Healthcare Solutions You'll Never See
Let's compare any major healthcare episode in two different worlds. Let's take out your spleen and while you're in the hospital, I'll take your dog to the Vet and he'll have his spleen out too.
You had no idea what the cost would be when you went in and bills will still be arriving in the mail three months after you're home from the hospital. Your Vet told me how much it would cost when I brought Fido into the office and I paid his bill in full on the way home the day after the operation. You paid well over ten thousand dollars, I paid about twelve hundred.
Why the difference for virtually identical procedures? Lawyers, Government and Insurance. Plus, you didn't wag your tail when the doctor checked in on you after you woke up in recovery.
Let's get busy and make some major improvements to human healthcare without giving up any of our rights and freedoms to Messiah Obama.
Step 1. The loser pays the winner's legal costs in all civil lawsuits involving patient care. Results: Frivolous and harassment lawsuits disappear. Malpractice insurance premiums fall to nineteenth century levels. Unnecessary tests and medication previously prescribed by physicians as defensive measures go away. Pharmaceutical companies begin to defend against frivolous lawsuits they would have formerly found it cheaper to settle. After drug companies win a few suits and recover their expenses from the predatory law firms, the lawsuits disappear and the companies devote more resources to drug development. The cost of medical care begins to decline noticeably.
Step 2. Allow Americans to buy medical coverage from a supplier in any of the fifty states. Results: States that mandate their insurance companies to include unnecessary coverage in health care policies will lose those insurance companies, their employees will lose their jobs and the states will lose the taxes paid by both to other states without such mandates. Before they leave, Insurance companies will hound the state legislatures to get off their backs or lose them. The cost of medical coverage declines sharply.
Step 3. Require healthcare providers to post quality-of-healthcare results online with the necessary guidelines and audits to make the information accurate and useful. Result: Low quality providers will improve or exit the business. The overall quality of healthcare improves.
Step 4. Return the FDA to its original mission of regulating pharmaceutical drug safety and ban it from re-expanding its mission to include drug efficacy. Result: The market will determine efficacy and success of drugs just as it does with hamburgers. Promising drugs will make it to market faster and at far less cost. Not all drugs work identically in all people but physicians have wider choices in prescribing drugs. Some patients respond remarkably well to drugs that would never have been approved under prior FDA regulations. Drug prices decline dramatically.
Step 5. Insurers currently provide first-dollar coverage and call it insurance. It should be more accurately called prepaid healthcare coverage. Catastrophic coverage for those bankrupting illnesses you hear so much about and hope you never get is legitimately called insurance. You can buy a million dollar life insurance policy that pays a million dollars when you die. Now you can buy a million dollar health insurance policy that will pay for a million dollars worth of health care until either it runs out or you do. Result: Healthy people will pay out-of-pocket for routine healthcare which will cost less in light of steps 1 to 4 and will cost less still as patients decide what services they are willing to buy and how much they are willing to pay. People can also choose to buy prepaid healthcare which will level their healthcare spending (and help to level doctor's incomes). It may cost more overall than pay-as-you-go but buys the benefit of predictable expense rather than receiving unexpected bills at inconvenient times. You can opt for the same thing now on your electric bill.
Step 6. Make Premiums for prepaid health care plans and catastrophic health insurance as well as medical costs tax deductible from the first dollar for individuals.
Step 7. Ban the artificial restrictions imposed by the AMA and other groups on the numbers of qualified students admitted to medical schools.
The first thing folks will say is "what about the idiot who won't buy any coverage at all, or the idiot who will but still won't spend it wisely, you can't just let him die when he gets sick and runs out of money can you?"
Haven't you let other people use your our own compassion to blackmail you for long enough? Since we can't stand to let idiots kill themselves we're about to sign up for a system where Government manages our healthcare and will eventually regulate every aspect of our lives related to healthcare and then ration us to death when we get old anyway. Which is worse? A. You're smart, you take care of yourself and are free to live your life as you please at the possible financial expense of maybe having an idiot relative you decide to rescue or maybe you don't at the emotional expense of watching him die; or B. Government manages your healthcare, takes your money and uses it to treat you and everybody's idiot relative equally and you all die from care rationing when you're old, sick and become a "burden" on society.
So let's see what happens to two people, Stupid Steve and Responsible Ralph, in the improbably imaginary world where we actually enact steps 1 to 7 above and then in the much more likely world where we enact ObamaCare.
A few years ago World One implemented tort reform, inter-state insurance markets, easily accessible information on healthcare outcomes and an FDA that approves drugs based on safety and leaves efficacy to the market place. Insurance companies now offer prepaid healthcare plans and catastrophic health insurance coverage in a nation-wide free market and all healthcare expenses, including coverage premiums are deductible from your income before taxes. Without the artificial admission restrictions, so many high quality doctors are emerging from medical schools that internships have become a livable experience for new doctors. With so many students entering medical school the cost per student has declined and new doctors no longer enter the field with seven figure school loans to pay off. Medical, hospital and healthcare coverage rates are reasonable due to competition among so many suppliers. With detailed price and quality information easily available on the internet, people are able to bargain for healthcare, both coverage and pay-as-you-go treatment, at least as hard as they do for a new car. Doctor visits are more relaxed and patients can discuss their problems in an atmosphere where the physician actually hears them and can make carefully considered diagnoses and suggestions freely without couching every sentence in ways to avoid a lawsuit. There are now so many doctors that fees are limited by competition and the profession no longer creates millionaires. Some doctors are disappointed by this and leave the profession. They are replaced by recent graduates who entered the profession because they love the practice of medicine.
Stupid Steve likes to live recklessly, enjoys recreational drugs, promiscuous sex, and dangerous hobbies but he's willing and able to pay if the results get costly. Steve has a good job and is making all his expenses every month with a little left over which he puts into a retirement savings plan. Because this is World One, Steve knows that if he loses his job he'd better find another one quick or he'll have to go live with mom and dad. Therefore Steve is a responsible employee and his boss would be unhappy to see him leave. Steve purchased a "whole-life" health insurance policy back when he bought life insurance. This guaranteed him a sum, let's say ten million dollars, to spend on big hospital and doctor bills over his lifetime just like his life insurance policy will pay out a million dollars on his death. In addition he purchased a prepaid healthcare plan. That means he has hired someone else to manage his saving and payment for his frequent trips to the doctor for injuries and STDs. He could put money aside and pay for the visits on his own and over the long term it would be cheaper but some months an expensive series of penicillin shots could put him financially under water. With the plan, his medical expenses are predictable. He can live his fun-loving lifestyle knowing that no one else will be on the hook for any mistakes he makes. Because this is a prepaid care plan and not insurance, his monthly rates will change from year to year based on how much he spends with his doctor. He is free to choose any doctor or clinic and he shops around in order to keep his monthly prepayments as low as possible.
His total monthly expenses include his coverage premiums which his income covers adequately along with his house payment, and the payments on his boat, motorcycle, and RV. He's deeply in debt but that's what "fun" costs. If he loses his job, he may have to walk away from all that debt but as long as he keeps paying those catastrophic medical insurance premiums he's set as far as any medical bills go. He can always buy another RV but he doesn't want to lose his catastrophic health insurance for non-payment now because with his current lifestyle and age a replacement plan would be much more expensive. He was prudent and put some money away for those premiums while he had a job. After all who'd be dumb enough to throw away ten million in future medical services. Since his fallback option is to move back home with mom and dad and they know it, they have always encouraged him to plan for the future. Later when Steve has an expensive illness he will try to find care that is as cost efficient as possible because he knows his medical coverage is a fixed amount that has to last his lifetime. If it doesn't last until he dies, he can always fall back on his personal savings which grew much larger over time due to the financial security of his catastrophic medical insurance.
Living right next door in World One is Responsible Ralph who likes to eat right, get plenty of rest, drink lots of (healthy) fluids and exercise regularly. Odds are he will be rewarded with good health and should enjoy the benefits of his self discipline, restraint and good sense. Ralph has the same catastrophic coverage that Steve has but his premiums are about half because he should have a longer life and many more months of premiums to pay. Being prudent he knows that life's lottery might throw him a curve so he's made sure he has enough to carry him through if he's careful. He didn't buy prepaid healthcare because his doctor visits are few and far between and he can afford to pay them although he always looks for the best care at the lowest price. Ralph gets paid about as much as Steve but his medical costs are significantly lower. Some of the extra money goes into his savings so his retirement will be considerably more comfortable than Steve's and there should be a tidy sum left over for the kids when he and his wife "kick the bucket".
The curve ball comes when Ralph notices a finger shaking at odd moments. He has it checked out and Parkinson's is confirmed. Drug development has been rapid since reform #4 took effect several years earlier and some promising new treatments are already available at reasonable cost. Ralph's doctor puts him on a regimen that controls his disease for the next ten years. The treatment qualifies as catastrophic and is covered out of his ten million coverage. He continues with his company, eventually retiring at 50 to enjoy whatever remaining years he has with his family. Drug development has continued and newer drugs make it possible for him to enjoy another fifteen years before the disease progresses to the point where he needs round-the-clock nursing care. He takes joy in his family and his grandchildren when they visit him and he continues what exercises he can in order to slow the progress of the disease. He spends his medical coverage money carefully. He dies in his sleep at age 75. There is still two million plus in the fund which his insurance company keeps but that means his disease hasn't depleted his personal or family savings. His children are surprised at the size of the inheritance he left them.
Both Steve and Ralph pay lower taxes in World One than they will in World Two because their taxes don't include subsidies for other people's medical payments or support of the huge inefficient bureaucracy that would manage a government plan and their costs for healthcare are low compared to pre-reform standards. Both are responsible employees because they know that they will have to bear the burden of their own mistakes. Over all nothing's for certain but Steve may have more fun and Ralph will likely live longer and no bureaucrat in some remote office will have a word to say about how either lives his life, at least from a medical stand point.
World Two, some people call it "World Third", signed ObamaCare into law about 5 years ago. By now most people have joined the government plan because, as it was with Medicare, you can't purchase private medical coverage because nobody offers it anymore. About twenty million people are still without coverage because they work under-the-table and don't pay taxes anyway. When they need care they drive into Canada or Mexico or seek care at one of the numerous "black market" covert medical clinics that have sprung up in garages where former medical professionals who have "dropped out" still do what they can outside the system to treat desperate people. Other black market clinics are not so professional. They are run by hucksters and scam artists who pop up and disappear just as quickly when business "dies" off only to set up elsewhere and repeat the cycle. Medical schools are graduating fewer doctors than ever before due to the well known stress and suicide rate in the profession. In an ironic twist, of the few American students who do enter the field, at least a third emigrate to the middle east to practice medicine where they have more freedom to operate and better pay.
Stupid Steve is covered, as are all the other employees in his company by ObamaCare. His medical care requires a small co-pay, a concession to the market, to try to introduce some cost consciousness to the masses. His doctor visits are frequent in this world too because he still likes his fun. The doctors all know him by name in the clinic where he's been assigned and he's become a legend in an annoying way. They clear up one STD only to have him show up with another in a few weeks. As a result his wait for appointments has been getting longer and his time in the waiting room when his day finally arrives has grown to four hours at a minimum. Steve isn't really happy with his care but he can't get anything better anywhere else and besides, it's four hours he doesn't have to be in the office. He's a little worried though because his office mate Frank, who leads a similar lifestyle, suffered a spinal cord injury in a motorcycle accident six months ago. After the accident he was quadriplegic but seemed to be slowly recovering some use of his arms. For a while it looked like Frank might recover enough to use a computer. Steve saw him regularly in rehab but after a couple of months he noticed that Frank was not getting regular therapy and was increasingly sedated each time Steve saw him. Two weeks ago Steve attended Frank's funeral. Steve remembered overhearing Frank's doctor on the phone discussing the cost of Frank's care about the time the regular therapy stopped. Since Steve needs to visit the doctor so frequently and the waits keep him out of the office for longer and longer stretches, his boss is considering letting him go.
Responsible Ralph is covered by ObamaCare too. The last time he saw a doctor he had to wait two weeks for the appointment. He almost managed to see a "garage medic" but the Obama Medical Police got there a day ahead of him and arrested the doctor and closed his garage clinic. Ralph's taxes are considerably higher here than back in World One. In fact they take more out of his paycheck than his World One taxes, catastrophic coverage premium and total medical expenses combined. As a result his salary barely covers his monthly expenses. Saving for retirement is out of the question. The ObamaCare law has immunized ObamaClinics from civil lawsuits so Ralph, whose infected toe had to be amputated after the two-week delay in seeing a doctor has no recourse for his loss. Lawyers who can no longer harvest fees from the medical field have expanded their efforts in product liability lawsuits and are suing Ralph's company. The company has filed for bankruptcy and Ralph will likely lose his job. On the bright side he still exercises regularly and will have more time for that if he loses his job. There is a question as to whether he will still be able to "eat right" with no money coming in. Ralph will continue to have his ObamaCare however so at least he's not worried about that. Unfortunately, within the three month probationary period on the new job he will land in a few weeks, he begins to exhibit the early signs of Parkinson's disease. The company goes to lengths, some of them illegal, to make sure he sees a doctor before his three month anniversary. When tests confirm he has Parkinson's the company lets him go. Tort reform is unheard of and increased FDA regulation has added to the cost of drug development. There have been no new drugs for Parkinson's in the pipeline since ObamaCare passed. Ralph's medical history is available to prospective employers and no one will hire him. In his destitute and stressed state, his disease progresses rapidly. He loses his home and is institutionalized in an extended care facility generously paid for by ObamaCare. He is routinely sedated to control his tremors and after 3 months due to an "accidental" overdose, he dies quietly. His wife and children are still at home. They've been receiving welfare payments for four of the last five years, after the savings ran out.
Steve and Ralph's taxes have risen to confiscatory levels in World Two because under ObamaCare everyone pays the same and gets the same shabby health care. The lack of incentive for prudent living hasn't caused the Ralphs of this world to live more carelessly but many of the Steves throw caution out and have as much fun as they can pack into their lives because they know they won't be living as long as their grandfathers did. As a result waiting rooms are always full, face-to-face visits with the doctor are rare and legally limited to two and a half minutes. ObamaCare is always on the verge of bankruptcy and taxes go up every year to cover the increasing costs. So many laws have been passed prohibiting many of Steve's "fun" but risky activities that he looks back with longing on Puritan times in America. The Department of Food Quality Administration Czar has issued regulations covering nearly every product on grocery store shelves. The term "Deep fried" is no longer in the lexicon.
Meanwhile Mexico is relaxing it's immigration policies because so many Americans are fleeing there, buying property and starting businesses that its economy has begun to virtually roar. The increased tax revenues finally finance a successful war on the drug cartels and they move their operations to Afghanistan which was abandoned to its own devices shortly after ObamaCare was enacted in the U.S. The rapid influx of Americans is occurring faster than government regulations can adapt and as a result the relatively free and open medical system rapidly becomes world class serving desperate Canadians and Americans who can no longer obtain treatment in their own countries.