Tuesday, October 13, 2009

Why "Universal Health Care" Won't Work

We're hearing a lot of inflamed rhetoric about health care right now. Some people are talking about "death panels," while others are talking about people dying because they can't afford health insurance. There's enough political strife to go around without me adding to it, and I know I've said several things about health care in the past few years, but maybe I can clarify my thoughts a little more with one statement:

The best thing we could do to improve health care in this country right now would be to cancel our insurance.

I know it's radical, but probably necessary. I know it won't happen, but it should. The very worst thing we can do right now is increase the amount of insurance available, or guarantee everyone health insurance. How do I dare make such a statement?

  • Health insurance raises health care costs. One friend of mine remembers going to the hospital emergency room with a broken leg. After the doctor had set the leg and put the cast on it, they were being checked out. The doctor was in the background as his secretary got the bill ready. "Who is your insurance provider?" she asked. His father told her they had no insurance and were going to pay in cash. Immediately, the doctor turned around and told her to rewrite the bill, that it was too high for someone paying out of his pocket. Do I really need to say more? I can. I once had a policy that paid up to $200 for emergency room fees. One night we had to take our son to the emergency room. I saw the sign -- in English and Spanish -- that stated that the Emergency Room fee was $200. I was thankful that it was covered. When I received the bill (seven months later, but that's another story), I noted that our insurance had paid $200 of the $450 that we were actually billed. I was left owing fifty dollars more for the emergency room than I would have owed if I had not had insurance. I now refuse to give any insurance information out until the bill is presented. A doctor's visit in our local town has dropped from the $75 they charge for usual "covered" visits to the $60 I pay by saying I have no insurance. What will happen if we all get insurance, and more coverage? I think you know.

  • Health insurance encourages corruption. Have you ever been "double-billed?" I have, and I don't think I'm unique. There are two ways to "double bill." One is merely to bill a large insurance company twice. Private insurance companies are a little greedier, and will try not to pay the extra, but they often miss it; on the other hand, government agencies run on the "there's always more where that came from" philosophy, and seldom check the double billing. It is a routine practice to bill Medicare and Medicaid a horrendous amount, and then some. For some reason, Uncle Sam does not mind paying 50 bucks for a Tylenol. He may think it's a bargain after paying 600 dollars for a hammer. There is, however, another way to "double bill." At a time when I had great medical coverage in the 80's, before the horrible inflation of medical prices, our son was born at a local hospital. We turned in our insurance info, and a day later, took home our new son. A month later, I was presented with a full bill from the hospital for the entire process, due upon receipt. I immediately called our insurance company, thinking they hadn't paid, and they offered to mail me all the records of payment. Two days later, I presented these records to the hospital, and their response was, "we will clear the bill." They had billed the the full amount after the insurance company had paid them. There was no remorse, no apology. I got the impression it was just business as usual.

  • The "airline syndrome." Once, flying on an airplane was like taking a luxury cruise. Of course, it cost what a luxury cruise costs as well. There were DC-3's that had been equipped with "sleeping berths," and well-to-do travelers could retire for bed after takeoff in New York and wake up to a bright morning in Los Angeles. As airlines sought to get more passengers, seats were moved closer together, costs were cut, and today riding on a commerical flight is not unlike boarding a cattle car to go to the slaughter house. Health care for all increases the work load of clinics and hospitals. When we are paying for health care, we are looking for bargains, and we debate whether we really need to go to the doctor to stitch a wound or just to bandage it and let it heal naturally. When we have paid the "big bucks" for our health insurance, we see it as our "right" to go to the emergency room for a hangnail or a sore throat. Cost is not a factor. Insurance has made the "private room" the standard for all Americans. We are overcrowding the hospitals and clinics in our communities. Add to this that the big money from government-funded health care has led to more government regulations, and hospitals and clinics that don't "measure up" have had to close. A generation ago, every town of 1000 or more -- and some with less -- had at least a local clinic and a family doctor. Now, there are cities of 25,000 and more who are losing their health care facilities. Specialization, created by government regulations, has depleted the capacity of the local clinic to treat all illnesses, and most people who visit a small hospital in a semi-rural town will end up in a metropolitan medical center at some time. Universal health care means more government requisites and regulations, and with it, the loss of more hospitals. Our emergency rooms are overcrowded and understaffed now, and it will only get worse.

  • I speak with the experience of someone who has lived in two countries with "universal health care." I have sat up all night with someone who was waiting to be attended. I have watched the long, wearying search for his documents, and I have seen the increasing pain as he waited through the night for his "number." I have sat in an emergency room -- not the waiting room but the actual emergency room -- and watched someone die on the gurney while waiting for a doctor. I saw the doctor arrive later and inject something into the dead man's heart because it had already been prescribed. He had to remove the sheet from the man to do this, and then he replaced it immediately afterward. But he did get paid for the administration of the medicine. In those countries, I, as an American, had access to more money than the locals. When my family needed attention, I could go down the street to a private clinic and pay the higher costs. I got immediate attention and quality service. Why? Because in that country I was rich. Universal health care does the same in all countries: it marginalizes the poor, and insulates the rich. I find it ironic that so many people want to have health insurance "to help the poor." Nothing hurts them more.

If we really want to improve the quality of health care in our country, the last thing we need to do is throw money at the system. Health care needs to be put into the realm of supply and demand. Local clinics need to be opened.

If the government really wants to help, we should use government funds to restore medical care centers to the communities in our country who have lost them due to federal regulation and medical specialization. We should offer incentives to those who study to be general practitioners, and give aid to restore OB/Gyn work to local communities. It is not uncommon for a woman in labor to have to suffer an hour or longer drive now to deliver a baby. If the government wants to help, health care funds should be given to develop more hospitals and train more doctors.

Medical firms and pharmaceutical companies should be freed to do more of their own research and development without the oppressive paperwork. If Pasteur had worked in this country in the 21st century, we would have never had any of the advances in medicine that he gave us. The ones he actually achieved would still be tied up in testing and waiting approval by some government bureaucracy.

If we really want to improve the quality of health care, hospitals and medical billing should be "called to account." If the federal government needs something to "regulate," try hospital billing. How ironic that we have to walk past so much new construction to enter a hospital that tells us how "broke" they are.

  • Hospitals should be responsible for in-house billing, and it should be immediate. Customers should be advised up front of billing practices.
  • Billing should be unified and itemized. No patient should ever be billed by a doctor they don't know from a city they've never visited, but it happens every day.
  • Bills should be sent to patients before they are sent to insurance companies, and insurance companies should work with their customers before any money is paid to medical institutions or practitioners.
  • No bill should be valid that is issued for the first time over a month after treatment. In other words, hospitals should be held to the same rules of accounting, honesty, and forthrightness that the businesses on main street observe.

It should be possible for anyone to pay a medical bill without being bereft of years of hard-earned money. Insurance was introduced as a luxury and a favor to those who wished to use it. It was never intended to be a "cover all" for all health care. That's why the best radical treatment for our "health care crisis" would be for all Americans to cancel their insurance policies tomorrow -- or today. The prices would float to fair market value, and an aspirin tablet would not cost 30 dollars.

I know it's a crazy idea. I admit it's crazy and reckless. But it's a better idea than I'm hearing from Washington right now. Attempting to remedy the health care crisis by throwing more money at it is like attempting to cure a cold by blowing your nose.

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