Tuesday, June 02, 2009

Serious Healthcare Reform - Starting from Scratch

When the world was young, life was simple. Marcus Welby was our prototype physician. He seemed to be wise, practical, compassionate and infinitely knowledgeable. He could handle everything from a splinter in your foot to ovarian cancer and he could fix an internal abdominal hemorrhage from a motor vehicle crash. Well, things have changed since then. We have CT scanners, which can give us a three-dimensional picture of a heart. Using a scope, we can remove a gallbladder with three small incisions that together add up to less than two inches.

Over the last 20 to 30 years, health care has become extremely expensive. Americans now spend over $2.1 trillion in health care, more than $7,000 per individual. We must remember that we are spending all this money and 46 million Americans are still not covered. It boggles the mind that we can spend such a huge amount of money and millions of Americans are not covered. It's crazy.
Many polls have suggested that Americans want to change our healthcare system, but everyone seems to have trouble with the specifics. Let's step back and start from scratch. What do we want from our healthcare system? It seems to me that a system that is cost-effective is crucial. An article in this month's New Yorker reveals that in McAllen, Texas they are spending over $15,000 per resident and their healthcare is no better. The residents in McAllen are no healthier than the residents in Los Angeles or Detroit... or Asheville, for that matter. I think most Americans would agree that they want their insurance to travel with them, so portability is important. As we live longer and develop more and more medical diagnoses, Americans see more and more physicians. These physicians need to find a better way to communicate with each other in order to improve health care. We therefore need a system that is integrated. Patients should be able to choose their own physicians and their own hospitals, so independence is required. This basic right should be preserved. We want the best. The medical profession needs to figure out what the best practices are and give incentives to physicians to deliver the "best" of medical care. Currently, most physicians' offices are open from approximately nine in the morning until five in the evening. The majority of people work during that time frame. Americans should not have to take off from work in order to see their physicians. Physicians must be more accessible. There should be incentives to open early and stay open later. Group practices should be encouraged to be open Saturday and Sunday. When problems arise between a physician and a patient or the patient's family, there should be a way to resolve these conflicts without going to court every single time. We definitely need improved conflict resolution. There should be a way to find problems long before they become lawsuits, a better way for the medical profession to police itself or to be policed. Finally, every American needs to be covered.

The plans that are bouncing around Washington right now are hybrids of private and public health care. They seem to be more complex, rather than less. Why does delivering health care have to be so complex? Why don't we make it simpler instead of harder? The primary reason that we are all discussing health care is because the costs have become astronomical. Does insurance add value and decrease cost? I think the answer is no to both questions. A single-payer plan that negotiates drug costs and pays physicians and hospitals for keeping patients well would be the most cost-effective plan.

Finally, most plans being talked about today have some sort of "value added tax" in order to cover the 46 million Americans who are without insurance today. If we eliminate insurance from the basic plan (insurance adds approximately 30% to our healthcare costs) then we don't need a "value added tax." We already have enough money to cover everybody. There's no extra expense. There's no need for employers to be involved. Businesses would save money. This seems like a system in which business wins, the American people win and the health industry wins. Outstanding! Now that I've fixed health care, I can turn my attention back to Guantánamo Bay and what to do with the detainees.


The Angry Independent said...

Dr. Thompson,

I agree... the plans being offered seem too complicated. But much of it has to do with satisfying the obstructionists in the GOP and Moderate Democrats who are concerned about costs.

But the more I thought about a parallel public program (to compete with the private sector) the more I believed it could work.

There's always the problem of employers dropping their coverage as soon as the new system goes into effect. That would make the costs shoot up.

I'd rather have single payer...but unfortunately there is not enough support in Congress....and not enough money to pay for it.

ecthompson said...

With insurance not adding any value to the equation what's the point? They don't improve healthcare. The only reason that I can see to include insurance is to make the industry happy.

Employers will not have to pay in a dime. Business is happy not to have to fool with that any more. the program is paid for by payroll deductions.

I'm going to give you some information that I will put into a future post. Phase out medicare and medicaid over 5 years. Roll everyone into this universal plan. The money is already there by excluding insurance companies. Single americans pay $3500 per year. Families pay $5000. WE are done. Everyone is covered. Money is taken out of your payroll check. For some Americans the amount of money will be less than what was taken out before.

Finally, we can improve the quality of medical care delivered by giving MD's bonuses for adhering to the Best practices. The Best practice guidelines are drawn up by physicians and not government employees.

Everyone wins!!

Liberal Arts Dude said...

There is an interesting article in the Washington Post that deals with how right-wing domination of the media has resulted in a lopsided debate which has all but written off the single payer option:

Polis, Edwards and Grijalva also noted that proposals for a Canadian-style single-payer health-care system, which they support, have fallen off the political radar. ... Edwards noted that if the public plan, already a compromise from single-payer, is defined as the left's position in the health-care debate, the entire discussion gets skewed to the right. This makes it far more likely that any public option included in a final bill will be a pale version of the original idea.

Chris Bowers at the Open Left blog argues in a very insightful post that:

Real health care reform--aka, a public option--is the lowest bar for progressives to clear with the current congress. It has the most lobbying behind it, bringing in not only health care reform groups, but also unions and mutli-issue groups like MoveOn. It only requires 50 votes in the senate, whereas Republicans will force 60-votes on virtually everything else. It is a very popular, not only in absolute terms (60%+), but also relatively popular compared to other major Democratic agenda items like climate change. And President Obama won't have a 60%+ approval rating forever, either.

The bottom line is this: if we can't get our most popular major agenda item, during the peak in Democratic popularity, when we need only 50 Senate votes, and on the issue where we have given our strongest lobbying and activist efforts, then we aren't going to pass meaningful progressive legislation on anything else.

Some food for thought. What especially irks me is that no matter how much of a good idea single payer is as a healthcare plan, it is being compromised already and being watered down because the influence of those who oppose it is just so strong and pervasive in our political system and culture. And this with a Democratically-controlled Executive Branch and Congress!

Liberal Arts Dude said...

Apparently there are two bills in Congress right now that promote single-payer, universal healthcare:

HR676 sponsored by Rep. John Conyers (D-MI)

S703 sponsored by Sen. Bernard Sanders (I-VT)

Given the political climate do they have a snowball's chance in hell of being enacted? It is doubtful. But we have to remember that there are people in Congress fighting the good fight. Even if they are currently marginalized let's remember who they are and support them. We need more legislators like them and they need our support.