Sunday, June 28, 2009

Access to a basic medical package

I was reading a summary report by a group of local doctors who had met to discuss how the proposed national health plan might be structured. It struck me as insightful that they came up with the mission statement or core purpose that any proposed health plan should provide, “ access to a basic medical package”.

I focused on the word “basic” as the bottom line of intent. They didn’t say access to equal care, or standard care, or quality care. They said “basic” care. So let’s for a moment assume any solution or implementation of a federal public plan accepts that some people will have to accept a “basic” level of care. There will be those who say there shouldn’t be varying levels of coverage as everyone deserves to receive the same quality and amount of health care. This,"basic" concept isn’t really as radical as it might seem.

I’m personally covered by the much referenced federal health program. But, I still have to decide among many programs and between high and standard options. The latter two are mainly a choice between higher co-pays or lower monthly premiums. Those with more money can easily opt for the high option. Those with less must make a cost decision.

As I chose a core (named) plan I also have to look at what’s covered and what’s not. The plans don’t provide the same medical options.

So here we have an existing federal precedent. All plans and all coverage doesn’t have to be equal.

Why then shouldn’t any public plan start off with the,"basic", package with an option to increase the package at additional out of pocket cost to the recipient? This would be a first step towards reducing any public costs.

Now on to cost reduction.

I’ve seen a hospital charge daily room rates in the $3000 range but accept Medicare reimbursement of a tenth that amount. And private health insurance reimbursement at much reduced levels. I can say the same for in home care for the elderly.

Emergency rooms staffed for 24 hours have the same total daily cost whether they see 5 patients or 50 patients as long as additional doctors aren’t required. Their monetary loss for caring for indigent patients is much less than we’ve been led to believe. Many of these costs are accounting gimmicks and tax dodges. Let’s review what a 24 hour emergency room actually costs to operate. If I’m going to be asked to pay for this plan, I want to be sure there’s no double counting or tax breaks being passed on to other players.

Reductions here would lessen the amount of public money paid out to this type of care. The cry of, “ Look at all we do for free in our emergency rooms”, might be silenced or at least muted.

The public sector shouldn’t EVER be billed for services at a rate higher than what the lowest private health insurance plan is billed. Nor should they be billed any lower as that becomes unfair competition.

I think it would be accepted as a national statement of intent that no one should starve in their homes, die in the streets or die from the lack of "basic" medical care. Let’s not let a search for perfection stop “access to a "basic" medical package” that is “good enough” .

Sunday, June 21, 2009

Health care costs

There have been many comments about health care cost, present and future, and how it might be paid for. A basic point to remember about most costs is that for one person to pay less, someone, patient or provider, must receive less.

Let’s discuss major exceptions first. While there are many examples of reducing costs in manufacturing and service industries through more efficient operations, machinery, materials or the economies of scale, the human body and its internal functions don’t much lend themselves to manipulation for maximum medical efficiency.

Almost all efficiencies will have to come from making the current health care support system more cost effective. This will require changes in what service is delivered and how it’s delivered.

In the same vein (no pun intended), medical advances tend to increase the patient’s end costs. Automated lab work can reduce costs but this leads to greater use of lab testing to help the doctor make a decision. Or, results might be improved at the expense of a more costly treatment.

From the big picture point of view, reducing end costs under current practices is more a myth than an achievable objective.

Back to how health care costs might be reduced.

The most obvious method is to ration health care. This brings out the cry of a class warfare and would be met as strongly as is the concept of choosing your own doctor. A sacred right.

But is it? Does your present insurance plan allow you to select any doctor no matter his cost? To go to him as often as you’d like? Would the most highly paid and sought after doctor take you for a patient? Could you, like Steve Jobs of Apple, travel to another state to get a transplant?

We already have medical rationing but it’s based on our ability to pay. Let me recite an anecdote. There was an auto repair shop with the sign, “ quality work done quickly, inexpensively --- pick any two”.

Isn’t this how we relate to our medical needs? Except that we want all three. That’s if we’re not in the 47 million who have no insurance.

A quick thought – if health care costs are to be reduced, some way will have to be found to utilize the tens of thousands of Emergency Medical Technicians (EMT’s) working in this country, mostly for fire departments. They could become the staff for a pre-emergency room, a place for medical screening to vastly reduce emergency room costs.

You can come up with many reasons this won’t work, but all someone has to do is come up with one way for it to work.

Enough for this blog. I’ll take it on again in a while. During the interim, think about what health care people of various ages normally require.

Wednesday, June 10, 2009

Private health insurance

Just to clarify the record, there are two types of private health products. There is health insurance, where individual facilities and medical personnel are contracted with to provide health care services to owners of specific health insurance plans, and there are health care packages where organizations operate their own health care facilities (clinics and hospitals), employ their own medical personnel and are usually referred to as Health Maintenance Organizations (HMO’s). Kaiser is probably the largest of these.

The current national discussion about health care focuses on the possibility of the government becoming a major player by developing a means for all Americans to obtain health care coverage. The fear from the private sector is that government will offer a health plan the private sector can’t match and put them all out of business.

Accordingly, the criticism so far has been directed at raising fears in the general public that government can’t operate efficiently and will just cost more tax money and destroy private health businesses without providing quality health care.

Government response so far has consisted mostly of saying, “No we won’t” and retreating into waiting for legislation to be initiated.

Why hasn’t government challenged the private sector to participate in the discussion by offering a wide array of private options that would make health care available to all Americans?

In that way it would become obvious where the private sector was willing to participate and where they aren’t. Government could then take care of those that the private sector isn’t prepared to serve.

To avoid letting the private sector pass off to the government responsibility for covering the poor and elderly, (current Medicaid and Medicare) certain parameters of service would have to be developed to protect these two groups. There would be disagreements but eventually some “rules of the game” would develop.

If the private sector is flexible and innovative they should be able to better the government’s plans. If they can’t, then let them compete with government offerings.

The devil is in the details but you have to start talking about the issue in general before the details begin to immerge. Just throwing rocks at each other isn’t discussion.

Tuesday, June 2, 2009

Obama’s Strategy

During the election campaign when Obama was being attacked, his supporters urged him to counter attack. He ignored them, didn’t attack, held the moral high ground and won because of it.

After the election and swearing in, he took on a full agenda of programs. He had health care, the financial crisis, GM and the auto problem, Iran, plus others front and center. His supporters, and some who weren’t, said he couldn’t accomplish his goals unless he selected one or two programs to concentrate on. He didn’t pay any attention to that advice either.

I think I see his strategy.

There are only so many hours of critical cable pundits and news broadcast a day. There are only so many print outlets that will criticize him. He’s decided to offer them a multiple number of programs to attack with the knowledge that his opponents either have to select one or two programs to focus their attacks on or split their effectiveness by trying to attack ALL his programs.

He has succeeded in that his opponents have been unable to coordinate their attacks because of their individual primary issues and ideologies. The results is, yes much criticism, but no concentrated attack on any one program.

Even those that attack him on all his different programs come off as nasty cranks, rather than dispensers of information. He wins again.

Add to all this mix the random daily events that impact America and there isn’t sufficient broadcast time or print coverage for others to define who he is and how his programs will hurt their various special interests.

Further, by appearing regularly on TV, he keeps the public on his side by showing he wants them to remain informed about what he and government is doing.

This guy is operating from a playbook that those inside the Washington beltway don’t even know exists because he’s not following THEIR rules.

Think about the Clinton health care plan in 1993 and how it was defeated by their opponents being able to all focus on that one topic.

Obama was paying attention.