The most appropriate response to today's health care system woes is neither a single-payer bureaucracy nor a head-in-the-sand refusal to see a problem. Here are 5 rational proposals to improve health care access and reduce costs. by Tully
(libertarian)
Friday, July 17, 2009
President Obama has launched his Class Warfare Health Policy Initiative. Economists, many Caregivers, and non-Socialists are understandably aghast at the proposal to spend over a trillion dollars, tax the "rich" at 45%, and let loose a system of bureaucracy-controlled health care services. But we need to do more than yell "NO!" We need to acknowledge the problems that do exist; propose solutions that address the problem; and do so within a context that has broad political support from the ideological 'middle' of the country.
With that in mind, I suggest the following parameters:
1) First, we must acknowledge that there *is* a problem in terms of affordable access to health care for many Americans. With 10% of the Labor Force out of work (and youth, stay-at-home parents, part-time workers, the disabled, many immigrants and the homeless are NOT included in the figure), estimates range from 30 to 50 million Americans living without health insurance. That means somewhere between 10% and 15% of Americans.
2) It has been demonstrated that those with a lack of access to health care delay treatment until their conditions require critical (and far more costly) attention. This adds to the expenses Providers incur (and often absorb) and the strain on existing government programs (and thus, increase cost to taxpayers).
3) We must agree that compassion and the political climate both dictate that a, "hell, tough on them!" approach is not an acceptable response.
4) Having said that, the solutions must address the problem. At my office (an Academic institution), one often hears people singing the praises of a Single Payer System. They frame the problem as the 'lack of a single payer system.' However, this response falls apart when weighed rationally. If 85% of Americans had affordable access to supermarket food, and 15% were lacking basic nutrition, we would never suggest that all 100% of the country have access to free food at the supermarket, with the bill sent to The Government. We all know intuitively that the result would be a run on food, a shortage of goods in the supermarket, wasted resources, and a broke country. And yet, that is precisely what the Single Payer Cheerleaders want for health care. If the problem is access for 15% of Americans, than the solution is a way to find access for 15% of Americans.
5) Insurance is both a blessing and a curse: it allows people to access health care (the blessing), but also permits non-emergency situations to crowd hospitals and ER rooms with unncessary service, as consumers receive thousands of dollars worth of treatment for a small copay of $10, $25, or $50. True Health Care Reform must acknowledge objective, observable economic realities and not be bases on some hand-holding kumbaya approach to human nature.
6) The provision of care must be centered on the Doctor-Patient relationship, NOT on insurers' profits or government bureaucracies "one-sized-fits-all" approach of form and process and procedure and approval.
7) We must acknowldge that the American health care system is the best in the world, bar none. Those who point to Canada forget that there is not a single modern machine in Canada capable of removing kidney stones. Those who trumpet Britain forget that Britain has closed 40% of her hospital beds since the 1940 NHS was enacted. Those who point to Scandinavia forget that it is the American doctors who win the Noebel prizes, the American researchers who have made all the modern major medical breakthroughs in the last century, and it is America that attracts doctors from all over the world.
So..in a nutshell: we need a system that helps those without affordable access to gain that access, in a way that protects and enhances the doctor-patient relationship, lowers costs to consumers and providers, and continues to support a profitable - and successful - health industry.
With all of those as 'context,' here are my 5 Proposals:
1) Permit community groups to form for the purpose of buying health insurance. Sounds simple, isn't it? But it's illegal. Individuals can *not,* under existing law, form 'groups' whose primary purpose is purchasing insurance. (Groups may form for business or fraternalh purposes, and then choose to buy insurance as an incidental benefit, but they can not form for no other reason than to buy insurance). End this prohibition, let the market dictate rates, let competition ensue, and there will be no need for a Federal Government-related Insurance Bureaucracy. Take it one step further: end State Monopolies on insurers. The Federal Government (not States) has the authority to regulate Interstate Commerce, and since people may have an accident *anywhere* and request their insurer to cover it, this is clearly federal jurisdiction. Blow open the lid on Insurer Competition.
2) Enact Tort and Medical Malpractice Reform NOW. It was reported 5 years ago that an OB-GYN doctor in Massachusetts has to deliver EIGHTY-FIVE babies just to cover his malpractice insurance premiums for a year. Worse, 5% of doctors are responsible for 95% of malpractice claims, raising all doctor's and hopistal's premiums. Limit Malpractice Awards, raise the negligence standards (so hospitals dont need to run unnecessary tests), and relieve the 95% of decent doctors from paying the premiums of the 5% convicted of malpractice.
3) Eliminate the FDA's requirements that drugs be safe AND EFFICACIOUS. Currently, the FDA requires that pharmaceutical companies prove that their drugs meet two tests: they must prove safe, and they must be 'efficacious,' that is, they must be proven to cure the condition they claim to address in virtually 100% of patients. This is a costly and unnecessary test: Many people react differntly to different substances. The Peanut Butter that fed me through high school will kill someone with an allergy. Let *Doctors* decide what to prescribe, with the understanding that the idiosyncracies of individuals means that results WILL be different with different drugs. A drug that doesnt work, will not be prescribed. On the other hand, if a doctor determines that medical marajuana is more efficacious and cost-effective than morphine, so be it. Eliminate tiered coverage that allows Insurers to cease to cover necessary, but expensive, pharmaceuticals.
4) Engage in Multi-national agreements with other nations to accept their pharmaceuticals. The refusal of the US FDA to permit the importation of Canadian pharmaceuticals is insane. An individual can come to the US from France, or Britain, or Mali, or India, and providing only a driver's license from their own nation, get behind the wheel of a 6,000 pound rental car and take off minutes after landing - even if they don't speak English or have never driven on the right side of the road. And yet, if a pharmaceutical company goes through hundreds of thousands of tests in Germany, or Britain, or Canada, the results are not considered 'valid' in the US. Now, realistically, which is more dangerous: the driver, or a drug produced in Canada?
5) Permit every American to have a Medical Savings Account. Currently, Government workers and some self-employed people can utilize a Medical Savings Account which permits them to cover medical costs using a credit-card-like card. These citizens have a certain amount of money deducted from their paychecks, and go into an account for medical expenses: prescription drugs, eyeglasses, dental work, and even over the counter remedies. These deductions are pre-tax, meaning it lowers the person's gross income, lowering their tax and even possibly dropping them into a lower tax bracket. Better yet, these workers can 'borrow' against future deductions if they incur expenses early in the year at no interest expense. If government workers are allowed these accounts, why not ALL Americans?
These proposals will not solve all of our problems, but they will go a long way to providing access for those who do not have it, lowering costs for everybody, and enhancing the doctor-patient relationship.
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Illegal Immigration and health care are heavily connected, believe it or not. Massive high taxes are imposed on the US taxpayer to pay for so called emergency hospital care for illegal immigrants and their families. Except foreign nation use the emergency room for their basic needs, such as the flue or a splinter in the finger. As always the taxpayer is the recipient? Health care revision can never happen while Taxpayer carry the heavy burden of paying for the millions of illegal workers and families, who have settled here. As an example 80 hospitals and clinics locked their doors for good in the Sanctuary State of California, because huge hordes of individuals came their for free health care. Why do you think California found themselves with a $24.5 billion budget deficit?
Those who want to just follow the same old road, can do so with the profit taking commercial insurance. Those who would be satisfied with a government run health care program, can now start demanding it from the lawmakers. Those who see a Universal health care system, similar to most developed countries in Europe, should start informing every Representative and Senate politician starting today. Rationing in places like England, was caused by the major impact of uncontrolled immigration. I see--THE RATS--are coming out of the woodwork, using propaganda and downright lies about government run medical care? The Special interest lobby, status quo have very wealthy fingers in the pie and do not want Health care for everybody? It's a trillion dollar business like Cancer treatments.
The pharmaceutical companies, AMA and others have very much to lose? Even many corrupt politicians are stockholders in this behemoth money machine. Most American working class can do--without-- high premiums, pre-existing condition clauses. deductibles, co-pays that is representative of the wealthy medical care insurers.
Unless our politicians commit themselves to a strong E-Verify, Police enforcement 287(g) and enforce all federal employees are vetted, so illegal immigrant workers can be rooted-out. The push for AMNESTY, will even draw another invasion in to our nation once the word goes out.
This free health care atrocity was placed on the unknowing American, years past and never been rescinded. This has favored the business community, because they pay--ABSOLUTELY NOTHING-- to a maimed or sick illegal worker, because it's passed on to the consumer. IF YOU DESIRE A NEW HEALTH CARE SYSTEM, WHERE YOU CAN CHOOSE YOUR INSURER? WHETHER YOU WANT THE FOR PROFIT INSURANCE OR GOVERNMENT MEDICAL CARE SYSTEM? TODAY IS CRITICAL. SO CALL YOUR SENATOR OR CONGRESSMAN 202-224-312. Just like illegal immigration , we cannot afford anymore to subsidize the business that hire them or the millions of illegal families. GOOGLE--on the web to find the truth.
Now it’s up to the American people to demand–NO MORE AMNESTIES! GOOGLE–illegal immigration and financial costs, because the public is constantly fed propaganda from the Liberals. Call your state or federal representative today! 202-224-3121 in addition to sign the petition for California, to stop billions of welfare benefits, to the overrun State at TAXPAYER REVOLUTION. See the truth at NUMBERSUSA,
Then in California right now–the SANCTUARY STATE–E-Verify is under a great deal of pressure, not to implement it. Assembly member Paul Fong (Cupertino) would prohibit the state, local governments, and special districts in California from requiring an employer to use the federal “E-Verify” system, even when that employer is a contractor to the government. This is typical at state or federal level, no matter the monetary consequences to the US worker. California residents should immobilize this idiot, and threaten him losing when it’s time for re-election. SAY NO to AB 1288
Re: Enact tort and medical malpractice reform now. Right problem but wrong solution. The root cause of high malpractice insurance costs is malpractice itself, not the amount paid to injured patients. The solution is to take action to revoke the licenses or restrict the pracatices of the only one to two percent of physicians who are responsible for over half of all the money paid out in malpractice settlements and judgments. Many of this one to two percent of physicians have multiple payments in their records but no action taken to restrict their ability to continue injuring patients. Limiting their practices would not only lower malpractice insurance costs but would also protect patients. It would be treating the disease, not the symptoms.
if everyone used their car insurance to change the spark plugs or replace the ash tray then what would that do to the cost of auto insurance. If a doctor can't charge a hundred dollars for an office visit then what's he going to do, work at McDonalds? I think you can tell where I'm going with this. Let's have health insurance be just that , INSURANCE.
Posted By: Jahfre Fire Eater
Date: 2009-07-19 07:55:27
Hi Tully,
These may be reasonable proposals with the ability to bring about some positive consequencnes. I don't know. It really doesn't matter.
When I read these kinds of articles, here is what I really hear:
"Hey everyone, we could make some great cherry pies if that tree was producing cherries instead of acorns." "Let's demand that oaks now produce cherrries and life will be good; Cherry Pies for EVERYONE!" "Wow! This social engineering stuff is easy, all we have to do is demand different outcomes!"
Making health care a political problem limits the options to political solutions. Just like every other "issue" from abortion to illegal boarder violations.
The lasting solutions are far off because only a tiny fraction of the citizens are pursuing them by preventing candidates from getting on ballots for local offices who support the cultivation of the system that produces the current deleterious results. Any change has to start with the roots, not the fruit.
I like your ideas. Daddysteve is right too in saying that insurance should not cover every medical expense. It should just be for big ticket items. I also think we need to get back to a competitive free market in health care to get costs under control. Normally I don't favor legislating solutions but we are so far from a competitive free market that maybe a little legislation to move us in that direction might be in order. Maybe doctors, hospitals and other medical providers should be obligated to provide a menu of basic services showing costs so that consumers can make informed choices. The menu should be posted at the place of business and online. Patients should also be given a written cost estimate before submitting to any procedures.
More mindless bigoted pro business drivel hidden in populous mumbo jumbo.
In one line you point out that part of our rising cost for healthcare is due to people delaying treatment and going to emergency rooms. Yet you also blast GB for removing %40 of their hospital beds since they went over to a universal healthcare system. Ghee, maybe they removed them because they spend all their dollars on preventative care and people don't delay treatment for treatable ailments and then crowd hospitals? Do you think that a nation like France; where people riot about all types of liberal issues; wouldn't be up in arms if their government funded health care system wasn't working? Strangely no one in the UK is complaining about how their tax dollars are being spent on health care; the latest government scandal seemed to be centered around members of parliment wasting tax payer dollars for personal use.
It's funny how people always point out that our medical technology is superior to the world's. Guess what? Most medical research in this country is government funded; universal healthcare would not affect how that research was done. Does anyone here know what was one of the most expensive privately funded medical research projects in recent American history? Viagra. Yeah we need to encourage more of that research. And by the way Europe collaborates with the US on most medical research projects and of course we produce more research; we are the wealthiest nation on Earth. The issue has never been about R&D; it is about ACCESS. Throwing this up as an argument misses the point entirely.
Any points about how undocumented immigrants(illegal alien is just a code word for undesirables) is flat out bigoted and just illustrate how ignorant you are about that reality. The issue is not that immigrants are using our health care system and not contributing; it's that American employers are using immigrant's undocumented status to rip off the government and not pay taxes and benefits that these people work very hard for and never receive. Average Americans do not realize that most immigrants do not come from countries that have entitlement programs; no Social Security, no Medicare/Medicade, no Welfare. In fact most immigrants come from countries where you absolutely fear the government. What do you think they are going to miraculously figure out that they can game the system and sign up for every program they can find? I am a first generation American; I grew up in the world that many of you look down on. Most of my family and most of the other families I grew up with worked very hard for everything they had and I can tell you that by and large most immigrants probably contribute more towards the economic prosperity in this country than alot of fully naturalized citizens. Oh not to mention the fact that Caucasian are the major benefactors for most of the entitlement programs in this country.
And last but not least. If universal healthcare is so bad and so inefficient then why does the UK, Canada, France and most other countries that practice Universal Healthcare meet or exceed every health indicator compared to us? In fact there have been numerous reports that we are quickly becoming an unhealthy nation. We are leading the world in obesity and diabetes and cancer yet it's true; we have the best medical system in the world.
Gee hurricane, what a Marxist blowhard you are. Some day after you move out of your mommy and daddy's basement your opinions will be relevant you blow hard loser. Don't blame the rest of the country that works hard for your own shortcomings and deficiencies you louse.
Please forgive Mr Tully for confusing this child with logic.
How quick you are to judge me and you don't even know me.
Dual Major Graduate of St. John's University (political Science and Paralegal Studies)
I was a Probation Officer for 5 years.
I am an hispanic male without a criminal record and no children out of wedlock. I worked for the government and now work for the IT industry. I have never taken advantage of anything and have been as hard working honest American as anyone here.
My observation comes from my education and my observation as a immigrant child who walked thru the dividing lines in this society.
My observation is based upon what I see in the world. What I see is other nations who are not even as wealthy as we are spend alot less money on healthcare and have just as healthy if not healthier societies. In my mind the entire goal of the healthcare industry is to keep people healthy; any reform needs to address that goal primarily; with the second goal is keeping cost down.
What I have seen is the profiteering of healthcare. The goal in today's HMO's and other medical institutions is not to cure people and keep them healthy but to extract as much profit from people paying premiums as possible.
Secondly; you have pointed out no flaw in my points; you merely attack me. All the arguments I have seen against universal healthcare basically boil down to one point; we can't profiteer anymore from this business.
Bottom line is; most of the Western Industrial World practices universal healthcare. Their doctors are not poor and people are not dying of illness in the streets. If this was a bad approach then why aren't we the healthiest nation on earth? Why is it that we have a significant percentage of our citizens, specifically in demographics which are the most at risk for major health problems (children, the poor, and immigrants), that have no access to healthcare? Why is the cost of healthcare even for people who pay for coverage still extremely high than in every other industrialized nation?
This is not some socialist agenda; this is about helping our citizens and making a better society. There has been documented testimony in Congress that Health Insurance companies are specifically motivated to pay as little as possible to provide coverage and charge the most. They denied coverage for people that have resulted in their deaths. For as much as you demonize universal healthcare I haven't heard one single story of Government managed healthcare system causing the death of a patient because they were denied coverage. I have not heard of a single incident of people who become homeless because of health costs in those places.
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