Health Care Reform—Yes, We Need It!
By Sherman Hope, M.D. Brownfield, TX
Whether we like it or not, money drives our society, including the medical system. How to reform our health care to get the most for our medical dollars is the real question in the current debate over health care reform. Unfortunately, it has become a public scandal as many Republicans block reform unless they get their way and some Democrats do essentially the same.
If we are going to have any real reform, there are certain basic economic facts that need to be addressed. These need to be resolved with cooperation—not with hostility and conflict. Our nation has the best medical care in the world, but it can be improved.
1. Our current system gives essentially a monopoly to about a dozen insurance companies, who operate to make money for their shareholders, NOT to provide health care. They set their rates (which go up yearly); they decide which doctor their customers can see; they set the doctor’s fees; they decide if and how long the patient can stay in the hospital; they withhold payment from the doctor and providers as long as possible; and they deny claims through unlimited bureaucracy and paper work.
Insurance companies and government agencies have set drugs lists from which the doctor must choose or else the drug isn`t covered by their plan. These lists are changed at least yearly, and are not always the best drug for a particular situation. It is estimated that about 20% of every dollar companies receive goes for their profit, administration, and political activities, but not for health care. Since health care comprises about 10-15% of all of the gross national production of our nation, this gives millions of dollars of profit to a very small, self-serving group, and takes more millions away from actually providing services for patients. If the public thinks that government medicine is bad, at least it is not trying to make money for itself, and it couldn`t be much more “controlled” than how our current system works.
2. Tort reform (lawsuits and medical liability laws) is a must. Virtually all doctors and medical providers spend excessive amounts of time, and certainly order excessive laboratory and imaging studies (X-rays, CAT Scans, MRIs) in order to be prepared for legal defense when (and not if) they get sued. Almost invariably, some time in their career, there is a very strong possibility that they will be sued. Virtually every twisted ankle gets an X-ray ($100 or more) and virtually every head problem—whether headache or a bruised head–gets a CT scan or MRI ($1,000—$2000) even if the symptoms and physical findings are minimal. The same tests are usually repeated if another doctor or institution is consulted.
When there are no laboratory and imaging studies and a medical lawsuit occurs, there is a greater chance of getting judgments against medical providers. But in the end the public pays the bill. The doctors and institutions must increase their charges to cover the cost of malpractice insurance. These excessive and medically unneeded tests also hike the cost to the patient.
Tort reform is also needed to decrease drug costs. It is estimated that drugs cost twice what would be necessary because of the law suit problem—the multiple million dollar settlements and the nationwide TV advertised class action suits. Tort reform needs to be national not just statewide. Tort reform has been blocked by the lawyers, who compose the majority of our national congress, both Republicans and Democrats.
3. Standardized billing for medical services should be instituted. The current billing system for medical services is a fiasco. Doctors and institutions all have different ways to bill for their services. Almost never is the first statement accurate and in most cases it takes months to get the payments, co-payments, and deductibles correct. Delays in payments and uncertainty of what will be paid by the insurance companies and Medicare/Medicaid confuse everyone—both the patients and the providers of medical care.
4. Portability of medical insurance should be nationwide. When people change jobs or move to a different state they should be able to continue their medical insurance. Local states should not give a monopoly to a particular medical insurance company.
5. Access to the medical community must be available. Having insurance, or a government program benefit, is of no use if there are not enough physicians to furnish services, especially primary care services. This means providing money and emphasis on training of more primary care physicians. Under our current system, most specialists will earn from two to six times the annual income of the primary care doctors, so of course, there is a great tendency for young doctors to go into specialties, or even super-specialties, where the money is better and the working hours are usually shorter.
6. Health care reform is not socialized medicine. Physicians, laboratories, hospitals, and all health care providers are already under supervision through licensing laws, recertification requirements, etc. Hospital peer review committees, medical societies, and state government groups can and do review quality of medical care. Freedom of choice of medical care providers and treatment will remain in the hands of the patients even with health care reform—at least as much as it is now.
7. Access to the medical community also means access to choices in health insurance plans. No company or government entity should have a monopoly on medical care. There must be competition produced by cost, service, availability, and quality of care. Nothing deteriorates the quality of care (and at the same time increases the cost) as much as an institution (whether government agency, charitable hospital, or private provider) having a monopoly or major dominance of the medical market with little or no competition. Under our current system, very few people actually have a choice in their care or medical insurance. The choice is made by their employer who makes contracts with medical insurance companies on a financial basis, and not necessarily in the best interest of the patient.
8. Preventive health care should be a priority in medical reform. Preventive health care is less costly than trying to treat or cure a disease. For example, treating hypertension (high blood pressure) is less expensive than treating its complications of heart disease and strokes. Taking care of diabetes is less costly than the care of the amputee and the blind patient resulting from uncontrolled diabetes. Finding breast cancer via mammogram and treating it early is less costly than the care of the advanced cancer patient. Immunizing patients is less costly than treating the complications of a disease. Good prenatal care is less expensive than treating premature and damaged infants.
Thus far, everything I have mentioned is either cost saving or at least cost neutral, and it would improve our current medical delivery system. Only partisan politics (both Democrat and Republican) and vested self-serving financial interests stand in the way of these reforms. With the attitude of “keep it the same” and “don’t mess with the best medical care in the world,” there is great opposition to reform. But, nothing as complicated as medical care and its delivery on a fair basis is not so good that it cannot be improved.
9. Now I will get into the more controversial area—expanding medical care to our people. This does cost money, lots of money. Is it worth it? It depends on a person’s viewpoint of what the government should do. The basic function of government has been historically to provide peace and protection for its citizens. So initially, even in our own country, it consisted of military defense, police protection, and fire fighters.
Then public health, such as clean water and sewage disposal, became a government function, costing more. Additional money was spent by the government on public education, as this responsibility was assumed (although this is still opposed by some groups). Then came public work projects—roads, dams, canals, airports—all costing more money. Social projects, such as public housing, food stamps, public hospitals and, agricultural price support became part of our society’s policy and expectations—again costing much more money and generating more opposition. But the costliest of all social projects are Social Security and Medicare/Medicaid. Still the public has been willing to pay for these programs.
The current question is whether or not our people are willing to provide more medical care to the public, and how to finance it. Should we expand our medical care to those who do not have adequate resources for their own medical care? Should we require insurance or government coverage for those who are already sick (have pre-existing problems)? Should we allow insurance companies to drop coverage on patients that have multiple claims or have expensive chronic diseases? Is health care a “right” or a “privilege”? Is it a social issue, a moral issue, or a political issue? Again, this depends on ones viewpoint.
Morally, most ethical and religious groups recognize an obligation to help the sick and infirm. Economically, a healthy population is more productive for a society’s well being. Socially, our country is more congenial when there is not the great division between the “haves and have-not” (in obtaining medical care or other issues of social justice). Medically, allowing all people access to affordable care (via insurance or otherwise) will help relieve the strain on our Emergency Departments and other urgent care providers. Institutionally, providing some form of payment for the poor will help the general public in part because hospitals would not have to “soak the rich” (meaning those who pay their medical bills) to make up for the losses from those with no financial resources.
So, how do we pay the bill? I leave that to the professional politicians who seem to find money for the other “necessary” government functions as well as for their local pet projects that keep getting them reelected. Certainly a nation at peace has more resources than one that is spending multiple billions of dollars fighting two wars.
Regardless of the method used to provide for our nation’s most needy, the problem should be addressed. And even if this problem of providing additional medical coverage is not solved in the current political climate because of the cost, partisan politics, or other reasons, there is still no excuse not to begin instituting some of the reforms and improvements needed. Health care reform? Yes, we need it.
