Wednesday, July 22, 2009

Health-care Rx


I'm beginning to believe (no, I know) that Congress and this administration are a bunch of doofuses ... witness their (independent of their political party) feeble and/or self-serving attempts to solve our health-care costs problem. First, I have an issue with the premise that our medical costs are "spiraling out of control." Fifteen years ago national heath-care costs represented 14% of GNP and today they are just over 17% of GNP. Wow!! Let's destroy our economy and our way of life for a three percentage point growth in health care costs over fifteen years.

But, OK, I will concede that we can't let this trend continue forever and therefore the major thrust of "health-care reform" should be cost containment and (hopefully) rollback ... not expanded standard health-care insurance coverage (which, by the fact that it inserts a government middleman into the existing process, is sure to be more expensive.)

There seems to me a number of obvious solutions for containing or reducing the cost of health care in this country:

1) Eliminate emergency room (E.R.) health care -- indigent outpatient clinics need to be opened in hospitals with appointments required, a minimum payment requirement (say $20?), and reasonable Medicare/Medicaid reimbursements. (This is the way it was 50 years ago.) Non-emergency medical treatment should not be permitted in E.R.s.

2) Tort reform -- today many doctors pay hundreds of thousands of dollars a year in medical malpractice insurance. This money must be made up in patient fees and, often, in dubious other practices (non-required tests) which compromise the integrity of many medical practitioners. We also need to eliminate lawyers' advertising on TV (which once was the case prior to the tsunami of litigious medical bonanzas, such as John Edwards reveled in)

3) Pooled major-medical insurance -- there should be made available a centralized comprehensive major-medical insurance provider separated from standard medical insurance. It can be private (preferred) or public, but should be so large as to spread the risk of medical catastrophes over virtually the entire population of this country. It would be available for individuals to purchase, but HMOs and other health insurance companies could re-insure through this entity (at a cheaper cost) the major-medical portion of their existing coverage.

4) Huge pooled drug purchasing at cheaper prices -- separated from normal medical insurance. Can be done privately (preferred) or publicly (like the current Medicare/Medicaid drug offerings). HMOs and other health insurance companies could take advantage of this consortium to reduce the drug purchasing costs of their health coverage. We should also eliminate all prescribed-drug ads on television (like it used to be). This would help reduce the cost of drug marketing to the pharmaceutical companies which might help offset the gross margin pressure forced by the cheaper prices engendered by this pooled purchasing.

5) No elective medical procedures should be paid for by health insurance companies. The cost of such things a liposuction, breast augmentation, etc. should be entirely borne by the recipient. This would cut back on many of these self-indulgent medical costs.

6) More program options for standard (non-major) medical insurance coverage. Families of two person (such as retired couples) should not be forced into a "family" category with young married couples with higher premiums than are justified.

7) Cutoffs for the tax-deductibility of gold-plated medical insurance premiums -- companies (and government entities such as Congress) should not provide (and pay for) employees tax-deductible health insurance whose premiums exceed a maximum level (say $20,000 per year per family). Those plans exceeding that level would incur a tax liability to the recipient

8) Eliminate from Medicaid and Medicare coverage the following groups -- prisoners (2.3 million), illegal immigrants (12 million), Americans living abroad (6.6 million), and millionaires (40,000).
9) All non-major-medical doctor or hospital visits and prescription drugs that are covered by standard medical insurance should have a co-pay of at least 5% of the cost to the provider. This would encourage better economic decision-making (such as switching to generic drugs and eschewing non-required tests) on the part of insured recipients.

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