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Is there anything good about the American healthcare system? In a mad dash to fix our ailing health-care system, we are destroying parts of our health system that has worked very well.
STATISTICS
Statistics is like garbage, easy to collect, but hard to get rid of.
Because we detect problems early, and are more aggressive when we find them, our five-year survival rates for cancer and heart disease are the worst in the world.
It is hard to compare our life expectancy in America, infant mortality, and other statistics to those of countries that have homogeneous populations. We are not they. States that have the greatest longevity are those that use the most sophisticated diagnostic imaging,
By banning self-referrals to a doctor owned diagnostic facility we could remove a great deal of wasteful spending.
TORT REFORM
To cut down on wasteful prescribing and imaging, we should reform our tort laws so the financial costs would not exceed the litigation expenses. Fearful of malpractice suits, doctors over prescribe diagnostics and drugs. The high malpractice premiums of specialists are passed on to you, the patient.
LONGEVITY
Longevity in the United States is unsurpassed. Once you factor out accidents, murders, and homicides, which pull down our life expectancy rates.
We have older than would-be parents, and higher fertility assistance techniques then poor countries this raises our infant mortality rate. Our neonatologists rescue more premature infants and keep them alive, often just for a while. In the past they would be logged as stillbirths and not pull down our infant mortality rates.
We suffer from more drug abuse, murders, traffic fatalities, that cut into our overall life expectancy.
All this lowers our life expectancy rates, because we don't take into account these non-health factors that affect our life expectancy rates. For example, murder rate are seven times higher then in Japan.
FEE FOR SERVICE COUNTRIES
Other countries have fee-for-service systems there are worse than ours. Ninety percent of Russians are technically covered, but doctors and hospitals demand financial donations for your free medical care. To get the service, you must pay up front for your private hospital and doctor services.
DOCTORS WAGES DON'T MATTER
It is irrelevant what doctors in other countries make, because they do not deal with the costs and issues unique to practicing medicine in America. In other countries, the government owns most hospitals. Doctors work there on salary, and are paid very poorly. A junior doctor makes less than $120 a month. The biggest money a doctor sees comes with his yearly bonus, (which is tied to the revenue he brings to the hospital or facility). So hospitals have an incentive to have lots of beds, and doctors have a great incentive to fill them, all to produce a profit.
A doctor in Cuba finds it more profitable to become a nurse in the United States. Coming to America, Cuban doctors often become nurses or lab technicians rather than retaking vigorous board exams. Many Cuban doctors left in the past six years, where they earned $25 per month. They find it more lucrative to practice as nurses here in America. A Cuban doctor, who becomes a hospice nurse, earns more than hundred thousand dollars a year.
Twenty five percent of American doctors are foreign and were trained overseas. We rely on them because they take jobs in underserved areas, going into primary care. Without them, our minority and poor populations would not be served.
UNIVERSAL COVERAGE
We tried to make healthcare finance by individuals on the basis of their ability to pay, but it should be available to all who need it on roughly equal terms. Universal coverage is so difficult, because most of us want to have our cake and eat it too.
Most Americans opposed limitations on their health care as an infringement on their personal rights. They believe they have a perfect right to have highly expensive, critically needed health care, even when they can't afford to pay for it.
But we have created this monstrous payment system through our policies that increase costs, reimbursements from Medicare, rewarding procedures, and paying for sick care, rather than for healthcare.
It is financially lucrative to be a procedure-based specialist. We will pay for MRI, CAT scan, balloon angioplasties, and surgical worthless procedures. This in turn increases healthcare costs.
However we will not reimburse a doctor for his time, explaining: why a test or procedure is not necessary, why their lifestyle must be changed, and why they shouldn't have a more expensive and invasive intervention procedure.
Most medical students want to be dermatologists, radiologists, or knee surgeons. They will get 2 to 3 times the amount they would get if they were family practitioners or internists. We must improve the fundamentals that will improve our cost and quality of healthcare.
Our entire economy is empowered by consumer purchaser relationship. We make choices, comparisons, and decisions in all our purchases. They all lead and drive down costs and improve quality, --that is everywhere except in the healthcare industry.
Our payment system does not reward integrated low-cost high-quality care that might be available by acupuncture, massage, and complementary and alternative medicine.
We assume that if everyone has health insurance, they will get better healthcare. Your health will not improve, just because you have easier access to health care.
BRINGING DOWN COSTS
All five bills in Congress have emphasized insuring the uninsured, rather than emphasizing on how to bring down costs for those who already have insurance.
It's wonderful and admirable to expand coverage for everyone, and have wellness and prevention treatments for all. But all this will increase our costs rather than subtracting them.
Congress had advocated a new way to pay doctors and hospitals. They are moving away from fee-for-service payments, which reward doctors for doing more procedures. Hoping to save money by modernizing and improving healthcare, Congress is looking for a coordinated system to pay doctors and hospitals to do better. Instead of revolutionizing how care is delivered, all the bills stress reining in costs. Nationally, it will take years to implement a system of paying doctors and hospitals for quality rather than quantity.
TORT REFORM
Not one of the bills addresses medical liability in tort reform, even though the congressional budget office concluded that it could save $54 billion over the next decade.
OTHER COST SAVING MEASURES
We are told we will save $110 billion from Medicare by cutting reimbursements to insurers that run the private Medicare advantage program. We extracted $80 billion from drug companies in the form of higher Medicaid rebates to the government. All of this will reduce costs, but has very little to do to change our healthcare.
Employees don't have to pay taxes on insurance purchased by their employers. If they had to pay for this insurance, workers would be more price sensitive and prompt insurance companies to market more affordable policies. Eliminating this exemption would also raise $250 billion a year and more than pay for the enormous expansion proposed by our health-care reform bill.
Not enough emphasis is placed on financial rewards and penalties based on health care outcomes. We could: reduce reimbursements to hospitals that have a necessarily very high readmission rates, bundle payments to medical teams that coordinate patient care, and providing bonuses to doctors who meet quality standards. The hospitals have already struck a deal exempting them from any cuts for the next 10 years. (There goes up our costs.)
If you look at whether to approve a new therapy because it's cost effective and is an improvement, you could slow down the rate of healthcare growth. All Congress wants to do is cut down payments, rather than fundamentally changing how the health care system operates.
We are asking everybody to pay for what they can afford for medical coverage. Healthy young people may decide not to buy insurance because they don't figure they will have high medical expenses.
MANDATORY INSURANCE
Insurance can't work unless there are a large number of people paying into it. They need enough contributions from the majority who are healthy, to offset the costs of those who are sick.
Forcing young people to get insurance is in their best interest because even they can end up with high medical expenses, from an accident or a serious disease.
By focusing payment on treatments and methods of care, we can make people healthier. There are various ways to reduce insurance premiums. By instituting standard billings and creative electronic medical records, we can reduce duplication of services and cut down on waste.
Congress says they're worried about controlling the cost of medical care, and yet they refuse to cut their costs by taking money from drugs and hospital industries. They oppose the most efficient way to deliver affordable coverage: a voluntary public insurance plan.
Watering down reform has its political costs. You might get a bill that voters don't like. If you appease the healthcare industry, you will get minimal concessions from it. Drug makers and hospitals now are getting off with minimal sacrifice. The average taxpayer must take the brunt of the medical costs.
This 2000 page health care reform package is too complex and has moved too fast. HASTE MAKES WASTE. Our healthcare system is 90% efficient, and we should be working on the 10% that needs repairs.
What do you think? Your comments are always appreciated.
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