Healthcare Reform. 25 Years Has Not Changed Reality

Ok, I’m speaking here as someone with over 35 years in the healthcare industry.  I started as a tech and research assistent as a college sophomore and have been involved in much of the major cardiac advances over that period.

There is a fundamental mistake happening in all of this.  The focus is on having insurance.  Whether or not you have insurance is not the real issue.  The real point is having affordable access to actual care. Yes, there is a place for insurance, but as a job benefit is certainly not the place.  All that does is shield it from market forces that would otherwise manage the cost.  There are parts to this plan that have good ideas.  Maybe it’s the best starting point we can get.

However, if you really want to solve the problem, I’ve been arguing the following areas that need to be addressed since Hillarycare back in 1992-1993.

1.  Eliminate the state line barriers for insurance.  The “replacement” plan does include this.

2.  Reforms for malpractice lawsuits.  This is a tricky one.  We cannot shield actual malpractice however, the ease of cashing in on the system whenever there is a bad outcome has to be addressed.  It’s not simply a matter of passing on the insurance costs.  There is also a great deal of over-testing and/or over-treating patients simply to try and avoid being sued.

3.  Address the cost impact of Medicare/Medicaid.  The two most important that come to mind is the rate of increase of benefits and regulatory restrictions on charging patients not on Medicare.  In the case of the first, if Medicare spending increases 12-14% annually simply because, guess what happens in medical practices?  You might not see the cost increase in your co-pay, but the insurance company certainly does.  The second point is best stated as a question.  Did you know that if you accept Medicare, it is illegal to charge other patients less than what Medicare reimburses?  In other words doctors are not allowed to charge less for someone who is poor.  Back in my clinical days in the 1980s, it was not uncommon at all to see billing paperwork marked as “Ins Only.”  That meant we’d just take whatever the insurance company would pay and write off the rest.  Medicare regs don’t allow that any more.  There’s more that can be done to fix Medicare – scrapping DRGs being high on that list – but these first two are the most important starts.

4.  End health insurance as an employer benefit. By making it a benefit, the buyer of health care services (whether insurance or point of care) has been separated from the seller of the service (whether insurance or care provider).  You, the patient, never encounter the actual cost of the care or insurance.  Ok … actually you do, in the reduction of wages and increased cost of other goods as the cost is passed on, but it still bypasses the pressures of market to find the proper balance between customer (patient) and seller (doctor).  Obviously, this will be the hardest to address simply because of the amount of money involved.  While still profitable professions, it will end the cash cow for insurance and big medicine that have been milking the system for decades.  Truth is, there won’t be a truly successful change unless this is addressed.

There’s a lot of other areas that could and should be addressed.  Regulatory burdens on Pre-Market Approvals (PMAs) and New Drug Applications (NDAs) are just one example.  DRGs (Diagnosis Related Groups) would be another.  This latter is what is responsible for that $24 aspirin on your hospital bill.  However, the four above are the absolute essentials for effective reform. 1992 to 2017. 25 years and the reality hasn’t changed.

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