem, would you rather see someone with 12 years of
general education and no expertise in your problem area, or would you rather see
someone with 12 years of experience working specifically in the area you need
I'm suggesting that in addition to de-regulation, we develop several new specialties and education levels, leaving the patients with the choice of who to go to for virtually any medical treatment. Obviously, to work in medicine, you'd want to require a base set of classes in anatomy, chemistry, biology, etc. But after that, training can be ultra focused to areas of specialty. Students could be given hands-on and written certification tests at multiple levels to demonstrate their ability in their area. We could have several levels of doctors or nurses. Think about how achievement in martial arts is structured. You start out at white belt and proceed through various colors all the way to black belt. To advance to each new level, you must devote a certain amount of time and demonstrate a certain set of skills. By looking at the color of belt, we instantly can guess a person's ability and level of training. Think about the financial planning profession.† A 2 or 4-year degree may get a professional his or her first job, but customers may not want to go to that person unless he or she has CPA, stock broker license, Certified Financial Planner qualification, etc.
Again, it's all about choice. We still need the heavily-trained individuals for the complex cases. We can save money by going to a lesser-trained, lesser-experienced individual if we want. Insurance companies could offer incentives to use the cheaper alternatives. For example, go to a "physical specialist" for your physical and there's no co-pay.
One last idea when it comes to specialties: ease requirements for the creation of businesses that specialize in performing certain types of tests; for example, CT scans, X-rays, etc. Businesses could be set up to do nothing but the type of test that's required. A specialist could streamline operations and squeeze out levels of efficiency like never before. Once again, regulation constrains true reform.
- Allow health insurance companies to sell across state lines.
One of our biggest obstacles to lowering costs, and one of the biggest examples of how government screws things up, is
the requirement that insurance companies can only sell policies within their own state. A change in this would increase flexibility
and decrease costs in a number of ways. First of all, it increases competition. More companies would be able to compete
for your business. The high-priced, low-efficiency companies would have to close up shop. Low-priced, well-run companies would
minimize overhead and better take advantage of economies of scale. Paperwork would be reduced, and technology-savvy companies
would increasingly dominate the market. More importantly though, the choking over-regulation of individual states would be eliminated.
States often impose mandates on what must be covered, including everything from Viagra to baldness treatment. Thus, policies for
everyone cost more. Over-regulated states such as New York charge 2-3 times as much as minimally-regulated states such as Idaho.
There's also little ability to customize policies. Have you ever seen those car, disability, or life insurance commercials that allow you to customize
plans to cover only when you want? Wouldn't that be nice to have in health care? Do you really need a plan to cover childbirth costs
if you've had a vasectomy? Do you want a policy that covers abortion and fertility drugs? If you're unfortunate enough to live in certain states,
you may face such mandates. Minnesota alone has over 60 mandates for what MUST be covered in your policy, regardless of your age, lifestyle,
and medical history. The high cost of policies in these over-regulated
states often drives healthy people from the market entirely as they opt for no coverage at all. Thus, there are fewer healthy individuals
to subsidize the cost of the unhealthy ones. Results: costs go up even further.
- Incentivize individual insurance over employer-provided insurance by taxing health-care benefits
as income or offering a tax credit for
buying individual policies.
It economically makes no sense to build health insurance around your job. It causes people to stay in jobs they hate, decreasing labor
mobility and overall productivity. It causes people to live in fear that they may lose their coverage if they lose their jobs. It
makes individual policies cost-prohibitive when compared to employer plans since they're not subsidized by the government. It also stifles
business growth since small businesses often cannot afford to buy a plan that competes with the larger companies. Employer-provided
insurance is more a side effect of shortsighted wage controls put in the World War II era. Taxing health-care benefits as normal income
would slowly wean most businesses away from offering health insurance. The tax incentive to buy individual insurance would allow
millions of Americans to pool their risk in the same way as it is with other types of insurance. Increasing competition and customization of
policies would drive down costs significantly. It would also remove one of the chief
complaints of our health-care system: the threat of losing coverage when becoming unemployed or changing jobs. It may seem burdensome
to tax something we have always gotten for free, but as mentioned, it will eventually divorce health insurance from employment. Companies
can make up for it by paying higher wages, and the tax credit savings of buying individual insurance would more than make up for any loss.
- Crack down on fraud and abuse in Medicare/Medicaid by creating additional auditing procedures and making it a serious felony (for
example, punishable by a mandatory 10 years in prison) for the act of defrauding one of these programs. Punishments for health insurance fraud
would be just as severe.
Medicare and Medicaid are both going bankrupt. It's only a matter on time, especially with the aging
population and the millions of new people added to each by Obamacare. Sadly, fraud & abuse of these program
accounts for tens of billions each year and is growing. Additional incentivized audit procedures should be added to the system (e.g. paying someone
based on the number of crooks or abusers they catch, or possibly paying a
percentage of the dollars saved in the abuse). Also, those that are caught defrauding these programs should pay such a steep price that
thieves won't even try. It should be a serious crime; after all, these thieves are stealing money used to treat people's medical conditions. The
steep penalty must be mandatory, since too many judges dispense slap-on-the-wrist justice. Only an attention-getting punishment will have a
major impact on the system. Similar mandatory sentences would apply to health insurance fraud. Although private industry has much better audit
procedures in place, a significant portion of the health care dollar goes towards fraudulent claims.
- Create a new statute to punish those who bring frivolous malpractice suits and extort money from doctors.
Frivolous lawsuits against doctors and hospitals, especially ones with
outrageous verdicts, have led to skyrocketing medical liability insurance. Many lawyers will extort money by
threatening lawsuits, even though they have no chance of winning. Doctors may opt for a quick settlement anyway since the cost of
a malpractice lawsuit is enormous compared to paying the lawyer to just go away.
A solution to this is to get back at the lawyers responsible
for attacking the doctors or hospitals that haven't done anything wrong. What I
suggest is a new law that requires that not only should the plaintiff have to
pay court & attorney fees to innocent defendants, but lawyers who encourage
the case be forced to pay a matching amount as a fine. The lawyer would also
lose "points" on his legal license, so those with a track record of bringing
frivolous lawsuits would lose their license to practice law.¬†
- Develop a new court system to deal with medical malpractice lawsuits.
Medical malpractice lawsuits are by far the most expensive to bring to trial.
This makes sense when you consider the subject matter of the trials involves
doctors who go to school for 8 grueling years, endure 4 years of 80-hr week
residency, and then work several years on their specialty. Can we really expect
a jury of 12 people who have little or no medical training to understand what's
going on? Not only is it expensive, but too often juries who don't understand
the facts must pick between a rich doctor and a feeble, dying, or disfigured
patient. So even if the doctor has done nothing wrong, he or she may get the
shaft. And that cost is of course passed down to us in increased health
insurance premiums. I propose setting up a specialty court system similar to
what we have for tax and bankruptcy disputes. Decisions would be made by trained
medical professionals who can better understand the issues and render fairer
- Create liability caps on damages for pain & suffering and punitive damages in malpractice lawsuits.
Doctors across America are walking off the job or giving up their practice
because of the exorbitant cost of malpractice insurance. Malpractice insurance
is passed on to all of us in higher insurance premiums. There should be no limit
to damages for lost income or medical bills caused by malpractice since they can
be objectively measured. However, pain/suffering and punitive damages are
intangible amounts that need to be reined in. Juries often come back with unjust
awards because they feel sympathy for the patient and figure a rich doctor or
insurance company can afford the loss. Everyone makes mistakes, and doctors
should be held accountable, but excessive lawsuits are changing the medical
system as we know it. Doctors are practicing expensive defensive medicine to
avoid getting sued as well as curbing or eliminating risky areas of practice. In
other words, they're practicing law in a way they normally wouldn't, such as
ordering extra tests that probably aren't needed to make sure their butts are
covered in a lawsuit.¬† A 2010 study published in the Wall Street Journal
put the cost
of defensive medicine at $46 billion per year, or 80% of the cost of the
medical liability system cost.¬† Remember, there are plenty of punishment options for doctors that screw up that don't involve money; for example,
suspension or revocation of their license to practice. This solves both problems: getting the poor-performing doctor out of the
profession while keeping our health insurance premiums from going up. A $250,000 or $500,000 cap
on damages would be a reasonable
start in addressing all these problems.
- Set up a government grant to a privately-ran,¬† non-profit drug research & development facility,
with the condition that all knowledge learned is public domain, and any drugs
produced from the facility have no patent-protection.
Prescription drugs are undoubtedly one of the most expensive components of rising health care costs. However, the actual
production of drugs is usually pretty cheap. The expense comes from the research and development. Remember, creating new drugs can take years or even decades of meticulous, expensive research & testing. And for
every successful new drug, there are hundreds that turn out to be a waste of time. Drug companies must charge exorbitant prices
to recoup their costs and ensure an adequate profit. Unfortunately, because patent laws create a virtual monopoly on their
product for 17 years, they can charge whatever they want (subject to market
price demand). I'm proposing the government donate money to start a not-for-profit drug
research facility where patents laws aren't applied and all experimental learning is shared with the public. There are
several advantages of such a facility.
First of all, once a drug is created and approved, anyone would immediately be allowed to make and sell it. Competition would drive the price to rock bottom levels. Second of all, time could be devoted to curing illnesses and diseases that aren't always the most profitable. For example, certain types of fevers such as malaria are almost non-existent in the U.S., but they are major problems overseas. We could develop remedies that were never dreamed of, possibly prompting other countries to do the same. Lastly, we will be able to build the knowledge base for everyone, leading to the faster develop of new life and pain-saving drugs. In the current system, drug companies almost have an incentive not to share their knowledge since doing so might lead to other companies gaining a patent first. In a non-profit facility without patent protection, we could, for example, require the results of certain experiments be posted online.
- Build a series of lawsuit-prohibited medical facilities, perhaps offering
tax incentives for creating them.
If you could save thousands of dollars by going to a doctor with the same expertise as other clinics but for which there
was no chance to sue if a mistake was made, would you go? Some people would say yes; some would say no. There's always
the chance you'd get lesser quality because the threat of lawsuit isn't there to
keep up the pressure; however, you may get better care since
doctors can concentrate on curing the patient rather than covering their butts. I suggest clinics be set up where patients
must sign a release preventing any legal action if they want to be treated. Doctors would be able to charge a
small fraction of what they currently do since they wouldn't need to pay hundreds of thousands in malpractice insurance.
You'd also be able to save money arising from unnecessary tests that are often
carried out to minimize legal
Remember, people are required to sign do-not-sue releases to go bungee jumping, sky dive, take a karate class, and do a number of other activities. Does this stop people from going? People will come to such a medical facility often because they have nowhere else to go or because they're not worried about malpractice when getting an antibiotic prescription. Is such a facility an unrealistic idea? Not by a long shot. Patch Adams, the doctor on whom a movie was based, founded a free clinic called the Gesundheit Institute and ran the clinic without malpractice insurance. He has since expanded and introduced all kinds of revolutionary medical ideas. Thousands of doctors have volunteered their time to his program. It's not realistic to operate all free clinics, but the costs of a clinic that doesn't need malpractice insurance is dramatically cheaper.
- Streamline or eliminate the FDA, and de-regulate the process of approving drugs.
While the FDA's purpose of protecting the public is noble, the organization has
become increasing less useful and is causing more problems than it solves. It was
originally set up to protect the public from charlatans selling snake oil and
other potions, but in today's complex pharmaceutical market, the organization
isn't as necessary.
Consider the problems caused by the FDA: 1) The FDA costs the taxpayers an enormous amount of money to function; we should always be looking for ways to cut government waste so the funds can be redirected to other areas. 2) The FDA delays the release of drugs, causing pain and death in patients. Like all government offices, bureaucracy slows operations to a crawl. It can take years, even decades, to get a new drug through the screening process, even though the seller has already screened the drug thoroughly. For patients who are suffering and those who will die without a new drug, this delay is unacceptable. The FDA will bring criminal procedures against the seller even when the patient is willing to assume all risks. 3) The FDA drives up the cost of prescription drugs. The impractical requirements placed on drug makers along with the added layer of screening forces companies to charge more for their products. 4) Drug companies invest little money or research time in less common illnesses or conditions since they can't possibly recoup the cost of development.
Some may ask "What about the consumer? Won't this increase the chances of unsafe drugs being put on the market?" The answer is a possible yes, but only marginally so. Remember, drug companies are worried about their reputation and don't want to be sued. One class-action lawsuit or the bad press of one unsafe drug could put them out of business. Thus, they take great pains to make sure their drugs are safe. And drug companies are run by human beings who obviously don't want their products to cause harm. How many scientific researches say, "I'm going into research because I want to make a lot of money?" Researchers do their jobs to improve the quality of life in humans, if the government would just get out of the way, that is. The FDA just adds a repetitive layer that isn't necessary. Patients and the doctors from whom they get a prescription are going to factor safety into their decision to use a drug. Thus, even without the FDA, it's likely a private screening company will develop to certify the drugs. Private policing of the industry is faster, cheaper, and more flexible. It's time to cut some of the FDA fat from the budget. In fact, if the FDA were eliminated altogether, it's likely some third-party private organization would form to provide some kind of stamp of approval.¬† In other words, a pharmaceutical company would voluntarily get a drug approved by the independent third party organization to give their product more credibility. However, the approval processed would be streamlined and less bureaucratic than in government.
- Streamline the process of purchasing drugs for consumers.
I went to the drug store recently to pick up some asthma meds. Despite the fact that I called a day ahead, I had to wait
45 minutes for my prescription. Why? Because I had to have a pharmacist explain to me how to use an inhaler I've been using
regularly for over 15 years. Have you ever gone to pick up a prescription and not been subjected to a wait in line? The cost
of pharmacy employees is part of the drug distribution cost. Wait times are ridiculous because overprotective,
condescending politicians have passed laws forcing pharmacists to read you a label that says
something like "Take this twice per day
with meals." After all, it's possible you can't read or didn't hear when your doctor told you the same thing the day before.
The average hourly cost of a pharmacist is over $70. Multiply the hours you'd save by the number of pharmacists in the country.
- Pass a law requiring publication of price lists of all medical services.
Did you ever stop to think that medicine is the only business that doesn't publicize it's prices? Can you imagine dropping your
car off for repairs and having the mechanic pick any price he deems appropriate? Publication of prices leads to more-informed
consumers. Consumers would be able to shop around for better prices and question
- Create a national website that stores information on all medical providers, including their prices, along with the drug costs of
all businesses licensed to sell prescription drugs.
Related to the last point, a national website would allow patients to compare and contrast all prices, saving them money and forcing
providers to price their services competitively. Licensing, experience, and education information would be required on the links for
all medical professionals. This would not only verify their legality in practicing medicine, it would allow you to see exactly what you're
paying for. For example, some patients may want to pay extra for an operation if one of the doctors have significantly more experience.
For less invasive procedures, or when the patient is strapped for cash, a lesser-trained or experienced provider could be chosen. Just
think how much a national publication site would help with drug costs alone. How many people do you think go to the same place for all
their prescription drugs (e.g. Wal-Mart, Walgreen's, Shopko)? Is their any reason for these drug sellers to price competitively if
patients blindly go to the same place and are only concerned with co-pays? Health insurance companies could even create incentives for
using cheapest options. Sellers would either have to lower their prices or lose a ton of business. A national website could have all
kinds of sophistication built in; e.g., you could design the site to suggest generic alternatives to more expensive brand-name drugs when
- Set up a new scholarship/grant program for those that want to enter the health
The average medical student graduates with over $100,000 in debt. Then, he or she must work a 4-year residency at close to
minimum wage. Is it any wonder that few doctors want to volunteer time or work in low-cost clinics? Is it any wonder they
try to squeeze in as many revenue-generating patients per day? They have
just to pay school loans, malpractice insurance, and other overhead! The nursing shortage gets worse every year, which leads to
longer hours for the current staff and more potential for costly mistakes. We should be doing everything we can to get
more students into the medical profession. The economic laws of supply show prices will drop proportionately, so the
scholarships should pay for themselves.
- Increase awareness of WebMD, Ask-a-Nurse, and other free medical advice.
There is an endless wealth of free information on the Web and on phone hotlines that people simply don't know about. Most
minor problems could be solved by the patient if he or she took the time to look up the ailment. Part of the problem is that
people don't know you can get diagnoses, symptoms, causes, related illnesses, etc. without paying a dime. Most of these
medical data banks will have a section "When you should visit a
professional", so the basic problems can be solved with minimal risk.
- Develop a national health information system that centralizes all medical
information in a standardized data format.
Did you realize that 60-70 percent of your medical dollar goes towards administration and insurance costs? How many
times in your life have you filled out a full medical history? How many times have you had to re-explain your medical
background to a new doctor?
Every medical office has its own set of medical records that
must be organized, filed, data-entered, and maintained. Every medical office must duplicate insurance information,
organize claim procedures, and manage their own computer system. This redundancy causes two major problems: 1) It creates a greater chance for error, by both the patient and
the hospital staff; 2) It doubles the administration costs which are passed on to all of us
as higher premiums. Think about
how much money we could save in the future if we integrated all this health information into one national database. Consider
how much better doctors could do their job if they could pull up a full medical history of the patient's treatment, including
treatment at other hospitals.
- Set up a pool of money to be awarded as prizes for those who develop technological
innovations in the health care and health insurance industry.
Those of us who have worked in the health care industry know that medicine, especially when dealing with record-keeping & claim-processing, is in the technological
stone age. For example, how many times have you had to write out a medical history? How much of that do you think gets computerized so that it can be easily
transferred to or reviewed easily by other doctors? Have you ever seen the amount of paper in a persons medical file? Another example--prescriptions.
Has anyone every got a new prescription
from a doctor that didn't involve a barely legible piece of paper written by a doctor that must be taken to a drug store before it can be processed? In an age of Ipods,
Blackberries, and credit-card-sized cell phones, shouldn't doctors have some kind of device that communicates directly with the drug stores to order a prescription? Shouldn't
the doctor be able to immediately access drug prices, generic substitute options, possible adverse reactions with other drugs taken by the patient, etc.? If the health
care industry wasn't so behind the times, we'd have the latest technologies such as these in place. What I'm proposing is a pool of prize money to
incentivize scientists and inventors to unleash their genius on health care. Prizes could be given for the best invention in a number of areas--claims processing, medical records management, prescription drug
communication, etc. Unfortunately, sometimes the best minds in science have no desire or talent for
entrepreneurship; thus, they don't get sufficiently rewarded financially
for all their hard work. The potential for million-dollar prizes will spur the best minds to bring the technology of the nation's health care to the 21st
century and beyond.
- Ease end-of-life options.
By far the biggest advantages to physician-assisted suicide are the preservation
of dignity, minimization of suffering, and the easing of anguish on family
members. These cannot be underestimated. It's almost callous to think it,
but there's another advantage that most people don't consider, which is the
savings of health care costs and freeing up of hospital staff resources.
Money and hospital staff time mean nothing compared to human life, but for a
person who wants to die and faces a certain painful death, wouldn't it
make more sense to re-direct money and hospital resources to patients that can be
saved and want to live? For example, does it make sense to spend
hundreds of thousands of dollars keeping a suffering
bone cancer patient alive to the last excruciating breath while occupying the time of a doctor, nurse, and CNA--all when
the patient wants to die gracefully?
Savable patients suffer and die every day because of hospital understaffing. We
need to be smart and practical if we are to achieve maximum benefit for society.
- Incentivize insurance plans that shift more costs from premiums to out-of-pocket costs, such
as Health Savings Accounts.
Perhaps the biggest reason why health care costs are out of control is that the economic laws of
demand have been removed from the industry. I've already talked about how stifling government regulation has limited the
supply of medical resources; now, let's consider demand. The U.S. has the most diverse and advanced access to medical
care of any country in the world. Consequently, we've become a bit spoiled. We've developed an entitlement mentality in this
country. We feel we are entitled to the best medical care regardless of expense, and we
think we should have to pay little or
nothing for it.
Unfortunately, the best technology, the best trained professionals, and the best prescription drugs
all cost money. If we were
forced to pay out-of-pocket for all our medical care, we would be a little more frugal. We would discipline ourselves
and modify our habits--Do I really need this CT scan? Should I run to the doctor
every time my child sniffles? Do I need a
doctor with 20 years experience to perform some routine surgery or would a new graduate be able to do it just as well? Do I
need the latest and greatest surgical equipment or would the cheaper conventional equipment do the job? Should I go to
the doctor for some antibiotics to cure this problem immediately or should I let my body fight it off?
Imagine if we had the same entitlement mentality with housing. After all, housing is a basic need that all Americans must have for survival. Imagine you had a $5000 annual deductible, but after that all your housing costs were paid for by insurance. Would you choose a small basic apartment that costs $5200 per year or would you go for a $15,000 penthouse with swimming pool, hot tub, and fire place? Would you like a small townhouse by the airport or a 100,000 square foot beach house?
The whole purpose of insurance is to spread the risk and costs of unusual and unexpected events. It was never designed to pay expenses from your daily lives. Health insurance premiums should be reduced to the same rate range as life insurance premiums and cover only the major medical problems costing, say $10,000 or more. Currently between business and individual contributions, $3700 is paid out on average per person every year before insurance starts to help out. Then you have to deal with co-pays and other costs. An out-of-pocket focused plan would mean that $3700 normally spent on premiums would be available to the consumer. For years where patients have no medical problems, the money could be pocketed. Obviously, people will be much more frugal shoppers. They will go only when they really need to and will demand better value for their money. Thus, economic laws of supply and demand would go back into health care, lowering prices to the point that $3700 per year will easily take care of almost all individuals.¬†Remember that 60-70 percent of each health care dollar is spent on administration costs. An out-of-pocket focused plan would mean hospitals could eliminate the tedious insurance claim process for most of their charges.
There are secondary benefits to such a shift in cost. If people are forced to pay more out-of-pocket for all health care, they're more likely to exercise, eat right, and practice preventive medicine, all of which are vastly cheaper in the long run. It's all about personal responsibility. We'd shift the focus of our society away from the pill-popping solution to every medical problem, which is counter-productive and causes a host of new problems. For example, overuse of antibiotics has led to the breeding of new superbugs. In other words, infections that used to be easily cured with antibiotics have grown resistant and now cannot be fought at all. The human body was built for one thing--survival. It can fight off most health problems if we simply let it.¬†
- Streamline and restructure the HIPAA law, eliminating many of the ridiculous, costly requirements, which adds costs to hiring/keeping employees,
processing insurance claims, conducting research, and a host of other items.
Privacy of patient health care information is definitely a good thing. Back before the HIPAA, health care providers and insurance companies
without prompting took common sense approaches to protect the information and keep it private. Then the government came
along, and even though it was trying to accomplish a good thing, passed laws and regulations that led to the typical government overkill. The
bureaucratic nightmare rules and compliance requirements, written by politicians with little or no health care, insurance, or information technology
knowledge, have turned the law into a nightmare mess. Take it from someone who's worked for several years in health informationation
technology. I work for National Audit, a claim auditor for most of the large U.S. insurance companies such as United Health, Cigna, and Humana.
The HIPAA requirements are long and ridiculous. Small commmon sense approaches can easily eliminate 99.999% of the chances that patient
information can be hacked. The governments laborious requirements maybe make that figure 99.9991%. Is it really worth the cost in its
current form? Examples of requirements - medium-size companies and above must higher full-time compliance officers and implement training program,
and the education must be repeated every year and given to all employees...even if they don't work with patient data. Another example - think of
all those patient rights forms that you have to sign when you become a new patient at any provider. That adds printing, processing, and storage
requirements. Another example - research. Medical databases accumulate a treasure trove of information on patient visits, diseases, treatments, lengths
of hospital stays, pairing of diagnoses and procedures, repeat visits,...the list goes on an on. Moreover, so much of the research would be easy to do
since so many items such as diagnoses, procedures, and drugs are assigned standardized numerical values. I personally have access to over half of the insurance
claim information in the country, and my wife, who's an RN, formally worked in medical research. Our minds race with possibilities for analyzing statistics
from all that data, streamlining a ton of research work and looking for patterns that were never thought of before. But of course, we can't too that.
Our company is restricted by the privacy laws of the patients by HIPAA. Also, remember that HIPAA laws must be monitored and enforced--which means
a heavy cost to taxpayers! And just like malpractice threats causes doctors to practice defensive medicine, health care providers often add another
layer of bureaucratic overkill in order to shield themselves from the wrath of the government penalties for any HIPAA violation.
I could literally write a book (and just may do so) about all the added, unnecessary costs of HIPAA.
- Ease legal restrictions on new types of online medical practice, such as forms of "virtual physician visits".
Think of all online possibilities for medical practice. Using Skype and other video/audio technology, doctors could perform a host of patient
visits with neither physician nor patient required to leave their own home. Technology could also be developed to monitor pulse, blood pressure, and
a host of other vitals that are sent to the online doc. Referral consultations, prescription renewals, medical advice chats, and online medical courses
are more examples of possibilities. Unfortunately, the burgeoning technology of the word is largely behind or lost when it comes to medicine, mostly
due to state or federal government restrictions, as well as threats of malpractice lawsuits. Remember, this is a free country and citizens are supposed
to have choices! Patients always have a choice whether they apply self-diagnosis & treatment, go to an online doc, call a national nurse helpline, make
an outpatient appointment, or whatever. Government/legal restrictions only hamper what could otherwise be an efficient system with seemingly unlimited options.
ConclusionAdmittedly, some of these suggestions may be difficult to implement. And there are plenty of disadvantages to following certain points. But the fact is, any controversial issue is going to have advantages and disadvantages. There is no easy solution. Otherwise, the issue wouldn't be controversial. However, the downsides of any action can paralyze us to the point where we do nothing. We have to analyze all the choices and come up with the solution that has the greatest weight of pros over cons. You might have noticed, but the old system also has a few flaws too.
"Always listen to the experts. They'll tell you what can't be done and why. Then do it."--Robert Heinlein
"The significant problems we face cannot be solved at the same level of thinking we were at when we created them."--Albert Einstein
"Insanity is doing the same thing over and over again and expecting a different result."--Albert Einstein
Joe Messerli at [email protected].
Last Updated: 07/14/2011