You Get What You Pay For

The healthcare reform debate continues to unfold and the arguments for and against reform are both full of contradictions. I can't help but think that a few years/decades from now, we'll look back and not believe we let this travesty unfold. In my effort to shed some light on the issue, I've put forth some of the arguments I hear the pundits making and my own rebuttals.




Arguments Against Reform:



We don't want bureaucrats involved in health care.



My reply: Guess what? Your access to health care is already controlled by someone in a far away location that knows nothing more about you than a few notes on his computer screen. Screeners for health insurance companies dictate who gets health care and what kind of care they get. Even with the best insurance plans, there are severe limitations on what kind of tests and drugs people have access to. For you to get your MRI or the newest drug, your physician and/or you end up spending hours on the phone with an insurance representative getting prior authorization. A recent study estimated that the paperwork required by insurance companies costs us $31 billion/year, or roughly 7% of all US spending on physician services.





Why is this fact so little publicized? If this is the case, why are so many people happy with the healthcare that they currently get? The reason most people are happy with their health insurance is because most people are healthy! Take a poll of the chronically ill and you'll get a much different viewpoint. I like to think of our current batch of insurance companies as highly paid backup quarterbacks. They are great and everyone loves them until they actually need them. When forced to utilize their services we quickly find out their extreme limitations. And of course, they are paid too much for doing absolutely nothing.







This is socialism! I hate socialism! The government needs to leave healthcare alone!

A national healthcare plan is no different that having public schools! Is that socialism? Is the fact that our current education system allows for public and private schools some left wing conspiracy? How is universal access to healthcare any different? The current plans allow you to participate in the public plan or pay more for the private plan. Sounds very similar to our school systems to me. And just like education, healthcare should be something that we should try to make available to everyone.



However, we should take a minute to examine the school analogy. The reason so many of our public schools are so horrible is because they are grossly underfunded. If we want the national healthcare plan to work, we have to be willing to spend more money.





We don't have the money to spend! It will cost TOO much!

Apparently we have enough money to spend to pay for new cars for people that don't need new cars! We have enough money to rescue failing banks. And my personal favorite, we have enough money to go oversees and kill a bunch of terrorists. What do you think kills more Americans? Terrorists or lack of health care? There are people dying everyday in your very city that can't afford the care they need and we don't want to spend money to help them. But if there is even a hint of a foreign threat that might endanger American lives, we're willing to spend whatever it takes to buy the latest bombs and planes. The VERY people against spending for healthcare due to financial concerns seem to be the people that would consider cutting back spending for our armed forces to be anathema. Confusing to say the least.







Arguments FOR Reform:



We don't have enough money!

My reply: The money argument is used by both sides of the healthcare debate. The people for health care reform envision cost savings by enforcing quality measures, regulating the types of procedures covered, and removing the profit motive. Another word for "Regulating the types of procedures covered" is rationing. It is true, that rationing in some form is already prevalent in the current health care system and in all aspects of life. If you don't believe me, take a look out on the street. Everyone isn't driving a Rolls Royce. If you wanted to get expensive procedures or drugs with the current healthcare plans, you would have to jump through many loopholes to qualify. This is rationing. Also, the current health care plans don't cover 45 million people. This is rationing.



However, switching to another form of rationing wherein you cover everyone but offer less services to each person is not a step in the right direction. As I have said before, our healthcare system is the best in the world and it is this great healthcare system that we are afraid of losing. I don't think that the proponents of health care reform want everyone to have access to crappy healthcare. They want everyone to have access to the best healthcare.



There are three variables involved here:number of people covered, services offered to everyone who is covered, and the total cost to the system. If you increase the number of people covered and hold cost stable (or decrease cost) then you HAVE to limit the number of services you offer to everyone in the plan. If you try to increase the number of people covered and offer everyone the same services, then you HAVE to increase cost.



The only way to limit costs in a national health system is to limit the access to care for everyone. These people argue that we are spending too much and doing too many procedures. A great example is the often quoted fact that the city of Boston has more MRI machines that the country of Canada. I like to believe that this might be the reason that you have Canadians coming to Boston to get healthcare instead of Bostonians going to Canada. However, the quality of the healthcare being offered in the US is a discussion for another post.



The current system waste too much money on end of life care. We need to focus on prevention.



President Obama recently used the death of his grandmother to explain how the US healthcare system wastes money. He thinks we need to provide less aggressive end of life case and focus more on prevention.



I would love to see ONE study that shows that prevention works. The sad truth is that the US healthcare budget cannot spend more money on prevention that the combined budgets of Big Tobacco, McDonald's, Coke, Pepsi, and Twinkies (who makes these by the way?). Also, as good as we are at taking care of medical problems, we cannot instill in people a sense of personal responsibility. People are going to gravitate towards instant gratification. Until we change our culture (eating habits, exercise routine, and our expectations for what healthy means) we will continue to have problems with chronic diseases. You can't imagine how many conversations I have had with people that weigh 250-300 lbs that don't understand that they are fat! The reason for this is because the patient's brother, his wife, his wife's brother, and all extended family and friends are actually fatter than he is. To him, being 250lbs is actually too thin! Until we realize as a society that we have to take personal responsibility for our health, no amount of money spent on preventative measures will make a difference. If you don't believe me, take some time to examine our own President who is a strong proponent of the national health care system and of focusing on preventative measures. If preventative measures work, why is he still smoking? He is a walking, talking example of the failure of preventative measures.



I apologize for the rambling nature of this post. There is so much ground to cover and it is sometimes difficult to focus in on what to talk about first. As you might have gathered, I hate the current health care system but I also think the focus by the Democrats to limit health care spending by instituting a single payer system isn't the right way to go.

However, unlike the town hall hecklers and the insurance industry that have no better alternative to offer, I would like to propose an alternative. Here are some of my ideas of how to institute health care reform:

1) Everyone gets access to a basic level of healthcare.

2) People have the option to purchase private healthcare out of their own pocket. If they do this, the amount they spend on private health care should be tax deductible.

3) There is NO role for insurance companies. People buy healthcare directly from the provider. If they want private healthcare, they pay whatever the provider bills them.

4) All healthcare providers are graded/evaluated under a national system and these evaluations are easily accessible to the public. This ensures that people know where they can get "quality" care and thus they can function as knowledgeable customers. The current healthcare system hides the true cost of healthcare from the consumer (patient) and hides the quality of the product being bought. We are paying some unknown amount for a service/good whose quality we can't judge.



5) We limit malpractice monetary rewards levied against individual physicians but at the same time we leave uncapped the amount of damages sought against health care systems. This ensures that hospitals will take a much more proactive role in picking out the bad apples.



6) We increase taxes on things that make us unhealthy. We tax unhealthy foods and we increase the tax on tobacco and alcohol. At the same time, we offer tax credits for restaurants that offer healthy food options. As an example, if McDonald's wants to sell fries and not pay more taxes, they can offer more salads. These costs will likely just be passed to the consumer but that isn't a bad thing. If you want to eat Twinkies all day, you shouldn't expect your neighbor to pay for you heart surgery in 20 years.



7) We stop covering medical problems caused as a direct result of breaking the law. For example, if you had a stroke or a heart attack because you were smoking crack. Guess what? You better have the money to pay for you medical coverage because neither the government nor any insurance plan will be obligated to cover your medical expenses. If you drive drunk and get in a car accident, you foot the bill. This seems simple to me. Our current system will pay for you to get all the medical care you need if you are the drunk driver and end up in a car accident. But the poor people you almost killed who might not have insurance are on their own. A fantastic system.



I would love to hear your thoughts on what I have proposed. Thank you for reading.