Heath care ramblings

As I see it, here are some of the most serious problems with our health care system
Insurance companies arbitrate their policies with little recourse.
Insurance companies are oligopolies
Overuse and waste
High cost of pharmaceuticals
Uninsured have access, but use the highest cost (ER)

I’m certainly no expert on this, but these are some of my observations that I would like to discuss.

Here are some things I see as the underlying causes to these problems:
The way insurance is sold in the corporate world is as a health care plan rather than actual insurance to protect a consumer from financial disaster. Not only does this create overuse and abuse, but it also creates unnecessary bureaucracy (not productive to the economy). A tank of gas cost about $50 for most people. Imagine if instead of just paying directly, you had an employer provided comprehensive insurance plan that included all car repairs, maintenance, and even gasoline. Now, the gas station has to hire somebody to file claims; the insurance company has to hire people to oversee, administer, and pay the claims; your employer has to hire someone to oversee and administer the insurance company. Now, your tank of gas may only cost you a small co-pay of $10, but the cost of the gas would probably be at least $200. Isn’t it possible, that these same sort of economic problems exists within the current framework of our medical system?

The first reform in my book would be to remove all government incentive for corporations having these comprehensive plans. Take away tax breaks, make corporations disclose on your paycheck how much they are actually paying (that is money that could be part of your salary), and remove the idea that group discounts are primarily at the corporate level. Next, expand the medical savings plans to be more like the HSA’s for those that work for large corporations Allow employees to have tax free savings accounts that they don’t forfeit so long as it is somewhere around their deductible. Next, require that all medical providers disclose the costs of the services they provide. Now, people are paying the providers directly, and are shopping for the best value rather than allowing insurance companies to do it. It may also be important to eliminate the idea that a corporate entity can negotiate a better rate than an individual.

We already have death panels – it’s called insurance bureaucrats. The best solution for this is as follows, no longer allow insurance companies to write plans where they are the arbiter of what procedures get paid and what doesn’t get paid. Force them to disclose in CLEAR language what they will cover and what they want, and allow the doctors to make the decision. If the doctor makes a wrong decision, it will be up to the insurance companies to go to court to overturn it. Increase penalties on doctors that misuse the system so that we can trust them as arbiters. There could be clear rules written into the contract, such as an insurance company will or will not pay for X treatment if someone has Stage 4 lung cancer.

There is no easy answer for the high cost of pharmaceuticals since the R&D dollars that go into these is extremely high. Producing them according to various governments’ regulations is also very expensive, and probably necessary. If these companies do not have a high ROI on their products, they will decrease the research, so regulating profits will not likely help (we may never know what we don’t find). One problem is that other countries do regulate the cost of these drugs, meaning that the US pays the highest share of the pharma profits. We need to go to battle with these policies so that the cost are shared. Another problem is that pharma companies usually have less than 10 years to make all their money since their patent starts at the time of discovery, not production. Perhaps, patent law could be changed so that these companies can produce the drugs longer. This means waiting longer for a generic, but likely paying less in the mean time.
Lastly, I think it is time to realize that we already have “universal health care”, but that we are doing it all in the wrong way. We have to provide a cheaper and more efficient safety net than Emergency rooms. Go to any emergency room, and you will see all sorts of people with colds and other minor medical issues. We aren’t going to turn away those that can’t afford to pay, so why not provide care to them in a cheaper way? This way ERs can be ERs, and the cost of a visit by indigents will not be paid by the unfortunate who happen to be able to pay the bill. Then again, if we eliminate insurance for things that shouldn’t be insured, the cost of seeing a doctor would probably be much less.