Posted by Pattie on 8/14/2009 08:23:00 AM

I just saw this posted in a forum (I will refrain from attribution because I don't want to debate the person, but the ideas):

The compassion of the IRS
the efficiency of the Post Office,
at Pentagon prices.

Without pointing out the immediate fallacy (no one is advocating "government run" care -- oops, pointed it out anyway) this is my response:

The compassion of Wall Street,
the efficiency of American Auto Makers,
at Hollywood Blockbuster production costs

Medicine is never going to be a free market because the knowledge and care needed at the worst possible times in our lives is complex. Those charging for these services are always going to have the upper hand. Free markets allow for buyers to shop, to refuse to buy, to obtain the best knowledge. Without consumer protection and a power player in the market that evens the playing field, we are at the mercy of the sellers in the worst way -- the consequences of not buying is death, disease and disability.

I happen to believe that it should be universally and singularly funded so that we have one representative for the people who negotiates the purchase of services for all humans (this is the Canadian system and having been a part of it for several years, I found it to be working fairly well). But I'm a realist and I don't believe that such a system would be possible at this time. Too many stakeholders with too much to lose.

What is a close second is what is being proposed by Obama and is being semi-fulfilled by the various bills being considered in Congress: make one of the players in the market a force to level the playing field.

What I find most disconcerting is that many of the criticisms that are being leveled and fears being expressed about government involvement in health care already occur in our system, just through the private sector.

This is my top seven list of misconceptions:

1. Everybody pays for their own health care.

If you have insurance, you are paying for everyone else in the insurance system -- the concept of pooling funds to cover the risk for a few is the basic concept of insurance. Excluding millions of people from the pool isn't very smart unless the people you exclude from the pool are the ones most at risk, thus, insurance companies do not want you in the pool if you are a child, if you are an older adult, if you have a pre-existing condition, if you have are at-risk because of family history or personal behavior, and, increasingly, if you get sick.

2. No one should have to pay for those who do not qualify for insurance.

One of the reasons that health care entities charge so high is they have to cover the visitors to emergency rooms and facilities who do not pay either through bankruptcy or through simply not paying all or most of the bill. This not only costs the entity the money spent on the time and equipment to provide the service, but also the staff time on social services or collection services at attempting to get the bill paid. The net result of this is that those who have insurance pay more than they would otherwise because they are paying for these overhead costs.

3. Doctors and nurses should decide on care, not bureaucracies.

This ship sailed in the mid-80s. Your medical decisions are being directed by nameless, faceless decision-makers who "qualify" your care through your insurance company. If they refuse to pay, you most likely will not receive care. The job of the decision-maker is to find whatever reason possible to deny care in order to maximize profits. Most the reasons they find are NOT medical reasons. They look for some little thing in your application that they can use to cancel you policy (btw, they do NOT refund your premiums when they "discover" these discrepancies). The number one complaint that most medical professionals have regarding the current system is that they cannot spend the time or provide the best care to their patients under the current system. This is why nurses, especially, are solidly for health care reform. They see the results of this system every single day.

4. If the government becomes a major player, we will lose the efficiency of the free market.

We currently have the most inefficient and costly system in the developed world. Fully 25% of our health care "costs" are due to the enormous administrative burden of going through the qualification process the each insurance company has. Most doctors offices now employ at least one staff member who does nothing but paperwork and sit on the phone all day working through the bureaucratic mess of private insurance.

Our emergency rooms are places of the biggest medical mistakes because they are clogged with people who have no where else to turn for care. In inner cities, airborne communicative diseases spread faster because of these centralized places for the working poor to gather when they are sick to sit for hours and hours of exposure. We are one big disaster away from the whole thing breaking down.

The current system is extremely inefficient and is getting worse. We are starting to see the results. A recent book asserts that medical professionals are misdiagnosing about 15% of the time.

5. The current system allows the freedom to get medical care without interference from bureaucrats.

This one is especially used by those who would scare older persons with the so-called death clause. Well, every single HMO that I've studied or been a part of has "end of life counseling" already. I'm asked every time I go to the doctor or hospital about whether I've set up a living will. The current profit motive is going to push and push us to consider opting out of their paying for care at every turn. This is not a medical issue. This is not a moral issue (you know, care for your loved ones by planning ahead, it is the right thing to do), this is a profit issue (tell your doctor to turn off the machines so we can collect from you and never have to pay out). Personally, I'd rather have this be a matter between you and your attorney and not be asked when I'm sick, but if people are sure that this is a government thing, they need to pay attention to this long-standing practice by the HMO.

This does raise another issue that I think is more important. Does universal health care mean anybody can get any medical service they want covered. The answer is "no" and has to be "no" because otherwise we will be giving free reign to medical providers to invent crappy medical interventions. Oh yeah, we already have that -- its called "fee for service" and only a government player in the system is going to push for an incentive that doesn't include keeping us sick in order to get more money out of us. In truth, this may be the only thing HMOs have been good for in the past 30 or so years, but because of their own profit motives, they found out that they like us being sick too -- that way they can refuse us coverage when the moment comes while keeping our premiums.

6. The current system is good for business

It is plainly not. Some of the business failures we have seen in the past few years have been in part due to the rising costs of health care coverage for employees and pensioners. The only business that the current system is good for is the HMO/insurance industry and the pharmaceutical industry. I mentioned in a comment on an earlier post, it is my belief that if we continue with the current system, we are going to see the United States lose ground in the world economy (and may be seeing this already). Outsourcing from other countries, moving of factories to other countries and brain drain exits of college graduates to other countries are all motivated in part by the rising costs of health care.

7. Our system is the best in the world, why mess with it?

Yes, we have more bells and whistles than most places. We do love our technologies. However, most of the time our technology drives up costs without producing much in the way of improved health. The fact is that we rank out of the top 10 in a number of health indicators such as life expectancy and infant mortality. When put in a per dollar perspective, we really suck. We spend more, receive less. We are not the best in the world and the best in the world are systems that have their governments involved in some way.