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HEALTHPLANUSA . NET |
QUARTERLY NEWSLETTER |
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Community For Affordable Health Care |
Vol VI, No 4, January, 2008 |
Utilizing the $1.5 Trillion Information Technology Industry
To
Transform the $2 Trillion HealthCare Industry into Affordable HealthCare
In This Issue:
1. Featured
Article: Be Healthy or Else! By Yaron Brook and Don
Watkins
2. In the News: Romney’s
Massachusetts Universal Plan Two Years Later
3. International Medicine: NHS Suffers
More Setbacks To Third World Health Care
4. Medicare: Should We Prepay Future Medicare Costs?
5. Lean HealthCare: Lessons from the Assembly
Line for Health Care Managers
6. Medical Myths: The Free Enterprise System Has Let Us Down
7. Overheard on Capital Hill: Save Your
Health Insurance For Catastrophic Events
8. What's New in US Health Care: When
government and insurance companies are
kept
away from the transaction, good new things happen.
9. Health Plan USA: Is It Armageddon for the Health Insurance
Industry?
* * * * *
We wish a Happy
and Healthy New Year to our 100,000 readers and web site visitors.
* * * * *
1. Feature
Article: Be Healthy or Else! By Yaron Brook and Don
Watkins, Op-Eds, (Riverside Business
Press, Oct. 22, 2007)
As part of his universal healthcare proposal, John
Edwards would make doctor visits and other forms of preventive care mandatory.
In a similar proposal in England, a Tory panel suggested that Britons should be
forced to adopt a government-prescribed "healthy lifestyle." Britons
who "cooperate" by quitting smoking or losing weight would receive
Health Miles that could be used to purchase vegetables or gym memberships;
those who don't would be denied certain medical treatments.
These paternalistic proposals are offered as solutions
to the spiraling costs that plague our respective healthcare systems. It is
unrealistic, states the Tory report, for British citizens "to expect that
the state will underwrite the health implications of any lifestyle decision
they choose to make."
But any proposal that expands the government's power
to control our lives--to dictate to us when to go to the doctor or how many
helpings of veggies we must eat--cannot be a solution to anything. Instead of
debating what coercive measures we should be taking to lower "social
costs," we should be questioning the healthcare systems that make our
lifestyles other people's business in the first place.
Both the American and British systems, despite their differences,
are fundamentally collectivist: they exist on the premise that the individual's
health is not his own responsibility, but "society's." Both Britain's
outright socialized medicine and America's semi-socialized blend of Medicare,
Medicaid, and government-controlled, employer-sponsored health plans aim to
relieve the individual of the burden of paying for his own healthcare by
coercively imposing those costs on his neighbors.
When the government introduces force into the
healthcare system to relieve the individual of responsibility for his own
health, it is inevitably led to progressively expand its control over that
system and every citizen's life.
For example, in a system in which medical care is
"free" or artificially inexpensive, with someone else paying for
one's healthcare, medical costs spiral out of control because individuals are
encouraged to demand medical services without having to consider their real
costs. When "society" foots the bill for one's health, it also
encourages the unhealthy lifestyles of the short-range mentalities who don't
care to think beyond the next plate of French fries. The astronomical tab that
results from all of this causes collectivist politicians to condemn various
easy targets (e.g., doctors, insurance companies, smokers, the obese) for
taking too much of the "people's money," and then to enact a host of
coercive measures to control expenses: price controls on medical services, cuts
to medical benefits--or, as with the current proposals, attempts to reduce
demand for medical services by forcing a "healthy lifestyle" on
individuals.
Properly, your healthcare decisions and expenditures
are not anyone's business but your own--any more than how much you spend on
food, cars, or movies is. But under collectivized healthcare, every Twinkie you
eat, doctor's visit you cancel, or lab test you wish to have run, becomes other
people's right to question, regulate, and prohibit--because they are paying for
it. When "society" collectively bears the costs of healthcare, the
government will inevitably seek to dictate every detail of medical care and,
ultimately, every detail of how you live your life. . .
Let's not allow the land of the free and the home of
the brave to become a nation of dependents looking to the nanny-state to take
care of us and following passively its dictates as to how we should live our
lives.
To read the entire OpEd, go to www.aynrand.org/site/News2?JServSessionIdr012=2axxrnfpg1.app1a&page=NewsArticle&id=15865&news_iv_ctrl=1021.
Yaron
Brook is the president of the Ayn Rand Institute (ARI) in Irvine, CA. Don
Watkins is a writer and research coordinator at ARI. The Institute promotes Objectivism, the
philosophy of Ayn Rand--author of Atlas Shrugged
and The Fountainhead.
* * * * *
2. In
the News: Romney’s
Massachusetts Universal Plan Two Years Later
NCPA
Health Issues: MASS. TO CUT PAYMENTS TO DOCS & HOSPITALS, December 17, 2007
Massachusetts's universal health-care plan is turning
out to be more expensive than predicted. Now the state is looking at
cutting payments to doctors and hospitals next year to make ends meet, says the
Boston Globe.
That
fiscal reaction, which some critics of the plan warned about, sends a stark
message to the other 49 states. Massachusetts has become something of a
model for the national plans proposed by Hillary Clinton and John Edwards,
among others:
·
The state requires
everybody to buy health insurance.
·
A subsidized health plan
offered to the poor as part of the program has proved more popular than
expected, and that's helping to push costs 20 percent over what the state had
budgeted.
·
The tab could run $619
million for the current fiscal year, $147 million over budget, the Boston Globe
reports.
Now the board that oversees the plans has approved
cuts of 3 percent to 5 percent in reimbursements to health-care providers
caring for those in the subsidized plan. The Globe suggests the cuts will
bring reimbursement in line with Medicaid. . .
Source: Jacob Goldstein, "Mass. To Cut Payments
to Docs & Hospitals," Wall Street Journal, December 14, 2007; based
upon: Alice Dembner, "Mass. panel approves changes to subsidized residents
health plan," Boston Globe, December 14, 2007.
Sounds like the first over runs of Medicare in 1966.
Will it also reach 800 percent?
www.ncpa.org/sub/dpd/index.php?Article_ID=15363
For text: http://blogs.wsj.com/health/2007/12/14/mass-to-cut-payments-to-docs-hospitals/
For Boston Globe text: www.boston.com/news/local/articles/2007/12/14/mass_panel_approves_changes_to_subsidized_residents_health_plan/
For more on Health Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=16
* * * * *
3. International
Medicine: NHS Suffers More Setbacks To Third World Health Care
THE influx of
thousands of Indian doctors into the National Health Service is going into
reverse. Hospitals in India are now said to be cleaner and better equipped than
many in Britain and doctors are quitting the NHS to work there instead.
The director
of one of India’s biggest private hospital chains said he was receiving five
job applications a week from NHS doctors and that half his 3,000 consultants
were from Britain.
“There’s a
feeling that India’s time has come and there’s a huge need for these people to
come back,” Anupam Sibal, director of the Apollo hospital in Delhi, said
yesterday.
Doctors say
they are moving to India because of its economy, state of the art equipment,
higher standards than the NHS and a better quality of life. In particular, they
say hospitals in India, which many Britons still imagine to be impoverished and
dirty, suffer less from hospital-acquired infections such as MRSA.
India has no
equivalent of the NHS but there has been a boom in private hospitals that
resemble luxury hotels, with marble foyers and corridors mopped by an army of
liveried cleaners.
One of those
who has made the transition is Mahesh Kul-karni, an orthopaedic surgeon, who
left Bristol Royal Infirmary after 10 years in Britain. He is now a consultant
at the Aditya Birla Memorial hospital in Pune.
“The
hospitals are better than in Britain,” he said. “This hospital is spotless and
clean compared with the old hospitals in the UK, some of which are more than
100 years old. I started in January this year and I have not seen MRSA here
yet.
“It’s had a
lot of investment, and things I couldn’t do in Britain I can do here. We have
‘clean air’ operating theatres [that remove dust from the air], and our
intensive care unit here is fully equipped with special monitoring instruments.
“When I went
to England 10 years ago, India was 10 years behind Britain. Now there’s hardly
any difference.”
Bristol Royal
Infirmary defended its record, saying there had been a 35% increase in spending
on new equipment and that its latest inspection had found cleanliness was
“acceptable”.
Ameet Kishore
had worked as an ear, nose and throat consultant in Glasgow Royal Infirmary for
12 years when he moved to the Apollo hospital in Delhi two years ago. Although
reluctant to criticise the NHS, which had taught him so much, he said that the
new Indian hospitals were cleaner and better resourced.
He contrasted
the number of cochlear implant operations that he could perform: at Crosshouse
hospital, Kilmarnock, the main ENT centre for the west of Scotland, he was
limited to 40 a year; in Delhi he had done 70 in the past six months. . .
Although salaries are
usually lower in India, doctors are finding that their standard of living is
better. Kishore said he lived in a bigger house with a driver, cleaner, cook,
nanny and watchman to look after him, his wife and two young children.
To read the entire
report, go to www.timesonline.co.uk/tol/life_and_style/health/article3056942.ece.
The NHS does not give timely access to health care,
it only gives access to a waiting list.
* * * * *
4. Medicare: Should
We Prepay Future Medicare Costs?
A novel way to deal with Medicare's deteriorating finances
is to create Health Insurance Retirement Accounts (HIRAs). Through these
accounts current workers will partially prepay future Medicare costs through a
fixed percentage of their total wage income and thereby reduce the projected
tax burden on future workers, say Andrew J. Rettenmaier and Thomas R. Saving,
senior fellows at the National Center for Policy Analysis.
Under this reform:
·
When they enroll in
Medicare at age 65, beneficiaries will use their HIRA balances to purchase an
annuity paying an annual fixed sum to a spending account, such as a Roth Health
Savings Account (HSA).
·
Beneficiaries will use
their HIRA annuities to pay for a share of their Medicare costs and any funds
remaining at the end of the year can be withdrawn tax free (like a Roth IRA)
and spent on nonmedical goods and services.
·
The annuities will
replace government spending obligations, and as they grow through time they
will relieve an increasing amount of the burden on future taxpayers that would
exist under the current financing arrangement.
Under reasonable assumptions:
·
By mid-century, reformed
Medicare spending is estimated to be 20 percent to 35 percent less than the
current program.
·
By mid-century or
earlier, total spending on the reformed program, including contributions to
HIRAs, is estimated to be less than the spending on the current program.
This reform proposal should appeal to reformers across
the political spectrum because it reduces the tax burden on future workers,
puts Medicare on a sounder footing, retains the progressivity of the current
program's funding, and produces cost sharing incentives that rise with lifetime
income.
Source: Andrew J. Rettenmaier and Thomas R. Saving,
"A Medicare Reform Proposal Everyone Can Love: Finding Common Ground among
Medicare Reformers," National Center for Policy Analysis, December 2007.
www.ncpa.org/sub/dpd/index.php?Article_ID=15385
For text: www.ncpa.org/pub/st/st306/st306.pdf
Government is not the solution
to our problems, government is the problem.
- Ronald Reagan
* * * * *
5. Lean
HealthCare: Lessons from the Assembly Line for Health Care Managers.
When Will Doctors Get As Much Respect As The Workers At
Toyota?
Jim
Womack Reports: For years I've
visited companies where "respect for people" is a core element of the
corporate philosophy. So I've asked managers in many companies a simple
question. "How do you show respect?" I have usually heard that
employees should be treated fairly, given clear goals, trusted to achieve them
in the best way, and held to account for results. For example, "We hire
smart people, we give them great latitude in how they do their work because we
trust them, and we hold them to objective measures of performance. That’s
respect for people."
When
in recent years Toyota made respect for people one of the pillars of the Toyota
Way I decided I should ask the best Toyota managers how they show respect for
people. The answer I have heard is a good bit different from what I’ve heard at
many other companies and goes as follows:
Managers
begin by asking employees what the problem is with the way their work is
currently being done. Next they challenge the employees' answer and enter into
a dialogue about what the real problem is. (It's rarely the problem showing on
the surface.)
Then
they ask what is causing this problem and enter into another dialogue about its
root causes. (True dialogue requires the employees to gather evidence on the
gemba – the place where value is being created -- for joint evaluation.)
Then
they ask what should be done about the problem and ask employees why they have
proposed one solution instead of another. (This generally requires considering
a range of solutions and collecting more evidence.)
Then
they ask how they – manager and employees – will know when the problem has been
solved, and engage one more time in dialogue on the best indicator.
Finally,
after agreement is reached on the most appropriate measure of success, the
employees set out to implement the solution.
For
many of us that doesn't sound much like respect for people. The manager after
all doesn’t just say "I trust you to solve the problem because I respect
you. Do it your way and get on with it." And the manager isn’t a morale
booster, always saying, "Great job!" Instead the manager challenges
the employees every step of the way, asking for more thought, more facts, and
more discussion, when the employees just want to implement their favored
solution.
Over
time I've come to realize that this problem solving process is actually the
highest form of respect. The manager is saying to the employees that the
manager can't solve the problem alone, because the manager isn't close enough
to the problem to know the facts. He or she truly respects the employees'
knowledge and their dedication to finding the best answer. But the employees
can't solve the problem alone either because they are often too close to the
problem to see its context and they may refrain from asking tough questions
about their own work. Only by showing mutual respect – each for the
other and for each other's role – is it possible to solve problems, make work
more satisfying, and move organizational performance to an ever higher
level. . .
I
also trust that all of us want to show respect for people. The challenge for
those of us in the Lean Community is to embrace and explain the true nature of
mutual respect for people – managers and associates – so all organizations can
move toward a new and better way of solving their problems.
To
read the rest of this newsletter and join to read others by Jim Womack, Founder
and Chairman, Lean Enterprise Institute, go to www.lean.org/.
Feel
free to forward this message to customers, or colleagues who are implementing
lean - or should be.
Wouldn’t it be cost effective and respectful if
Medicare, Medicaid, BC, BS, HMOs would implement lean by asking doctors for their
input, like these Toyota employees?
* * * * *
6. Medical Myths: The
Free Enterprise System Has Let Us Down
Socialized
Medicine? Check Your Premises! By Bob
Burg, July 24, 2007.
From TheAtlasphere.com
Perhaps the greatest gift I received from reading Ayn
Rand was an admonition that has helped me think clearly and logically whenever
I felt the heat of emotion carrying me to a faulty conclusion:
“Check your premises.”
Things don’t happen in a vacuum. Typically, not only
is there a reason for something, but that something happened further back than
the emotional decision point.
So, first, check your premises. Go back to the
beginning and make sure you are basing your solutions on the correct basic idea
or assumption.
Case in point: Universal healthcare is now the big
topic of the day. The mainstream Democratic politicians are totally for it, and
even Republican politicians are getting there.
Heck,
former Republican Governor Romney instituted a forced — er, I’m sorry; a much
nicer word is “mandatory” — state-run healthcare system in Massachusetts as did
Republican Governor Schwarzenegger in California.
In addition, Michael Moore’s newest movie, Sicko,
is already playing in much of the country. Most likely he’ll introduce us to
Americans who have no health insurance and are being left to suffer, or worse,
to die.
And, you know what? When I see those people on screen
I will feel terrible. My heart will break for them. Indeed, like many others,
I’ll ask myself why — in this most abundant of nations — should we have anyone
without healthcare?
But before I go running to our federal government to
set things right for us . . . I’ll check my premises. Before asking government
to solve our “ills” — something they’ve proven not proficient at in most areas
— I’ll first ask, “why are we in this position in the first place?”
Well, I know what most politicians, what Michael
Moore, and, unfortunately, what most Americans would answer: “the free
enterprise system has let us down.”
The reason I know this is because I hear it
constantly. I only wish that before people — especially influential ones —
utter these conclusions, they would first take Ms. Rand’s advice and check
their premises.
So, is it the free enterprise system that destroyed
our health care system?
Let’s take a quick look back about 50 or so years ago.
At that time, our U.S. healthcare system was basically market-driven. What were
the results?
Well, let’s see:
* Practically all Americans who wanted health
insurance had it. It was affordable.
* Doctor’s offices weren’t reminiscent of Grand
Central Station. In fact, doctors actually were known to make house calls.
* People who were less fortunate financially could
always find a doctor or hospital that allowed them to pay on a sliding scale.
* And, hospitals? Well, if you recall, practically
every major city had at least one charity hospital.
Was anyone ever left out in the cold? Unfortunately,
yes.
Utopia — even in our great country — has never been an
option. However, our healthcare system came pretty darn close. Certainly closer
than at any other place and time in history, before or since.
And, then, a funny thing happened on the way to our
healthcare system breakdown....
Government got involved. Really involved. I mean,
really, really involved. As usual, they decided they knew more about how the
market operates than . . . the market.
Between excessive regulation of private health
insurance, coverage mandates, lack of price competition for medical services,
Medicare, Medicaid, government-forced reliance on third-party payers, more
rules, more regulations, more taxes, etc., we have been driven into a system in
which far too many American families go without any kind of health coverage
because they simply cannot afford it.
Was this government’s purpose? Surely not. It’s just
what they do.
They take either non-existent, slight problems, or
even legitimate problems, and they turn them into national disasters.
Now government is being asked to come to the rescue,
and they will gladly oblige. Just listen to Hillary, Barack, Edwards, Romney
and others. For them, a complete or virtual government takeover or supervision
is the solution to your healthcare woes. . .
The point: Free enterprise did not give us our current
“Sicko” healthcare system; government intervention did. . .
The solution is actually quite simple. Get the
government out of our healthcare system and let the free market, private
charity, and loving-kindness do what it once did: Provide us with a healthcare
system that really works.
Please, don’t buy into this new government takeover.
And don’t buy into Michael Moore’s propaganda, as well-intentioned as he
probably is. Don’t let emotions make this decision for you.
Instead, check your premises.
To read the entire column, go to www.theatlasphere.com/columns/070724-burg-healthcare.php.
Bob
Burg speaks on the topics of positive persuasion and business
networking. His books, Endless
Referrals: Network Your Everyday Contacts Into Sales and Winning Without Intimidation: How to Master the Art
of Positive Persuasion, have each sold well over 150,000 copies. For more
information, visit his web site.
* * * * *
7. Overheard on Capital Hill: Save Your Health Insurance For
Catastrophic Events
Opinion Editorial: Control
Your Own Health Care, By John
Stossel, Oct 3, 2007,
From TheAtlasphere.com
Candidates for president have plans to get more people
health insurance. Some would compel us to buy it; others would use the tax code
to encourage that. Regardless, insurance is the magic that will solve our
health-care problems.
But contrary to conventional wisdom, it’s not those without
health insurance who are the problem, but rather those with it. They
make medical care more
expensive for everyone.
We’d
each be better off if we paid all but the biggest medical bills out of pocket
and saved insurance for catastrophic events. Truly needy people would rely on
charity, not government, because once government gets involved, unintended bad
consequences abound.
If people paid their own bills, they would likely buy
high-deductible insurance (roughly $1,000 for individuals, $2,100 for families)
because on average, the premium is $1,300 cheaper. But people are so conditioned to expect
others to pay their medical bills that they hate high deductibles: They feel
ripped off if they must pay a thousand dollars before the insurance company
starts paying.
But high deductibles may be the key to lowering costs
and putting you in charge of your health care.
Five years ago, the Whole Foods grocery chain switched
to a high-deductible plan. If an employee has a sore throat or a sprained
ankle, he pays. But if he gets cancer or heart disease, his insurance covers
it.
Whole Foods puts around $1,500 a year into an account
for each employee. It’s not charity but part of the employee’s compensation.
It’s money Whole Foods would have otherwise spent on more-expensive insurance.
Here’s the good part for employees: If they don’t
spend the money on medical care this year, they keep it, and the company adds
more next year.
It’s called a health savings account, or HSA.
CEO John Mackey told me that when he went to the new
system, “Our costs went way down.”
Yet today, some workers have $8,000 in their accounts.
“That’s their money,” Mackey said. “It builds up over
time because the money is compounding for them.”
It will cover all sorts of future out-of-pocket
expenses.
Most important, since employees control the money,
their behavior changed. Whole Foods workers started asking “how much things
cost,” Mackey said. “They may not want to go to the emergency room if they wake
up with a hangnail in the middle of the night. They may schedule an appointment
now.”
There was no need to ask about costs before because
the insurance company seemed to pick up the tab. But that drove up costs for
everyone. Now, saving money makes sense to employees because the money belongs
to them.
HSA critics ask whether individual accounts will
encourage people to save money at the expense of their health.
Mackey has the right response. “The premise in those
kinds of questions is that people are stupid. They’re not smart enough to make these
decisions for themselves. It’s sort of an elitist attitude. The individual is
the best judge of what’s right for the individual.”
And apparently, most individuals are making smart
choices.
Harvard Business School professor Regina Herzlinger
says studies show that “people who have these high-deductible health-insurance
policies take a lot better care of themselves. They have more yearly physicals.
Because they’re saying, ‘If I keep myself healthy, in the long run, I’m going
to be spending less money.’” . . .
To read the entire article, go to www.theatlasphere.com/columns/071003-stossel-health-care.php.
John Stossel is co-anchor of ABC News’ “20/20” and the author of Give
Me a Break: How I Exposed Hucksters, Cheats, and Scam Artists and Became the
Scourge of the Liberal Media (January 2005), as well as Myth,
Lies, and Downright Stupidity: Get Out the Shovel — Why Everything You Know Is
Wrong (May 2007), which is now available in paperback.
Next: Where competitive health care is already
working. See Section 8 Below:
“If you put the government in charge of the Sahara Desert,
in five years there would be a shortage of sand.” –Milton Friedman
* * * * *
8. What's New in US
Health Care: When government and insurance companies
are kept
away from the transaction, good new things happen.
Opinion Editorial: Medical Competition Works for
Patients, By John Stossel, Oct 10,
2007,
From TheAtlasphere.com
Health-care costs overall have been rising faster than
inflation, but not all medical costs are skyrocketing. In a few pockets of
medicine, costs are down while quality is up.
Dr. Brian Bonanni has an unusual medical practice. His
office is open Saturdays. He e-mails his patients and gives them his cell-phone
number.
“I need to be available 24 hours a day,” he says. “I
want to be there when a patient has questions, and I want to be reachable.”
I’ll bet your doctor doesn’t say that. Bonanni
knows he has to please his patients, not some insurance company or the
government, because he’s paid by his patients. He’s a laser eye surgeon.
Insurance rarely covers what he does: reshaping eyes so people can see without
glasses.
His patients shop around before coming to him. They
ask a question that people relying on insurance don’t ask: “How much will that
cost?”
“I can’t get away with not telling the patient how
much exactly it’s going to cost,” Bonanni says. “No one would put up with it.
And the difference of a hundred dollars sometimes makes their decision for
them.”
He
has to compete for his patients’ business. One result of that is lower prices. And
while the procedure got cheaper, it also got better. Today’s lasers are faster
and more precise.
Prices have fallen and quality has risen in other
medical fields where most people pay for care themselves, like cosmetic
surgery. Consumer power works — even in medicine.
When government and insurance companies are kept
away from the transaction, good new things happen.
A doctor in Tennessee I talked to publishes his
low prices, such as $40 for an office visit.
Most doctors would say you can’t make money this way.
But Dr. Robert Berry told me you can. “Last year, I made about the average of
what a primary-care physician makes in this country,” he said.
Berry doesn’t accept insurance. That saves him money
because he doesn’t have to hire a staff to process insurance claims, and he
never has to fight with companies to get paid.
His mostly uninsured patients save money, too. Unlike
doctors trapped in the insurance maze, Berry works with his patients to find
ways to save them money.
“It’s coming out of their pockets. And they’re afraid.
They don’t know how much it’s going to cost. So I can tell them, ‘OK, you have
heartburn. Let’s start out with generic Zantac, which costs around five dollars
a month.’” . . .
Sometimes the $4 pills from Wal-Mart are just as good
as the $100 ones. . .
When consumers pay for medicine themselves, saving
insurance for the big things, and doctors deal directly with consumers, doctors
begin to compete. They start posting prices and work to keep them low.
And consumers gain more control
of their health care. Instead of governments and insurance companies
deciding for patients, patients decide.
Competition gives consumers more choices. And choice
gives them power. Remember that when you hear a politician promise to make
health case accessible and affordable through the force of government.
www.theatlasphere.com/columns/071010-stossel-medical-competition.php
John Stossel is co-anchor of
ABC News’ “20/20” and the author of Give
Me a Break: How I Exposed Hucksters, Cheats, and Scam Artists and Became the
Scourge of the Liberal Media (January 2005), as well as Myth,
Lies, and Downright Stupidity: Get Out the Shovel — Why Everything You Know Is
Wrong (May 2007), which is now available in paperback.
* * * * *
9. Health
Plan USA: Is It Armageddon for the
Health Insurance Industry?
Universal Health Care Defeated in
California: Can the Health Insurance Industry Survive?
The concept of a state-based health care
system seems to recycle every few years, as the inadequacies of the current employer-based
financing system become more apparent. Dr. David Gibson, a health care
consultant in Sacramento, states that arguments for using the government to
enforce the pooling of risk across the entire population make eminent sense
from a purely actuarial perspective. He reports in Sacramento Medicine that 54%
of health care underwriting is employer-based, 14% is Medicaid, and 20%
uninsured. (For details of the remainder, visit www.ssvms.org/articles/0609gibson.asp.)
However, Gibson continues, whenever such a
system is presented to the voters, it does not fly. For example, in 1994,
Californians resoundingly defeated Proposition 186, a single-payer health-care
initiative. In November of 2002, Oregon voters defeated a measure that would
have provided universal health care for state residents. It failed by almost a
four-to-one margin. In 2005, California voters rejected Proposition 72, a
referendum to support SB 2, which was a state law requiring employers to
provide health care benefits to workers. It is of interest that, despite
intensive support by unions, the California Medical Association and a host of
consumer groups, the proposition went down to defeat.
Gibson
contends that Americans have lost confidence in the competency of their
political system. Politicians at all levels of government have demonstrated
that they lack the self-discipline required to competently govern. Thus, these
politicians cannot be trusted with America's health care system. You do not get
re-elected by saying no to special interests, even when their demands represent
bad public policy. The public’s ultimate protection from politicians is the
voter’s initiative.
Gibson concludes that support for this
assertion can be found in California. The state's economy generates $1.3
trillion in annual output and is the fifth- or sixth-largest economy in the
world. During the dot com bubble in the mid to late 1990s, California
politicians, responding to entrenched special interests, created a structural
budget deficit of such magnitude that, even if the state fired every single
person on the payroll (every park ranger, every college professor and every
Highway Patrol officer), it would still be more than $6 billion short. No
public or private company in America could survive with this quality of
leadership. Self-disciplined politicians are an oxymoron.
Bill to Abolish Health Insurance Companies
Vetoed
Governor Arnold
Schwarzenegger vetoed a bill that would have created a universal health care
system run by the state in September 2006. Senate Bill 840, written by state
Senator Sheila Kuehl, D-Santa Monica, would have abolished the role of private
insurance companies in health care. Instead, the state would have covered
everyone. Theoretically, the system would have been financed by taxes on
individuals and businesses that would have replaced the health premiums that
both now pay to private insurers.
In his veto message, the Republican governor said government-run health care
was not a solution. About 6 million Californians are uninsured. "I want to
see a new paradigm that addresses affordability, shared responsibility and the
promotion of healthy living," Schwarzenegger wrote. "Single-payer,
government-run health care does none of this." (Clea Benson, Sacramento
Bee: www.sacbee.com/296/story/28096.html.)
What Is the Answer?
I’ve been part of a working group that includes physicians, MBAs and ITs. We
have met weekly on Tuesdays from 6:00 to10:00 p.m. for the past two-years to design a health insurance program for the
United States and, by extension, the free world. Patients would be involved in
the decision-making process at every step of their health care. It is a
variation of the recent consumer-, or more appropriately, patient-directed
health care plans on the market. Claims would be Web-based and payment from the
insurance company would clear the next day, much as a check, credit or debit
that is deposited. There would be less cost by eliminating the insurance
biller, since any member of the physician, hospital, x-ray, pharmacy or lab
provider’s staff would just simply enter the code to charge the patient’s
Web-based account. All charges, as long as they fell within the 90-percentile
range, would be paid and electronically deposited into the provider's bank
account the next day.
There would be no need for claims review
because patients, by paying a percentage of each claim, have a vested interest
in reviewing their claims to make sure it is the lowest possible charge. If
they were unhappy with the charge, that physician, hospital, x-ray or lab
facility would obviously lose all further business from that patient. Estimated
savings of this simple maneuver was estimated at 15 to 25%, or the cost of the
provider’s business office.
This would be coupled with an electronic
medical records system with physician entry into medical templates, saving the
cost of a transcription service, which can be significant. Our last transcriber
charged by the line, which came to about $5 a page. Thus, a four-page
new-patient medical history and physical exam report could cost $20 in
transcription fees. To put this in perspective, our Medicaid reimbursement is
$21 per office call. The cost was becoming untenable and so we implemented
templates completed by the physician.
In our plan, all orders were also entered
into the Web-based chart, which could be filled by any provider (laboratory,
pharmacy or x-ray facility) the patient chose, allowing full freedom of the
marketplace, which is ruthless in finding the lowest cost in the neighborhood
and beyond. Thus, the continuous vigorous reducing of health care costs becomes
a constant mechanism.
But the Answer Cannot Be Implemented
The group then had an actuary, whose primary job is with a large insurance
group, evaluate the business plan. This was a real eye-opener about the status
of health insurance or even Medicare reform in our country. He said that this
plan would save between 40% and 50% of all health care costs, which would be
reflected in a reduced premium to about half the current rate. But he added
that his insurance company and all the large players would vigorously oppose
such an entry into the medical marketplace or more specifically, the health
insurance marketplace. They would even use congressional force to try to
prevent it.
This was further brought into focus when
an entrepreneur looked over the business plan. He was very impressed with the
logic, ingenuity and simplified nature of the plan. He estimated the cost of
bringing it to market at $45 million of venture capital plus $10 million in
lobbying costs to stop congressional action instigated by the major players in
the health care field wanting to prevent any and all marketing efforts.
Is There a Government Solution?
Health reform in the public or political arena is a lost cause. There have been
many states that have implemented various efforts to include the uninsured from
increasing Medicaid coverage, increasing the CHIP program to grants, subsidies
and other slight-of-hand maneuvers. In each case, the cost of health care has
increased but the number of uninsured has not changed or decreased. Thus,
government involvement has always increased health care costs but has not
ameliorated the problem of extending coverage.
The Solution Lies Outside of the
Government
Health care reform has to come from the private sector. Government is incapable
of accomplishing anything that will either solve the problem or reduce the
cost. It will only increase the cost and the problem. If the private sector,
outside the current vested interests, could invest the projected $45 million
startup costs plus the $10 million projected lobbying costs to placate
Congress, according to this one entrepreneur, health care reform could occur.
It would then be relatively inexpensive, related to each individual’s wants or
needs, save the health insurance industry from government extinction, and place
it in the health insurance marketplace, where every insurance agent or broker
could market it. Otherwise, it just could be Armageddon for the industry.
www.healthplanusa.net/OE_UniversalHealthCareDefeatedInCA.htm
This column first appeared in Health
Insurance Underwriters in October 2007. http://hiu.nahu.org/article.asp?article=1660&paper=0&cat=137
* * * * *
10. Restoring Accountability in
Medical Practice by Non Participation in Government Programs and Understanding
the Devastating Force Of Government.
·
Grover
Norquist, President of Americans for Tax Reform, www.atr.org/
keeps us apprised of the Cost
of Government Day® Report, Calendar Year 2006, Fourteenth
Edition. Cost of
Government Day (COGD) is the date of the calendar year on which the average
American worker has earned enough gross income to pay off his or her share of
spending and regulatory burdens imposed by government on the federal, state and
local levels. Cost of Government Day for 2006 was July 12th, a one-day increase
above last year’s revised date of July 11th. With July 12th as the COGD,
working people must toil on average 192.5 days out of the year just to meet all
the costs imposed by government. In other words, the cost of government
consumes 52.7 percent of national income. If we were to put health care into
the public trough, the additional 18 percent would allow the government to
control 70 percent or nearly three-fourths of our productivity. We would have
almost no discretionary income. We would have very little healthcare after a
few 20 percent yearly increases like Medicare and Massachusetts.
·
John Berthaud, President of the National Taxpayers Union, www.ntu.org/main/, died unexpectedly on September
27, 2007, peacefully in his home. He had been keeping us apprised of all the
taxation challenges our elected officials are trying to foist on us throughout
the United States. I understand the staff is rising to the challenge to
continue his mission in life. To find the organization in your state that’s
trying to keep sanity in our taxation system, click on your state at www.ntu.org/main/groups.php. To
find important tax news, just click on the URL above.
·
Ayn Rand, The Creator of a Philosophy for Living on Earth, www.aynrand.org/site/PageServer,
is a veritable storehouse of common sense economics to help us live on earth.
To review the current series of Op-Ed articles, some of which you and I may
disagree on, go to www.aynrand.org/site/PageServer?pagename=media_opeds.
·
John and Alieta
Eck, MDs, for their first-century solution to twenty-first century needs.
With 46 million people in this country uninsured, we need an innovative
solution apart from the place of employment and apart from the government. To
read the rest of the story, go to www.zhcenter.org.
·
Michael J. Harris, MD - www.northernurology.com - an
active member in the American Urological Association, Association of American
Physicians and Surgeons, Societe' Internationale D'Urologie, has an active
cash'n carry practice in urology in Traverse City, Michigan. He has no
contracts, no Medicare, no Medicaid, no HIPAA, just patient care. To understand
that Medical Bureaucrats and Administrators are basically Medical Illiterates telling
the experts how to practice medicine, be sure to savor his article on
"Administrativectomy: The Cure For Toxic Bureaucratosis" at www.northernurology.com/articles/healthcarereform/administrativectomy.html.
·
PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY
with Larry
Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/.
Dr Huntoon does not allow any HMO or government interference in your medical
care. "Since I am not forced to use CPT codes and ICD-9 codes (coding
numbers required on claim forms) in our practice, I have been able to keep our
fee structure very simple." My goal is to provide competent,
compassionate, ethical care at a price that patients can afford. Private
Neurology also guarantees that medical records are kept totally
private and confidential - in accordance with the Oath of Hippocrates. Since I
am a non-covered entity under HIPAA, your medical records are safe from the
increased risk of disclosure under HIPAA law. Ever have a blinding migraine and
couldn't even drive to see a doctor? Dr Huntoon even makes house calls.
Canadian patients are welcomed. Such a deal.
·
PATMOS
EmergiClinic - where Robert Berry, MD,
an emergency physician and internist states: "Our point-of-care payment
clinic makes acute and chronic primary medical care affordable to the uninsured
of our community by refusing to accept any insurance (along with the hassles
and crushing overhead that inevitably come with it). Read the rest of the story
at www.emergiclinic.com.
* * * * *
Stay Tuned to
the MedicalTuesday and the HealthPlanUSA Networks and have your friends do the
same.
Articles that appear in MedicalTuesday and
HPUSA may not reflect the opinion of the editorial staff. Sections 1-8 are
entirely attributable quotes in the interest of the health care debate.
Editorial comments
are in brackets.
ALSO NOTE: MedicalTuesday receives no
government, foundation, or private funds. The entire cost of the website URLs,
website posting, distribution, managing editor, email editor, and the research
and writing is solely paid for and donated by the Founding Editor, while
continuing his Pulmonary Practice, as a service to his patients, his
profession, and in the public interest for his country.
* * * * *
Del Meyer
Del Meyer, MD, CEO & Founder
HealthPlanUSA, LLC
www.HealthPlanUSA.net
DelMeyer@HealthPlanUSA.net
6945 Fair Oaks Blvd, Ste A-2,
Carmichael, CA 95608
Words of Wisdom
Never
doubt that a small group of thoughtful, committed citizens can change the
world. Indeed, it is the only thing that ever has. -Margaret Mead,
US anthropologist & popularizer of anthropology (1901-1978)
“It
is not the critic who counts, not the man who points out how the strong man
stumbled or how the doer of deeds could have done better. The credit belongs to
the man who is actually in the arena, whose face is marred by dust and sweat
and blood, who strives valiantly, who errs and comes short again and again, who
knows the great enthusiasm, the great venture and spends himself in a worthy
cause, who at the best knows in the end the triumph of high achievement, and
who at the worst, if he fails, at least fails while daring greatly so that his
place shall never be with those cold and timid souls who know neither victory
nor defeat.” -Theodore
Roosevelt, twenty-sixth president of the United States (1901-1909)
All That Is Necessary For The Triumph Of
Evil Is For Good Men To Do Nothing. -Edmund Burke, Irish statesman, author, orator, political theorist,
and philosopher (1729-1797)
Some
Recent Postings
HPUSA: www.healthplanusa.net/October07.htm
HPUSA: www.healthplanusa.net/July07.htm
HPUSA: www.healthplanusa.net/April07.htm
HPUSA: www.healthplanusa.net/January07.htm
On
This Date in History
January 1 is the day when traditionally, our good resolutions
are put to the test. Historically, it is a day full of good intentions, and,
happily, of the beginning of the triumph of good.
On this date in 1831, William Lloyd Garrison published the
first issue of The Liberator, an anti-slavery periodical.
On this date in 1863, President Lincoln issued Emancipation
Proclamation.
On this date in 1898, Brooklyn merged with New York in a
single city.
On this date in 1942, 26 nations signed United Nations
Declaration in World War II in Washington, DC.
On this date in 1735, Paul Revere was born, in 1752 Betsy
Ross was born, in 1745 General Anthony Wayne was born.
After Leonard and Thelma Spinrad