Wednesday, October 7, 2009

Health Care musings

It's been awhile since I posted anything. Here are a few random comments... In the future, I'll be (hopefully) more organized and (hopefully) more precise with (hopefully) less speaking-off-the-cuff as this missive will prove to be... hopefully...

- There is one thing we could do NOW, do easily and it would have a nearly immediate anc clearly positive impact: Allow individuals to buy (private) policies offered in any state, not just the state where they live. #1 - This will enhance competition. #2 - It will force the state regulators to take a serious look at just how much existing rules and regulations affect competition for insurance dollars... Yet, no one seems to talk about this option. I wonder why buying an insurance policy from the Government (the so-called 'public option') - which is essentially buying a specific policy across state lines - is just fine and dandy, but buying a private policy is somehow Wrong.

- If the driving force for reform is to provide the best possible patient care, let's agree to take any government-controlled "public option" off the table. Whenever it has been tried - repeatedly, and around the world - it has proven to result in long waiting lines to see a doctor, substandard care, and an end to medical discovery (among other things). Caveat: Not that such approaches are 100% totally wrong or inadequate, mind you, but enough to matter when you compare Care against Care. We have no reason to believe it will be different this time, just because OUR government is doing it. There is plenty of time to go down that road LATER... *IF* providing care is the Real Goal. (If that is *not* the Real Goal, it certainly explains a lot about all these proposals, doesn't it?)

- I haven't seen many proposals such as new incentives to purchase low-cost health savings accounts by individuals, providing tax credits for individuals and families buying health policies on their own, and extending subsidies for those who can be reasonably shown to legitimately (and temporarily) need financial help. What is wrong with incremental steps? Oh, no, we need a 'complete overhaul', and we need it RIGHT NOW!... Why? Someone explain why amputation is the only solution for a hangnail...

- What about the right of patients to privately contract with physicians to ensure they have PRECISELY the medical care they want, without penalty—regardless of what the government pays? Today, if a doctor wants to bill a patient for additional payment over the Medicare reimbursement, he has to withdraw from Medicare entirely for two years. A patient who agrees with this arrangement can't receive any Medicare money for that period, either. Why is this particular regulation even in existence? Someone explain to me Who, exactly, is losing in the equation when the money (and the decision) comes out of the consumer's pocket and not the taxpayer's?

- Where is the simple acknowledgment that we need PEOPLE to provide all this medical expertise? If you cut payments going out and increase bureaucracy, it is almost 100% certain fewer individuals will enter the medical field. And that's not even considering finding enough qualified TEACHERS for those programs... Look, every patient wants to have the best possible medical professional on his case, according to HIS judgement. Trust me: a patient with cancer wants to see a doctor who has had years of training in oncology *and* is knowledgeable about the latest ways to beat the cancer. It appears that in HR 3200 - e.g., the 'medical home model' section - physician assistants and nurse practitioners may *NOT* get the authority to make important medical decisions. To say nothing of the PATIENT. What makes a bureaucrat MORE QUALIFIED?

- Discussions on Real Tort Reform with respect to Health Care are (strangely) missing... Statistics from private insurers (and a Justice Department report of 2007), indicate 80+% of malpractice cases are closed without payment. Moreover, when there is a trial, the physician (defendant) wins 89% of the time. What is glossed over is that these lawsuits, even when dismissed or closed without payment, cost doctors time and money, and encourage defensive medicine. This adds billions to the cost of medical care. It also increases malpractice insurance premiums - and you better believe that cost gets passed on to patients. This is so obvious, it make one wonder exactly WHY the topic is not part of the conversation ANYWHERE.

- What I *really* want to see - from EITHER party - is a plan that focuses on the real MEDICAL issues facing patients and doctors, and manages to keep patients in control with doctors as their trusted advisers. Sorry, I just don't see where adding a brand-new, all-powerful bureaucracy HELPS any *any* level.

*** just food for thought...

- Steve

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