Health care reform – seven suggestions to consider

by Lesley Politi on March 25, 2009

My last two articles talked about some of the problems with currently proposed forms of health care reform and some of the economic hazards any reform must overcome. I did not post those words to be pessimistic, but to offer a realistic warning about what is wrong with the system and how well meant, but poorly considered fixes might make the problem worse in the long run. Of course, there are solutions I can offer so today I’m going to point out what we might do to truly improve the health care system.

Transparency – One of the biggest problems with health care is no one knows what any procedure really costs ahead of time. Some well meaning individuals decided that should hospitals and doctors have clear and easily understood pricing posted, they might compete over pricing and reduce quality. This has not worked well and needs to be abandoned. Hospitals and doctors should openly post their pricing and be allowed to enforce a single price for every procedure rather than the current system were the uninsured pay one price and each insurance company negotiates its own price for each procedure.

Quality Control – Right now the civil legal system is used to enforce an almost ad-hoc quality control over doctors. Someone who is unhappy with the results of a procedure can sue their doctor for malpractice and potentially gain a huge sum of money if they find a sympathetic jury. When you are dealing with as complex an organism as the human body, some of these lawsuits are not based on any true fault of the doctor, however poor policing of doctors by the AMA and licensing boards has created a feeling that lawsuits are the only way to punish bad doctors. This needs to be fixed, both to eliminate the lawsuit lottery, and to raise the quality of care. The presence of less than competent doctors has tainted the industry and allowed the problem to fester; the only other industry with a similar problem is the legal profession where unethical lawyers are shielded from punishment by their peers rather than immediately disbarred for their actions.

Simplify Payment System – One of the best arguments for single payer systems is the fact that it eliminates a huge amount of paperwork for the doctors. No longer does a doctor have to employ two or more clerks simply to fill out and submit forms to multiple different payers for reimbursement. Especially as every insurance agency has its own unique forms and policies it wants followed before it will release the money. This has acted to increase the costs doctors must bear, and naturally they have passed this on to their customers. If there was a single standardized form to be filled out, it would reduce their costs and the savings could be passed on to customers, especially if we include price transparency and people knew which doctors were passing the savings on.

Return Insurance to being Insurance – In every other area where insurance is sold, homes, and cars, insurance does not cover regular maintenance. Its used to cover the for catastrophic damages while payments for the regular and routine maintenance is left to the owner. Somehow health insurance has become a health maintenance payment, without people realizing the increase in costs that represents. Some private group insurance policies are going back to a system of catastrophe insurance with a high base deductible before they start to pay any benefits, which encourages a more reasonable approach to the use of health care.

End Unlimited Free Care – Right now anyone who cannot pay or who wants to avoid paying can go to any emergency room in the nation and receive free service from the hospital. Hospitals are unable to turn people away if they enter through the emergency room, and its become a drain on the system. There is no question that all people deserve care, but emergency rooms need to be for true medical emergencies, not for indigent customers who are unwilling or unable to pay normally. Removing this feature will reduce the costs that must be spread over paying customers and allow prices to fall. Right now an increasing number of hospitals are closing down because they can no longer afford to treat patients who are unwilling or unable to pay.

Return Insurance to Insurance 2 – end the mandates for coverage for treatments like acupuncture, chiropractics, laser hair removal and fertility treatments. Some of these might be “quality of life” issues, but they are not true health issues and if insurance truly is about protecting a person’s financial situation in chases of bodily injury than these treatments have no place being covered.

Limit Medical related bankruptcies – Right now its possible to remove all your medical bills by declaring bankruptcy. Unfortunately, this leaves the medical providers with a large loss in their accounting books, a loss they tend to make up by charging others a higher rate. It becomes an almost self-fulfilling situation. Hospitals need to recover lost payments caused when patients default and declare bankruptcy, so they increase their fees for all procedures, which only pushes other patients into default. There needs to be a middle ground where the hospital can still receive some money after treating a patient. However, the world of six figure bills also needs to vanish if that is to be possible.

This is not a complete list, but if we just chose three of these seven ideas and put them into play, the cost of health care would start to fall. Of these the only one that has even been suggested by most liberals is the single payer system, and that only because they see a government umbrella over health care as a workable solution. The fact that the inevitable result will be rationing of care seems to elude them.

And there will be rationing no matter what method we use to “fix” health care. Price is used to influence the choices we make. If people are fully aware of the price of something, and are cognizant that they cannot avoid paying, they will self-ration when they decide the costs outweigh the benefits. Right now with no true idea of the costs, there is no impulse to ration beyond the people who have discovered that overuse of health care has left them unable to obtain insurance and unsure of the costs involved in treatment. I can say from experience that being treated while insurance and uninsured for the same malady is quite a surprise. I have twice gone to the hospital suffering from a kidney stone. The first time I had insurance and the total bill paid by the insurance company was under $3000. When I was uninsured, the final total of all the bills was $9000 for the same treatment. Unfair perhaps, but the difference was merely a result of a failed market, caused by too much government interference


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