Saturday, August 15, 2009

Healthcare Reform, Rounding Third and Heading Home!

Recently, The Spine Blogger published the blog, "The Commercialization of Medicine." We were encouraged by the "pro and con" comments that were elicited by our readers. It was evident that many of you believe in a "free-market" where the price of goods and services are determined by supply and demand. Just like a hot and hazy August, the healthcare debate has heated up. So the question posed to our readers is; "how do we create an affordable, good quality, and equitable healthcare system?

The fact remains that the U.S. spends over $2 trillion per year on healthcare, or $7,000 per person, or an estimated $28,000 per annum for a family of four, for that kind of money, we should be able to obtain universal coverage for those that place a tremendous financial burden on the industry (illegal aliens, uninsured and underinsured, young people, etc). So why is the system failing us, and where does this money go? Experts state that 1/3 to nearly 1/2 of our annual cost are directed at marketing, advertising, unneeded and ineffective medical procedures, management, fraud and abuse in billing practices.

So why are American's upset over reform? Is it because we like to talk about change, yet, when confronted with it we have trouble ridding ourselves of our Puritanical genome. Would it be bad for private insurance to compete with the government (read on)? Does anyone believe that the consumer would be forced to accept a different plan if they were happy with their current healthcare plan? What would happen if you had a better option? The most perplexing aspect of the on-going debate is that up until reform became the focal point for the POTUS, no one complained about government involvement in Medicare and the Veterans Administration. Wouldn't these be considered socialist programs? If its good for the government to provide healthcare for those who serve and protect this country, wouldn't it be good for us? Recently, the Treasury bailed out Wall Street to the tune of billions of dollars, wouldn't you consider this welfare for the banking industry? What happened to the uproar over the bailout? Obviously, Congress did not hold any town hall meetings! It's interesting analyzing the publics' reactions.

Just like the Obama Administration, the Bush Administration tried its hand at managing the rising cost of healthcare. The model that was proposed would be an industry in which the consumer would be responsible for buying and investing in their own services, hence the moniker Consumer Driven Healthcare. This platform included insurance based on type of coverage (high-deductible-low premium/low deductible-high premium), a medical savings account, and the freedom to choose. The premise was that in a free-market, hospitals, diagnostic centers, clinics and physicians would compete for your business based on price and quality of care. The intent was to encourage ownership in how much you spend, and what type of medical treatment you want. Physicians, diagnostic centers, hospitals and clinics would publish a price list, and the consumer would have a choice whether they would want lettuce, tomato, a pickle or ketchup. In simplistic terms, it would be like ordering a sandwich! Yet, the question must be asked, how would you, the consumer, compare price and quality? Can consumers be prudent decision makers when they have no medical education, and little information about the nature of services that they would need?

Think about the current state of healthcare. Unfortunately, the Bush model did not compel a change in the behavior by the insurance industry, it did not change a fee-for-service reimbursement system, or the confusion that lies in hospital billings and insurance reimbursements. Would a consumer driven healthcare industry be chaotic? Consumers may be able to make good decisions in choosing insurance plans, physicians, and hospitals, yet, can they be expected to act as the decision maker? We are curious to know if our readers are willing to endorse a system where you would share the risk, and assume the cost of your healthcare, or does anyone have a better idea? Could it potentially be a co-op? Single Payer? Or, do we continue going down a path that could put us into another teetering economy? Since Congress cannot agree on anything, maybe its up to the people, the Spine Blogger wants to know what you think?


  1. First and foremost we as a country have to quit providing free healthcare (as well as education) for illegal aliens. I know this seems to upset people like we are cruel or unkind, however this is a huge burden on our system and resources as well as an incentive which encourages people to break the law. How is this different than mandating that if someone is robbing your house and they are hungry that you have to feed them prior to them leaving?

    Next if you are to have a "true" free market you cannot not have the situation in which entities have to compete with government funded entities when the government is influenced by the lobbyists and is regulating bias. Case in point as manufactures, distributors and sales reps we are no longer allowed to provide doctors something as simple as an ink pen yet alone a bottle of wine worth over $50 as it might "influence" their decision. And yet hospital and pharma lobbies spend millions wining and dining, flying congressmen and representatives to high dollar resorts on private planes specifically to "influence " legislation. A perfect example of this is that if a hospital waives a copay to a medicare patient it is considered charity and I believe is even deductible. If a physician waives a $10 medicare copay it is considered an inducement and is punishable by a $10,000 fine, possible imprisonment or loss of license. Regulations such as this make it extremely difficult if not impossible to compete.

    Next you have to have true transparency in the actual costs of providing care. With the current system the hospitals can file for and receive a disproportionate payment at the end of the year from the government for providing government services such as medicare and medicaid if they lose money. This actually encourages them to show a "loss" on every procedure and they do this very well.

    As for the price list idea why should it even be published? A consumer should be able to negotiate for care just as anything else they buy. And yes I believe the consumer is educated enough to do this. Just because they negotiate for their care would not change that all doctors carry licensure, that hospitals or surgery centers would still have to meet the same JACHO accreditation. The fact that there is competition should not bring down the quality it should raise it.

    Americans aren't against true reform they are scared of (and hopefully fed up with) plans which are mandated by people that have no intentions of participating in them. We would do well to go back to the basic premise of the constitution where it states people will leave their homes farms and businesses and go to Washington to enact laws in which they come home and live by.

    Again these are just my thoughts and humble opinions.

    Thanks for the blog to express them.

  2. I could not have said it better. There should be term limits on senators and representatives. This is brief public service and not a long term career. Congress should have the same healthcare as the public. They should get rid of their ridiculous pensions. The lobbyist should be shown the door, for good
    this would help to fix our broken government