Fixing HealthCare with Common Sense
What it will finally take is anyone’s guess. Our candidates for public office are great at talking a good game, and oh what a show Wednesday on ABC promises to be, but what ultimately it will take is a combination of “Common Sense” (written in 1776 from Founding Father Thomas Paine*) and a return of major corporate ethics, with effective, consumer driven oversight and simplified regulation.
Assuming we keep a private, free enterprise system, lets finally put the consumer in charge, just like with other types of insurance. Lets simultaneously expand HSAs and FSA programs and benefits to further breed responsible healthcare consumption.
It is likely the best solution, easiest to implement without burdening us with bigger government. I say let companies like Geico, Progressive and others that market auto insurance direct to consumers into the ring. Let consumer choice drive them to cut costs by uncoupling dollars from non-benefits payment. Give them simple rules to follow, nationwide, exempt from state lines. This could be huge, and would not take any dismantling of our major delivery systems.
Remember, Medicare runs on 4% administrative overhead, but currently private health insurers are closer to 25%. Much of this goes to the questionably ethical profiteering of extreme proportions, exorbitant salaries for executives and contributes to ridiculously poor provider reimbursements.
And, how about adding return of premium benefits to reward the healthiest while not penalizing the seriously ill. This is a tremendously powerful idea that would reap huge benefits for the consumer. It’s already done with disability and some other types of insurance and mutual insurance companies regularly pay dividends to payees. So, Lets make sure that some of insurance premium dollars can be returned if consumers stay healthy.
Lets also finally de-link health insurance from employers and employment benefits once and for all. This has been an absolute catastrophe. Even the Boston Globe recently acknowledged this. The extreme burden on US businesses of all sizes from health care premiums is well known. The trickle down benefits to business, like the automakers, municipalities and others could also be a huge economic stimulus.
Uncoupling health insurance benefits from employment would make consumers ultimately more fiscally savvy and responsible. This could quite likely increase their wages simultaneously as employees would now purchase all benefits outside of their work. Uncle Sam can help with deductibility and tax exemptions, maybe larger in the beginning to help foster the transition.
I also believe that there should be real consumer dollars available for CAM (Complimentary and Alternative Medicine) that can be used in the treatment of our most common and non-life threatening disorders especially if the consumer does not utilize more expensive traditional pathways for the same condition. Back pain and headaches are two very real examples that both happen to be still the most common reasons for doctor’s visits, and are at least in part linked to stress and unhealthy lifestyles.
This mechanism alone would foster consumer education to choose their own healthcare pathways with taking an additional financial hit in addition to premiums.
Any effective system must simultaneously provide equitable reimbursement and other incentives to all licensed doctors of all disciplines as well as ancillary providers for our society to keep great healthcare providers in the system.
This must include simplified reimbursement schedules, equal across the professions for identical procedures. I strongly favor a diagnosis-based system with utilization review only for those cases outlying the norms. This could be a technological piece of cake with a national electronic healthcare database for all Americans.
Of course, there are other issues that need to be simultaneously addressed. These include malpractice provisions (some experts suggest in a separate healthcare “court” in addition to capped awards). Better awareness of poor outcomes vs. malpractice by society at large would really help as well.
Drug costs, competition and widespread availability of tested alternatives to prescription drugs all need to be handled. Again, a consumer driven Wal-Mart type of distribution may be what already does it.
So, how can we help? Lets make sure we educate ourselves first and foremost as to what’s wrong with our current system and push our lawmakers toward better consumer choices. Take a real hard look at their differences on these topics when you vote and support any politician, as some are huge. Let your patients know who these consumer friendly elected officials are in your area are too.
Utilize cost effective preventive screenings in your practice, and advocate the same for our families. Lets make sure we teach our kids and our patients all the rewards of better health choices like non-smoking, stress management, diabetes prevention, relationship choices including illicit drugs and sexual behavior, and permanent weight control.
How it will all turn out is anybodies guess. I continue to be as vocal about these issues with my patients and community, and urge you to do the same.
Not Unlike Thomas Paine did over 200 years ago.
(*Society in every state is a blessing, but Government, even in its best state, is but a necessary evil; in its worst state an intolerable one: for when we suffer, or are exposed to the same miseries BY A GOVERNMENT, which we might expect in a country WITHOUT GOVERNMENT, our calamity is heightened by reflecting that we furnish the means by which we suffer.)