Friday, July 17, 2009

Universal Health Care

My issue is that the game of life has well-written rules. Some jobs have better benefits than others-and health insurance is a good benefit to have. Employers that provide health insurance usually require education, hard work, and dedication.

The playing field is level. Person High graduates have been accepted to Ivy-league schools. Anyone can work hard, get the great job with the excellent health benefits, but fewer and fewer people put in the time.

Since I did work hard, why should I have to carry the freeloaders? Consider the story of Chris Gardner (Pursuit of Happyness). Asked about his rags to riches success on a morning news show, he had this to say:"I did it with a 10 month old. What's your excuse?"

Health insurance is a great thing to have, but it's not an inalienable right. We have the "right to life, liberty, and the pursuit of happiness." Personal liberty is spelled out in our Constitution. It places very specific limits on the power of the Federal government, limits that have largely been ignored, trampled on, and forgotten since the Philadelphia Convention signed the document.

It's well known that merely pursuing happiness does not guarantee that one will actually find it.

But Life, that sounds like it falls under the purview of Healthcare! If we are guaranteed life, that must mean we're guaranteed the best quality life that modern medicine can provide! Au contraire, mes amis. The right to life simply means that the government won't kill you outright. Thomas Jefferson mentioned nothing about Quality of Life when he wrote his Declaration. It is a fact that good health drastically improves one's quality of life. So does having lots of money. And these days, it seems that money and health are mutually exclusive goals.

Free health care for all persons in the United States, be they here legally or otherwise, sounds like a great idea. But it will fail. America has the greatest doctors in the world, and that's in large part due to the fact that doctors here get paid a lot more than they do in other countries. Doctors provide a service that everyone will need at least once in their lives. They can pretty much charge whatever they want, and someone will pay it. However, CMS (Centers for Medicare and Medicaid Services--the existing government health care plan) only pays a certain amount for each procedure, visit, and consult. Given what equipment is necessary for a procedure, CMS might not cover the expenses. If a physician wants more money, he has to make it up with private insurers, or self-pay patients. most insurers pay only what Medicare pays, so if the doctor charges more, tough break, he's going to get reimbursed at the CMS level. Any overhead, then, is left to the self-pay patient, who either pays, or gets his credit rating slashed.

It's expensive to be a doctor, just with equipment, training, support staff, and overhead, but then there's the lawsuit-hungry culture we live in. If the weatherman calls for 6 inches of rain and there's bright sunshine instead, he's never called to task. A doctor can diagnose a patient complaining of hot flashes and headaches with symptoms of menoupause. But if the patient dies of complicatiosn related to pheochromocytoma, then the doctor will get sued. The doctor will do his best to isolate teh pheochromocytomas from the menopauses, but mistakes happen. When a doctor makes a mistake, people die. Consider if everytime you missed a turn when driving, someone died. Before too long, you'd drive very carefully, and you'd almost never miss turns. But you'd never be perfect, and once in a great while, you'd get cut off at the last minute, or the exit wouldn't be marked, or you'd be tired from the fourteen hour workday you were finishing, and you'd miss your turn. And everytime that happened, you'd have to shell out at least a couple hundred thousand dollars, and that's if it wasn't any fault of your own.

And people wonder why healthcare is expensive?

So how do we fix it?

Tort reform is a good start. John Edwards made millions suing the pants of physicians. You can bet he doesn't want tort reform. There's lots of good money to be had there.

Pay for performance is another option. Right now, doctors get paid based on the number of patients they see, and the number of procedures they complete. From a billing standpoint, MRSA is the best thing that ever happened to hospitals. I haven't seen any models for how pay-for-performance works, but the idea behind it is that physicians get reimbursed at a higher rate for patients that stay healthy after seeing the doctor. If a patient has to come back repeatedly, the doctor wont' get paid as much. That has it's own legion of dangers, though. Doctors will only take on simple cases, with healthy patients, and the sickest won't get the care they need.

Warranties is a good idea though. Geisinger Health offers a warranty on heart surgeries. There's a standard price that the doctor gets paid for the heart operation. Any complications with the surgery then come out of the hospital's profits. If the patient gets sick as a direct result of the surgery or hospital stay, the patient does not have to pay extra. It puts a great burden on the doctors to provide the best care they can.

Those are just a few ideas. The one that we know will never, ever work, is government control. Do you want your hospital run like the DMV? Or the Post Office? Or Amtrak? Or Acorn?

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