Chris and I have been discussing healthcare. Parts one and two are on his blog.
There’s a funny thing about your “concierge plan”. It reminds me of the care I used to get before the business of HMO’s promised me affordable care.
Let me see if I remember the steps that got us from there to today’s Rand report failures.
1) Observe there is a lot of money to be made in health care.
2) Promise to provide better care at reduced cost.
3) Step up to be the middle man who could provide these improvements.
4) Explain your case to lawmakers to set up favorable conditions.
5) See who can be persuaded with dinner and golf and campaign contributions. Spend time discussing business with other health care providers.
6) Promise doctors better pay scales to get them on board.
7) Promise consumers better care at cheaper cost from qualified, in house, doctors.
8) Bide your time until a majority of healthcare dollars pass through your hands.
9) Complain about lack of profitability, raise prices.
10) Complain more, lower payments to doctors.
11) Address doctors’ complaints about less money by suggesting they improve efficiency and spend less time with each patient.
12) Repeat steps 5, 9 & 10.
13) Address patient complaints about poor quality by pointing out that sick people are always unhappy.
14) Repeat steps 5, 9 & 10.
15) Reduce costs by providing different services under different plans, referring to them as plan A complete coverage, or plan B, full coverage, thereby reducing expenditures when patients get sick with the thing they are not covered for.
16) Address doctor and patient complaints by helping lawmakers create regulations to improve efficiencies. Take lawmakers on a fact finding tour to Ireland. Play golf.
17) Repeat steps 5, 9, 10 & 15.
18) Explain Doctor and patient complaints about quality by pointing to recently enacted, troublesome regulations.
19) Repeat steps 5, 9, 10 &15
20) Change paperwork coding regularly, making payments to doctors late and if incorrectly coded, reduced or not at all.
21) Explain doctor complaints about not earning enough as due to expensive insurance for practitioners. Ignore doctor testimony about being rushed.
22) Recommend limiting malpractice payouts (after all, that costs insurers too).
23) Point out how many wonderful jobs have been created to handle vast amounts of paperwork.
24) Don’t forget to repeat 5, 9, 10 &15.
25) Address increasingly angry patients and doctors by financing Rand report which points out the problem is patients not helping to control costs.
26) Divide your enemies. Point to Rand report solution of raising co pays so patients challenge physicians to recommended fewer or cheaper services and still get them healthy.
27) Attend congressional hearings (not under oath, what are you, kidding).
28) Testify you have the utmost integrity; you are a business dedicated to increasing shareholder value. Keep straight face.
29) Recommend the best solution is always to leave business to police itself (search history for that success story).
30) Repeat steps 9 through 29 as long as you can.
The problem is that the insurers making policy either do not see the sick or are able to not care.
This is about lives, not styling in cars and somehow I am unable to see them as the same thing.
Government is not the problem because they failed in their task to represent the insured adequately; instead they so far have failed to be the solution.
Twenty years ago we began switching from traditional (concierge) plans to HMO’s in an effort to reduce costs.
Today we have fewer doctors entering the field, and pushing health care paperwork is a top ten growing career (That’s not a warning sign, that’s a problem).
Meanwhile my insurance policy cost has tripled in 15 years and provides less coverage.
Do I have a solution? I know where to start looking for one.
First stop pretending that Government wrote the health care regulations.
They signed off on them. They did not write them. Insurance is writing them.
Second, stop pretending that a janitor, or a carpenter, or a Fool, or anybody outside the medical fields can understand medical terminology enough to decide which plan is right for them.
It’s a career, not something you handle over the weekend. Besides the coverage will be changed again next year.
So let’s stop the abuse of confusing health care coverage. Doctors should decide what care is necessary.
How much insurance should charge to cover me is up to insurers (free enterprise, right?). But my goal is good healthcare.
Since I am trying to create good health care, I need advice from docs who care about people.
So let’s get a team of health care providers from volunteers to decide on what care goes into a minimum plan.
People from “Doctors without Borders” or Red Cross volunteers.
If I wanted to help the insurers, I would ask the insurers to supply the doctors. So I am not asking them.
I will task this team with deciding what goes into a minimum coverage intended to get people healthy. I will task this team to remember that it costs.
Maybe cosmetic surgery gets covered, maybe it doesn’t.
Maybe Ritalin goes in, maybe only after diet and exercise are tried first.
Let them reach out to the insurers or drug companies or holistic faith healers if they want to.
But if a drug co. or insurance co. representative contacts them, jail the rep.
Maybe psychiatrist/psychologist recommended treatment goes under a separate policy, maybe include them.
O.K. so now we have a plan. I know, you imagine it will cost $20,000,000 per person. Me too.
Lets find out. Ask the insurers how much they have paid for each of the included services.
Ask the providers they paid, if they were actually recieved that amount.
Maybe 3 trillion will cover the plan. Maybe less, or more.
Maybe we’ll save money when less people are needed to figure out what is covered, because that is already settled.
Maybe the team will have to re-work the plan to eliminate some services to make it affordable? Maybe there is room to add some.
Maybe coverage for a family will cost $10,000/year. I don’t care if I pay it to Medicaid or Great-West if I am getting the coverage I need. Maybe Great-West is great deal for me.
But I bet if you cut out the need for paper-pushers (21% of insurer costs), and personnel in the doctors office who do nothing but figure out billing (?%), we could save some cash and improve care.
I bet we could negotiate 30% out of our drug costs from where we are now.
Even if we cannot save a dollar off of the $5500/person we spend today, maybe we could get our moneys worth.
Would I try to get Docs some liability breaks? Definitely. If I have health care my medical expenses are covered, I don't need to sue. I've got social security to see my kids through high school and loans to get them through college.
And lets face it. If your concierge screws up, and you cannot work and spend your savings, all you'll have left is medicare and SS too.
Pain & suffering? Money won't help us with that. Give the docs (x) free passes a year, after that, if they suck at being doctors, change professions.
Will abuses happen? The insurers are guilty of that today.
Me, I think hiring fifty or so doctors to do this would be tax money well spent. Even if it means in the end, I have to acknowledge that business is doing a great job. But right now the results are saying otherwise.