Prez Obama's NYT Op-Ed 08-16-2009

President Obama wrote an Op-Ed for the New York Times about the need for Health Reform. Which, to me, doesn't say a whole lot. There wasn't anything new in it. It was kinda like listening to the old Charlie Brown cartoon adults that sound like waa-waa'd french horns as heard by the Peanuts children. The Op-Ed can be found easily by going to:

http://tr.im/wuRt

We all know we need some kind of health care reform. We all agree on that. The big thing is how much the U.S. Gov't needs to be involved in the health care process. Near the top of the Op-Ed is four paragraphs that is the summary of why health care needs reformed. They read like this:

1. First, if you don’t have health insurance, you will have a choice of high-quality, affordable coverage for yourself and your family — coverage that will stay with you whether you move, change your job or lose your job.

[kinda sounds like the federal law for 'Cobra' to extend benefits beyond employment (for an extra fee).. partly. I've always thought that the Cobra exectution was a little expensive, it's meant to keep the gap of health insurance filled until the next job is found to get covered by the next job's group health.]


2. Second, reform will finally bring skyrocketing health care costs under control, which will mean real savings for families, businesses and our government. We’ll cut hundreds of billions of dollars in waste and inefficiency in federal health programs like Medicare and Medicaid and in unwarranted subsidies to insurance companies that do nothing to improve care and everything to improve their profits.

[waste an inefficiency ... well, when it comes to waste and inefficiency, the gov't seems to be a real expert at over spending, over wasting, and over inefficiency. I'd center the discovery and repair of waste and inefficiency centered around Medicare/Medicaid fraud. Get those dollars back first before anything else is done.]


3. Third, by making Medicare more efficient, we’ll be able to ensure that more tax dollars go directly to caring for seniors instead of enriching insurance companies. This will not only help provide today’s seniors with the benefits they’ve been promised; it will also ensure the long-term health of Medicare for tomorrow’s seniors. And our reforms will also reduce the amount our seniors pay for their prescription drugs.

[heh, heh, heh.. to me this says... all the money wasted .. we still need to spend! By making money more efficient, it justifies spending more at the level of gov't.]


4. Lastly, reform will provide every American with some basic consumer protections that will finally hold insurance companies accountable. A 2007 national survey actually shows that insurance companies discriminated against more than 12 million Americans in the previous three years because they had a pre-existing illness or condition. The companies either refused to cover the person, refused to cover a specific illness or condition or charged a higher premium.

[yeah.. health care/insurance should be as easy to buy as it is to get car insurance. Heck, I can get car insurance from AAA, AARP, The Hartford, Progressive, Online, Offline, in an office, off the street, etc. I can buy car, home, truck, boat, renters insurance from a lizzard. Why can't is this not available to me for health care/insurance?]

To me, points #2 & #3, should be something that should be re-engineered anyway for existing programs. That should be a no brainer. Companies that are in business are challenged constantly as to how to make more and more profit by making things more efficient by reducing waste. Gov't has no incentive to make things more efficient to reduce waste. There seems to be a notion, in the gov't ranks, that the money they spend is the gov'ts money. No... it's not, it's the people's money. It's the people that fund the gov't. The only gov't product that is sold to the people is US Postage Stamps.

The fine-tuning of Medicare/Medicaid should be an ongoing process. It shouldn't take (at least I don't imagine it should) a move of the US Congress to change the rules/regulations to tighten the efficiencies of these programs. Medicare is a Fed Gov't program... there should be a CEO (or equivalent) of Medicare that can make these kinds of decisions. Medicaid is a different beast. It's a blend of Fed, State, and Local gov't monies to get different things done. I'm not exactly sure where the different sandbox lines are drawn that enumerate where the different sandboxes lie.

As far as #1 and #4 goes, I think that health care insurance/plans should be more accessible by anybody wanting it. The insurance companies, because they are motivated by profit, have to receive enough in premiums in order to make money so that they can keep their employees paid and not have to reduce their work force. I've already written about 'obscene profits' in an earlier blog posting. So I'll not write about it again. The 'real honest thinking' blog had a very good article about 'Health Insurance Company Profits' at: http://tr.im/wuWs that is a must read for anyone wanting to learn more about that and to get a little bit of education about the difference between *profit* and *profit margins*.

I think that ultimately, when we talk about guaranteeing health insurance / health care to anyone, there are really two issues. Is health care a right? Are people guaranteed a fundamental right to health care? If yes, then that'd mean that regardless of condition, because health care is administered by one person serving the next, then to say that health care is a *right* that'd say that the serving health care providers have no choice to sacrifice/use their time to serving others. It'd be a mandate to enslave the health care providers in the health care profession to do what they do. They wouldn't have the privilege to say NO because health care is a right and not a privilege. So, no... Health Care isn't a right. It's a privilege.

Since health care isn't a right (everybody gets it regardless of health), the next thing is cost of health care so that when it's obtained, a premium price isn't paid to obtain it. What are the things that drives up the cost of health care at the doctor's office level? Well, let's list a few: malpractice insurance, malpractice litigation, employee payroll and benefits, rent on building, utilities, laboratory equipment and testing, drugs, medical equipment, medical supplies, office supplies, and maybe a few other things. Of these things, several of these items are fairly constant and can be about the same kind of charges each month to the doctor's office/clinic. The ones that aren't about the same from month to month is malpractice insurance costs, malpractice litigation, medical equipment, medical supplies, and to a certain extent laboratory equipment and testing. All of these amounts are items that potentially get more expensive as time goes (especially for the things related to increases in technology) and we can't change that. People live longer now because of the medical advances brought through technological increases (which is also increases in good pharmaceuticals too). Some of the more elaborate pieces of equipment of technology used in doctors offices is directly related to the needs to keep malpractice costs low. Order extra tests, so the Dr can CHA (cover his/her ass), so that malpractice can't be levied to a Dr/Clinic. The tests cost money to provide CHA services. The suit-happy public, that sees a Dr/Clinic as source of income, then brings a lawsuit to bring their payday to them.

So, it comes back to the lawsuit happy public. For the Dr's that are trying to do the right thing and trying to provide a good and honorable service to the community, they should be able to stay in business and their business not cost an arm and a leg, plus a few more arms and legs, plus more body parts of more people than should cost to be reasonable. For the Dr/Clinic's that are in it soley to see how much $$$ they can rake in, and are only marginal at their health care (like Dr Frank Burns of M*A*S*H) they probably should be raked over the coals. But, instead of persecuting them at the legal level, let their review happen at a medical board level which also has the teeth to take assets of the business away. Keep it out of the courts.

For the lawsuit happy public... well... I say let's get the tort (tort is a system for compensating wrongs and harm done by one party to another's person, property or other protected interests (e.g. reputation, under libel and slander laws) system reformed. Instead of a person/patient being rewarded $1.5 million for *whatever* (which is also the also all the stupid lawsuits that result in all of the warning stickers placed on product... like hot liquids can burn from a coffee cup, cruise control isn't auto-pilot in Winnebago's, etc), they definitely should receive less. Everytime that someone is paid millions of dollars in a malpractice claim of wrong doing, or hot liquid spilled in a lap, or a Winnebago crashed because they set it to cruis-control and then walked to the back to make lunch (in a moving vehicle), the company that pays out .. will eventually have to charge more from existing customers to get the money back. The small person, will always end up paying the costs of the uber wrong they is brought to the legal system. It also doesn't help that the legal fees collected by the lawyers that bring the wrongful/harmful claim is usually around 33% of the amount collected from the wining lawsuit. So, if someone is wrongfully *burned* in their lap from hot coffee, and the court awards the plaintiff $1.5 million, then the winning lawyer/law firm gets a cool $500,000. That's just once a big award is declared in court. Now multiply that times the thousands and thousands of times it's happened, and you have a lot of lawyers are incented to find the different injuries and malpractices happening all around them. Ever hear of the term .. Ambulance Chaser? Well, this is the modern version of ambulance chasing.

Technology.. will march on. As it marches, it'll get more expensive. Wrongful suits, don't need to happen at the rate it happens now. Take the incentive away from these mega dollar lawsuits and health care costs will go down.