Tuesday, August 25, 2009

Six Things I Believe About Healthcare

Hi, guys! The picture lured you in to this blog post, didn't it? Ha! The real subject is healthcare and some observations of what I believe to be true.

1. Health insurance is misnamed.

Insurance is a policy written by a company which protects you from the aftermath of some accident or natural disaster. It is a bet between you and the insurance company, made possible by actuaries who can predict what the exposure of the insurance company will be to any risk over a large population. You pay premiums based on the amount of risk the insurance company accepts.

In health insurance, it is a certainty that you will visit a doctor. The insurance company thus pays everyone who owns a policy, some more than others.

To be a real insurance policy, the company should have to pay only your catastrophic health care costs if such a catastrophe befalls you. All the normal healthcare expenses should be borne by the individual or by his company should they choose to offer such a benefit. The latter would not be insurance - it would be part of your compensation package.

2. Healthcare in America should not be called a "right."

A "right" is something which everyone has just by being an American (for example, life, liberty and the pursuit of happiness) and the government must protect everything that is a "right." Healthcare, however, is a service, which occasionally protects life, but more often just provides temporary or permanent relief from sickness or injury.

Healthcare for you is similar to automobile maintenance or repair for your car. Some people can afford to have the very best mechanics and concierge service, some choose to spend the minimum on Jiffy Lube - and some do it themselves.
In healthcare, some spend a fortune on executive scans and checkups, see the best doctors, have multiple elective surgeries, use personal trainers in personal gyms, etc. Others may get a yearly physical and visit their doctor only on those occasions when their home remedies don't work. And there is a third group that goes to the emergency room for sniffles and coughs. Yet those who claim healthcare is a "right" would also require that everyone get the top level of healthcare which only the rich presently can afford. The cost would bankrupt the American taxpayer, already on the ropes.

Some might ask, "so would you let people die in the street?" No -- that's what emergency rooms are for and why we spend lots of money on Medicaid for those who cannot (or choose not to) buy any healthcare, relying on the rest of us to pay the bill. Yet somehow, the indigent always seem to find money for booze, smokes and even cellphones - look closely at the photos...

I read the press every day, and never read nor hear of Americans dying in the streets from lack of healthcare. The "dead in the streets" argument is a strawman, set up by liberals to demand that everyone should get equal healthcare treatment, just as they want all Americans to "spread the wealth around."

We conservatives believe in equality of opportunity, not equality of outcomes. Everyone should have access to healthcare, but the type received will vary based on the willingness/ability to pay.

3. There should be no automatic exclusion of "pre-existing conditions," but policy premiums must reflect the risk assumed by the insurance company.

If your house is on fire, no insurance company should be expected to issue a policy amid the flames. If you live near the coast in Florida, your opportunities to buy home policies from a number of competing companies have greatly diminished. If you have had cancer, like me, you must expect that any insurer will either not take you or will charge you a lot more for a policy which includes cancer coverage.

However, a health policy which covers other health catastrophes, such as a heart problem, should be made available to cancer patients. But we must recall that healthcare is a business and healthcare profits help fund innovation and progress. Only if we want health insurance providers to commit corporate suicide should we expect that everyone get equal coverage at the same price.

4. Medicare is not an example of a program of universal healthcare, as some have said.

Those who propose universal healthcare would make it a "right," as described above. Medicare, on the other hand, is a health program for those over 65 that has been developed for that group of seniors based on taxes collected from them during their working years. Unfortunately, like Social Security, it has become a "pay as you go" program, with current taxes paid by younger Americans for current older American recipients healthcare, not by money saved "in a lockbox" from their previous contributions.

We, the American people, allowed our Congress to spend Social Security and Medicare trust funds for other "priorities" rather than invest them for growth and eventual payment. Seeing all that Social Security and Medicare tax money sitting in a trust fund was just too tempting for the Congress not to grab...

5. Universal healthcare under a "single payer system" is a disaster.

I spent more than two years in England and Canada in the mid-1990's. At almost every lunch or dinner with clients and prospects, the subject of the Brit and Canadian healthcare systems was discussed. The Canadians said that one of the reasons 90% of their population lives within 100 miles of the American border is because they turn to American healthcare when their system places them on a months - long waiting list for something as routine as an MRI. My son, Thomas, reports that there are more MRI machines in Cleveland than in all of Canada.

And in England, there is a panel in the National Health Service that calculates the cost/benefit ratio of procedures based on "quality of life years" or "Qualys", as they're called. If the procedure is expensive and the expected benefit will not be used over a significant number of years, then the procedure is disapproved. Keep you alive for another two years? Not cost effective. This is not fantasy - it actually exists!

6. Any healthcare reform that does not address tort reform is pandering to the Trial Lawyers, pure and simple.

I have medical doctor classmates from West Point who report that they pay over $70,000 per year for malpractice insurance, yet they have never been sued. They must practice "defensive medicine," often requiring MRI's and other tests when the results almost never change their original diagnosis. When asked to declare someone disabled for worker's comp purposes, they do so, fearing lawsuits from patients.

They believe that every patient should have legal recourse if actually harmed by a doctor or hospital, but that the current practice is not that. Currently, the medical profession is being held hostage by the legal profession.

Adding millions more indigent patients to the public healthcare rolls will be great for trial lawyers and poor patients who need money from anywhere they can get it. Like the current TV law firm ad says, "We'll deal with the government - you have enough to worry about." It will be a disaster for the healthcare community and will reduce the number of providers.

I would be quite interested to hear your thoughts on or additions to my list of six things I believe about healthcare. With some polishing and/or better thoughts, I intend to send my list to my Congressman and Senators.

The healthcare high ground...


Apis Melliflora said...

This is a very polished list. I agree wholeheartedly.

Unknown said...

Being a health care worker I have to agree with you on all points. I do not know where we are going with health care but I fear we will stop may an employer from providing any form of health care.
Health benifits are one of the reasons I am still working.
One question-Do you think health care will go the way of the polar bear?

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The Dragonfly said...

I think your list is comprehensive and succint. I worry for my baby Ollie that with universal healthcare, he may not be a priority because he is not a voter.

Apis Melliflora said...

From Stickpop:

On point #6:

The tort lawyers are just a part of the problem. So too are the judges, the juries and the insurance companies.

The simple solution: pass a law saying Doctors cannot be insured for more than $250,000.-- because the Plaintiff's attorneys are fundamentally suing against the insurance companies.

drmike said...

I have been in dicussion with a fellow adjunct professor. She teaches Economics. She indicates that all funds for Social Security that are in excees of expenditures are to be invested in Treasury Notes. She indicates that is part of the law for Social Security and Medicare. I can find no legislation that indicates that or can refute her statement. ave you found any?


Kernal Ken said...

Dr. Mike,
Your friend is exactly correct, but there's the problem.

Every dollar of social security taxes, instead of being invested in some security that pays a market rate, is instead LENT to the US Government to spend as it sees fit. In return, the Treasury issues notes, and the Congress spends the money it has been "lent."

And, as even your friend the Econ Professor will readily admit (I used to be one), the value of Treasury notes will decrease over time as the value of the dollar falls and interest rates rise due to gross overspending.

The current debt of the US is over $11 Trillion. This administration plans to increase that debt to $20 Trillion in ten years. Do you think your Soc Sec dollars are being "invested" wisely?

The Neil R. Van Leeuwen Family said...

Get the government out of our face. Hey we are glad you have good opinions but like our congressmen it was too long to read. HA! Joan Van Leeuwen