Healthcare Reform in the US

When it comes to Healthcare in the United States, I believe the argument has less to do with the quality of care than it has to do with how to pay for it. If you truly want to compare the quality of care, you need to look at hospital survival rates, not life expectancy. Countries, such as Great Britain have a higher life expectancy because they don’t have the same level of gang and gun violence that we have in the States. These young deaths quickly hack away at life expectancy.

Great Britain is often cited as an example of where “socialized” medicine works, but as reported in the Daily Mail, Great Britain has among the lowest cancer and heart disease survival rates in the developed world. Where the U.S. has the highest cancer survival rate.

The U.S. already has Universal Healthcare. If a hospital or other healthcare institution receives any state or federal dollars (from medicare and medicaid, to tax breaks or grants) they are required by law to treat every patient that comes in the door, regardless of insurance, or even citizenship status. This is evidenced by the crisis many hospitals in our southern border and west coast states are facing financially.

The rhetoric in the debate makes it almost impossible to get a straight answer on what the bill actually provides. Complicating matters is the fact that finding the bill itself is a difficult matter, and that it is over 1000 pages makes finding specific provisions a daunting task for your average citizen to undertake.

It’s a good thing our Senators and Congressmen took the time to thoroughly study the bill, debate the provisions, and then explain it to their constituents before they passed it.

Oh! Right! I forgot. That’s exactly what they DIDN’T do. Why are the bill supporters so surprised that a majority of American voters oppose the legislation? My primary question is: if this this bill was such a critical piece of legislation, why was it rushed through with some of it’s biggest supporters saying, “…we have to pass the bill so that you can find out what is in it, away from the fog of the controversy,” (Nancy Pelosi)? Why was the minority party barred from the planning sessions? Why is the legislation purely partisan? Why wasn’t the public given an opportunity to read the bill for themselves? Why did they need to bribe representatives to support it?

If President Obama had lived up to his campaign pledge to make every piece of legislation available for review before he signed it, we would have been able to find out what was in it before it was passed, away from the political rhetoric.

Common sense dictates we read the contract before we SIGN the contract. The current Democratic representatives either lack common sense, or were motivated to ignore it. I haven’t decided which is worse.

I do not disagree that we need Healthcare INSURANCE reform. There are a number of provisions I agree with: encouraging ‘universal’ participation, preventing denial of coverage for pre-existing conditions, and dropping of coverage due to illness to name a few. I suspect the underlying goal of left-leaning citizens is to provide quality healthcare to people of all income levels, without them worrying about their own financial stability to do it. Please correct me if I am wrong in my assumption.

However, I disagree almost universally on how these issues are being handled in the existing bill. Every provision increases the role and involvement of government into increasingly private aspects of our lives.

The existing bill is…

Punitive:

• Taxing those who choose not to get insured; mostly young, healthy adults just starting their professional careers, who fall into the lower-middle class, breaking Obama’s pledge not to increase taxes on the lower and middle classes.
• Taxing businesses with 50 or more employees who do not provide insurance to their employees regardless if they can afford it or not.
• Taxing pharmaceutical companies. Companies don’t pay taxes, the customer (higher costs) and the employees (lower wages and benefits or layoffs) do so the company maintains their profit margin. If you’re trying to REDUCE medical costs, you don’t force a medical organization to have to INCREASE their prices.

Restrictive

• Insurance companies cannot charge more for patients who use more care. An equivalent example is if an automobile insurance company to take on a new customer who has an accident every few months and charge the same rate as the guy who had a 30-year clean driving record. The only way a private company can stay in business this way is to increase the rates of EVERYBODY to compensate for not being able to charge more for the accident prone customer more.
• Flexible spending plans can no longer be used to purchase over-the-counter medications and treatments. I’m sure like many people I used this benefit of FSAs to purchase necessary cleaning equipment for contacts, purchase cold medicine, and buy pain killers to try and deal with chronic pain.
• Flexible spending plan limits are being cut in half from $5,000 a year to $2,500 a year per family. While this limit doesn’t affect me personally, I can only imagine how much this will impact a family of 4 since I can easily burn through $1,000 – $1,500 on my own in any given year.

This is to say nothing on the unknown, but frequently mentioned topics of overall cost, phasing out of private insurers in favor of state-government run exchanges, rationing, and more.

There was a period in my life where I was unemployed, without insurance, and dealing with a recurring illness. This gave me an opportunity to interact with my primary care physician and a couple of medical specialists outside of the normal filter put in place by healthcare insurance companies.

A few things occurred that surprised me:

• Every one of them charged half of what they would normally charge the insurance company. The reasoning one of them explained to me was that they didn’t have to deal with the paperwork and bureaucracy that was involved with the insurance companies, saving their staff a lot of time and effort.
• My primary care physician spent nearly a half an hour with me during one visit. As the appointment continued beyond the normal 10-15 minutes, he explained to me that the insurance companies required him to spend no more than 15 minutes with any one of their patients on any given visit.
• Over the course my treatment that year, I spent about $650 out of pocket. That’s exactly how much healthcare insurance plan at $25 every two weeks would have cost me in premium alone. Not to mention the $25 co-pay for each Primary Care visit and the $40 specialist visits.

I mention this only to demonstrate that I have been on “the other side” and used the opportunity to learn more about the benefits and costs of healthcare insurance.

During the Healthcare Summit that president Obama hosted to give lip service to bipartisanship, several ideas were mentioned that I believe would be improvements over the current legislation. These ideas promote personal responsibility and limits government involvement.

• Incentivize insurance buy-in with Tax Credits (not deduction) that amounts to 50-75% of the plan’s premium rather than penalizing non-compliance. The Tax Credit allows every person to choose whether or not they want to be insured, and the freedom to choose from which insurance company they buy while retaining the affordability for low-income families.
• I know it’s a 4-letter word to many on the left side of the aisle, but Deregulation that allows insurance companies to sell policies across state lines would allow greater competition between insurance companies. This would result in increased customer service quality and more competitive premium costs.
• Portability. Policies should not be tied to your employer or the state you live in. If you were to move to a new job, even across state lines, you should be able to retain your policy.
• Tort Reform. The high cost of healthcare has a lot do with the exorbitant malpractice insurance every practitioner must buy. A review of costs associated with a recent surgery I had shows that the single greatest cost of the surgery was the fee associated with the Anesthesiologist (the actual surgeon was the lowest paid individual on the bill). This has a lot to do with the ridiculous premiums that Anesthesiologists and OB/GYN’s need to pay to keep themselves from being personally bankrupted by the ridiculous punitive damages that can awarded in court proceedings. Factored into this is the number of unnecessary tests and diagnostics that PCPs do to avoid being sued for negligence.
• Give physicians and patients greater control over which procedures and diagnostics need to be done, rather than allowing an insurance company (or worse, government) board to dictate what will, and will not be covered.
• Something the right side of the aisle hasn’t discussed is federally recognizing domestic partnerships (straight or gay) under this or any health reform legislation. Under existing tax law, organizations, such as the one I currently work for, willing to provide benefits to domestic partners must report the premiums they pay as taxable income for the employee. This is unlike married couples in which both premiums are considered tax-deductible under current law.

A dear family friend contacted me with a link to what appears to be a new favorite Facebook forward regarding the healthcare debate. The message from my friend appeared to be kismet as she was wanted to read my thoughts on the link and I’d just decided to start a blog.

Whether or not the validity of the source is accurate (a young doctor sending a letter to the White House), I couldn’t agree more the message. Much of the debate would be better served if we focused on personal responsibility and prioritizing our personal resources over relying on the government to pick up the slack. For all the arguments about making this reform to help those below the poverty line, only in Western civilization do the poor also suffer from an obesity epidemic.