Wednesday, September 2, 2009

Healthcare and the AAOS, Where Are We Going?

As we approach the home stretch of another beautiful summer, hopefully Congress has re-energized its batteries and read all of the pages of the Healthcare Reform Bill that will dominate the halls of the Capitol this fall. Depending on the architecture of the Bill, the future of our industry and this country lies in the hands of a divided government and its citizens. Not only will this division exact a toll on our lives and careers, it will affect our children and grandchildren's future standard of care. Fortunately, the Spine Blogger does not have to attempt to use scare tactics to persuade its readers that some change needs to be made as major financial fissures have exhibited themselves in the U.S. Healthcare System much longer than we would like to admit. The last three to four weeks has been pictures at an exhibition in mediocrity by both parties. The Democrats fumbling over their inability to convey a Healthcare Reform Bill in simplistic and concise terms, the Republicans behaving like the bogeyman telling grandma and grandpa that they will be put to death (I've already notified grandma that I won't let the government take her). America is a great country, reactionary as it may be, as long as it doesn't ask its people and the medical industrial complex to have to make a sacrifice.

Let us look at healthcare in the U.S. Over the past eight years we have seen an attempt to pass on the cost of medical care to the consumer. The objective was to have consumers make prudent, educated and cost-efficient decisions about their healthcare. People would take ownership. Employers loved it because this platform would offer high-deductible/low premium policies, health savings accounts, therefore, shifting a greater portion of medical bills to the patient, and attempting to create a publicly accessible database that would help patients make their own decisions ( I don't believe this ever materialized). But what this plan failed to address was the behavior of the insurance industry, fee-for-service payment to physicians, the ongoing confusion over hospital reimbursements, nor did it mandate a change in the way healthcare is organized and delivered.

The fact remains that the greatest percentage of healthcare expenditures in the U.S. is for serious diseases. The sickest 10% of the population accounts for about 70-75% of all healthcare expenditures. I am not sure what percentage of that figure includes illegal immigrants (illegals will not be covered under the proposed plan), young people electing not to be insured or underinsured, and those eligible for Medicare. However, there has been a tradeoff. New developments in technology, the increasing number of specialists, the high fees paid for new procedures, and intense market competition to increase revenues for those in the medical industrial complex contribute to the ever rising incentive to provide expensive healthcare. Consumer Driven Healthcare is utopian, yet, what happens if the consumer is seriously injured? I will argue that I have never met a prudent shopper in the emergency room. Usually I have heard, "God, don't let me die!"

Do our readers believe that we can create a price-sensitive and consumer driven industry that would result in competitive pricing? Is health-care another consumer driven business? Does the asymmetrical relationship between healthcare providers and consumers allow for ordinary free-market forces to occur? Should the public be made solely responsible for managing the cost of his or her healthcare? What happens if you lose your job? What kind of information would you need to make potential life threatening decisions? Will pay for performance work? Life or death decisions are always better left to the individual and their physician, yet, has Consumer Driven Healthcare really worked? This commentary does not mean that I believe government should have any say in making a final decision on your life.

So what can we do to make the system efficient. Let's start with a single payer system. I can hear the uproar! This would eliminate the confusion that exists between doctor and insurance company, patient and doctor, hospital and insurance company when it comes down to reimbursement. This would have to be built around a central reimbursement entity. If you believe in the free-market, why shouldn't those who cannot afford insurance have the option to purchase some form of reasonably priced, publicly funded insurance, that would also be available to people that lose their job, have no insurance and become terminally ill (I think it would be called Catastrophic Healthcare, duh)? Has anyone had to pay for COBRA? The cost is criminal! Do you really care that the government would be the gatekeeper for the uninsured or underinsured. As long as you have the option to keep your existing plan, how does this effect your liberties as an American? Besides, if we believe in freedom of choice, who are we to tell those that cannot afford healthcare coverage what is right for them? Is it because we are so arrogant to believe that we know what is best for others? Why can't we overhaul the system? Is it because we are truly afraid of change (remember my comparison to our Puritanical ancestors in a previous blog)? Let's face it, we have failed in an attempt to modify our healthcare system incrementally, it hasn't worked. Most of the previous programs have either increased the cost of delivery, reduced coverage, or reduced the quality of healthcare (read on). As much as we love to deny the facts, whenever the uninsured seek medical care in the emergency room, a tremendous financial burden is place on the current payers into the system in the form of higher costs.

Major reform will require a rational discussion with all parties involved to understand the basic problems with the current healthcare system. Yet, we continue to see hard working, good Americans ranting and raving without knowing the facts. Recently, the AAOS responded to the ongoing healthcare debate as a result of inaccurate remarks that were made by the POTUS. Sometimes its better to leave some things unsaid! The Academy had every right to deliver a response to what is wrong with healthcare, constructive as those remarks were, here are some observations. HIGH ADMINISTRATIVE COST is a by product of the insurance industry taking an estimated 10%-25% off the top for profits, the only remedy for senseless litigation is TORT REFORM, and will that ever happen, an INCREASING SHIFT IN CHRONIC DISEASES is a result of the "bigger is better" mentality that pervades Americans diets, as well as their lifestyles, no need to elaborate on the SHIFTING COST of the uninsured to those of us that are insured because the cost is passed on to us,, and lastly UNNECESSARY PATIENT CARE. My question to the Academy would be, who should share the responsibility of policing unnecessary patient care, the consumer, physician, or the insurance company? Generalities are wonderful, but where's the beef? Who becomes the gatekeeper?

The Academy's position on what policy makers should consider follows; shift responsibility on control of spending dollars to consumers. Hasn't this concept been experimented with and been shown to have flaws? Ensure unencumbered access to specialty care (isn't that what PPO's offer). What does that mean? Make healthcare coverage more affordable. Who is going to absorb the cost, and what does affordability mean? Improve the quality of Care. Basically, the Academy is admitting that the standard of care is "sub-standard" by making that recommendation. If the physician is the gatekeeper, how do you measure quality? Extend coverage to the uninsured (who absorbs the cost) and the underinsured? Where does this money come from? The Chinese? The US Taxpayers? Avoid new unsustainable programs. What does that mean? That sounds quite nebulous. If the current programs aren't working, should we sit back and watch Rome burn?

As heated as the debate has become, all complicit parties do not offer any remedy. They offer a diagnosis. Let's face it, if the U.S. Healthcare System was a patient, right now the patient is on life support and the we cannot find anyone that can agree on the modality of treatment. The Spine Blogger wants to know what its readers think!

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