Monday, August 17, 2009

Acting Healthy, Wishfully Wealthy and None Too Wise

I don't know about you, but I'm about worn out. This barrage of information, disinformation, inference, dissembling, nuanced quotes, spin, circumlocution and outright lies that pass for a national 'debate' about the health care in this country are national alright. A national disgrace. We've no one else to blame as we've bought into the 24-hour bombardment of all news, all the time. It comes at us in a cataract, so fast and furious that no time is left to separate the wheat from the chaff--if there is any wheat. We have lost the ability to have a reasoned conversation or disquisition about health care. Or about any controversial subject for that matter. If it's not citizens exercising the right to scream, excoriating the 'other side', then it is politicians continuing the incessant percussion of one side or the other. We're disputacious simply for the sake of it. From either pole we're told what's best for us, didacts all around. Liberal v. Conservative--both can't be right, but is one totally wrong? Where is Rodney King when we really need him: "Can't we all just get along?"

Here's what I know and it isn't much. I know that our health care system could use some tweaking, just a little at a time. Kind of like making lemonade and tasting it a few times so you don't put too much sugar in it. Want it to be just right or you have to throw the batch out and start over. We can't afford to start over. Just cannot. Lemons cost too much and in the meantime we'd be really thirsty.

Speaking of sugar, we eat too much of it. I'm very guilty. We eat too much of a lot of things in this country. We are the fattest in the world. The scales reveal that some 60% of Americans are 'overweight', whoever decides that sort of thing. It doesn't surprise me. Just look around. I realize that, at least on the 'weight front', I won the genetic lottery, but even still I work at it. Moreover, estimates are that 25% of our fellow citizens are morbidly obese. Is it any wonder then that our life spans are shorter than those in other countries, that we have more heart disease, more cancer, more everything. I suppose it's because we have more money. Aha. That's why I'm not overweight. Tuition poor.

Because I've been told over and over and over again, I've assumed the truth of the argument that we spend more of our hard-earned cash for health care (as a percentage of GDP, of course) than we did 10, 20 or 30 years ago. A lot more. But didn't we get something for that? Don't we have the best system on the planet? If not, why do all the heads of state and other big shots come here when they are really sick? We bagged a lot for our bucks. I can testify. But for the invention of MRI as a diagnostic tool in the past 15 years or so, one of my daughters would not have been diagnosed with a rare brain condition and it's likely she would be paralyzed by now, requiring full time care instead of being on the cusp of joyfully entering her sophomore year in college in fine fettle. I also know that the continuing advances in treatment for various forms of cancer bought my kids 33 months with their mom--and she with them--time that would have been lost to all ten, even five years ago. Am I willing to pay more for the kind of incremental improvement in care that can do that? Are you? The answer is a simple one for me.

It may not be so simple though for someone who's never faced such questions of life. It's easy to bellow back and forth in a vacuum. It's more problematic when one is parachuted into a war zone, fighting for health or life and being reduced to begging beseeching medical science for something, anything that will heal. I hope it never comes your way.

So, here are a couple of things, simple ones I think, that we can do to make our system work a little better. Only one involves the government.

1. Do something to fix Medicare before even looking at anything else. It's a mess because the government runs it. A pediatrician friend of mind loses money every single time he innoculates a medicare patient--every time. It's not just the value of his time. He loses money on the reimbursement for the actual drugs. He continues to treat these patients because of his adherence to the Hippocratic Oath and because he is a good guy. Is it any wonder though, that doctors run like wild mustangs from taking any more Medicare patients? Whatever your business, would you elect to lose money on many of your customers? One 'fix' for this bureaucratic nightmare would involve legislation, though I shiver at the idea. I am a big believer in the freedom of choice in this country. For example, I wear a seatbelt always, but don't think it should be a law (except in the case of kids). It should be up to me. However, should I be in an accident without one and require medical care, guess what. No help from the government. My problem. I elected to take the risk, so I take the penalty. Same with refusing to wear a motorcycle helmet or smoking cigarettes. Okay, I have the right to choose, but I don't get to have your tax dollars pay for my reckless behavior.

2. Stop eating Big Macs, Whoppers, fries, two-pound burritos and drinking Big Gulp sodas all the time. Push away from the table occasionslly. 'Abstemious' is an adjective that would fit us all well without having to go on the 'Cardiologist Diet: If it tastes good, spit it out.' None of us has to give up everything. We need food for the body as well as food for the soul. Without the latter, life would be grey indeed. However, anyone who continues the porcine habits and develops diabetes or heart disease, don't expect me, i.e. my tax dollars to pay your medical bills. Take some stinking responsibility. It's genetic you say? Even more reason to drastically change your behavior.

3. Every insured family would be required to have a Health Savings Account--including members of trade unions and Members of Congress. We're told we seek and/or our doctors recommend too many tests because for us, it's only a co-pay--little fiscal pain. Why worry about it? Here's why. Some of it isn't necessary, overkill. There's plenty of blame to go around for the 'why'. Look in a mirror for some of it. I went 'cold turkey' starting two years ago when I first tried an HSA. The first $5,000 of cost were on me--doctor appointments, prescriptions, tests and everything else for my family. Believe me that I started giving some more thought to where exactly that money went. I selected that amount because I felt I could swallow an average of $400 a month, though I had no clue how it would evolve over a years. The kicker was that my monthy family insurance premium decreased to the point that the total was about what I'd paid for coverage in the prior year. The bonus is that if I didn't spend $5,000, my annual total was less. In the first year, we had a couple of significant costs and blew through the $5K. After that, every dollar was paid by the insurer. This year, so far so good and no major issues have arisen. The HSA amount each family can afford is different, of course, but I guaranty the structure will cause people to alter behavior. That will translate to lower relative costs for all.

4. One of the provisions of the myriad Congressional proposals floating around is that insurance policies should be portable, i.e. an insured can take it from job to job. That makes sense to me, but perhaps I'm uninformed. Enlighten me.

5. Lifetime caps on an the amount of coverage for any one insured under a policy is a complex issue. Many if not most policies establish a $1 million cap per insured. Sounds like a lot doesn't it? It's not. Judging from my own experience, when dealing with a serious illness, that amount can race over the horizon without warning and I can testify that I had no idea until the end. Maybe there is a larger number that makes sense or maybe there should be no cap. That's fine, but it will be reflected in the premiums we pay. I'd rather pay.

6. Pre-existing conditions - That's a tough one as well. I tend to think that as the mindset of our population changes, that has to change as well. I read somewhere that my generation has or will change jobs an average of 3 or 4 times in a lifetime. The next generation are likely to change careers more than that. Translation: More movement and under the current system, many would be excluded from coverage at a new employer. I don't think any of us believe in a slavish existence, tied to a job we don't want simply because of the need for insurance. It's not good for either employer or employee. I'm not sure how many people are cut out by insurers today other than the ones trotted out for media coverage, but it seems they could be absorbed in some manner. I don't know the monetary effect, but emotion rules on this one.

7. Give hospitals statutory liens on the property--including government assistance--of any patient who comes into an emergency room for treatment and refuses to pay.

8. Ask our doctors to come down from the pedestals upon which we placed them. I have many friends, many, each of whom is dedicated to saving lives and relieving suffering. They are good decent people, but they are not gods. They are humans. They deal mostly from symptoms. They are not infallible. They make mistakes. They should be held to a standard that befits their education, experience and gut instinct. Conversely, we should be forbidden from suing a doctor simply because we didn't care for an outcome. We shouldn't sit on a jury and give fellow citizens money from doctors and their insurers simply because it's there for the taking. Yes, in egregious instances where a doctor ignores the evidence, doesn't exercise the care which is common to his specialty or worse, consequences should follow. Sometimes though, money is no compensation, but mere a windfall. I well know. No amount of money, not Bill Gates' money, can buy us what we really want when a loved one is sick. Or worse. We should stop looking around when something bad happens and assuming that someone must pay for our pain. Sometimes, it's nobody's fault.

So, a couple of suggestions that would modify our current system, but not subject us to an unknown that may not be workable, not because it doesn't have merit in theory, but because the government has shown it can't run anything efficiently. Though some would argue otherwise, the bellwether that are the systems in Western Europe are not ones to emulate.

What about the '46 million uninsured'? First, subtract the illegal aliens. Then require those that can afford coverage to actually buy it. Those two groups removed from the total will reduce the number substantially. There are other sub-groups that can be deleted as well. The gross number has become 'conventional wisdom' simply because the media have repeated it so often. After stripping out those that can be accommodated, the remainder can come under the aegis of Medicare even as it is being overhauled.

I admit to the simplistic approach outline herein and that it has not been researched to the nth degree, though I have read about the matter ad nauseum. But then is this all as complicated as we've been led to believe by those on both sides of this uncivil war? I think not. Perhaps we should add just a little sugar to the lemonade and see how it tastes.

No comments:

Post a Comment