Tuesday, February 09, 2010

Health Care Made Simple

I don’t have a home-entertainment system. I buy my clothes off the rack at Macy’s. I drive an ordinary sedan. My dinner table is graced with wine costing less than $10. We shop sales. But my wife and I splurge on health care (as we did on our children’s educations).

Are the values reflected in these choices unusual? I doubt it. But this is the nub of the health care issue at the epicenter of American politics the past year.

We have had a confusing and dishonest debate. Senator Kennedy made this a crusade. Presumably, the reason for crusading was compassion for the uninsured, an estimated 50 million Americans who are not without health care, but who get less of it and of a lower quality. Fair enough. Had Obama had the political courage to ask the rest of us to kick in an extra hundred bucks, or whatever, in taxes so that these folks can get the same care most of us get, I’d have been ready to ante up.

But he didn’t think he could sell that, so he said the urgency of health reform was to save all of us money and reduce the deficit. This is what motivated Teddy’s last crusade: Reducing the deficit? Balancing the budget? Give me a break.

We were told that the reason for Obamacare was that health costs were eating up 17 percent of GDP and rising faster than inflation. Yes, and so are college costs. And for the same reason (i.e. these things are more precious to us), buyers will stint on them less than other things, tilting the market to the sellers’ advantage.

This is the basic engine of rising health costs. It is compounded not, pace Obama, by greedy insurance companies, (they are greedy, of course, but not more so than other companies), but by three factors sacrosanct to Democrats. First, malpractice suits, which add to the cost of practicing medicine and encourage excess treatment. Second, untaxed employer-provided health insurance that further diminishes cost-conscious shopping by health consumers. Third, Medicare and Medicaid, which are worthy programs that I support—but if the government is buying things for people they couldn’t afford themselves, the dynamic of supply-and-demand will drive up the price. Additional government subsidies, as Obama proposes, will increase it further.

Obama’s plan to reduce costs is a Rube Goldberg machine requiring a 2,500-page bill. But the issue can be simplified. Where will the savings come from, especially if 50 million people will now get more and better services? Will the providers get paid less? Then we will have fewer and less talented providers. Can the insurance and drug companies be squeezed? Perhaps some, but they are not earning more than other enterprises. If profit margins are reduced too much, capital will shift to other sectors. In short, the only way to hold down medical costs is by providing less or lower quality medicine.

Is that a goal worthy of a crusade? Why exactly is it bad that health costs are 17 percent of GDP? What percent should they be? So what if they rose to 20 percent? Here’s a question for my fellow aging boomers. Say medical breakthroughs make it possible for us all to live to 100 relatively spry. But the costs are high and will drive medicine to 25 percent of GDP. Would that be a tragedy?


Real Healthcare Reform: Kill the Lawyers

Now that a stake has been driven through the heart of the omnibus healthcare bill proposed and drafted by the Obama-Pelosi-Reid Axis (with an assist from Henry Waxman), we can get down to real reform. The President has stated that he wants to work with Republicans. Then let’s start with the most obvious cost control factor – malpractice/tort reform.

There is some truth to Democratic claims that several of the proposed reforms are interlocking and thus to address one specific issue might be difficult to accomplish. However, this in no way justifies their ridiculous proposal, including its huge growth in the federal government and its invasive government panels.

Unfortunately, the Democrats ignored the biggest opportunity for cost reduction: eliminating spurious lawsuits and getting ambulance-chasing lawyers out of the medical malpractice business. It is also clear that this reform is not interdependent on other reforms.

Doctors spend an enormous amount of time and effort protecting themselves from lawyers and avoiding lawsuits. They order extensive, expensive tests whose only purpose is to protect themselves from lawyers, and pay outrageous malpractice insurance fees just to rid themselves of these predators. Once lawyers get involved, a doctor’s world is always turned upside down.

Consider what happens in these situations. A lawyer takes on a case for someone who has real or imagined harm. The lawyer has no medical training except for the knowledge they have gained from working on other lawsuits. They run up significant costs that they front for the client, and then pursue a legal remedy. Frequently the insurance company settles (makes payment) to the litigant to minimize outlays. If not, the case goes to court in front of a judge (i.e., a lawyer) or jury, neither of whom typically has any medical training. Either way, the lawyer is reimbursed all the up-front costs plus 33-40% of the remaining funds. The person filing the case is often left with less than half of the proceeds.

We need to stop entrusting these issues to unqualified people through a legal system established mostly to enrich the participants as opposed to the truly harmed. Lawyers have no special knowledge or expertise to determine harm in these situations and neither do judges. We have allowed this system to get out of control and we, the American people, must insist that if any change is made to our medical system it starts right here.

Toward that end, I have a proposal. We need to establish a separate forum to handle claims of medical malpractice. We must accept that as dedicated as our medical personnel may be, mistakes are occasionally made due to stress, confusion or just human error, and the people who are harmed should be justly compensated for those mistakes. In addition, there is occasionally a bad apple in the medical field whose care and concern for patients does not meet established standards. Those patients should be compensated for any harm done to them.

The proposal that I suggest is to establish a five-person panel. The panel would consist of two retired judges, two retired doctors and one retired, respected businessperson. There would also be a Medical Advocate’s office – skilled in the issues of medical procedures due to their exclusive focus on medical claims and disputes – that would represent the patient. The advocates would be salaried employees, much like a public defender or district attorney, with no direct financial benefit from winning the case. The accused, be it a doctor or medical facility, would be able to have their own representative to defend themselves against any charges.

Any outcome would be decided by the five-person panel. The panel would not only understand the law, but would actually be able to examine the charges made against the accused and provide an educated medical analysis of any harm done. The businessperson would be able to judge credibility of the business practices used and weigh the economic effects of the decisions being made. The result would be a balanced decision made with analysis of all the ramifications – medical, legal and economic. No longer would lawyers be profiteering on the backs of the medical system and the American people.

I realize that this proposal has little chance of being adopted. After all, the trial lawyers have their hands so deep in the pockets of the Democrats you might assume they were Siamese twins. Despite “reforming” almost all aspects of the medical system in a bill rumored to have ballooned to over 2,600 pages, the Democrats managed to merely “suggest” that the nation might consider a pilot program for malpractice reform.

The Democrats have to decide whether they care more about American people or American lawyers. They have to decide whether they want to truly control the costs of our healthcare system or just launch platitudes. Ultimately the American people will have to choose between their doctors and their attorneys. The two just do not mix, and the national interest is clearly not being served. If they decide for the medical professionals – as they should – the Democrats will need to make real change, or have real change forced upon them: retirement.


The Mirage of Bipartisan Health Care Meetings

With the seating of newly elected Massachusetts Senator Scott Brown, Barack Obama has now agreed to hold televised meetings with Republicans and Democrats on health care reform. This feeble attempt by Obama and the Democrats to look bipartisan is nothing more than calculated damage control trying to prevent the inevitable losses in the coming 2010 mid-term elections.

According to Politico, Barack Obama stated that he wants to “look at the Republican ideas out there.” But the real question is, where was this idea six months ago when Congressional Democrats were having backroom meetings while crafting a bill like a one-party aristocracy?

This shows once again that Barack Obama and his Democratic colleagues in Congress will only listen to the American people when they are forced to. And in this case, it took the special election in Massachusetts.

If this government was truly created “by the people, for the people,” then why was it that the Obama Administration and Congress refused to drop their push for socialized medicine even though the American people were vehemently opposed to it? (Final Health care poll showed 58% opposed the current bill according to Rasmussen Reports)

And before we get all excited about Obama’s newfound ways, let’s remember he has only promised to “look” at Republicans and not to start over with bipartisan input. In fact, at the Obama-GOP Baltimore confab some weeks back, Obama explicitly said that he had “read every Republican bill.” Apparently, that gem now enters the growing repository of Obama “misstatements.”

This paper has repeatedly called for Barack Obama and his Democratic majority in Congress to go back to the drawing boards and take an honest and open look at ways to lower costs in the health care industry.

One major idea that has been ignored by Obama and his cohorts is to allow state-to-state competition. It’s simple, why should someone from North Carolina not be allowed to buy health insurance from South Carolina?

In almost every case, more competition equals lower prices.

Another major idea that has been ignored is tort reform. According to Legal Newsline, “the Congressional Budget Office director, Douglas Elmendorf, has said as much as $54 billion could be saved over the next 10 years if Congress enacts legal reforms including a $250,000 cap on damages for pain and suffering and a $500,000 cap on punitive damages and restricting the statute of limitations on malpractice claims.” And this doesn’t even include the likely savings that will occur based upon a reduction of defensive medicine often practiced by doctors today.

These are just two entirely obvious ideas that have been ignored by the Obama Administration and Congress. They should be included in the mix when Congress goes back to the drawing board. And they should start with a tabula rasa – to be filled in at the will of the American people.


Australia: Queensland Health a bureaucratic mess

ONE of the world's top medical experts has delivered a damning assessment of Queensland Health five years after the Bundaberg Hospital scandal. The unflattering report comes despite billions of dollars in extra funding being poured into the system after the Bundaberg fiasco. The top-level review, conducted by recently retired UK chief medical officer Sir Liam Donaldson, found the department and the independent watchdog set up following the 2005 health inquiries had little idea who was responsible for improving patient safety.

Obtained by The Courier-Mail, the August 2009 report said hospitals had overlapping and unclear safety standards, were too reliant on overseas-trained doctors while staff were burdened with duplication. There was also no strategy for remote and regional areas while the public was given a "weak voice" in the system.

In one of a raft of botched policies, Sir Liam identified an "ambiguity" between the roles of Queensland Health and the Health Quality and Complaints Commission. "(There is) no clear agreement on the respective roles of the (HQCC) and Queensland Health in quality improvement," the report said.

Sir Liam, who visited for a week last year focusing on clinical governance, said Queensland had made a "major commitment" to reform, including an impressive roll-out of programs, strong leadership and accountable services. But he also identified areas where policy was ill-defined or lacking, including unclear and varying reporting standards. "Some standards have strong clinical and managerial credibility, others are not valued," the report said.

Sir Liam, whose bill is expected to hit about $40,000, said recruitment was strengthened but that it took four to five months to hire doctors. "Many areas are still heavily dependent on locums (mainly international medical graduates)," the report said.

It also said that the role of the QH Patient Safety Board needed refocusing. "At the end of every meeting, the board should ask itself: 'Have we concentrated on the most important things?'," Sir Liam said.

Sir Liam noted patient safety was comparable to other countries but the PRIME incident reporting system was overburdening staff. "There is a clear sense of 'implementation fatigue' permeating the current system," Sir Liam said.

Predicting tensions, Sir Liam said QH should own responsibility for quality standards but said the HQCC was "ambitious" and wanted to be proactive in patient safety culture. "On the other hand, it is unlikely that Queensland Health's senior management would accept a wide-ranging quality improvement and cultural change role for the commission," he said.

Centre for Healthcare Improvement boss Tony O'Connell said it was moving in the right direction but admitted more work was required. "This is always a work in progress and we'd never say we'd completed all tasks," he said.


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