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Solutions to
the Rising Cost of Healthcare
When in Doubt, Cut It Out.
SOURCE: Information gathered by the American Policy
Roundtable
Compiled by Professor Charles McGowen, M.D. and Chief
Medical Advisor to the American Policy Roundtable; August
11, 2008.
One of my friends, a
surgeon and a colleague, has a favorite axiom that he has
frequently used in deciding upon the proper care of an
acutely ill person who presents with increasing right lower
abdominal pain; “When in doubt, cut it out.” Sometimes that
which the surgeon excises requires the addition of something
to replace the missing tissue or its intended function. In
the illustration used above, the appendix is one exception.
However, if for example a thyroid gland is removed, thyroid
hormone must be prescribed to replace the missing vital
metabolic substance it produced. In the case of a sick
healthcare system, cutting out the offending agent is in
definitely order, but we must also have a proven method of
replacing that which is no longer available in the care of
our citizens. Furthermore, that entity which is used to
replace that diseased system that has been extirpated must
have a proven track record of success. Having now
diagnosed the problem, the etiology of our ailing healthcare
delivery system, as being the multilayered, bureaucratic,
managed care that has been provided by HMOs, all we need to
do now is to “cut it out.” We must immediately remove it and
replace it with a more workable system; the tried and true
method of all successful American business called free
enterprise.
As explained in a previous
article, the HMOs with their over paid CEOs, the multiple
layers of bureaucratic intrusions, the needless rules and
regulations, the reams of paper work, the hours of
surveillance upon the practices of physicians and their
patient’s charts, plus the thousands of HMO employees
needing paychecks are collectively what has caused the cost
of medical care to reach unbearable levels. We were able to
function quite well before those managed care organizations
were put in place, separating one’s doctor from oneself, and
we will be able to function just as well after they are
gone. The reader may recall that the HMOs were supposed to
be the cure for the increasing cost of medicine; they have
resulted in just the opposite. The government planners who
put those managed care organizations into place failed to
realize that another bureaucracy, the federal Medicare
System was the real cause for that initial, insidious rise
in the cost of care between 1965 and 1980. Thus having
misdiagnosed the problem, it was only natural to expect that
the wrong remedy would have been implemented. Having
prescribed the wrong therapy, the metaphorical patient (the
delivery of healthcare) not only remained sick, the patient
became critically ill, had to be sent to the intensive care
unit and is now on life support. Had practicing physicians
been consulted early on, the misdiagnosis would have never
occurred and the deadly therapeutic mixture (the HMO fiasco)
would never have been prescribed.
As an aside, one of my very
wise mentors once told me that the patient would always
provide me with the correct diagnosis if I simply asked the
right questions. The reason that the Federal government and
managed care organizations have never correctly diagnosed
the problem or offered an efficacious cure is because they
have failed to ask the right people (practicing physicians)
the right questions. This has also been true of hospital
administrators and boards of directors (on which I have
served); they seldom ask the ones who really know the
answers when it comes to the efficient, expeditious delivery
of health care.
By excising the failing HMO
organizations we can better utilize the billions of
healthcare dollars being consumed by those uncaring, bottom
line, business people and focus those monies, not on
improving the profit margins of the insurance industry, but
instead in refining the delivery of health care at a price
that people can afford. The following is the scenario that
will work. First the employers of our working millions take
the money they now confer to the HMOs (roughly $13,000 per
family) and instead give it to their employees. Federal
legislation needs to be put in place so that those payroll
dollars are not taxed if they are documented as having been
used for the purpose of health care. The employee must
verify that he/she has put half of that increase in pay into
a health savings account (HSA) and that they have purchased
catastrophic health insurance (CHI) with the remaining half;
I.e. $5000 deductible. The employer still gets the tax
deduction and the employee need not worry about paying more
taxes for an increase in his or her income.
The catastrophic health
insurance will cover any extraordinary hospital expense that
could normally bankrupt a non-covered person. With the money
in the HSA, the employee can shop for the best deal with the
best doctor that will meet his self determined medical need.
That is the basis of consumer driven free enterprise.
Currently, neither a physician, a laboratory, a radiological
facility nor a hospital receives the exact dollar amount
they bill for the service they render. For example, if you
are covered by Medicare and have supplemental health
insurance, by simply examining your most recent bill, you
will notice that the practitioner or facility charged a
certain amount, while Medicare allowed only a certain
percentage of that billed amount and that the supplemental
insurance picked up only a portion of that which Medicare
did not pay. In the case of people under the age of 65, the
HMO pays much less than the bill indicates. The total of
what is paid to the doctor, the hospital or ancillary
facility typically amounts to less than 50% of the original
charge, and in some cases it is even less. In fact, I
recently read a bill that was submitted to Medicare by a
sleep study specialist. The bill was $500 for interpreting
the numerous bits of data that was collected while the
patient was asleep over an eight hour period. Medicare paid
the physician $122.87 and the patient’s co-insurance paid
another $24.57. Thus the physician’s total reimbursement was
$147.44 or 30% of that which he had originally billed.
Therefore, by establishing new fee schedules based upon what
they actually now receive under the managed care system,
physicians, ancillary facilities and hospitals can
immediately lower the cost to the patient but still not take
a cut in their current income. The difference will be that
which was formerly siphoned off by the HMO.
By using the HSA wisely,
and not seeking medical care for minor problems or going to
expensive, crowed emergency rooms or ambulatory health care
facilities, young, relatively healthy employees will be able
to accumulate quite a large sum of funds in their HSA, which
also accrues interest, that will no doubt cover any
extraordinary expenses in their later years that will more
than off set the $5,000 deductible portion of their
catastrophic health insurance. Furthermore, as this consumer
(patient) driven free enterprise system is implemented and
the cost of medical care falls, even those persons not
covered will be better able to afford care when they really
need it. After seeing that the elimination of the HMOs has
improved the delivery of healthcare for the under 65
population, a similar adjustment in the Medicare delivery
system can also be employed. Prior to 1965 doctors managed
quite well caring for the elderly. In fact today’s over 65
senior citizens are in general, better off financially than
most working younger folks who are raising families and
saving for their children’s education.
Free enterprise also
stimulates entrepreneurs and that will further improve the
health of our nation’s health care system; this would be
what we physicians call adding adjunctive therapy following
surgery to remove a cancer. I can envision groups of
physicians who treat similar illnesses affording their
patients a one-stop shopping, specialty mall. These
facilities can be built in conjunction with contractors with
a similar entrepreneurial spirit. Diabetics are often
treated by their primary care physician (internist or family
practice physician) in cooperation with a team of other
physician sub-specialists: an endocrinologist if the
diabetes is particularly severe, an ophthalmologist (for eye
care), a nephrologist (if renal failure ensues or dialysis
is needed), a podiatrist (for foot care) and a cardiologist
(heart disease being common in diabetics). Given the rising
cost of travel, the diabetic would welcome having to devote
an entire day in that facility to see his or her various
physicians. There would no doubt also be a need for
radiology and laboratory facilities as well as a coffee shop
in that mall. Free enterprise stimulates the economy;
socialized medicine as proposed by Senator O’Bama and other
liberal minded politicians stifles it. This proposed free
enterprise, which is so dearly needed, will not happen
unless every citizen who finds the current cost of medical
care intolerable demands that their respective, elected
representatives to congress (House and Senate) change the
system. If they refuse, we can offer them the same exit (and
extirpation) that we are offering the HMOs, and then we will
elect representatives who do have our best interest at
heart. Be assured that the HMOs will be lobbying very
earnestly to protect the golden egg that the proverbial
goose (called managed care) has deposited in their bank
accounts.
Several other remedies are
needed to supplement this principal cure (a surgical
excision) for our ailing health care system, the additional
adjunctive therapies will be addressed in articles over the
next two weeks; namely tort reform to reduce malpractice
fees and unwarranted suits, the reduction of pharmaceutical
costs and the essential need for every American to become
more serious about his or her own general health.
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