Insurance competition is not enough…

To call it the American health care system is an oxymoron – there is no “system” to it as a whole. No wonder the House bill is 2,000 pages long. Such a multi-faceted issue is not as simple as whether or not to have a public option.

The shared goal of all our federal legislators for health care reform, as they would tell us, is greater accessibility at lower cost. (I won’t go so far as to say they all agree on “universal” access and affordability. That’s what you and I want, but we don’t get tax-free tips from the health care industry.)

So in those 2,000 pages we see odds and ends of “reform” for who pays, who provides, who insures, what is successful treatment, what’s a fair price, when do you get a subsidy, what does a given service cost, who gets taxed, who’s responsible for supervising, who negotiates, what’s covered, and on and on and on. Reminiscent of herding cats. Where to start?

Americans spend twice as much per capita on health care as the next most expensive country. But we don’t get anywhere near the best care, despite what we pay.

Have you checked the rate-per-hour of a surgeon lately? Thousands! Yet doctors of my acquaintance say they’re barely making it at today’s rates of reimbursement. The cost of their training takes years, decades perhaps, to pay back. Then there’s the cost of all the high tech equipment they need, the medical staff, the liability insurance, the bookkeeping staff. Indeed, some hospitals have pointed out that they have more billing staff per bed than they have nursing staff. Doctors and hospital administrators all live pretty well by my standards, but I will take their word that it’s not like it used to be.

In any case, they pass on to the “payer” the cost of all that. Ultimately, that’s you and me, not them.

No doubt the so-called system today encourages over-testing, over-treating. That’s certainly due in part to their legal liability. Tort reform is an element of reducing the CYA component of health care costs, but it’s not the only fix needed.

So what does either the Senate or House bill do to curtail the CYA practices, and impose industry standards, or “best practices”? Numbers show we over test, and that does NOT improve outcomes. “Evidence-based medicine” requires a payment structure that guides what is seen as potentially helpful and what isn’t. Medicare does it, and it works very well. The docs are relieved of some the legal liability if a government entity decrees a standard that is “evidence-based,” and they follow it. That doesn’t mean they fail to perform tests or treatments they deem necessary for a particular patient. It means they don’t take a shotgun approach when a sighted-rifle will do the job.

Hospitals used to be non-profit. Amazing how the costs of an aspirin and a bandaid provided during your hospital stay have skyrocketed out of control since they became for-profit care providers, isn’t it?

Pharmaceuticals show record profits, but government (Medicare) isn’t allowed to negotiate prices? They can sell their stuff in South America for a fraction of what they sell it to us? How do these bills address this ridiculous situation?

Then there’s the issue of anti-trust exemptions. Insurance companies are allowed to control a market in a specific state. But changing this won’t guarantee more competition; there are different regulations and secured funds requirements in each state; it’s expensive to set up shop in a new state. A few bad customers in a small state (think millions in medical bills for someone with several significant lifelong issues) can kill the profitability of a company with a small market share in that state. Perhaps if they were in every state they could spread the liability around, but surely we can all see that this won’t reduce premiums overnight.

And we come to profits for Insurance Companies. They claim their profits are only 2%. Seems pretty reasonable, doesn’t it? How can we expect them to decrease profits?

I submit that’s creative accounting. That’s what they report to the IRS, not what they report to their shareholders. Wouldn’t a large discrepancy like that raise a few eyebrows if it were offered by a person, not a corporation? Special tax rules for corporations with lots of cash to flash in Washington and throw at campaign offices across America?

And executive salaries are considered expenses, remember? No limits there, of course. That’s just overhead. 30%. Is there any real attempt to limit profits and overhead in the health insurance industry in either bill?

Fiscal conservatives, you should like the idea of letting Bean Counters make the decisions about appropriate care and legitimate overhead -- especially when it’s tax dollars that are paying, like in a “public option.” But that’s not what Blue Dogs and Republicans are jumping on. Truly cutting costs means suggesting that a patient can’t just get every drug and procedure and test they’ve seen on TV. That’s a hard sell to the American public who already have insurance that someone else pays for.

So since we all share the same goals of greater accessibility and lower costs, you might think the Blue Dogs and Republicans would support a plan that gives this highly controlled option not only to Medicaid recipients, but also those too cheap to buy insurance who mess things up for the rest of us. They should get “rationed care” as dictated by the Bean Counters. So that’s where the fiscal conservatives jump in, right? But no, they say forget the public option. Let’s stick with what we’ve got. Gotta save those tax dollars – right? Regardless of the people who pay for that attitude with their health, indeed their very lives. 40,000 die every year from lack of health care coverage and the outrageously high cost of care.

Hate to be a broken record, but the only way to even begin to fix ALL these things is a single-payer system. Truly, a system. Would it be perfect? Of course not. Ask people in countries that have one. But would it cost less? Ask those same people and they’ll give you a resounding “Yes.” Would it improve access to health care? Duh. See previous answer. Would it improve the health of the American people? Just check the statistics that show we rank 37th in the world, behind every country that has a universal single payer system.

But we can’t even consider such a thing. It’s socialism, remember? Best practice, when it comes to health care, is apparently not good business, it’s socialism, according to the Blue Dogs and Republicans. And you know what THAT would mean! Better, faster, cheaper. We can’t have that in America!

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Footnote: Then there’s our ol’ pal Joe Lieberman. What I want to know is, where are the protests from Connecticut? 64% of those folks, according to the polls, want at least a public option in the health care reform bill. 64% of the people he represents. And he won’t even let the Senate have an up or down vote on the subject? I should be able to hear the screaming all the way down here in South Carolina. He absolutely does not deserve to caucus with the Democrats, much less be chairman of the Homeland Security committee, or even keep his seat in the Senate. Can you impeach a senator, Connecticut?

JM