Yes, it has been a gold rush and it has been nasty because there is
no easy market driven correction built into the system except
outright bankruptcy and that continues to be underwritten by the
Federal government even when the private sector simply takes the
cream.
The need is universal and it is not voluntary. The solution needs to
match. Canada's system can be better but it has a base from which it
can be better. The US system delivers excellence to what is on the
way to becoming a minority and spotty service to most everyone else.
It is time to start over before the bankruptcy court does it for you.
Canada had the good fortune to set up in a time when the industry was
overcapitalized to start with. Doctors were not doing great
financially although they always did well compared to their patients.
Our health care system eliminated the collection problem and allowed
them to function on health care albeit with a set of rules to work
around.
It is still changing and evolving, however our doctors can have a
good life, and even operate under clinic environments which provides
him ample time off. I expect it to actually continuously improve as
time progresses and folks actively work at it. It certainly has
since its inception almost fifty years ago and you can not ask for
much more.
Health Care
Spending: A 21st Century Gold Rush
Friday, 15 February
2013 09:51By Philip Caper, Bangor Daily News
Winston Churchill once
remarked, “Americans will always do the right thing, once they’ve
exhausted all alternatives.” His observation, at least the second
half of it, is proving itself as we continue to struggle with our
health care system, especially its out-of-control costs that are
crippling the budgets of businesses and government alike.
There is a lot of
money in our health care system, and no enforceable budget. That
leads to carelessness when it comes to spending that money.
What are some of the
reasons health care costs continue to rise? Here are a few examples.
For at least the past
40 years, I’ve heard colleagues say, “We’d better get our fees
and charges up now, because next year they’re really going to crack
down on us.” It has never happened, yet. The problem is
intensifying as outpatient “providers” have morphed from being
real people into being corporations.
The Los Angeles Times
reported on a case where a teacher’s group health plan was billed
$87,500 by an “out of network” provider for a knee procedure that
normally costs $3,000. Her health plan was willing to pay it.
Outraged, the teacher ratted on the orthopedic surgicenter to
California’s attorney general. After the press got involved, the
charge was “reduced” to only $15,000. Not a bad pricing strategy,
from the surgicenter’s point of view.
The New York Times
reported an incident where a student who needed emergency gallbladder
surgery ended up with a couple of “out-of-network” surgeons
through no fault of his own. He was billed $60,000. His insurance
company was willing to pay only $2,000. He was left to deal with the
rest of the bill on his own.
There are many more
examples. Privately insured patients are not the only ones affected.
Governors around the country are continuing to struggle with how to
pay for their Medicaid programs. In Oregon, Democratic Gov. John
Kitzhaber is trying to find ways to impose a fixed budget on
Oregon’s Medicaid program without adversely affecting Medicaid
beneficiaries. But, he acknowledges, disciplining Medicaid alone will
not do the job. He hopes his approach will be adopted by most other
health insurance programs.
In Maine, Republican
Gov. Paul LePage is struggling not only with how to keep up with
burgeoning current Medicaid costs, but also how to pay the state’s
almost $500 million past-due Medicaid debt to hospitals. He has
proposed lowering liquor prices to boost sales, and mortgaging
Maine’s future liquor revenues to secure bonds to pay the debt. His
Republican colleagues in the Legislature have described this idea as
“creative.”
One of the central
features of Obamacare is the creation of “health insurance
exchanges,” or online marketplaces. But the law has recognized that
many people will need help making the right choices. So it has
created an army of “navigators” to help them. A recent Washington
Post story points out that a huge number of such experts will be
necessary (California alone plans to certify 21,000 of them). Their
cost will be reflected in higher health insurance premiums and has
sparked opposition from insurance brokers who view them as
competition. That will be an expensive fight, without increasing the
amount going to actual health care by a single dollar.
Then there is the
purchase of politicians by powerful corporate interests. When the
Medicare prescription drug benefit was enacted in 2003, it was
prohibited from negotiating lower drug prices, even though the
veterans health system and many Medicaid programs are permitted to do
so. The lead congressman pushing that provision retired from Congress
soon after it was passed to take a lucrative job with the
pharmaceutical industry. This has become standard practice in
Washington.
And don’t forget the
for-profit levels of compensation paid to the executives of nonprofit
hospitals.
Meanwhile in
Massachusetts, where Obamacare was born, health care costs are
expected to rise six to 12 percent next year. Last year, their
legislature passed a law capping increases in total private and
public spending statewide, limiting them to the rate of growth of the
Massachusetts economy. But the job of figuring out how to actually
get it done was turfed to an “expert panel” of “stakeholders.”
My bet is that such cost control will be difficult or impossible to
achieve unless we simplify and centralize the way we finance health
care.
Why does this
financial abuse of taxpayers and patients continue? Because we let
it. Americans often react to structural problems by simply throwing
more money at them. We seem to be unable to say “no more.”
Maybe it’s time to
revisit the part of Churchill’s comment about Americans always
doing the right thing — by emulating the policies of most other
wealthy countries. They have health care systems that are more
popular than ours, provide better access to care, get better results,
and are far less expensive.
Maybe it’s time to
put everybody into a single, nonprofit system we can all support,
within a budget acceptable to the majority of people. That
arrangement would eliminate the political fights among people in
different health insurance programs, each questioning change by
asking, “How does it benefit me?”
Such a system would be
best if done at a national level. But it could work initially at the
level of individual states, such as Maine. That’s how the
Canadians did it — one province at a time. If Maine could be one of
the first states to do that, the people of Maine could truly say
“Dirigo, I lead.”
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