How to Fix Healthcare, Part 1

I've been having this conversation a lot with friends, family, people I work with, etc. I get pretty worked up since the direction those in power are trying to take health care will, I think, completely ruin things, and affect my livelihood directly. If you have a different opinion from mine, please, please comment. I like interaction on this, since that's the only way I'm able to figure out what will really work versus what is just sound-bite fluff we all hear from both sides every day.

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I don't think we need, or would do better with, nationalized healthcare. People say that's not what the current proposal is, but if you look at the implications of a "government option" that's the direction it is headed. Regardless, if you look at quotes from President Obama himself in the past and quotes from everyone surrounding him, it is obvious that nationalized, single-payer healt"care" is their end-game.

Everyone for the socialized medicine always asks what the solution is when I point out the flaws of centralized, government health care systems. It's as if they think there is no other option out there and that the question will end the argument. However, there are lots of ways to improve our current system, while retaining it's benefits.

#1 Get Rid of Medicare/Medicaid

"Changers" use the blanket statement "Our system is broken" to argue in favor of socialized medicine. However, the current system is mostly governement. The majority of payments in our current system come from the government through medicare/medicaid. So, isn't that an argument against government control? Not to mention the fact that the government controls nearly all pricing of services since all private reimbursement uses the Medicare formularies as a guide.

These entitlement programs will bankrupt our country. Medicare Part D alone (thank you Mr. Bush) will bankrupt our country.

#2 Look at Car Insurance

People are generally happy with their car insurance. If they're not, they're probably in the process of changing to one they DO like. Every policy must have catastrophic coverage and everyone (that drives) must have it. No one ever goes bankrupt because they got in a car accident (besides medical bills, but that's the point). Coverage is very portable and very customizable. New companies have relatively few barriers to entry to the market and can provide low-cost options that may provide fewer services while reaching people who prefer that mix (anyone use Geico?). In addition, car insurance works across state lines.

Why can't we deregulate health insurance to allow companies to offer plans that are just catastrophic coverage and also coverage for routine visits? That way you create what I like to call the "Golden Donut Hole" similar to what you have in auto insurance. If you ding your door, you might not get it fixed because it will come out of your pocket. In the same manner, I would like to see health care coverage completely cover the big things that usually bankrupt people, and then, when your knee hurts and you go to the doctor, the coversation is very different from what happens now. Right now, if you have insurance, you will get an MRI, or some other expensive workup. If not, and something is found down the road, the doc will get sued. Since there is a third party involved in the decision, it is a no-brainer. However, if the person with the hurt knee had to pay for the MRI, he would have an in-depth conversation with the doc about the relatively low likelihood of something serious being wrong and then make an informed decision, weighing the costs and benefits of proceeding with a costly workup.

If he proceeds, he will get a cheaper price than the insurance company would have. All doctors (and dentists) know that there is an out-of-pocket price that is way way cheaper than what would have been billed to the insurance company. Part of that is because of the extra overhead that comes from having to deal with the insurance company. The other part is to cover the bills that will never be paid and get rejected.

If he decides that knee is the equivalent of a dinged-door and he will just rely on the physical exam of the doc in the office to quell his fears that nothing big is the matter, then the doc will make note of that in his records and, down the road, there really is no case for the doc to get sued since it was an informed decision made between two parties obeying risk/benefit market principles.

This "Golden Donut Hole" would cut out a crap load of waste currently in the system from unneeded test and workups that are ordered just to cover all parties involved. And don't think the government is immune to this. I'm currently doing a rotation at the VA Hospital and it happens every day there too.

We need to reintroduce true two-party free-market decision-making back into medicine.

#3 Right Versus Priviledge

This is a big one. Arguments for socialized medicine always state that health care is a right and that the worst kind of discrimmination is in health care. However, we need to talk about what the meaning of a Right really is.

To me, a right is something that everyone could have, but not necessarily something that everyone does have. For example, everyone in the world could have the right to the pursuit of happiness. One person having it does not detract from the ability of another to have it. There is not a limited amount of "pursuit of happiness" and we're not going to run out of it.

The highest level of health care we enjoy in the United States cannot be a right, I believe, since it would be impossible to give that highest level to everyone. If Joe Drunkhead goes out, gets lit, then wanders into the middle of the busiest street in the city and gets hit, is it his right to have the highest level of healthcare our hospital can provide, immediately? Can he pound his fist and demand an MRI right now, saying "Health care is a right!" even though he might not need one? He could, but he woud be putting himself in front of a long line of people waiting for that MRI, who are probably more legitimately in need of it than he is.

So, if there is a limited supply of these resources, then can the highest level of healthcare be a right? By my definition, NO. The answer is that SOME level of healthcare is a right, but not the highest level. And if you think my example is a poor one, you need to see what the majority of patients I see come in with and the reason for their injuries or poor health.

Therefore, WHAT level of healthcare is a right? Well, that's a better discussion. One that I like having. See, I think that we have a potentially great health care system here in the US. We shouldn't throw out the baby with the bathwater just for the sake of change. Not all change is good, and some change is irreversible. Government entitlements are stuck, once put in. Welfare was supposed to be temporary when it was started over 50 years ago. Once you give poeple something for "free" (=paid for by someone else) they don't easily give it up (nor do the beaurocrats with fancy new jobs easily give up their new gravy train). I would hate to see our system changed for the sake of change irreversibly with no (mostly) private health care system left in the world for the rest of the world to mooch innovations from. It would be a global stagnation of health innovation and conflagration of dissatisfaction.

The Poor

But, what about the poor who can't afford my envisioned affordable free-market plans. Am I just some "I've got mine, screw you" elitist who doesn't care about the poor? (No, I am not, and I serve the poor every day where I work.)

Stay tuned for next post where I'll tackle that one...