The Wrong Way To Do Health Care

[FiddlingAnt]

My local paper had a lead editorial last Saturday titled ¨Health Care is a Moral Dilemna¨. The writer, John Florez, argued that the moral thing to do is spend more money providing health care to poor people.

I agree that health care is a moral dilemma, but for an entirely different reason.  The way health care works in America is the average household spends about 6 percent of their income on health care but the nation spends about 18 percent on health care. Where does the other 12 percent come from? Mostly employers and government. In the case of government, more and more of the money spent is not money collected from taxpayers, but borrowed money that will have to be paid back by future generations.

That´s not morally right.

I think it is immoral to not only take money from a child´s piggy bank, but stuff it full of IOU´s that he or she will have to pay back when they grow up, all for money spent on my generation.

This is a crazy system and totally ignores free market economics that has proven how to lower costs to affordable levels. It´s easy to see why our system is so messed up. Consider a system where you only have to pay one-third of the cost of your food and someone else has to pay the other two-thirds. Do you think your buying habits would change?  Of course they would. You would spend more money because most of it is not yours.

The morally right thing to do is to fix our health care system so we can pay for it ourselves without passing on the bill to our kids. Our most expensive-in-the-world health care system was rife for reform before Obama Care made it worse. America pays more for health care without a comparative boost in benefits. Numerous studies show that there are many other countries with far lower health care costs with healthier, longer living citizens. Unfortunately, Obama Care was a political solution to an economics problem. President Obama proved to be too inexperienced and too unwilling to provide leadership to use the historic opportunity he had to make corrections to the health care system that would lower costs and thereby make it more affordable to more people.

Here is the crux of the problem. Obama Care focused on goals (affordable health care access to all). Economics doesn´t work that way, it is incentives, not goals, that you have to watch for.  That is why employers are not hiring more people, keeping the number of employees under 50, and dropping worker´s hours under 30 hours. They are trying to avoid the higher costs associated with Obama Care. None of these things will help more people get health coverage and actually result in fewer employed people and fewer work hours. Meanwhile, special interest groups get exemptions from participating in Obama Care, to the detriment of everyone else that is stuck with it.

It´s the incentives, not the goals that drive actions.

• We know that we could lower the cost of health care if there was more price competition with prescription drugs.  This was not part of health care reform.

• We know that we could lower the cost of health care if there was tort reform to limit the add-on costs created by the trial lawyer industry. This was not part of health care reform.

• We know that we could lower the cost of health care if providers were paid on the results of their actions.  Instead, the more procedures, needed or not, are performed and billed, the more money providers can make. This was not part of health care reform.

How bad did Obama Care blow its chance to fix health care? Here is a quote from Confidence Men, by liberal author Ron Suskind where he talks about Dartmouth Method reformer Dr. Jim Weinstein, whose research had found widespread waste and unnecessary procedures throughout the health care industry and was hopeful that Obama Care would address these obvious problems.  However, special interests squelched any chance at these much needed reforms.

     To spend a ¨once-in-a-generation¨ effort on extending coverage to the uninsured--without any real teeth in using evidence about what was effective in reducing unnecessary procedures, and driving down costs--was a ¨stunning error.¨

     Â¨It made things worse,¨ he said solemnly.

     And then he got frustrated. ¨I can´t believe how wrong they got it. This was our one chance, and we completely blew it.¨

What´s it going to take to get a health care system that is based on economic realities and not political special interest lobbying? Let´s stop the fiscal child abuse of stealing money from future generations to pay for today´s health care costs.

[Celtic Rose]

I would like to give a little perspective as a person who works in the health care system. 

A) Regarding price competition for drugs.  I have never met a doctor who was attached to name brand drugs when there was a generic equivalent.  In fact, some of the prescription forms I've seen automatically default to a generic unless the physician specifically says not to use it.  However, many highly effective drugs do not currently have a generic equivalent.  I work in the ICU, and I just looked up a few of the most common IV drugs that I give on a regular basis, and many of them don't have a generic equivalent, but they are highly effective.

I also have issues with idea of setting price limits on drugs.  Pharmaceutical companies spend millions researching new drugs, many of which will never make it to market.  The prices of their drugs are high to recoup losses from the huge number of drugs they researched that weren't effective.  Also, they only have 20-25 years of being the only equivalent drug on the market, and once the patent is up the sales numbers will drop dramatically as everybody will start opting for the generic equivalent. 

B) I fully support Tort reform, and I agree that it should have been part of the current health care reform bill.

C)  The idea of an unnecessary procedure is difficult for me to define.  A procedure is only unnecessary until you get an unusual result.  Almost every patient on a ventilator gets a chest x-ray every morning.  Most of the x-rays don't show anything really significant.  They might show that the patient's pneumonia has improved slightly, or confirm that the breathing tube is still in the right place, but every now and then, there will be a highly abnormal result that we are able to act on immediately.  The same goes for morning blood draws.  We test all sorts of things in the blood every morning.  Sometimes they are spot on normal, sometimes we have to replace some electrolytes, and sometimes we end up starting a blood transfusion at 4 in the morning. 

On an outpatient basis it is difficult to decide what is necessary or not until the results come in.  When I was 14 I fell and hurt my wrist.  It didn't swell, it didn't look at all bruised, but I couldn't rotate my arm.  My mom took me to the doctor, he said it was likely just sprained, but he would get an x-ray just in case.  Ends up, it was definitely fractured and I was in a cast for 6 weeks.

My brother hurt his ankle when he was 13, and the doctor treated it like a sprain for almost a month.  My mom finally insisted on another x-ray, and they found that the end of his tibia had actually crushed in like an egg and they had missed it in the original x-ray.  He ended up having several surgeries to repair it. 

This of course also ties into the idea of tort reform, if we don't test for something, and the patient is adversely affected by it, the hospital could be sued. 

Obamacare is attempting to address the idea of paying for results, but they are going at it the wrong way.  One of the new rules is that hospitals won't be reimbursed for a re-admission within 30 days for the same problem.  However, that completely ignores the patients role in maintaining their own health.  If a person has been educated on their disease, the doctor has given them all the tools necessary for disease management at home, and we schedule an appointment with a doctor outside the hospital for disease management, and a patient doesn't take advantage of any of it, how is the hospital responsible for their readmission?  I've had patients argue that their blood sugar just runs high so a blood sugar of 300 is "normal" for them, patients who skip dialysis treatments willy-nilly, patients who just don't bother taking their medication, and yet the hospital is supposed to be held responsible for the readmission because we didn't "educate" them well enough. 

[MrsSmith]

I would like to give a little perspective as a person who works in the health care system.  


...


Obamacare is attempting to address the idea of paying for results, but they are going at it the wrong way.  One of the new rules is that hospitals won't be reimbursed for a re-admission within 30 days for the same problem.  However, that completely ignores the patients role in maintaining their own health.  If a person has been educated on their disease, the doctor has given them all the tools necessary for disease management at home, and we schedule an appointment with a doctor outside the hospital for disease management, and a patient doesn't take advantage of any of it, how is the hospital responsible for their readmission?  I've had patients argue that their blood sugar just runs high so a blood sugar of 300 is "normal" for them, patients who skip dialysis treatments willy-nilly, patients who just don't bother taking their medication, and yet the hospital is supposed to be held responsible for the readmission because we didn't "educate" them well enough.  

      (I totally agree with your entire post, shortened it to save space.)

I would like to add that one of the reasons Obamacare didn't do anything to reduce costs would include our President's love of GE.  GE is beyond any doubt one of the worst companies in the US healthcare market.  Oh, they build good equipment, and it lasts a long time, but they are profit-driven to a standpoint that I've never seen in any hospital.  I recently needed to replace a part in a GE machine...it was a tiny board, a relay, a switch and about 6 other components.  If it went in a PC or a game deck, it would likely cost $30 or so.  GE charged nearly $700...and that was AFTER our price deal...it started at close to $1000.  They are like this in every area, one of the worst companies to work with in the world.  But they do tons of business anyway because administrators don't see the after-effects.  (And recall, they pay less US taxes than most international companies)  

Another reason Obamacare won't reduce costs is that it isn't designed to.  After the huge costs of equipment and equipment repair, the cost of government regulations drives prices up.  Things I have seen personally in my small segment of healthcare include a sanitization procedure our dialysis clinic used to follow annually and "as needed."  This procedure runs $2000 each, and is now required monthly despite the fact that the test results have not changed AT ALL from the annual to the monthly timing.  But there is no avoiding it, Medicare says, "Do it," we do it.  

I have no doubt that somewhere between 50 and 60% of all health care costs increases could be traced directly back to medical equipment and government regulations.  I would bet that almost all the rest of the increase is due to law suits and the resulting insurance costs.  I do know for a solid fact that most not-for-profit hospitals at best have a 3 or 4% margin, and at worst, lose money every year.