Healthcare Soundoff. Tracking Today's Vital Issues.

Our "Take" on Healthcare Reform! (1/2/2009)

Independent studies all agree that healthcare costs will rise 10% in 2009.  One study shows that 82% of Americans want significant changes in the healthcare system.  Recently Healthcare Soundoff had the privilege of attending one of 8500 “Community Discussions” sponsored by the Dulles Chamber of Commerce and organized by the Obama-Biden Transition Project targeting healthcare reform.

The new administration is soliciting views and answers to key questions about the healthcare system and reform.  The attendees at the Dulles Chamber of Commerce meeting were educated about healthcare, well informed, and representative mostly of small business.  What struck Healthcare Soundoff was the divergence of views of the participants.  About 20 people attended and as many different views of the current system were put forward.  Each attendee had a different “take” on what direction the new administration should proceed.

Here are some of the major issues that Healthcare Soundoff heard and our interpretation of agreement among the group:

·         Healthcare is a “right.”  Therefore every legal resident of the United States should have access to affordable healthcare.

·         The current healthcare system is “dysfunctional.”  It encourages behavior that increases costs without improving the overall health of the community.

·         The existing employer financed healthcare system (180 million employees) no longer works.

·         The United States currently spends approximately twice the amount for healthcare than in most other industrialized nations.

·         No one, not policy makers, Medicare, doctors, patients or health insurers really knows what healthcare really costs (we refrain here from using the word transparency since most consumers do not know what it means).

·         The current economic climate will discourage business growth if healthcare costs remain as high as they are.

The view of Healthcare Soundoff is that we need reform that forces “behavior change” yet has a simplicity that makes sense in terms of medical care and costs.  If you look at our previous postings you know we believe the major behavior in the healthcare system is that everyone in the system thinks they are spending “other people’s money.”  If that behavior is altered healthcare reform will work.

The economy is putting pressure on all of us and the government has committed to stimulate by spending more.  If more is spent on reforming healthcare the impact on business will be positive and the impact on taxpayer “behavior” could be substantial.

David Brooks in a New York Times column stated it succinctly, “People don’t change when they see the light. They change when they feel the heat.”   Much like Thomas Friedman on the energy crisis, Healthcare Soundoff proposes we turn up the heat.

Here is our proposal:

1. Remove physicians from the current health insurance system.  Eliminate the current HCFA 1500 billing system and let them bill on their own directly to the patient.
2. Raise deductibles for institutional healthcare services to at least $3,500 and comprehensively cover catastrophic costs so we don’t hear stories as depicted by Michael Moore in the movie “Sicko.”  Mandate a national catastrophic healthcare coverage that all insurance policies must have so there are no surprises for people who get sick and find out there is no benefits.
3. Remove diagnostic tests from the current healthcare system.  Let them compete in the market based upon supply and demand.  A recent study by McKinsey shows we spend an extra $678 billion dollars on physicians, CT scans, and MRIs which produce no improvement in our health.
4. Issue a refundable tax credit to everyone of approximately $2,500 that can only be claimed if the person undergoes a comprehensive annual physical along with appropriate lab tests and associated predictive modeling.  Essentially force each consumer to spend approximately $350 of the tax credit to interface with a physician regarding their health and the steps needed to improve that health.
5. Allow Medicare to negotiate prescription drug prices.  We now pay 50% more than industrialized nations for drugs and our major purchaser has no buying power.
6. Require every healthcare provider to create a web site that clearly informs the public what they accept for performing each service they provide.

There are many details that we will comment on in coming columns.  Healthcare Soundoff believes this proposal attacks the major behavior changes needed in the system. 

Doctors are the central focus of our plan.  Nothing happens in the healthcare system unless a doctor acts.  The doctor either performs a service or orders a service.  In order for “behavior” to change we need to first change the behavior of the Doctor.  By forcing the Doctor to relate economically with the patient, rather than just spending someone else’s money as they do now, doctors will create a better overall relationship with patients.  Consequently they will come up with innovative ways to have that relationship succeed in terms of both health and economics.

We realize the political realities favor tinkering with the current health financing system.  All players in the system, because of the way they are regulated either through the CPT/ICD code mechanism, state insurance regulations, or pharmaceutical patents are basically happy and like the status quo.  We need to find somewhere to turn up the heat.

We propose attacking the basic lever in the system, the role of the physician and force behavior change through that role. 

Questions From Barack! (1/2/2009)

Healthcare Soundoff  wonders if the Obama-Biden Transition Team really “gets it” when it comes to healthcare reform.  Their “Participant Guide for Health Care Community Discussions” asks 7 questions that seem to avoid the tough issues on the one hand or deal with issues that are not relevant on the other hand.  See what you think.  Here are the 7 questions (paraphrased slightly) and our comments.

1. Briefly, from your own experience, what do you perceive is the biggest problem in the health system?  Our experience is that this question gets as many answers as there are people answering.  The problem with the “system” is that the “system” itself does not work other than to perpetuate routinely high costs and no personal responsibility on the part of consumers and providers. A new “system” is needed.
2. How do you choose a doctor or hospital?  What are your sources of information? How should public policy promote quality health care providers?  What is the relevance of these questions to healthcare reform?  Quality is a subjective standard for most of us.  Perhaps the better question for us is “do we perceive we are getting value from the healthcare system?”  Although all of us have different antennas when it comes to “value,” most of us are competent to measure it from our experiences.  Our routine answer to the “value” question a is a resounding “no!”  We want a different “system.”
3. Have you or your family members ever experienced difficulty paying medical bills? What do you think policy makers can do to address this problem?  Anyone with high medical bills has experienced difficulty paying them.  Look at the personal bankruptcies filed and you will see that 50% stem from high medical bills.  Policy makers know what to do.  They can’t get away from the special interests to solve the problem.  First, do not let providers send bills for “charges” to non-insured patients.  Limit those bills to the lowest reimbursement rates received.
4. In addition to employer based coverage, would you like the option to purchase a private plan through an insurance-exchange or a public plan like Medicare? Stupid question. We all would like as many cost effective options as possible to see what fits best within our own budget.  Stupid direction. We cannot merely extend the current insurance “system” to provide more options.  The “system” itself is broken and added options will just add more chaos.
5. Do you know how much you or your employer pays for health insurance?  What should an employer’s role be in a reformed health system? This is the most important question asked.  Most people do not know what the employer pays.  And most people do not care, so long as when they get health services they are only paying a co-pay and minimal co-insurance.  We have harped on the “other people’s money” syndrome for over two years now.  If it is not addressed within a “system” change healthcare reform will not happen.
6. Certain types of preventive services are necessary such as screening mammography, flu shots, and cholesterol screening.  Do you get the preventive services you need?  How can public policy help?  Public policy should force us to use benefits for preventive screening either directly or through the tax system to reward us for using the preventive services.
7. How can public policy promote healthier lifestyles?  Public policy can encourage a useful exchange between doctor and patient.  Health lifestyles are an individual choice.  If individuals do things that negatively impact the rest of us (smoking in public places) public policy should step in, otherwise encourage physicians to be more interactive with their patients.

OK, what is your opinion?  We will be following the course of healthcare reform and continue to comment.  We hope you will comment as well.