A Sick System: Why Our Health Care Needs Reforming

Gregory Wlodarski, M.D.

Sunday, March 21, 2010

Health care is a service that becomes more costly the longer it is delayed. It’s a service that allows people to succeed in their family, financial and employment lives. The availability of this service is largely dependent on the wealth of the nation.

If we were an Angola or a Nigeria, then a health-care system akin to a shoe store or volunteer fire department may be considered appropriate. But we are one of the wealthiest countries, if not the wealthiest, on the planet. Thus, the service should be akin to a contemporary fire department or police department, available to all at a cost that does not burden a person’s successes in family, financial or employment lives.

Heath-care costs are rising for several reasons, some of which have been mentioned in the media more than others.

Insurance corporations contribute to costs through their drive for profits, advertising and their corporate structure. Medical technology continuously increases, and as it does, so do the dollars associated with it. Avoidance of routine health maintenance causes small problems to inflate to larger and costlier problems.

Excessive medial testing contributes, I think, to a large measure of the cost differences between our system and those of other developed countries. This may be driven by two forces. One is to produce the information necessary to insulate the doctor from potential malpractice suits. The other is the philosophy of intense testing.

The primary-care doctor may be driven to test sooner than later, as there’s pressure to see more patients to make up for ever-lower compensation. Spending precious time to sift through a stream of irrelevant answers to the questions of “where, when, how” is often a time-consuming luxury that may be circumvented by testing.

The specialist may feel pressure to test sooner rather than later as the specialist feels “the buck stops here” — thus to be so comprehensive as to exhaust all measures to find the answer and all related issues as quickly as possible.

The ideal solution is one that is a true and optimized insurance program.

Health insurance is a vehicle to reduce the financial burden of disease prevention, evaluation and treatment on any individual by spreading the risk to other members of a population. Each member of the selected population contributes into a pot that is tapped to pay for any individual’s health.

An insurance program is more successful when it’s able to spread the risk to the largest pool of contributors possible. The largest pool of contributors to any insurance plan is everyone. The only way a plan can have everyone as a contributor is by being the only plan. Being the only plan, not having the costs of competition, makes more funds available to cover health-care costs.

Additionally, to make the most of the money in the pool of its members’ contributions requires the organization to be a nonprofit, or a “mutual” entity in which the contributors are the organization’s stockholders, thus reaping the benefits of its profitability. The closest thing we have to an “ideal solution” is Medicare. Every working person contributes. No one is denied. All services (or all that the bureaucracy allows) are covered.

There are problems, though: The bureaucracy does not allow certain elementary services such as an annual physical. The 20 percent co-pay without a yearly or lifetime maximum can be a burden for some. The coding system for services is Kafka-esque. The bureaucracy is deliberately unhelpful in negotiating its labyrinthine regulations. Provider reimbursement is painfully low. Its low reimbursement is used as a benchmark for private insurers who had previously compensated for Medicare’s low reimbursement but who are now approaching the same numbers.

I want to be sure the reader is aware of the distinction between Medicare and Medicare Advantage. The latter is a private plan for which payment is made to private insurance corporations with Medicare funds. The OMB determined in 2007 that each Medicare Advantage enrollee costs 25 percent more, per enrollee, than regular Medicare.

Thus I am not surprised that this plan is being cut, as it has allowed private corporations to siphon off funds from the greater pool. Unfortunately, those against health-care reform are trying to confuse the public by saying there will be Medicare cuts, when the primary focus of cuts will be in Medicare Advantage, rather than Medicare.

Current, Proposed Solutions

The current solution is a patchwork of solutions to make the insurance companies happy by allowing them to profit, and to minimize the angst of the taxpayer by making the employer pay in part or total.

I don’t think insurance should siphon off a portion of its contributors’ money as profit any more than I think employers should serve as a nation’s social service provider. Health-care service should be taken away from corporations, and the cost of health-care premiums should be removed from employers. Only when the user of a service directly shares in the costs of a service can that user feel ownership of that service and its efficiency.

The proposed solution is far from ideal. It’s still a patchwork to solve many problems of the original patchwork but continues to strive to make the insurance companies happy by providing them with a greater pool of contributors by mandating coverage. It also strives to redistribute, hide or reduce the visible costs through a number of imaginative means.

Though far from ideal, it’s better than what is currently present. As such, it is the first real step toward any solution in decades, and if not passed will be the last.

The forces against the bill are using many tactics to stop it. Some propose solutions that have no real merit or are a giveaway for insurance companies.

The most touted solution is the across-state-line purchasing of health care. This would permit corporations to take a member’s contributions until the contributor became more of a liability than an asset, at which time the corporation across the state line would deny service, drop coverage or refuse to pay the doctor or hospital.

In this case, which state insurance commissioner will pursue the case? Neither, as there is enough going on to keep commissioners busy where both corporation and enrollee are in the same state.

Toxic Politics

Others want the bill redone, but I think this is a groundless delaying tactic, since the same group that wants the bill scrapped in favor of another had 10 years to do something and did nothing other than provide two systems for corporations to siphon money away from the American taxpayer.

Those two systems are Medicare Part D, in which the taxpayers are not allowed to negotiate drug prices (a practice of every managed-care corporation and the VA); and Medicare Advantage, in which taxpayers pay 25 percent more to private insurance corporations for Medicare enrollees while the insurance corporations reimburse physicians at Medicare rates.

The politics in the U.S. right now is the politics of special interests. Politicians, and voters alike, are no longer motivated by what is good for the country and open to compromises, but rather by what is good for their party or ideology, closed to the possibility of compromise.

This motivation has invited an avalanche of money used to lobby sitting politicians and influence current elections. It is anti-democratic for corporations to be able to contribute to a politicians’ campaign, just as it is anti-free-market for a politician to be able to give earmarks to a corporation. It is anti-democratic for fundraisers in one state to influence an election in another state.

I am pessimistic regarding the direction of politics in this country and its potential to create real solutions while politics is awash in money.

Recent Supreme Court decisions suggests that the only way politicians can start thinking in terms of the country instead of special interests is by way of one or more constitutional amendments that state: (1) corporations are economic creations of the state and are not afforded any rights of a human being; (2) a corporation cannot engage in political speech unless 100 percent of its membership supports that political speech, and (3) a politician’s campaign contributions can come only from within that elected official’s district, the potential voters.

Dr. Gregory Wlodarski, a family physician, practices in Pinehurst and lives in Southern Pines. Contact him at pinetree@earthlink.net.

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TheNeedle 3 years, 2 months ago

One quick question: How's it feel to be on the losing side?

TheNeedle 3 years, 2 months ago

One quick question: how's it feel to watch your party have their butts handed to them by Nancy Pelosi and Barack Hussein Obama?

SoPines4ever 3 years, 2 months ago

Is this healthcare reform going to provide affordable healthcare? Whose definition are we going to go by to determine affordable? Is it going to be like mortgage payments, 33% of gross monthly income?

tneal14 3 years, 2 months ago

We shall see. I think it is a bit premature to be gloating especially when all you've done is swallowed hook, line & sinker what those snake oil salesmen are selling. I happen to agree with Anglofile on many of his points. It will be very interesting to see how this will "change" things. I have a hunch it will make a severe impact on our wallets & ultimately our way of life.

None 3 years, 2 months ago

Perhaps the Jack Kevorkian approach to health care that the GOP wants to start all over with would provide immediate health care for those who have been denied coverage, priced out of coverage, or can no longer afford to live due to lack of health care ~ except for the wealthiest American's. Atnea as well as several other prime time insurers have instituted HHD [ High Healthcare Deductible] given that one doesn't have a pre-existing condition like "breathing". Jump on board with a $10,000.00 deductible and up! Good luck with your will to live, since medical care is out of reach for most of us.

TheNeedle 3 years, 2 months ago

Tsk. So angry, and so bitter. Pity you can't enjoy your life more instead of spending all your time ranting and raging at strangers on a message board. Do your clients at "Dornoch Capital Advisors LLC" know what a sad silly little man you are, and how you spend your time?

confused 3 years, 2 months ago

Does all this health care business mean that I am going to have to pay for 35 yr old losers who are spending their lives smoking pot and playing video games in their mother's basements?
Am I the only one who thinks bad behavior is being rewarded?

djcalaska 3 years, 2 months ago

This was never about health reform. This is about government control. If congress wanted things changed, congress would have changed them. There was not a need for a "major health care reform". Congress needed to pass a couple of bills regulating profit, interstate competition and tort reform, etc.. That was it. Now, the government is really going to dig into our pockets. The "speculated cost increase" of families with insurance is going to be in the neighborhood of $2000. - $2500. Our families have been paying into the social security system for decades and it was not designed to carry the load it has been. Walk into the emergency room of First Health on a Fri. or Sat night and take a look around. This is where a lot of our funds are going. Politicians are afraid to address the immigration issue and have no intentions of messing with the compaign contributions of the insurance companies. By the way, BCBS made a net profit of $189,000,000.00 in NC, alone in 2009 and still wanted a rate increase! Get ready for tax and rate increases. Ironically, in all the turmoil of revamping our insurance program, I do not believe anyone has mentioned restricting rate increases!! Just wait for the "cap and trade" scam to come out! The democrats are laughing this week!

nbrabham 3 years, 2 months ago

this is to anglofile, you have alot to say why not run for office. you seem to forget we are in this mess because of the conservatives. In my opinion , all are entitled to affordable healthcare. Millions of people work paycheck to paycheck and can't afford healthcare coverage. Sorry you are an angry individual and that you do not like democrats. But life goes on grin and bare it. Yes the immigration issue needs to be addressed but the conservatives helped open that door now they can't close it. This is not a win win situation I just hope my elderly mother can get to a doctor when she needs and she worked longer than alot of us has been alive and she struggles now and I help her.

intrepidreader 3 years, 2 months ago

You better tell Mom to hang on for another four years, nbrabham, because that's how long it will be before any benefits from this swell new plan goes into effect. Maybe looking forward to the day when she gets free gummint insurance will distract her from noticing that her Medicare benefits are being reduced even as the cost of it rises.

I think everyone should read this piece from The Huffington Post, written by Jane Hamsher. As the founder of firedoglake.com, her progressive, liberal, left wing credentials are even more impeccable that those of The Pilot's own resident Obama shill, Dusty Rhoads:

http://www.huffingtonpost.com/jane-hamsher/fact-sheet-the-truth-abou_b_506026.html

tneal14 3 years, 1 month ago

Supposedly, some things will take effect in 6 months. Other "benefits" may not be in effect until 2010 or 2014. Obama probably won't be around to see "his plan" come to full fruition. Things are going to get ugly. I bet our paychecks and benefits will "change". Yikes!

tneal14 3 years, 1 month ago

Yep...more & more...cap & trade and let's not forget "immigration reform". WE ARE TOAST!!!

tneal14 3 years, 1 month ago

The U.S.A. is going through radical changes I'm afraid...

None 3 years, 1 month ago

@Anglofile: Good for you...contributing to escalating health care so insurance company CEO's like retired bank investment brokers can continue sucking the life blood out of the American public. Were you one of the recipients of the government bailout of AIG, Bank of America, AG financial? Fat Cats like you are the reason this county was on the brink of another depreciation.

Take heed, Anglofile, I'm not in the least reluctant to spare with you here or anywhere else. I really despise bankers and former bankers. Bring it on big boy!

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