A Few Ramblings about Health Care “Reform”

Over the past months, we have been subjected to our politicians’ ranting and raving for and against health care reform.

The Democrats appear to want to pass “A” bill, regardless of whether it will actually do anything to reform our system of health care, and the Republicans object to passing the current legislation, ostensibly because it won’t fix the system (which it won’t), but really, since they had 8 years to do something about it and didn’t, because they are playing politics.

The reality is that BOTH sides are playing politics while we, the American people, are paying the piper.

If they don’t sit down and start with an analysis of strengths and weaknesses of the current system, including a detailed breakdown of the costs of healthcare, how on Earth can they expect to make health care affordable?

A couple of years ago, while on a business trip to Germany, I had occasion to visit the emergency room of a hospital near Stuttgart.

After waiting at least 20 minutes to see a doctor (yes, that was irony), I spent over 2 hours being poked, prodded, scanned, examined, and tested.  The doctor spent at least an hour with me.

The total cost for this?  118 Euros, which at the time was somewhere around $150.

What do you suppose the cost of this visit would have been at an emergency room here in the USA?

Based on my own experiences with emergency rooms, I will guess that it would have been several thousand dollars, of which I would have paid $50, since I had medical insurance.

Everyone seems to be focused on the high cost of insurance, the greed of the insurance companies, insuring those with no coverage, and a variety of other things that are symptoms of a broken system.

But, the underlying question in all of this should be “Why does health care in this country cost as much as it does?”.

What are the cost drivers of health care?

There are many.   Some of them include salaries, malpractice insurances, excessive testing, excessive profit margins across the board (drug companies, insurance companies, doctors, etc.), systemic waste, and many more.  These are only the ones that spring to mind at the moment.

So, how will the proposed legislations address any of these concerns?  As far as I can tell, they won’t.

Even non-profit insurers, such as Blue Cross-Blue Shield, are prohibitively expensive.  They cannot control the costs that force them to raise their prices.

At what point will we, as a nation, address why our doctors are arguably the most highly paid doctors in the world (with certain exceptions, like general practitioners, who are not very highly paid)?  Why is a medical license seen as a guaranteed path to riches?  Look at the doctors’ parking lots and count the number of Mercedes, BMW’s, and other luxury cars.  That is a quick indication of one element of cost.

Another is the intrusion of the legal profession into medicine.  Our litigious society is an integral component of health care costs.

Any “solutions” or “reform” that do not address tort reform will simply not be able to affect costs significantly.

Another area affecting health care costs is illegal immigration.  Throughout the Southwestern USA, there are hospitals drowning in costs to cover care for illegal immigrants.  It is an issue throughout the country, but is especially acute in that region because of the high concentrations of illegals from Mexico.  In many cases, people receive long term care at no cost, since there is no one to bill.  The government does not pay for this, nor do they seem particularly interested in deporting illegal patients when hospitals call to request assistance.  If the hospitals don’t get reimbursed for these costs, it shows up in the form of higher, direct medical costs (and overhead).

I am not an advocate of turning away anyone who needs acute medical aid, but in the event of longer term, ongoing care, I think illegals should be deported to let their own countries deal with their health care issues.

Based on my experiences as a patient and as a consultant who has done some work within the health care industry, my perspective is that there is a horrendous amount of waste within the industry.

One relatively simple measure that would save millions of dollars (or more) every year would be to have congress require that insurance coding be standardized.  This would eliminate the mass confusion that results in every insurance company using its own codes.  The costs resulting from this practice are myriad, including cost due to coding errors (staff time to correct, patient time, time at the insurance companies, etc.), software costs (imagine how much it costs to spend the time gathering and coding all the different codes into every medical software package!), time looking up codes, etc.  Eliminate this confusion – the benefits are almost immediate and the cost to do it is very low (comparatively).

Like most people, I would love to see the cost of healthcare held to a reasonable level.  I would love to see all citizens and legal residents covered, BUT, I have a significant problem with spending money we don’t have to do it.

Some estimates are that waste comprises about 50% of our healthcare costs. We should be working to require cost savings within the industry FIRST, then worry about expanding coverages.

If costs are lower, insurance premiums can be lowered, making insurance more affordable.

If we aren’t spending $2.2 Trillion per year on health care, our financial health improves, as well.

In summary, I believe that we need to be working to ascertain the true cost drivers of health care in this country, then address them logically rather than mount a witch hunt against the insurance industry, regardless of how much that industry needs reform.  There is plenty of “low hanging fruit” to be picked, reducing the costs of health care immediately.

The current reform measures do NOT address the majority of issues affecting health care cost, or do anything to make it affordable.  In fact, it is likely to increase our costs.

I don’t know about you, but I think we already pay enough taxes without piling on more to implement legislation that won’t do what needs to be done.


2 thoughts on “A Few Ramblings about Health Care “Reform”

  1. The new bill is now the law of the land, You can read it in full on the Internet. I suggest that it be read in its entirety to avoid the lies, misstatements. etc. Good bad or indiffernet it is now law.

    I do not believe it will be repealed or declared unconstitutional. I do believe such actions are being used as fund raisers, as have appeals for funds re violence against both sides is being used. I trust the police agencies will handle those inclined to violence.
    I also believe the fund raising in the Boston area for the newest senator to fight off a run for senator by Rachel Maddow, who has declared nightly that she is not a candidate and never was, is a scam. I hope all the suckers that send money for a lie, enjoy being screwed by such an appealing new senator.

  2. The actual Bill has become law. Many of the new laws will benefit all. We can keep whatever insurance we currently have but the insurance companies can no longer refuse you for pre conditons; cannot cancel you if ill; etc. Your children can remain insured on your policy,etc and over 30 million people will get coverage. The new laws are not perfect but are better than what we had. There are still a few more days to negotiate some changes, so it is not all a done deal yet. Overall, I think it is a good thing and hope over the next few years it will be improved.
    I have no ax to grind as our mediacal care is thru Medicare, ChampVA and the Veteran’s Administration, plus a Supplemental policy thru AARP.For all those that have not benn able to either get insurance or could not afford coverage, it is a blessing.We managed to incur over several trillion dollars in deficits over the previous eoight years. Perhaps those on both sides of the Congress that aloowed that to happen, can now tell us how thee planned to pay for what they allowed to happen.That would help reduce our deficits to only those incurred since the new administration took over.With both problems being attacked by all members of Congress we should be able to bet back to the surpluses we had prior to 2000.

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