One of the larger problems facing the nation is what the heck to do about health care. I do have to commend Barack Obama for at least trying to do something about health care. However, I feel he and his administration have gone about it the wrong way. The huge new bureaucracies which have been and are being created, the complex exchanges, the coercive regulations facing business, the layer upon layer of government red tape, the need for thousands of waivers to prevent catastrophe and the questions about possible conflicts of interest these waivers create--for these reasons and more the plan known as "Obamacare" should be overturned. It also looks as if it may be unconstitutional from the viewpoint that it abrogates states' rights, but we'll see when that case comes up. Its constitutionality is also being tested concerning the government's ability to force people to buy a product. We'll see how this one comes out as well.
I do think that both of these ideas are unconstitutional, but not because government doesn't have the power to coerce. Government coerces all the time. If you don't buy auto insurance you can't legally drive your car and stiff penalties face you if you are caught. However, this is a power exercised by the states. I think that health care should work the same way. It should be a state issue. States should mandate health care coverage and have a means test which would identify a pool of people who need assistance obtaining coverage. These people would receive their health insurance for free, and their policies should not have deductibles. The means test could even be on a sliding scale so that people approaching poverty could receive some assistance with their health care costs. The details of this and the associated costs need to be worked out, but two points are relevant here. First, if we are going to have universal coverage, it is going to cost a lot of money, no matter what the system. Second, I do NOT think that any system should be federalized. It should be run by individual states. Block grants to cover costs could come from federal taxes, and be apportioned by population, or federal taxes could go down and state taxes go up. Either way would need to be worked out.
The other side of the issue, cost of care, is even more important. If cost of care can be reduced, costs will come down across the board. I have had a brain tumor removed, and my wife has fought breast cancer. My son was recently diagnosed with a rare and potentially fatal disease which almost killed him. In all three cases insurance covered the bulk of expenses, but when I saw the bills I was astounded. Diagnostic tests which cost thousands of dollars, tens of thousands of dollars for hospital stays, doctor visits which cost hundreds and lasted five minutes, the list goes on and on. My wife, who is a breast cancer survivor, needed a certain type of shot when undergoing treatment which cost $3000 per dose! These type of exorbitant costs are ridiculous and to me are about as much of a scandal as a $3000 hammer or a $12,000 toilet, things we saw before when we had a scandal in defense spending. So the following is what I would recommend from a cost standpoint. First of all, I've said in a previous post that I recommend starting a program which would be run like the service academies, only for doctors. Students who were accepted into this program to study medicine would be required to work for six years in government run hospitals such as VA hospitals, or in government run clinics which would service the poorest in our society. They would work for a reduced income compared to others in the field but after their six years they could become a "free agent", so to speak, and go into private practice or join some other form of doctor group. They could also continue to serve their country by staying in their position, which would have a graduated pay system much like civil service.
In addition to this idea, I would give tax credits to doctors' offices and other clinics to buy medical equipment (as long as it was American made) so tests could be done on the premises. When there is a huge supply of medical equipment, costs for tests will go down. An X-Ray shouldn't cost over $1000!! An MRI shouldn't cost $3000!! Testing a patient's blood shouldn't cost hundreds or thousands! These machines and testing equipment should be everywhere, much as you can find blood pressure machines at every drugstore you visit. Granted, those aren't truly diagnostic in nature, but it does show that if you have enough machines it becomes cheap to use them. In addition, I would increase the incentives for people to buy machines made in America. This would help with our employment situation as well as help solve medical costs. We also need to enact tort reform, which would relieve the crushing insurance costs facing doctors, thereby further lowering costs.
So, the health care problem isn't insurmountable--no problem is. If we think of these things in logical terms, we can solve anything. This is America. We've always been able to solve our problems. Our problems right now are many. This is one of them.
Okay, Commonsenseman, I agreed with you so far, on taxes, so-called "isolationism", and voting identification and immigration. I even like your presidential campaign, so far, and agree that it's about darn time to have a "citizen president".
ReplyDeleteBut, you lost me on the health care issue.
Here is an outstanding article by David Goldhill, published in Atlantic Monthly: http://www.theatlantic.com/magazine/archive/2009/09/how-american-health-care-killed-my-father/7617/. Don't let the sensationalist title put you off... seven pages later, Goldhill gets to a really feasible and reasonable solution. Along the way, he does a fantastic job of deconstructing the issue, teasing out the contributing factors, and laying the groundwork that supports his proposed solution. And it makes sense.
You have put yourself out here so far as a guy who makes a lot of sense when it comes to cutting government waste and spending. But your health care solution goes against your own philosophy. Remember what you said about government having a mandate to only address issues that need our collective strength -- such as National Defense? Well, in my opinion, healthcare does NOT qualify as a National Mandate issue. So don't make it one.
Please read Mr. Goldhill's article, and see if that doesn't alter your point of view, or even bring you to a new position/conclusion altogether.
Best regards...
Actually, I think that health care is a national issue because its costs are part of what are draining our national resources. Attacking the problem on the supply side rather than on the demand side is the right way to go. We need tort reform so that doctors don't pay exorbinant insurance rates, which drives up everyone's costs, and we need cheaper doctors. No matter what, health care is going to cost the country money. People are now going to emergency rooms, and the costs to treat them there are exorbinant. We claim to be a nation of compassion, so we can't just turn people away. Therefore, I believe my "Peace Corps"-like proposal to train doctors is a good way to provide much cheaper health care. It also helps with job creation.
ReplyDeleteIf you are serious about running, are you registering as a Republican or Democrat? Please don't try and do an Independent as it would end up being a Ross Pierot effect. I do like a lot of your ideas, but don't agree on your healthcare issue. It is a privilege, but not a right. Do agree that it should be a state issue, not federal.
ReplyDeleteOn health care, I didn't say it is a right. However, if we are a compassionate nation, we are going to treat people. We're not going to turn people away from hospitals and let them die in the street. That's not America. People are getting treated right now who don't have health care--usually in the hospital emergency room, the most expensive way. So we have to figure out the most cost efficient way to provide health care. I think attacking it from the supply side, as my ideas go, is the right solution.
ReplyDeleteMr. Grady, I'm in agreement with the first anonymous. I like what you're doing, but I'm not on board with your healthcare solution. Really, the only way to keep health costs down is for people to know the true price of what they're getting, which insurance shields people from. If people knew prices up front, they would be more selective about tests and such and save loads of money.
ReplyDeleteWhat we need is no more employer-provided healthcare (which isn't fair anyway as it's a tax break for only part of the population; I'm saying this as someone who receives healthcare through an employer), so that everyone is on the same playing field, and then we need high deductible plans (more like how car insurance works. That's how insurance is supposed to work!). People should pay for their own office visits, labs, and all the "little stuff." Then people won't be so spend-happy with healthcare and I guarantee you the money we spend on healthcare would drop. By the way, I'm okay with chipping in on the state level to help the indigent pay for their care and I agree with you that such needs to continue to be part of what the states do.
Also, if people paid out of pocket for "little stuff," that could eliminate mountains of cost in billing departments.
Look into the old Bennett-Wyden bill, if you haven't already. It didn't fly but was a decent, truly bipartisan bill that sought to implement some of these ideas. The Bennett-Wyden bill would end employer-provided healthcare but the law stated that employers would then have to give everyone a raise in the amount of what the employer was contributing to the employee's healthcare.
I'm convinced the only way prices will ever drop in healthcare is if consumers are in the driver's seat and know the prices. We, as a country, actually demand more health care than we need; I've already turned down many "routine" tests for myself which, after discussion with doctors, we found really weren't necessary. Most people on insurance just go along with everything the doctor does and question nothing, but if they have to pay out of pocket, they're far more selective, and the demand for healthcare will drop.
Allow me one more point. I know people think that paying out of pocket for all of that is expensive, but the idea is, we're already paying for it in premiums. How nice it would be to have most of the premium back (truly high deductible plans--maybe $3-5,000ish--are far cheaper than typical plans) in our pocket and then, when we opt out of unnecessary healthcare, we get to keep the extra. This provides an incentive to not demand as much healthcare. What a concept. And if people didn't have employer-provided healthcare, I guarantee more people would select such a plan for themselves, because they would finally see the full cost of the premiums for the plans they've had and wouldn't want to pay that much.
I'm sorry, but I respectfully disagree with you. You are putting health care decisions in the hands of people who aren't trained as doctors. I agree that too many tests are performed, but part of the reason for that is because doctors are covering their you-know-whats. People can't decide what tests to have or not to have; that is why we have doctors. So the costs have to be reduced from the supply side, and we also need tort reform so doctors won't be worried about huge, frivolous lawsuits. Then not only will they not schedule so many tests, but their malpractice insurance will go down, further lowering costs.
ReplyDeleteI appreciate your thoughtful response. To clarify, I'm not saying that people should simply refuse tests of their own accord and go against doctors' wishes, but that when they question their doctor, there will be times the doctor and patient will decide together that a test isn't necessary.
ReplyDeleteFor exaple, look at prenatal care. I'm a mother, and when I've attended my first prenatal visit for each of my children, the first thing healthcare providers do is order a "pregnancy panel," a standard group of blood tests. When I asked what specific tests the panel includes, it turned out that there are several that don't pertain to me (hiv screening, genetic issues that some like to know about in case they want to abort, etc.), and my doctor was in agreement with my decision to forego those tests. However, if I had said nothing, as I did with my first pregnancy, when my insurance covered everything 100%, the tests would have all been done, as they routinely are for every new patient, despite some being irrelevant or unnecessary.
Similarly, it has become commonplace at many doctor's offices for a healthy pregnancy to have three or more routine ultrasounds, although there is no medical reason to do so and experts agree they should only be done when medically indicated. I believe the American Congress of Obstetricians and Gynecologists' guidelines state that reasonable practice is just one ultrasound for a normal pregnancy. So why are so many ultrasounds being performed? Part of the reason is CYA from the doctors, but there are two other reasons as well. Since most obstetricians have ultrasound machines in their offices, the $350-$500 a pop tests are great revenue streams, so it is in the doctor's interest to perform the ultrasounds. Also, the patients genuinely want to do them (who doesn't love a glimpse of the new life forming within her?). The only way to cut back on the unnecessary ultrasounds is to have patients aware of how much they cost, and even footing the bill. Then, I guarantee you, they would go back to being an "only when deemed necessary" test.
Please allow me one more example (I apologize for being long-winded). Among some friends who are also mothers, we were once discussing the cost of an office visit to our pediatricians. My friend and I, both on high deductible plans, both knew the cost of a visit. Another friend, on a full coverage plan, said that an office visit was $5. We told her that, no, the office visit doesn't cost $5, but she then insisted that it's only $5. We then explained that $5 was only her portion, and it turned out that she had no idea what the full cost was (this is an educated woman--a teacher with a master's degree). All three of us have well-looked after children who see the doctor when they really need one, but can you guess which one of us takes the kids into the doctor for every little sniffle?
I believe you can increase the supply as much as you want, but unless consumers are a part of your equation and know and feel the prices (both of their healthcare visits/tests/etc. and the insurance premiums) of what they consume, which includes removing employers from the equation since they shield consumers from the full cost of premiums, then they typical supply/demand principle won't apply here and healthcare prices won't drop.
I agree that people need to look at what they are getting and perhaps make better, more informed decisions. However, the vast majority of the population won't do this. They either aren't paying attention, like the lady in your example, or they want all those tests just to make sure. The way I see it is, once again, attacking it from the supply side. Lower the costs of the tests. You mention your prenatal blood screening, and how you really didn't need all the tests. But as I was saying in my original post on this subject, if we created a system which rewarded doctors' offices for purchasing testing equipment so that testing equipment became widespread, the cost of tests would go way down. There aren't enough diagnostic tools out there, so it costs way too much to do tests. As far as the doctors are concerned and their costs, I think that they charge way too much and are a big part of the problem. However, there are a couple of things driving up cost. First of all, their malpractice premiums are sky high because there are a lot of people who target doctors for lawsuits. Follow the money if you will. Another big cost driver is that doctors treat uninsured people. Doctors don't work for free, so they charge higher fees to paying customers to make up the difference. I guess there are some doctors who are a little greedy as well and want a bigger mansion, but they are few and far between. Most of them are honorable. But if we have tort reform and get the uninsured people to treatment centers rather than emergency rooms, costs will drop drastically. At least that is the way I see it.
ReplyDeleteTom - I think you should also really read up on Heath Savings Accounts (HSA) paired with high deductible medical insurance. I have such a plan myself, and the net effect is very similar to a standard PPO. If I visit a doctor for something minor, I spend from my HSA. If I use more than a set amount from my HSA in a year due to a major medical issue, then the high deductible insurance kicks in.
ReplyDeleteI have funded my HSA with my monthly premium saving versus what I would spend for a standard PPO and after a couple of years I now have a nice cushion against an unexpected medical event.
The biggest difference is I see the bills and if I do not feel I am getting the value I am paying for, I will find another provider. Or if I find I was billed for something erroneously, I will call the billing department and have it removed. If I were not paying the bills directly, I would not look so closely.
I like your idea of states covering the premiums for insuring indigent legal residents. A safety net is only humane. I also agree that tort reform would go a long way to reduce the component of costs related to malpractice insurance.
I do not agree with your ideas related to tinkering with tax credits for equipment and service academies for doctors.
The market can best decide how many MRIs we need, and the tax code is a poor way to steer resources. I assume that such equipment can already be deducted as an expense and that should be incentive enough. As for service academies, I would not like to see the poor and indigent with different doctors than the more well off. Creating a two tier system is dangerous and potentially inhumane if poor funding leads less skilled students or doctors to work in these government run facilities. If government is a superior supplier of essential goods and services why don't we have government run grocery stores or barber shops? How about community run or charity care for routine health care, and for major medical issues indigent insurance guarantees the same level of care as everyone?
Thanks for taking the time to throw your hat in the ring. I laud you on your efforts to be a citizen candidate. I hope you inspire others to become as involved as you are. paul
Mr. Troon,
ReplyDeleteThank you for your insightful response and your support. I understand your concern about a two tier system, but we already have one where poor people can't really hope to become doctors because of the financial obstacles they face. My plan would eliminate this. Also, I do like HSA's from the consumption side and what they do, but really, there are a lot of people who just plain won't understand them and won't know how to use them properly. Having the option is definitely a viable idea, but making them mandatory would be a disaster. As far as letting the market dictate how many MRI's are needed, the market in this case is fixed because doctors order lots of unnecessary tests to cover their backsides due to threats of lawsuits. Tort reform would help here, but getting the machines everywhere would help too. Thousands of dollars for one test is unacceptable. The system is too rigged. Thanks for joining the discussion!
The salient point of Health Care should begin with "individual responsibility." Note that the average citizen is at the behest of a media that flaunts high fat/sugared food even to the point of a tv program that challenges food consumption(?) which contributes to all
ReplyDeletethe major diseases. Those diseases that are not avoidable, however, should be addressed. Agricultural price supports by the Taxpayer, which only enrich farmers, should also be examined since they are the MAIN contributing source in illness, Diethylstilbesterol, a female hormone, injected into Cattle/Dairy-Cheese/Other/High Fat. As a result the female hormone from the cattle, humans and women who take the Pill, is URINATED into the PUBLIC WATER SUPPLY. It is known as "SURFACE WATER," which CANNOT be ELIMINATED. Consequently MALE FISH have developed FEMALE CHARACTERISTICS. Can you imagine how this affects the general population in the US since Female Hormones are indicative in Cancer while having other unknown or negative side effects? Instead of a National Sales Tax, a NATIONAL LOTTERY would be preferable. Why penalize the taxpayer for "UNEARNED" ENTITLEMENTS? With the rise
in Crime, ELIMINATE OR RESTRICT appeals that enrich attorneys at taxpayer expense, while the FAMILY/FAMILIES of the victim CONTINUE to SUPPORT the criminal? ELIMINATE the costly EXERCISE EQUIPMENT in prisons which only STRENGTHENS the criminal at the risk of the general population. Examine WHAT OTHER special interests are connected to the prison system which would be more efficient if Prison Ships were utilized such as used tankers.
Regarding Paul's comment about a two tier system of healthcare and the implication that such would lead to a lesser quality of care...
ReplyDeleteI don't see how providing funding for the education of someone of limited means in exchange for that individual working in a clinic or other facility for a term equates to lower quality medical care.
Being unable to afford higher education or working in a clinic for a limited term in exchange for the ability to obtain the higher education does not mean that the individual will be any less well trained than any other medical professional. It's simply erroneous to assume one would only be entitled to sub-par care.
Tom's proposed program is simply a means to an end for someone who might not otherwise have the opportunity to fulfill the dream of becoming a medical professional. In fact, it's a damn good idea and could possibly be applied to other professions as well, i.e. lawyers, engineers, scientists, etc.. It's a great vehicle and benefits both the individual and our society in multiple ways. It's a trade off and in my estimation, a more than fair one.
Costs for higher education are high today with little to no chance of them going down again anytime soon that I can see. While the education would be government funded, society benefits, too, in that we have well educated, well-trained individuals who would then be able to provide a service in whatever the capacity of their chosen field. It can only be a win/win.
I linked directly from a comment you left on a news-site, to your position on healthcare. While you're correct that Republicans need a solution, I'm not impressed with your state-based solution.
ReplyDeleteSo I'll endeavor to persuade you that there is a truly free-market position a Republican candidate can take, that is actually being field tested at this moment.
It's easily understandable. Medical clinics compete with each other for the subscription paid directly from their patients. The price is $65 per month per patient. The clinic receives more money per patient annually then today's standard third-party insurance system.
If a patient is unhappy with on clinic, they simply switch their subscription to a competing clinic.
Superior customer service is far more likely in this system then in today's third-party payer system. Waste is directly controlled by the clinic. No need for clinic to fight with third-party payers and the associated paperwork.
For more details and facts, please read information presented by the doctor behind this idea. Here is the link to the medical clinic that is field testing this concept: http://gwfamcare.com/
Also google on "insurance free, subscription based healthcare".
I wish this was available in my home town.
Some thoughts of my own: there are additional features that can add to the viability of this concept. The clinic's patient base constitutes an insurance pool (like a large employer does today) and could provide the large group for true catastrophic-only insurance. Which is what "insurance" is supposed to be anyways. The monthly subscription could include that.
Also a new legal framework could/should be established to enable this healthcare concept and to reduce inefficiencies and unfounded suing and whatnot.
This seems a win-win for doctors and their patients. Expect proponents of statism to resist!
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ReplyDelete