Tuesday, March 17, 2009

5 Steps to a Happier Healthcare System

Too many nights on call, too many weekends on call, too little sleep lately to blog coherently. Oh, I've tried, but get 2/3 of the way through a post and realize that what I have written makes about as much sense as a Jackson Pollack painting --- colorful, but impenetrable and eventually utterly meaningless to someone who spends any time looking at it. So, I'll try again.

Much ink has been spilled recently in the newspapers regarding "health care reform," and many more pixels have burned brightly on news sites and blogs about the same. Since nobody in Washington gives a rat's rear end about what I have to say about the subject, I'll offer my prescription for health care reform right here. It's a 5 step program, easy to implement, but impossible for the politicians and lobbyists to swallow.

Step 1. Uncouple health insurance from employment. Basically, allow folks the same degree of freedom in selecting a health insurance product that they enjoy in selecting life, disability, and auto insurance. Ever notice how all of those GEICO and Progressive auto insurance ads tout not only better pricing, but better service as well? That's the cool thing about a competitive marketplace --- it tends to keep prices reasonable and allows an even playing field.

How to do this? Actually, despite the protestations from the Obamanistas, Sen. McCain's idea of allowing a tax credit for individuals purchasing their own insurance, while taxing the benefits of employer-provided health insurance was a reasonable step in this direction. I would prefer to simply not tax income used to purchase health insurance, regardless of who is footing the bill.

Why won't this be allowed by the folks in Washington? As is pretty obvious, the folks currently running the world's biggest money wasting entity simply want to find ways to get more of your hard-earned money, including taxing your health care benefits (but without the tax credit). Gotta pay for that "stimulus," you know.

Step 2. Eliminate state-specific health care requirements, and allow folks the freedom to choose health insurance from providers across the country. What many consumers don't know is that each state sets the requirements for what a health insurance plan must cover. For example, in my state, chiropractic care is mandated to be covered. That's sort of like requiring coverage for readings by Miss Cleo, in my opinion, but that's beside the point --- I, along with every other Colorado resident must pay for chiropractic care when paying for health insurance. And I am not allowed to call bullshit "Pelosi" on that and purchase coverage from an insurer in a neighboring state that doesn't have this requirement.

How to accomplish this? I think that most Americans can agree on a basic set of requirements of a health insurance plan, which could serve as a basic starting point for consumers to compare plans and coverage options that could be done more in an a la carte fashion. You want chiropractic coverage, aromatherapy, and massage therapy? Great, here's the pricing schedule. To my mind, this would be the only place where the feds would set policy, and eliminate the ability of lobbyists to get state regulators to insert a host of costly add-ons to plans that consumers don't want.

Why won't this be allowed by the folks in Washington? If those self-serving idjuts won't even allow a la carte pricing for cable TV, do you think they would do it for health care? Besides, the lobbyists for folks wanting their bailiwick to be fully covered would be out in force, so achieving a consensus on a basic level of coverage would be damn near impossible. Given the stinking pile of Pelosi that passed as a "stimulus package," we would probably end up with "basic" coverage that would be far more expensive than what we have now. Even so, I can dream, can't I?

Step 3. Tort Reform. This is a concept near and dear to my heart....and should be to anyone who runs a business. Tort reform would positively impact every single industry in the country, not just health care, with significant savings. Loads and loads of information here.

How to accomplish this? Take Shakespeare's suggestion (Henry VI -- Act IV, Scene II).

Why won't this be allowed by the folks in Washington? They are all lawyers, and most importantly the party currently in power owes a tremendous debt to the trial lawyer lobby. This will never, ever happen in our current political climate.

Step 4. Establish a system of health courts. Just because I think tort reform is desperately necessary for the U.S., I do not think that folks should be unable to access the legal system if they have been truly wronged, whether in the health care system or due to gross negligence in another field. But in the current medical malpractice environment, the only winners are the attorneys.

How to accomplish this? Once again, this would require the full participation and engagement of legislators willing to ignore the trial lawyer lobby.

Why won't this be allowed by the folks in Washington? See the answer in question 3. Ain't gonna happen, no matter how many good folks support the idea.

Step 5. Make me king. "Aggravated DocSurg, Lord of all that is Good and Reasonable, Emperor for Life." Has a nice ring to it, don't you think? That way, I can make sure that this is all accomplished with a minimal amount of bloodshed fuss.

OK, that's not realistic, at least not until I become better armed (time to visit Dragon Man). Actually, step 5 is to tackle the many headed hydra known as Medicare. There is simply not enough money lying around in the pockets of "the rich" to satisfy this cash sucking beast, but there are some concrete steps that could be used to rein it in a bit:

  • Eliminate coverage for chiropractic care. I mean, really, what a waste of cash. We'd be as justified as having Medicare cover astrology as chiropractic care.
  • Allow physicians and hospitals to write off the difference between what Medicare pays and what they would otherwise expect to get paid for the same care. Everybody knows that there is cost shifting going on, and Medicare simply does not cover the costs of providing care to most patients. Why shouldn't I be able to write that off as bad debt or charity on my income taxes? This would immediately solve access problems for patients, particularly in primary care; it has gotten so bad that in my community I cannot find physicians willing to see Medicare patients in many instances.
  • Put the institution of ICD-10-CM on the back burner. Permanently. Coding for care is expensive and time consuming, and the next version of the international classification of diseases is an exponential increase in complexity for coding, with no benefit to payors, consumers, hospitals, or physicians.
  • Eliminate the "3 day" rule to get patients from the hospital into a nursing facility. This is frankly a silly rule that increases costs for all hospitals and for Medicare.
  • Eliminate the rule that prevents Medicare patient from being held overnight at an outpatient surgical facility. This, too, is a silly rule that increases the costs that Medicare and patients must expend to have procedures done.
  • Eliminate the bastard stepchild of Teddy Kennedy and the Balrog known as GPCI. There is no difference in a laparoscopic cholecystectomy done in Colorado as compared to New York, but the pay from Medicare is different based upon Geographic Practice Cost Indices, which are determined by a formula so poorly designed that it would make Einstein blush. It's a ridiculous abuse of the physicans participating in Medicare.
  • Allow seniors with enough of their own money to fully opt out of Medicare. While this is currently technically possible, it is pretty damn difficult to achieve, and because of the issues above is pretty damn expensive.
  • Last, but not least, mandate that all Congressmen and their families be placed into the Medicare system during their time in office and for five years after they leave office. That will eliminate a whole lotta political poppycock.

Pipe dreams? Sure. But heck, if I can dream of being emperor for life, at least I can dream of doing something good with the title.