A Sick System: Why Our Health Care Needs Reforming
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.
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 firstname.lastname@example.org.
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