The need to do something intelligent and effective about providing the best treatment at the lowest cost for everyone is indeed a challenge. From almost any side of the issue, the consensus view is that the cost of health care is risng with no end is sight. All kinds of reasons are presented to us as the cause; the high cost of drugs, expensive test equipment and procedures, exorbitant lawsuit awards raising insurance premiums, faulty tax code incentives and regulations, expensive facility maintenance and labor costs, and illegal immigration abuse. Nonetheless, the health of the citizens of our nation is important to all of us, and we need to create efficient ways for everyone to get the the health care they need.
The entire issue has been studied to death, pun intended, and it should come as no suprise that our do-nothing politicians still cannot or will not step forward and do something real. They do the easiest thing of course; just as with our energy crisis, they blame capitalism, which in this case means the greedy pharmaceutical companies. Likewise, the easiest do-nothing answer follows the immigration issue, using that same famous code word, comprehensive. Since we are in a presidential election cycle, don't expect too much.
Still, there are ideas in play that could move us a long way towards providing health coverage for just about everyone. Some of these are not that hard to implement if the partisanship would get out of the way. Changing the tax code structure to provide tax deduction allowances for premiums and establishing Health Savings Accounts should not be controversial at all. Creating a secure (like your bank card) and uniform computer based medical records system would go a long way towards eliminating unneccessay duplication of expensive testing and treatment procedures. A realistic approach to tort reform could also help by lowering insurance costs. Significant additional expense would be eliminated if our vote hungry politicians would act on illegal immigration. In parts of the country, notably California, the intense use of free hospital facilities and services by illegals has forced the closure of some, and many more verge on bankruptcy.
There are some other regulation ideas that I believe would help. Health plans offered by HMOs should be like electricity. If you move from Maine to Arizona, you will not have a problem plugging in a coffee maker or TV set in your new home. That is because there are nationally recognized and professional standards for electricty. Likewise, basic coverage health plans offered by the HMO's should be standardized so that you can buy the same plan no matter where you are, and coverage should be transportable. The HMOs can and should offer a variety of plans to meet different needs, such as one for single people, another for families, etc. The only point would be that Plan A or B, or C be the same no matter which HMO you buy it from. They can be competetive with each other by being more efficient, having better customer service, having more doctors and hospitals to choose from, or offering lower co-pays or lifestyle incentives. Options such as "catastrophe only" or drug coverage could also be offered at competetive rates. With a number of ways for each HMO to differentiate itself from the others, consumers can choose a company that best meets their own needs. This type of standardization is on the operational end and would not affect the quality of care. The best run HMOs will do the best.
Medicare should aslo be part of this healthcare reform. The HMOs should have a category for seniors. Currently, we pay Medicare taxes during our working years, then get to receive medical care at the expense of the government when we retire. Those taxes tend to be high, but not actually high enough to cover the costs. A better approach would be for us to pay lower medicare taxes that go into a fund to pay the insurance premium. This will eliminate the federal government from having to pay for healthcare costs. Additionally, participation in this program should be totally voluntary. If you feel you will be able to pay for your own insurance premium upon retirement, you should be able to opt out. The particulars of when and how an individual can participate or opt out will need to be worked out.
Also, as a way to increase participation, there should be a uniform cost to each of the basic care plans. I do not mean to say that the government should tell the HMOs how much to charge. Each HMO can charge whatever it decides is the best price for any particular basic plan. For example, company number one thinks that it can offer a single person a plan for $150 per month, but company number two can offer that same plan for $125 per month. Each can set pricing based upon the many factors involved in making such business decisions. What should be required is that no matter which plan a consumer chooses, the HMO must offer that plan at the same cost no matter if the consumer is self employed or works for IBM. There is no reason for a self-employed person or small comany purchaser to pay a higher premium. Insurance is not a widget, and the purpose of it is to spread out the costs among a large group, i.e. the entire community of purchasers. Well run HMO's would attract more people, thereby adding to its pool and benefiting the HMO.
To provide coverage for those with chronic illnesses, a risk pool similar to auto insurance should be established. No one should be denied coverage because of that, but in order to spread the risk, all such individuals would be placed in a pool and each HMO would be required to insure it's share of those needing the insurance.
A large part of the rising costs of health care is often attributed to the frequent use of emergency rooms for often minor, routine care. HMOs could partner with hospitals to create walk-in clinics that would provide care for such situations. Many times, worried parents whose children might have an earache or stomachache rush to an emergency room designed to handle serious situations. In such cases, if these parents were directed to a clinic facility at the hospital that was more appropriate for that kind of treatment, costs could be kept down.
The one thing we do not need to do is to implement government sponsored universal health care coverage, sometimes called single-payer. Can you name one government program that you would think of as efficient, effective, and well worth the cost? I can't, except for maybe the the space program. In that case however, the truth is NASA is semi-offiicial and subject to cost controls modeled after private enterprise. If you think about it realistically, you have to admit this is true. In addtion to that, we should learn from experience by observing the results of government controlled health care in Canada and Europe. There is absolutely no doubt that these socialist attempts to provide health care demonstrate how bad an idea that is.
In both cases, the access to care is limited, thereby increasing the wait times for treatment. This is in part caused by the high price of building and maintaining medical facilities and the lack of motivation by doctors who have no incentive to do more work. The availability of expensive testing equipment is also limited due to the cost and maintenance of such, and also the lack of highly skilled technicians medically authorized to operate these machines. In some cases, certain treatments and procedures are not available at all in these countries. There are even laws against seeking private medical care.
None of this of course, is a problem to the rich. They routinely come to the United States to get timely and effective treatment. The regular folks like you and I simply wait it out, suffering, and in many cases dying. Similarly, here in America, the high costs involved in medical care do not affect our elite politicians. You can bet that their government benefit package allows them the best and fastest treatment available. That, in conjunction with the upcoming election, is part of the reason they are not moving anytime soon.
As an example, I can site the recent case of Senator Tim Johnson from South Dakota, who had a severe stroke. It's been about six months since then, and he is making rapid progress, actually doing legislative work from his hospital room. By comparison, I offer my own mom's experience when she had a stroke a number of years back. Despite the known advantage of administering bariatric treatment as soon as possible after a stroke, she did not receive it. The physical therapy treatment at the hospital was insufficient, and the rehab center she was put in afterwards was equally poor.
Unfortunately, my mom was not rich and was stuck in the medicare system. That system is an inefficient mess that is also contributing to the high costs of medical care. The cost of this government sponsored program is soon about to go through the proverbial roof when I and other baby-boomers start retiring! The poor care and quality of this socialist endeavor will be repeated if we allow the government to get into the health care business. Sad to say, the politicians will not take action and use some of the ideas listed previously to fix health care coverage. They are too concerned with getting re-elected. When it all falls apart, they will tell us the only fix is federal intervention, and we will be stuck with government health care. |
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