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David M. Walker

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SCOTUS and Health Care Reform: We Are Arguing Over the Wrong Things

Posted: 03/22/2012 4:13 pm

A colleague of mine, Kathleen Benanti, was hit by a drunk driver in 1992. The whiplash crushed her neck's C6/C7 joint, creating shrieking levels of pain. Unfortunately, the driver didn't have car insurance and Kathleen didn't have health insurance, so all she could manage was paying for an X-ray, which was inconclusive. And she couldn't afford treatment.

She was in such pain that she couldn't move her head up, down or sideways, which made using the phone at work quite difficult. Absent any insurance, doctors told her to wear a head set, and sent her on her way.

But when she landed a job at Morgan Stanley, with its very comprehensive health insurance program, doctors were suddenly eager to help. They suggested a litany of tests, so many that Kathleen turned most of them down. Finally, she found a doctor who didn't see her as a revenue stream, but as a whole person in intense pain. He did one X-ray and an exam, then cleared his schedule so he could do her surgery immediately.

Today, Kathleen is fit, healthy and happy. She works with me at the Comeback America Initiative, and helps us advocate for a health care system that is affordable, of high quality, and sustainable. Her experience reveals what the experts already know: America doesn't have a health care system.

The reason is simple: instead of a health care system, we have a "sick-care" system that provides perverse incentives and inadequate accountability.

A real health care "system" would focus on health and result in efficient and effective utilization of available resources. But our approach provides few incentives for physicians to practice preventive medicine, which would reduce the need for "sick" care in the first place. This misaligned incentive system encourages costly and sometimes unnecessary procedures that drive up our health care bill, and can even harm patients.

And as our nation's former top auditor, I know firsthand that if there is one thing that can truly bankrupt our country, it is out of control health care costs. Believe it or not, almost half of all healthcare purchased in the U.S. is already financed by the government, an amount that is growing fast and is unsustainable. Nonetheless, we achieve below average societal heath care outcomes despite spending about double per person as compared to other major nations.

No matter what you think of the nation's new healthcare law, its primary purpose was to insure about 48 million more Americans rather than to reign in out-of-control costs. Even after health care reform, we still have trillions in unfunded Medicare and other health care promises that are growing daily.

Regardless of the Supreme Court's decision on the constitutionality of the new health care law, our health care system is in need of radical, reconstructive surgery. Without major reform, health care could bankrupt our country. And it doesn't do enough in connection with key incentive and accountability issues.

Unfortunately, meaningful health care reform is not a high priority or "sexy" issue. There are no celebrities making cool viral videos about the need for creating a real and sensible health care system. So voters don't know the details, and they aren't pressuring politicians to take the steps that health experts know are essential.

You can do your part. Watch the video I've posted about smarter health care. Then take a moment to tweet about the video, or share it on your Facebook page. And please take the time to learn more -- once we all know the facts about health care, Congress won't be able to continue to duck its responsibility.

David M. Walker is CEO of the Comeback America Initiative and former comptroller general of the United States. His "Myth of the Month" vlog on YouTube this month focuses on the myth that America has a health care system.

 
A colleague of mine, Kathleen Benanti, was hit by a drunk driver in 1992. The whiplash crushed her neck's C6/C7 joint, creating shrieking levels of pain. Unfortunately, the driver didn't have car insu...
A colleague of mine, Kathleen Benanti, was hit by a drunk driver in 1992. The whiplash crushed her neck's C6/C7 joint, creating shrieking levels of pain. Unfortunately, the driver didn't have car insu...
 
 
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09:13 PM on 03/28/2012
I once saw David Walker on a Bloomberg rountable discussion about healthcare, the economy, etc... He's been one of my 2 or 3 favorite authors/pundits/columnists since then. No partisan BS like most of them - just the facts. Sadly, most people aren't interested in facts or solutions anymore. They'd rather tune into cable news for some rabble-rousing red meat.
Michael5555
I built it despite you people
05:53 PM on 03/28/2012
Very nicely written article.
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FLDeziner
Body in FLA, Heart in Chicago
10:49 AM on 03/27/2012
The whole system is about to get much worse. I hand out the meds at a pharmacy. It's not unusual for patients to be on 7 different medications, all with different side effects that cause additional problems for the patients, that will then be treated by additional meds. Many of these patients are in their 40's. What do you suppose will happen if they make it to 65?

Four people come in for the same cholesterol lowering drug & one is charged $400 because they have no insurance, and the three others are charged $138, $8 & $0 for the very same drug depending on their insurance coverage. How is this fair?

Get the profit out of the health field. Want to see prices drop? Stop insurance coverage for prescriptions. Then big pharma would only be able to charge what patients could pay, or maybe the patients would ask their physicians if there was something else they could do or take instead of a drug that would help their condition.

Now that Viagra is no longer covered by most insurance programs, the amount we hand out has dropped to almost nothing. $500+ for 30 pills is a lot of money to pay for most patients.
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nikanj
free the fnords
05:01 PM on 03/28/2012
Those of us addressed in this article -- the small business owners -- get the worst deal of all.

We carry catastrophic only coverage, so that in the event of a medical catastrophe we don't
lose said small business. Premiums now run about $10,000 / year. With a $10,000 / year deductible. We have NEVER filed a claim, in some 20 years and counting.

For anything less than $10,000 we are billed as private pay patients. Most people are unaware
that private pay patients are billed at much higher rates than insured patients. So, even though
we pay hefty premiums which we have never made a claim against, we pay the exorbitant
(extortionist, really) fees charged to private pay patients.

Predictable result -- we avoid seeking health care unless absolutely necessary.
More out of disgust for how the system 'works' than anything else.
Fortunately, we live active healthy outdoor lifestyles and grow our own food, etc.
But, like everybody else, we are still only one misstep away from a potential catastrophe.

And according to this article, we can only expect that $10,000/year premium to increase.
Perhaps exponentially. Realistically, we cannot pay much more than we are now.
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onionboy
Blessed are the Cheese Makers
02:58 PM on 03/23/2012
We nee a fundamental change. Most importantly, a fee-for-service model must be retired. The current system provides a financial benefit for failing to provide the proper treatment the first time around. You make more money the more treatments you give...regardless of whether they work. It's just plain silly.
GHarry
Kitty wrangler
08:22 AM on 03/23/2012
Americans don't need health insurance. We need health care. The very concept of "health insurance" is immoral and strange. Only in America would such a widespread ripoff be celebrated as "free enterprise." It's like watching thousands of people die of a certain disease while we celebrate the high profits of those who sell the high-priced cure for that disease.

That said, the health care ripoff is only one of many in our nation, and the best way to fight this kind of crap is to get all private money out of the elections process. Notice how that was talked about for about one minute a few months ago, and now all the corporate media outlets carefully ignore the subject? That's not a coincidence. Guess who gets the vast majority of the billions of dollars spent on campaigning -- the same media who now refuse to talk about efforts to clean up that situation. We need to make the No More Buying Elections campaign our Job One, or forget about ever again having a decent country to live in.
10:11 AM on 03/23/2012
Sure...we NEED health care??? That's why when leaders of other countries...KINGS..need healthcare and can afford to go ANYWHERE...CHOOSE AMERICA FOR THEIR TREATMENTS AND CARE...What you meant to say was we demand FREE HEALTHCARE, right? But why stop there? Let's all demand FREE LEGAL CARE for all too....Let's all demand free GASOLINE for all drivers. In your world, no one should be allowed to earn a living, after extensive and expensive training in whatever field of endeavor they choose. FREE EVERYTHING..RIGHT? PUTZ....
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onionboy
Blessed are the Cheese Makers
02:55 PM on 03/23/2012
You're living in the past. The US is no longer dominant in medical tourism. In a 2008 study, we had 10x the number of people leaving the country to receive medical care as coming into the country to receive it. And the number leaving went from 500K in 2006 to 750K in 2008. The UK has us beat in terms of medical tourism, and has for quite some time. India has probably already past us or is about to. S.Korea and New Zealand are two growing locations too...and many others.

Every first world nation has third world kings visiting for care. The US used to be #1 choice. It's not anymore. In many cases, they're not even going to 1st world countries any longer. Some of the finest and most modern hospitals in world are in developing countries (eg, India) and were built specifically to bring in those king and captains of industry...including from the US.
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Mary Elizabeth Jimenez
09:36 PM on 03/23/2012
I love how you hopped on the slippery slope train with those ridiculous statements. Many other countries have AFFORDABLE health care. GHarry did not mention that we need "free" healthcare. So I really don't know where you got free gasoline and free legal care from... Please respond to people's comments and to articles with more maturity.
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usna73
We are all in this together
08:19 AM on 03/23/2012
David, you are one of the few who "did the math." End of life care eats up the lion's share of dollars spent in Medicare. Unnecessary procedures are used to offset other costs that hospitals incur in the emergency rooms tending to the indigent.

Once again we are determined to make everyone the "loser."

We will only wake up when it's too late.
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frank1946
Tell the Truth
08:02 AM on 03/23/2012
Let the Healthcare System go Bankrupt...............failure always cleans out the inefficient and the
wasteful..................deregulate Healthcare. Nurses can do it all along with PA's and Pharms ?

Urgent Care and the local Hospice, just the basics, Medicare in 1965 ?

Who needs Organ Transplants ? High Tech Med is a Con Game. It is destroying the USA.
07:47 AM on 03/23/2012
I am a New York primary care physician (Dr. Marina Gafanovich MD, 1550 York Ave, New York NY 10028, (212) 249-6218). I have a few words to say about the reform. Over the last few years, a few of my fellow doctors in Upper East Side have stopped taking Medicare. Believe it or not, it was not worth it. With all respect to providing healthcare services to the underinsured and underserved it is not the physician who should levy all costs and charges. All the talks about "escalating healthcare costs" do not always feature the provider's view point. I personally see the *decrease* in funding, not the increase. As you know, the first person on the line of the budget cuts is the Doctor. That said, I am advocate of the reform even though it might not seem "sexy".
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usna73
We are all in this together
08:14 AM on 03/23/2012
Without personal animus, all I can tell you is that you will be replaced. You live within an anomaly of the country's demographics. For far too long, "flyover" America has subsidized the monopoly monopoly money lifestyles of NY, DC and Silicon Valley.

The models of the VA, Mayo and Cleveland Clinic can and will expand, providing the best and lowest cost outcome based medicine. The shift will and MUST happen.

If you are an outstanding physician, come to Cleveland. You'll live more happily and professionally.

I speak as a native New Yorker. Get away from the "bubble."
10:14 AM on 03/23/2012
I thought Cleveland was a sewer?
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Boston Doc
MD in private practice
03:11 PM on 03/26/2012
Replaced with what? Obamacare administrators?

Do you know how what is average waiting time to see docs in my specialty? 3-4 weeks. Demand is so big that doctors can afford to rescind those insurers which shortchange them.

When you turn 65, and there is no Dr. Gafanovich to see you, because you only have Medicare, which pays less than overhead costs, then you will remember my words.


Medicaid OFFERS to pay me something like $ 8 to diagnose cancer. I don't accept it.
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eoagent0007
06:03 AM on 03/23/2012
Thank you David will forward your thoughts on Facebook and Twitter.
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eoagent0007
06:02 AM on 03/23/2012
Thank you David for being one of a select few to recognize the real problems with our broken health care system. I believe that you are nearly on the same page with Fareed Zakaria. He just had a 1 hour program with analysis of our system and a comparison with other much more successful models around the world. The one hour program is repeated this Saturday at 8 PM on CNN.
Zip Zinzel
If a Nation expects to be both Ignorant & Free . .
04:16 AM on 03/23/2012
instead of a health care system, we have a "sick-care" system
===============

ACTUALLY, the system we have now, is a CASH-COW system
Everyone in the Medical Provider Industry, just wants to milk the system for all it's worth
AND THAT IS A PROBLEM THAT EVEN A SINGLE-PAYER SYSTEM WON'T FIX

1) Rebates for consumers who keep their medical expenses below average
2) Lots more Fraud Investigators & Investigations + Mandatory Jail time
3) Sizable Rewards to consumers who turn in Medical Fraudsters
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Boston Doc
MD in private practice
03:14 PM on 03/26/2012
I am a doctor.

I think my service is worth certain amount of dollars. If you pay, I will perform the service. If you don't, I won't.

How is it unfair? Why is this considered 'milking the system', instead of getting paid for the job well done?
Zip Zinzel
If a Nation expects to be both Ignorant & Free . .
11:13 PM on 03/26/2012
ALMOST EVERYONE in the Medical Care Provider system pads all their bills to the maximum extent that they can get away with.
EXAMPLES=
1) someone out here on HuffPost told me about their mother in a hospital whose bill was charged $15.99 for a small tin of CARMEX Lip Balm that you can get in a convenience store for less than $2.00

2) Many dubious lab tests billed that go to firms that the doctors have a financial stake in
////////////

NOT EVERYBODY IN THE BUSINESS IS RIPPING OFF THE 3RD PARTY PAYERS, but IMHO "PROBABLY" most are.

To me, there is only one real solution to this runaway ripoff problem is by using competing HMO Insurerer/Provider Organizations like Kaiser Permente who both a) provide Insurance, and b) deliver the healthcare
SINCE THESE ORGANIZATIONS WILL HAVE NO INCENTIVE TO RIP THEMSELVES OFF.
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03:50 AM on 03/23/2012
If products like "Pink Slime" would have been impossible (FDA failure?) there would not be that much need for Health Care. There is actually little real care for health, it is all care for profitts of the Food Chain (industry), care for the effects on peoples health is minimum
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dijit44
12:51 AM on 03/23/2012
You cannot lead to the change that is needed if you misdiagnose the situation.
You have a system designed neither for health care nor sick care, but for profit making.
That being the goal, the system works very well for those who run it.
No amount of babble about prevention and effectiveness will make it a good health care system, unless and until it can be turned into a health care system - a system which has as its primary purpose the promotion of good health..
You are in other words, in the near term, screwed.
12:10 AM on 03/23/2012
I'm all in favor of Government paid for health insurance. God knows I don't wanna pay for it. The only problem I see with Governement provided health insurance is there's nothing that the Government does that the private sector can't do better, faster, cheaper and turn a profit at the same time.

You look at the losers we got in the White House, in the Supreme Court, in the Senate and in the House of Representatives, and you think these clowns can come up with anything but a shambles for a health care plan?
Zip Zinzel
If a Nation expects to be both Ignorant & Free . .
04:17 AM on 03/23/2012
YOU MUST BE A REPUBLICAN !
11:32 PM on 03/22/2012
I agree that preventive care is key - but giving doctors more incentive to practice that way is both logistically difficult (the doctor whose practice is next to the Whole Foods will likely have a different patient population than the one whose practice is in an urban food desert - how do you fairly distinguish between their performances, and more importantly keep doctors from fleeing underserved populations?) and a deeply oversimplified approach. Doctors constantly struggle with doing lots of tests just to cover their butts, with over-prescribing to mollify "healthcare consumers," and laying off the diet and exercise talk because they fear it will harm certain doctor-patient relationships (I.e. "it's better that they keep coming back for blood pressure meds than not see a doctor at all"). Some doctors are awful people with god complexes and $$$ in their eyes, but most are decent folk struggling with difficult choices. Preventive health care goes much deeper: it's a struggle against a culture of over processed foods, suburban sprawl, "the customer is always right," and instant gratification. There's only so much the doctor alone can do.