Healthcare – Define the Problem

In my earlier post asking for suggestions, I quoted noted Writer and Editor, Dorothea Brande who once penned,

“A problem clearly stated is a problem half solved.”

This will be my attempt to Define the Problem.  This is my opinion and I would like to hear yours.

First, I believe that the Goal of the broader

Medical Community should be to optimize the human potential of the community by supporting the health of the community.

Next, I think that the Objectives of the broader Medical Community should be to: 1.  Help patients prevent injury and ailment;  2.  Diagnose injuries and ailments;  3.  Provide care to bring injured or ailing patients back to health and/or to help them lessen the pain and suffering that accompanies their injury or ailment.  These three objectives must be met within a budget that provides funding sufficient to ensure the health and stability of the Broader Medical Community, while conserving enough to not be a burden on the community.

Our Healthcare System (broadly speaking) is inefficient at preventing illness and injury since there is more motivation (money) to fix what is broken, than to prevent the breakage.  Consider the difficulty of keeping a patient on a high calcium diet as opposed to the ease of mending a broken arm.  One requires patience and large numbers of small, inexpensive interventions (pills or diet).  The other requires one quick, expensive intervention (reset and imobilize) with a less expensive followup.  So, in my view, issue number one is that we need to find a way to increase the emphasis on prevention of health problems over the current emphasis which is focussed on curing problems that exist.  Though, as I stated in my earlier post, this is not the most commonly voiced problem, I believe it is problem #1.

Our current system supports both the Goal and the Objectives (above) but not to the extent that many people, including many politicians, want.  Those who rail against our current healthcare system site as the prime evidence that the system is broken is the fact (highly questionable) that 42 million Americans are without healthcare.  First, it is just plain untrue that 42 million Americans can’t afford or get healthcare insurance, as Mr. Obama and Mr. McCain claimed.  It is estimated that at least 10 million of that number are ‘undocumented aliens.’  Another 8 million are people who make over $75,000 annually and choose to spend their funds elsewhere.  You might also add in yet another 7-8 million who earn over $50,000 and are not covered.  The fact is that everyone in the country who presents himself to an emergency room will receive health care.  So, in fact, everyone is covered.  So, in my view, Issue #2 is increasing the ease of access to and efficiency of delivery of healthcare.  To many, that means ‘universal healthcare.’  Many say this is a right.  My concern is that those who feel this is a right have no understanding of the costs to society for giving something at a cost to the entire society without requiring people to earn that right.  For example, should illegally entering the United States give you the right to access to our healthcare system at no direct cost?  Should free public healthcare be given to the person who makes a good living and who owns a boat (for recreation) paid for with the $800 a month he saves by not buying health insurance?  These and other questions lead me to believe that the only thing that we should consider as universal about healthcare is that we have enough facilities, enough doctors and nurses, and enough insurance options to allow people to choose how much they want to buy.  I believe that when catastrophic care insurance becomes available to all, the decision will be in the hands of the people.  Access will be available to the vast majority of our population and lack of access will be due to choice, as it is for most Americans today.

Next, is the problem of cost.  Our President and many members of Congress tell us that  ’Healthcare costs are bankrupting our small businesses and many big ones as well’.  My view is that there are many components to the cost of healthcare and there is plenty of blame to go around for its rapidly increasing cost.  Plaintiff’s attorneys are blamed for driving up the cost of medical malpractice insurance which in turn increases the cost for medical professionals to provide services.  Are we not to blame for voting down numerous proposals to limit liability?  What about the cost of hospitals to serve anyone who walks in the door, whether insured or not.  The more uninsured patients, the more the ‘emergency room healthcare system’ increases the costs to those who pay for our healthcare.  What about Medicare and Medicaid?  Both pay far less for treatment of their patients than the cost to the providers.  To balance losses to Medicare and Medicaid, Medical Professionals and Hospitals must charge more to their regular paying customers.  Now Mr. Obama and Congress seem to want us to rely more on Medicare and Medicaid since they are so ‘efficient.’  That will only lead those who pay for their health insurance to pay more to cover the provider’s losses to the government plans.  There is also the problem of medical records and the paperwork associated with medical treatment.  The cost of the paperwork and procedures required by government to comply with medical record keeping guidelines is another huge and growing cost of medical care that must be addressed.  Many will argue, and I would be one, that if we could spend less time complying with government mandates and paperwork, we could significantly improve care and lower cost of care.  There is little coordination of care facilities.  As long as there are sufficient facilities to effectively treat patients in a timely manner, why should every Hospital have MRI capabilities?  Why

Issue number four is Government mandates for insurance coverage.  This is primarily a problem with State government mandates, but looks to be a very significant problem with a proposed government run healthcare system.  Every time a government agency requires a health insurer to meet some new mandate, it drives up the cost for all those who do not fit the criteria of the mandate.  For example, if a government mandates a sex change operation be covered by an insurance plan if it offers infertility treatments in its coverage, up goes the price.  Or the insurance company must drop the infertility treatment coverage.  Either way, the cost goes up or the care goes down.  If a state should mandate smoking cessation drug treatments be covered, that raises the cost for everyone, smokers and non-smokers alike.  Why is mandating that treatment better than offering an optional policy to those who want it and are willing to pay for it?

The next issue is the quality of our healthcare. This is an argument often made by those who want us to emulate European Socialized Medicine Systems.  Rarely do proponents of such a plan acknowledge that timeliness of delivery of health services is key to quality and not something for the socialized systems to brag about.

Simple Catastrophic care Insurance coverage is not available on a large scale. This is partially due to mandated coverage.  If all those who were medically qualified could get $10,000 (or some similarly high amount) deductible catastrophic care coverage, I think most young people who opt out of insurance due to the cost, would opt back in.  This would add to the pool of funds and take much pressure off of the “free emergency room and ‘almost free’ Medicare that now cover large numbers in our population.

Portability of Insurance is my last problem area.  Since much of the population is covered by insurance plans provided through places of employment, people often lose coverage when they lose their job.

SO THIS IS MY STATEMENT OF THE PROBLEM:

1.  Our System Lacks an Emphasis on Prevention;

2.  Access to and Delivery of Health Services can both be Improved;

3.  Costs Need to be Contained and Cost Drivers Eliminated;

4.  There are Too Many Government Mandates;

5.  Quality of Care Varies and our System Lacks Easily Understood (by patients) Standards for Outcomes;

6.  We need Simple, Low-cost, High-deductible Catostrophic Care Insurance as an Option;

7.  We need the Option of Portability of Healthcare Insurance.

To solve this problem without creating new problems (increasing expensive, non-responsive bureaucracies, making care less personal, etc.) is the challenge we face.  With Congress and the President seemingly intent upon a system based on Government Control of health care, I am not optimistic that their solution will achieve the needed results.  We should be discussing this problem, not just trying to craft a fix that will put government agencies in control.

We have wonderful examples of successful systems (Grand Junction, Colorado, the Woodland Clinic, Kaiser Permanente Health Plan, the Mayo Clinic, etc.) that have been made less efficient by Government Mandates and limitless medical malpractice liability.  Why don’t we look at these systems rather than trying to build on the failing Medicare model?  I think the answer to that question is, “Politics.”

If you haven’t written to your Senators or Congressman to give them your input, you will have no one to blame but yourself when you find yourself covered by a socialized medicine system similar to Canada or much of Europe.  If you think that is what you want, chat with a friend who lives in Canada and ask him why he comes to the U.S. to get timely care.