Posted tagged ‘reform’

Health Care Reform: The Good, The Bad, and The Ugly

July 21, 2009

The Pediatric Insider

© 2009 Roy Benaroch, MD

We can all agree that the current “system” needs a-fixin, and there is no shortage of good ideas that could be implemented quickly and fairly, and could dramatically improve access and costs. But there is also no shortage of truly bad ideas, and unfortunately, there is one Huge Ugly Problem that guarantees to muck up the whole process if left unchecked.

The Good

Allow people to shop for health insurance across state lines. Current laws allow a small number of huge plans to flourish in each state, stifling competition and choice. One tiny law with 15 words could immediately allow consumers access to hundreds of different plans.

Stop discriminating against individual plans. Currently, if your employer buys your health insurance, you don’t pay taxes on the premiums—but if you want to buy your own policy, you lose thousands of dollars back to Uncle Sam in increased taxes. That’s stupid, and unfair, and unreasonable. Stop it. Allow a personal income tax deduction to people who choose to buy individual plans.

Make it less easy to exclude pre-existing conditions. Current HIPAA laws forbid health insurance companies from excluding pre-existing conditions—but ONLY if you’re only covered by a group plan, and switch to a different group plan. If you’ve got individual insurance, the group plan or individual plan you’re considering switching to can exclude anything. Again, stupid; a loophole like this can be closed by legislation like *that* (that was me snapping my fingers).

Permit businesses to pool their employees and seek discounts for group insurance plans. Can you believe this is currently forbidden? Again, *snap*, the cost of group insurance for employers can drop dramatically if competition and group purchasing power is allowed.

Encourage the use of health savings accounts, so people can set aside money for health costs. Not those stupid “medical savings accounts” that are confusing, and allow money to disappear at the end of the year if you don’t use it—but real HSAs, controlled by individuals, where money can be used for any health reason, or rolled over from year to year.

Reform the medical malpractice litigation. There are many creative ideas here—“loser pays” or caps on punitive damages would be an excellent start. At the same time, make it easier for people who are genuinely harmed by medical errors to get quick compensation that doesn’t end up in lawyers’ hands. The goal of med-mal should be reducing errors and compensating the harmed—NOT to create a bonanza for lawyers, a nightmare for doctors, and an atmosphere where errors are hidden instead of studied.

The Bad

Creating a new federal “right” to health care. Sorry, health care isn’t like “freedom” or “the pursuit of happiness.” Health care has costs, and someone has to bear the costs. Remember elementary school civics? Your “rights” are only a “right” if they don’t interfere with my “rights”—and if I don’t want to pay for your health care, yet you’ve got a “right” to it, now the government has to take my money away from me. So much for my “rights.” You can’t pull a “right to health care” out of the air any more than you can invent a “right” to food or a “right” to housing or a “right” to high-speed internet access. A civilized society ought to have a mechanism in place for health care for all, as it should also provide for the infirm and the elderly and the meek. That doesn’t mean that all government social services are a “right.”

Pushing all costs into the future. Good Lord, we’re considering saddling our children with debt unimaginable, far far larger than even the made-up numbers in the newspapers. Do we want to be a generation that leaves a country entirely bankrupt for our children? We need to be honest about the costs of things, and we need to be honest about who will pay the bills and when. Our representatives in Washington, from both parties, have been profligate to the point of insanity.

Micromanagement of mandates. Health insurance should always cover certain basic services that could be outlined on a single sheet of paper. Beyond that, consumers should be allowed (but not mandated) to pick further coverage as they see fit. You want chiropractic coverage? You want prescription medications? How about brand-names? Do you want to be able to choose from a list of 100 participating hospitals, or is 3 enough? The law should stipulate that insurance plan information should be honest and easy-to-understand, so that what is and isn’t covered is clear. Beyond that, let the consumer decide if they want plain-vanilla, no-frills coverage, or if they want to pay extra for more-comprehensive coverage. States that have long lists of mandates end up with very expensive premiums that no one can afford—so few people actually benefit from the expanded coverage anyway. Who really thinks government bureaucrats  are in the best position to decide that A must be covered, but not B, for everyone?

The Ugly

President Obama says that health care legislation must be passed this summer, by August. Remember the Stimulus Bill, the one that was pushed through in the wee hours, the one that no congressman could possibly have read in its entirety? At least that was a one-time deal. Reforming health care is much bigger, and could shape the American economy for years to come. Let’s think about this, think about the ideas, allow time for congress to listen to their constituents, and come up with a plan that has been well-researched and well-discussed. The current rush-em’-through system benefits the Washington insiders, the lobbyists, and the cronies at your expense. Let’s take a breath and think this thing through, or we’ll end up with a huge ugly mess.

Health care reform: We got it bad (and that ain’t good)

May 21, 2009

The media keeps telling us that the US medical system delivers poor quality care. Examples abound: our infant mortality rates are higher than many other countries, and our life expectancies are no better. These perceptions are driving the current “health care crisis” reform initiatives, and providing public support for a government solution, or at least a government “something.” But are things really that bad here, compared to everywhere else?

Take infant mortality as an example. The CIA’s data of estimated 2009 infant mortality ranks the US down at #45, well behind France, Israel, Australia, and Wallis and Futuna. But a closer look at these statistics reveals that we’re not really making a fair comparison. In the United States, any baby born with any signs of movement, breathing, or a beating heart is considered a live birth, but many other countries do not count these babies in their infant mortality figures. Some countries use a minimum length or weight to consider a baby “alive,” or a minimum gestational age. Since prematurity (and therefore small birth size) is by far the leading cause of infant mortality in the developed world, by not counting these babies as “living” in the first place many countries shift statistics from “infant mortality” to “stillbirths.” Looking at infant mortality rates between countries that collect this data differently is not a reasonable or fair judgment.

What about the effectiveness of medical treatments? In a detailed, well-referenced report by The National Center for Policy Analysis, cancer survival comparison statistics make us look pretty good. Men in the United States have a five-year survival rate of 66%, compared to 47% for Europeans. In Canada, women have a 25% higher mortality rate from breast cancer. How about the treatment of chronic health problems, which contribute to most elderly mortality? High blood pressure is well-controlled in 36% of US diabetics compared to 9% in Canada.

Will a socialized system lead to rationing of services and waiting lists? In 2000, Norwegians waited 160 days for a knee replacement and 2 months for cataract repairs. In some provinces of Canada, waiting times for orthopedic procedures can be over a year (though this varies very much by province and local availability.) You think the wait won’t be as long for something more urgent? 46 days was the average wait time for coronary bypass surgery in Norway, after it was decided that surgery was medically necessary.

There are some big problems with health care system in the USA. Health care access for the poor and uninsured is unreliable and inefficient; an astronomical amount of money is being wasted on defensive and unnecessary medicine; and a great big chunk of the health care expenditure pie is sucked up by insurance companies and pharmacy benefit managers, diverting resources away from actual health care. Despite this, there is still good health care being performed in the United States. Let’s not let exaggerations and over-simplifications back us into a system that may be much worse than what we’ve got. To paraphrase Duke Ellington, thinking we’ve got it so bad may not do us any good.