Healthcare

I am a bloodsucking parasitic Insurance Solicitor that sells health insurance. What that means is I have to go around and find able bodied healthy people who don't want health insurance because they think they are immortal and convince them that the only time they can buy a policy occurs when they don't need it! Once a potential client gets a condition, I can't find an underwriter to offer a policy to damaged goods. Would you? And without health insurance, the men and women I approach run the risk of getting financially wiped out if something "bad" happens. Translation--a $100000 hospital stay that they can NEVER imagine.

I don't try to scare people. I tell them the facts. It is something you cannot afford not to have. Health insurance needed to avoid paying the disease Piper his due. County hospitals are good, but no substitute bargain. Only an idiot refuses to get the protection he/she needs from illness wipe-out when they have the money to pay the premium. I've met a lot of idiots.

What do I get out of it? Approximately 5% of the premium paid every year it's paid.

 IN OTHER WORDS, I DO NOTHING TO CONTRIBUTE TO THE HEALTH OF ANYONE, AND I GET PAID FOR DOING PRECISELY THAT.

With health insurance, once signed, you are in the system and others handle your needs. I have, in essence, an annuity--as long as my clients live and pay premiums I never have to see them again. EASY MONEY.

I have a friend, Dr. TOM-TOM. From his perspective, health insurance is a maze wherein he has to negotiate the twists and turns with his hands behind his back and his eyes blindfolded. I once asked him if doctors would stay in the profession if they could make the same money doing something else. His answer struck me in two respects--the actual answer and the speed with which it was delivered. In a cliché nanosecond he said, "They'd get out." As one of the country's finest doctors in his specialty, he makes a six figure salary. If he worked in an HMO environment, he estimated that he would make about one-fifth to one-quarter of his current income. He spent about the same amount as an HMO salary in bookkeeping and office expenses solely tied up with the collection of monies from insurance companies for procedures he felt his patients needed, and for having these intrusive entities as his not-so-silent partners. He was furious about the number of times and the time he spent on the phone calling insurance personnel, described by him as teenage medically unqualified secretaries, to get an O.K. for a procedure, They might be good secretaries, but they sure didn't know  what the medical problem was all about. And some people think the doctor is the one making decisions. What a joke! The insurance company is the one that has to survive the operation.

I have another doctor friend HMO DOC, who runs servicing HMOs. His contracts with insurance companies usually require him to pay about 18% of the premiums collected. Let me explain. The insurance companies go out into the marketplace and sign people up for premium paid, guaranteeing these people what procedures are covered. To get the most clients the insurance companies try to keep their prices down; they are competing with each other. An insurance company (or more than one) then goes to my friend and promises him lots of potential patients, if he will agree to accept a flat fee of 82% of the premium collected per patient AND will handle ALL the medical needs promised to the patients he contracts for. So, in effect--turning it around, my friend was hiring insurance companies for 18% of the premium to find patients for his facilities. At the time he told me this, he was making money on all his HMO contracts except one.

HMO DOC had a dilemma. In order to make this profit, he had to figure out how to reward his doctors. If he paid them by the hour, they might work to slowly and not see enough patients so that he has to hire more staff; if he paid them by the patient seen, they might work too fast and not do all the necessary treatment for the case in question. That might open him up to lawsuits for malpractice.

The insurance companies according to my friend, are sucking each other up; the big buying out the small. In time HMO DOC might face an in-country cartel; he'll either have to accept their price or go out of business as profit margins get shrunken. Therefore medical decisions might once again be based more on a company surviving than on patient need. Exactly what is contributing to doctors practicing for HMOs.

Dr. TOM-TOM had this experience. Asked to sit on a board of review to judge whether another doctor should be stripped of his right to practice  due to malpractice, he accepted. He feels a duty and responsibility for the standards of his profession.(I told you he is the best of doctors--a PRINCE.) What was his reward when he and other doctors on the five man panel found the accused incompetent to remain licensed? A lawsuit by the doctor so judged, charging Dr. TOM-TOM with restraint of trade!!!

Another anecdote. I met a friend of HMO DOC, and she is a bona fide expert on medical practice, business and otherwise, in this country,  She told me a story about a doctor in a New Jersey hospital who became Chief of Staff. Number One. He was always talking gung-ho about how doctors should police their own profession and get rid of the bum doctors. On his staff was an anesthesiologist who he believed was responsible for the death of one patient on the operating table. A questionable flat out medical blunder, but not one the Chief of Staff felt he could get a review board to take the big step and throw the incompetent one out. But when the anesthesiologist medically blundered a second time, another patient dying on the operating table--sad to say, Number One was ready to prevent a third catastrophe. He formed a panel, sat on it himself, and for taking away the anesthesiologist's license, he too was sued for restraint of trade. See, doctors do consult with each other!! When my medical expert acquaintance confronted the Chief of Staff, he ruefully admitted he wasn't so hot to be on another board.

NOW HERE THIS: The previous material was an education for me. Dr. TOM-TOM's

frustrations were beating an  epiphany into my mind, and the medical expert made me laugh depressingly. So here is my version of how HEALTHCARE for the USA should be conducted and constructed.

I hold the following to be self evident, the only entities making Money from the healthcare system are as follows:

1) doctors, nurses, hospital personnel

2) drug companies

3) hospitals

4) manufacturers of medical equipment

Let's take them one at a time.

It is impossible for doctors to be perfect, mechanically or mentally in their decisions, all the time. The human body is still too complicated to demand perfection from people even though they spend nearly ten years getting to the point where they start to practice. Even good doctors make mistakes and can be second guessed. Heart surgeons get patients whose last chance to live depends on the  doctor performing a medical miracle. Such talent should not be lost when the patient dies on the operating table; sometimes what is obviously a "no chance" procedure gets graduated up to "nothing left to lose shot" which sould be made clear to the patient and relatives of same.

I WOULD IMMUNIZE ALL DOCTORS FROM MALPRACTICE SUITS, provided doctors would  throw the well known bums in their profession out. No more restraints of trade suits. Gone. Just like the incompetent doctor. If doctors do not live up to their end of the bargain, the world can always go back to the old way. Sue or be sued. And as a professor in college once lectured to my organic chemistry class: SCIENTISTS PUBLISH THEIR MISTAKES, DOCTORS BURY THEIRS. That will remain the same.

Doctors would start a fund, say twenty-five cents--or some nominal sum--for every patient they see in the course of their practice, every time they see the patient, and such money collected would go ONLY to pay for the medical expenses incurred in trying to make up for the MEDICAL harm any doctor had done in treating a patient. Thus, doctors would be hiring other doctors to correct, if possible, or alleviate as well as could be done, for what might otherwise have ended up as a malpractice suit. NONE OF THE MONEY WILL BE USED TO PAY FOR MENTAL ANGUISH AND PAIN.

For people who feel abused for not being allowed to sue the doctors, I suggest that INSURANCE COMPANIES offer policies to the PUBLIC that allow collection of monies to compensate for pain and suffering and loss of income and whatever else the INSURANCE COMPANY  wants to offer. This way PEOPLE  can hire LAWYERS  to sue the INSURANCE COMPANY, go to court or settle out of court, BUT THE DOCTOR(S) INVOLVED WITH THE PATIENT WOULD NOT BE THE OBJECT OF THE SUIT OR NEED TO PARTICIPATE IN IT.

Allow me this moment to tell you another Dr. TOM-TOM life experience. As I heard it, years ago when malpractice insurance rates were going up so high that he could not make a decent living and the possibility of ending his career in medicine was getting close to a reality, the good doctor asked his patients to sign a private agreement that any disagreement would be settled by friendly arbitration. No lawyer vs. lawyer harangues. He put his house on the line!  He didn't want to leave his patients in duress. I told you he was and is a PRINCE. Doctors like him should never feel the fear of being driven from the profession by lawsuit. One more tidbit. Dr. TOM-TOM is adamantly against doctors with medical practices that own the labs that do the testing the doctor orders. CONFLICT OF INTEREST, BIG TIME. Did the patient really need the test, or was the doctor padding income.

Nothing wrong with a doctor finding a good lab and promising to give it all the tests needed to be done if a discount saving is agreeable and applied to the PATIENT'S cost.

Drug companies have a difficult task. They often need years to search for and create a successful drug. They deserve patent protection. Without it, no useful drugs. As I see it, the cost of a drug being different from country to country is NOT a burning issue. Think about it. The number of possible users of a drug in a particular country is relatively fixed.

No amount of advertising is going to get a great number of more users--you either need the drug or you don't.  If your country is wealthy, you will pay more. If another country has a population of possible users with less income, the drug company is doing the right thing by lowering the cost but still making some profit. If you shout for the same cost everywhere, then the populations of poorer countries will not be able to buy the drug, and the drug company will RAISE the price to the users in the wealthy country to insure the same total profit. Not good results anywhere from what might have seemed fair initially.

Here's a question for you--a new drug comes on the market, should you buy it? Face it, you know next to nothing most of the time about the efficacy of that drug. You trust your doctor to understand the science, to see which patients might have a need for it, and the side effects it causes. The word gets around in the medical world. You and I don't need to be bombarded with umpteen commercials everyday telling us to "ASK YOUR DOCTOR IF WONDER DRUG IS RIGHT FOR YOU." Better to have drug companies put the advertising budget into research and salaries for their personnel.

Hospitals should not be owned by corporations listed on stock exchanges. There should never be a stock issued to form a hospital--that is just asking for trouble in the form of stock manipulations, falsifying bottom lines, and corruption

Universities that build teaching hospitals with endowments, communities that issue bonds to make certain they have care for their own, and privately financed hospitals are the best way to go. No matter how started, non-salaried boards of directors--getting only minimum travel expenses and committed to the best hospital possible, will oversee that the facility survives with most of its income coming from services rendered with an eye on the needs of the equipment needed in the future to keep the hospital as modern as possible or for needed expansion.

Manufacturers of medical equipment can be anything they want to be--private businesses, corporation listed on stock exchanges, or some genius in a garage who designs and builds a prototype. Manufacturers live and die by market forces. More power to all of them.

I want to ramble a bit here to let you know how healthcare has been treated in some parts of the world and give you a heads up on what might seem like hypocrisy in our country.

Conservatives in this country call single payer government controlled healthcare "socialism". In that sense it is to be construed as the near ultimate curse word, the ultimate being communism. Surprisingly, the Conservatives in Great Britain, when Lady Margaret Thatcher was Prime Minister, bragged to the voters there how they built one hospital or medical facility per week since her first election, and they were committed to defending National Health  Service into the future.

My Canadian friends routinely fly back to Canada, WHERE EVERYONE IS COVERED, when they need extensive and/or intensive expensive treatment that isn't an immediate emergency. I asked  two of them to compare the system in the good ole USA with the one in Canada. Made me laugh when both of them identically said succinctly "IT SUCKS". It's not just the cost that upsets the Canadians, it is also the paper work. When they go to the medical facility in Canada to be treated, all they do is hand over their medical card to get the process started.

I have a friend who is a retired professor of chemistry at a major university in Canada--but still dabbling in the lab--who considered retiring to the USA with his wife. When they analyzed the medical situation they would face here, they decided to stay in Canada, because they could not take the chance of being pauperized with medical bills here.

In Japan, the correspondent there for NPR reported over ten years ago, they have a twelve member committee--three doctors, three members from the insurance industry, three members from Government, and three lay people (perhaps academics)--and this committee meets once every two years or as circumstance demands. Doctors in their system are basically associated with hospitals, and failure for a doctor to have such an association is essentially to be barred from practice (but I don't know if that is true today). The committee sets prices for procedures, guaranteeing in the price structure that doctors will be in the upper income strata, making more than 70 % of their countryman, as I recall. AND EVERYONE IS COVERED.

O.K. Take a deep breath. If you have made it this far, you are wondering how the healthcare in the USA is to be financed.

NOW HERE THIS:

Dr. TOM-TOM believes strongly in fee-for-service. But who should set the cost of the service? That's the problem. If you want market forces to get the price as low as possible, then you need lot's of doctors competing for customers (patients). But in this system the poor can't always buy the product or service, yet have the same life threatening illnesses and needs as those who can pay the tariff. Should the poor and needy  (especially children) learn how to die when they have no money to pay the fee for the service required? And do we want doctors, even a tiny percentage of quality medical practitioners, to leave the profession because they can't make a profit. That's how free markets work--beat your opposition into going out of business and give them a turkey to eat on Thanksgiving Day.

The Plan:

1) Fee-for- service

2) National board that sets doctors fees and an individual's payments

Board members will come from doctors(3),  nurses(3), academics(3), government(3), corporations(3), unions(3). 

In case of a tie vote on any issue, the tie will be resolved in favor of the majority vote of doctors, nurses, and academics. The doctors and nurses will be elected from their own professional groups; the academics must come  one from economic professors whose expertise lies in medical costs, one from professors whose expertise lies in sociology, and one from professors whose expertise lies in the field of organic chemistry; the corporation representatives will come one each from drug companies, maunfacturers of medical equipment, and from the banking industry; unions will select theirs by their own devices.

Members of this board will serve for 2 years and can be

Re-elected as often as they wish to serve.

3)  Everyone pays premiums

No matter who you are, everyone over the age of 18 will pay premiums into the national pool. Parents will pay for themselves as well as their children. All monies paid will not be considered income as far as tax law is concerned. Anyone not able to pay, can do sweat equity for the healthcare industry to make up what you owe.

Entrepreneurs and corporations will no longer have to involve themselves with healthcare plans. They have enough to do trying to stay in business.

There are people who think that being forced to pay for what you might not wish to buy is anti-American, say. However, your health and mine is partly determined how each of us takes good medical care of ourselves. Also, facilities exist-Emergency Rooms--to handle anyone taken there. Lastly, many people will have more money, and usually large sums, spent on them late in life just to keep them alive for indeterminate lengths of time--some very short. Well, YOU, who think you are immortal but forced to pay now, are just making it possible to have money in the pot to save your "behind" later. Try this mode of thought--you own a home with a mortgage. The bank insisted you have a fire insurance policy and you acceded since no policy begets no loan. You are certain that you will never start a fire that will burn down your house. One day, you pay off the mortgage. Do you give up buying a fire policy? Hell, no. The people who live next door might have a faulty wire that sends their house up in smoke and a spark visits your abode which now turns into rubble. Do you think everyone you meet can't spread something contagious to you?

WITH EVERYONE PAYING INTO THE SYSTEM THERE IS ANOTHER BONUS SINCE OUR MEDICAL UNIVERSE IS LOPSIDED.

Consider this analogy to cars. You buy a lousy car, you need lots of repairmen. Buy a well made car, you need far fewer. We have lots of doctors who are specialists. We live longer--GOOD,  and we have forty-five million people who have no medical insurance--BAD. Longer lived people need specialists to keep going; uninsured people need specialists to take care of complications that should not have developed with exposure to simple preventive medicine AND THEIR HIGHLY COSTLY PROBLEMS WILL BE INITIALIZED BY AMBULANCE RUSHES TO HOSPITALS FOLLOWED BY EMERGENCY ROOM TREATMENT. The failure to not follow the old ounce of prevention that's worth a pound of cure adage. We, as a people, burn the candle at both ends. WE ARE SICKER THAN WE SHOULD BE AND IT COST MORE TO GET US THAT WAY! Preventive medicine is a BIG COST SAVER. By demanding All pay premiums, ALL will get yearly tests--ESPECIALLY CHILDREN--to catch problems EARLY.

SOME FINAL THOUGHTS

Recently, a loved  one in my family had to go to one of the world's finest hospitals. Stayed 4 or 5 days. Cost around $50000. NO OPERATION INVOLVED.

A Canadian friend went back to Canada for her yearly mammogram and tests.

The 18 tests cost $276, and she told me they would cost over $2000 in the USA.

Consider this scenario. A group of OUTSTANDING EXPERT doctors in the USA don't want to be part of a single-payer fee-for-service plan. Suppose they want to build their own hospital and set their own rates. Their hope is that the very rich will opt for their services if the doctors can convince them that waiting times for being cared for are shorter than the nation's other hospitals. The rich will still have to pay premiums into the national pool, just as they  have to pay taxes to support the operation of the public schools in the district they live, while sending their children to private schools. But the object of the hospital's owners is clear--create a niche market.

Something similar to this is allowed in Canada, but not on a full hospital scale. A Canadian friend recently told me that in the Province of Quebec they have private clinics for orthopedic surgery (knee and hip replacement) and eye surgery (cataracts). Other provinces also have clinics..

As for my hypothetical, there are two ways to handle this. Outlaw it, for one. Allow it but exclude doctors who start such a hospital from being immunized from malpractice lawsuits, for two.

IF BY NOW I HAVE NOT CONVINCED YOU TO BACK THE PLAN I OFFERED, LET ME ASSURE YOU THAT THE EASY MONEY YOU INSIST ON ME HAVING WILL STILL BE EASY FOR ME TO SPEND.

Comments

[DrVeruju]

I still support DK on this and most of the other policies he was prevented from bringing before the people by the corporate conspiracy that controls the US.

[LeftRight]

Sounds like a pretty good plan to me, at least on the surface. I'm not going to lie and say that I wouldn't need more readings to confirm, but so far it looks good.

[jmpurser]

Capitalism is an excellent way to make sure there's bread in the supermarket. It's a LOUSY way to build a health care system. Let's stop being stupid about this and fix it!

[KenTao]

Excellent job explaining the benefits and sane approach of the Single-payer Universal Health Care we hear about so much these days. How hard is it for people to understand that "It's the Insurance Companies, stupid!"?

Earthlings Unite!

[The Collinbrandt]

Health insurance is an unworkable bussiness model. Everyone will one day need catastrophic care which in insurance terms, hundreds of thousands or millions of dollars of care. Therefor, you must eliminate the middleman, health insurers or, subsidize them by letting millions of people die prematureley to gurantee profits for health insurance companies. Health, is not an insurable asset. No matter how we live our lives, we will all need catastrophic health care at the end of our lives whether we die of alcholizm at age 40 or a degernerative nerve disease at age 70. The numbers don't add up for the greedy evil republicans that say everyone gets what they deserve except, the poor should pay for the health care of the rich(those in government and the heads of business).