By Jack E. Lohman (Comments ON)
First and foremost, the solutions are political. Totally!
Not because politicians don’t know how to fix the problem, but because they are being paid not to.
With campaign cash coming from every direction – insurance companies and agents, pharmaceutical companies and pharmacists, hospitals, doctors, clinics, nursing homes, lawyers, even CEOs and shareholders – it’s pretty hard for politicians to keep their “public protector” hat on.
The public wants reform, the moneyed interests want the opposite, and it is they who are funding the elections.
Get used to it.
We could provide first class care to 100% of our population for the same 16% of GDP we are spending today, if the politicians wanted to. EVERYBODY could have CheneyCare!
So what would these politicians do if cash were not flowing into their campaign coffers?
They’d fix the system, but let’s look at how and who would object. I’ll abbreviate the opponents I, P, H, D, C and N.
This is the biggest and most obvious fix needed. Instead of sending wasted health care dollars to the insurance industry, they’d change the system to bypass this middleman bureaucracy and save 31% of healthcare dollars. Hospitals and doctors would remain private, but they’d be paid by collective taxes rather than insurance companies.
No, it’s not socialized medicine, it’s public-private like Medicare is today. It’s the same kind of single-risk pool that funds our police, fire and other vital services, and it uses the same private doctors and hospitals we’ve always used. (Opposition: I,P,H,N)
2) Certificate of Need:
They’d restore the CON committee that they disbanded years ago after pressure from their contributors. All hospitals, physicians, clinics and nursing homes would be required to seek CON approval before expanding in beds or expensive technology and services. (Opposition: H,D,C,N)
They’d prohibit the building of duplicative hospitals or adding beds in areas already adequately served. They’d not be able to expand to provide, say, open heart surgery, without a community need and CON approval. They’d not be able to hire their own physician referral staff, who now are obligated (and sometimes pressured or paid bonuses) to fill empty and unnecessary beds and order unnecessary tests so they can pay for the expensive technology they’ve invested in. Physicians would remain independent.
And a law should be passed that prevents for-profit corporations from buying non-profit hospitals and healthcare providers — which they’ve done at 50 cents on the dollar, thus ripping off the community they serve. (Opposition: H)
They’d not be able to purchase expensive testing equipment or services that are adequately provided by area hospitals or independent labs. These purchases not only draw revenues away from hospitals and destroy the economics, they become cash cows for the clinics and physicians. According to a recent McKinsey report, physicians who have such ownership are up to eight times more likely to order tests than physicians without such conflicts of interest.
Physicians also should not be allowed to receive outside consulting fees from medical device manufacturers and pharmaceutical companies, which can add $200,000 per year to their income. This creates a serious conflict of interest that can alter treatment decisions and affect proper patient care when they implant lesser-desirable technologies. (Opposition: D,C,P)
5) Nursing Homes:
They would be watched more closely. They’ve been known to sit patients in front of a TV set and bill Medicare for a therapy session, or sit them in a coffee clutch and bill for “group therapy.” With #7 below, these abuses will dry up overnight. (Opposition: N)
6) Medical Liability:
It’s a problem, and though minor when compared to all else, representing less than 1% of all costs, it should still be fixed. They’d create a three-judge medical court rather than a 12 man jury with no medical expertise. Lawyers would have three strikes and then start paying defendant’s legal fees when they bring frivolous cases. Punitive damages (if awarded) would go to the healthcare fund rather than to plaintiffs and attorneys that have already received fair damages. (Opposition: Lawyers, plaintiffs)
7) Fraud/Abuse oversight:
All medical providers would be required to educate employees on what health care fraud is, how to report it, and make them aware of the whistle-blowing laws and financial rewards. Once employees are aware of fraud rules we’ll see them providing the oversight government has failed to provide in the past. (Opposition: P,H,D,C,N)
8 ) National Patient Database:
All patient data (symptoms, diseases, drug therapy, but not patient ID) would be made available to all physicians so they can make evidence-based decisions on patient treatments and negative drug interactions. This will someday lead to transparency and competition on the basis of physician quality rather than price. (Opposition: Civil liberties types, even with the security safeguards)
The system would be administered by a non-partisan healthcare panel, similar to the Federal Reserve Board with members serving staggered 14-year terms. It could be state-run with national guidelines. (Opposition: Politicians, because they like control that generates campaign contributions)
10) Political system:
What else would you expect? Politicians will oppose all of the above because their campaign contributors oppose them. They like privatization because private companies can give campaign contributions and public entities can’t.
Of course health care is not the only area of government that has been destroyed by our corrupt political system. We pay enormous taxes to offset the unnecessary spending by politicians receiving cash contributions from special interests. Tax breaks, pork barrel projects, subsidies, no-bid contracts and the giveaway of other taxpayer assets amounts to $1300 per taxpayer per year at the state level and $4000 each at the federal level. Even conservatives should hate this corruption, because both political parties cost us unnecessary taxes.
The solution is obvious. If politicians are to be beholden to the taxpayers, the taxpayers must fund their elections. And at $5 per taxpayer per year ($10 at the federal level) it’d be one terrific bargain.
Why would politicians not like this? Because it levels the playing field and politicians don’t like level playing fields. So they argue that it will “increase taxes” even when it will do just the opposite. And they’ll make other pathetic claims just to keep the fat cats alive and well, and themselves in office.
If you reallywant to fix it fast, take away health care from 15% of the legislators, underinsure another 15%, and force the balance into high-deductible health savings accounts. Then watch the scrambling. 8)
(I sure get tired of writing about the corruption, but will continue as long as it remains. Only by pulling support from worthless incumbent politicians of both political parties will we either get a fix, or new blood.)