Thursday, March 11, 2010

Risks, Alternatives, Cost Control and Health Reform Twitter #HCR

Let’s talk about these powerful words in relation to the current health care crisis.

If the doctor patient relationship was established with a greater risk component, then the patient and not the doctor would be assuming the risk of deciding upon a treatment protocol. In my opinion, this is a healthy way to contain costs in health care. Law suits are not driving up the cost of health care but any medical professional will tell you that defensive medicine practices are. If the medical professionals shift the risk to the patient, then patients will be assuming risks for treatment. I recommend this shift for several reasons.

  • The growth of alternative medicine in providing comfort where cures do not exist
  • The growth of defensive medical practices
  • The growth of information sources now available to patients that did not exist 20 years ago.
  • The need to tie cost containment to health care delivery systems
  • The growth of electronic means of reporting and monitoring medical treatment

So let the patient beware. One of the reasons that health care has had explosive costs is because health care does not have reciprocal mechanisms built into it which occurs in our free market. This has been a primary cause why health care costs have gone out of control. It also has had an impact on the growth of bio-medical stocks exploding growth in a recessive economy. If the government is going to write a bottomless check for health care, then why not invest in it? Most investors wisely see that they would be foolish not to. The argument that we have the world’s best health care and it should be protected is breaking down. This week The Cancer Society reported that PSA blood testing in 50 year olds is a cash cow that is not delivering any real benefits for many men. I still believe that we have the best health care delivery system, but unchecked medical research and development can not survive on a bottomless pit of borrowed money.

Alternative medicine can provide relief to people where a cure does not exist. For example, pharmaceuticals are not the always the best way to manage pain. They can lead to addiction where withdrawal is just as significant as the pain they are attempting to control. The alternative medicine field is less expensive than the traditional medical practices. They have less burden of regulatory compliance and few defensive medical practices because the patient assumes the risk. Electronic portable devices have made the monitoring and reporting of medical treatment portable. Patients can now monitor their own vital signs and feed back that information to a medical professional with wireless technology.

Perhaps in the future a consumer protection agency for patients can be established that will protect the interests of patients. This regulatory idea is far more preferable to defensive medical practices that encourage medical professionals to exacerbate costs to protect themselves. It is not medical malpractice law suits that are raising our health care costs. It is the threat of them. Medical professionals tend to be compliant individuals that cross their "t’s" and dot their "i’s". They will do everything in their power to avoid being accused of negligence. These people have good values that are being turned on the ear because of the threats of law suits.

Tuesday, March 9, 2010

Why insurers don't control costs

I read Ezra Klein's article in the Washington Post today. It is titled ...  Why insurers don't control costs
From Wikipedia ... "Health insurance like other forms of insurance is a form of collectivism by means of which people collectively pool their risk, in this case the risk of incurring medical expenses."

The pooling of medical expenses is a good idea. The problem with our insurance is that it is managed badly. Employers paying 70% of the cost is a bad idea. The risk must be shared for cost containment to work. Otherwise it is viewed as an entitlement that we deserve. I would prefer the private sector doing this, but we are saddled with Medicare now so fix it.

We do not deserve anything that we do not pay for. If we are going to use a single pay-or system then raise the tax for Medicare and bail it out. Begin to pre-pay Medicare instead of pay as you go. When we pay forward our medical expenses through a pay roll tax we will treat it differently. The magic of compounding interest will put us in the enviable position of having medicare surpluses.

Contain costs by introducing more reciprocity into the health care delivery system. Open up choices for patients to consult with medical professionals and not just doctors. I even think that alternative medicine can provide more comfort at less money than our current system.

Get rid of defensive medical practices. Patients should be aware that all surgery and medical treatments have some risk. Assume the risk or refuse the treatment. Medical reporting and monitoring should become electronic to reduce mistakes and decrease administrative costs. Wireless devices make every home a hospital

I am for any business that is profiting from health care paying an excise tax on profits. If a company is benefiting then they should share their profits with the recipients of health care to lower costs.

Friday, February 26, 2010

I give in!

I give in!

Let's pass it, but let's also continue to work on making health care something that we can pay for as well as benefit from. Let's continue to work on developing technology with an eye toward cost savings as well as health care.

I think regulation on alternative medicine should be loosened to emphasize comfort over cure.

I think that insuring 30 million Americans is worth the risk of a few bad apples if there are incentives put in place to stop abuse.

The respect the economists in the NY Times article. There is no reason why medicare can be fixed and defensive medicine corrected after this bill is passed.

Our President has done a masterful job of bring the stake holders together. Although I think the summit could have taken place with a caucus process.  (See my previous post) I believe that he make the changes necessary to the health care bill after it is passed.

Monday, February 22, 2010

The Blind Spot of Obama Health Care #HC

Let’s simplify things about the health care debate. Republicans are for states rights. They generally would agree with a health care proposal that has the most limitations on the federal government. Democrats are for federal initiatives. They disagree with the republicans that states should solve national problems and wish to maximize national solutions. The libertarian camp has recently entered the debate in the form of Ron Paul. They go a step beyond Republicans to maximize individual rights over the rights of individual states. I would recommend that there is a forth point on the political compass that is being ignored. That point could be called the “Statist” solution. A statist solution would delegate our democratic freedoms to a panel of experts for a time to solve a problem. This solution would be the way that countries like Germany have traditionally solved problems. Countries like Germany hire a commission of experts to solve these problems, and then take the governing of this solution out of political hands so that the commission can stay the course and solve the problem. Recently, our president set up a bipartisan commission of two former deficit hawks in both parties to remove this blind spot from our eyes. I believe that our president is on the right track here. Why shouldn’t this same strategy work on health care?

I appreciate technological tools like twitter that open up this debate to small voices like mine to enter the fray. Many of the news commentators and journalist have a vested interest in selling advertising. They choose to interview people who are controversial so they can increase their ratings. I do not believe that the German solution has much controversy or democratic input to drive public policy debate. That is why it is currently a blind spot in the health care debate. America is a country made up of salespeople. We love to give our best pitch and hear about ideas we believe in. I think it is time to give the Americans with more or an engineering perspective a turn to govern. The health care system is broke and it needs to be fixed. Should we consider all possible solutions? Problems that do not appear in the blind spot of our rear view mirror may be better solved by us looking directly to the experts for a time until the problems are more easily seen.

Wednesday, February 10, 2010

The Third Rail of Politics meets Twitter Health Care Reform #HCR

There are three problems facing our president as he prepares for his upcoming televised health care summit. I am a progressive Republican who is rooting for his success. I am going to suggest something that a politician should never do. I would suggest Mr. President that you boldly touch the third rail of American Politics.

1.    He should fix the funding of Medicare and social security.
2.    He should tie the future costs of health care to our standard of living.
3.    He should form an alliance with the Republican Party as well as secure populist support with all stakeholders.

My proposal would be to pre-pay Medicare and Social Security with a 13.5% payroll tax for the employee and employer. A 13.5% payroll tax would enable to begin pre-paying social security and then slowly reduce the tax over 10 years. This could also be accomplished by keeping payroll taxes as they are now and taxing employee benefits. Then contain costs by tying future expense to GDP growth. If our country is not growing, then we must make decisions about comfort instead of cures for those of us in need of health care. Another funding proposal to pre-pay Medicare and Social Security is to empower the IRS and the Social Security Administration to debit $3500 from every retirement account in US. These funds would be used to pre-pay medicare for those designated social security numbers in those households. If a household does not have a retirement account then they would have the option of a 13.5% payroll tax to meet the prepayment option. The magic of compounding interest multiplies the usefulness of these pre-paid funds. Within five years payroll taxes can be lowered to more reasonable levels. The investment options for these funds will be determined by an independent commission  of economists elected by the National Association for Business Economics. (NABE) It could be set up similar to the federal reserve board.

Health care must make sense…

•    Pre-existing conditions must be included in the insurance pool
•    Health Insurance should be able to be purchased across state lines.
•    Those with out health insurance should pre-pay medical expenses at a discount for preventative health care.
•    The uninsured should continue to receive acute critical care through the established practice of cost shifting.
•    Universal health coverage can still be explored at the state level.

Health care cost must be contained

•    Pharmaceutical companies should pay a portion of health care based on their profits.
•    Disincentives must be built into the health care delivery system for patients to sue. 
•    Alternative medicine practices should be encouraged to provide comfort when cures are beyond our ability to pay for them.
•    Electronic reporting procedures must become standard in the delivery of health care by medical professionals.

We are currently being slammed by a snow storm in the Mid-Atlantic States. I am history teacher stuck in my house spinning solutions to problems that I have no business attempting to solve. Perhaps this snow storm can generate more ideas right now. A snow storm can slow things down enough to include the average Joe’s opinion on issues that matter to us all. I want you to solve these difficult problems that are facing our nation. I believe that your judgment is probably better than the intellectual community as you enter into negotiations with the stake holders of this dilemma. I am at the bottom of the list of these stakeholders. The beauty of democracy is that when a snow storm happens I have the time to think through these issues as both the least significant and most numerous of your constituents as I twitter my thoughts to you.

I see the stakeholders as …

•    The Democratic Party
•    The Republican Party
•    Organized Labor
•    Small business
•    Pharmaceutical companies
•    Defensive medical practices
•    Medical community
•    And me Pat Citizen

Thursday, January 28, 2010

The State of the Union.

I am progressive Republican that likes President Obama. I think he is one of the best speakers the American Presidency has ever seen. I am a teacher currently on service learning trip with my students in Panama. My concern is about global competition Mr. President. If we continue to leverage our debt to other countries like China will we continue to have the same standard of living that we now experience? This question is meant to be constructive criticism. I am concerned about the future of my students and my five children. When I speak with people in Panama I get the impression that the United States is in an economic slide.
I am very impressed with the way that you have tackled your own party and political interests that will benefit the country, but not your political career. When I say that I was referring to examples like the Cadillac tax on health care which unions oppose and the pharmaceutical tax which corporate interest would fight. Of course, as a republican I think the trial attorneys should have some kind of incentive to curb defensive medicine practices, but you are steering through a mine field better than I could have. My advice to you is read about the life of Abraham Lincoln in the book, “Team of Rivals”. Lincoln was able to balance competing interests in a different time when information was not instantaneous. Your task is much harder. I pray that you will be able to do the same.

Monday, January 18, 2010

Twitter to Massachusettes on #HCR

 The Commonwealth of Massachusetts currently has universal health care. The replacement of the former senate seat of Ted Kennedy is ironic. From an outside perspective we may think that Massachusetts citizen's  are rejecting the Obama health care reform bill. Actually they are rejecting the unfair cost shifting of Massachusetts money to other states like Nebraska when they are already holding ground on paying for their own citizens. 

Brown is currently leading in the polls

I am a teacher in Pennsylvania, and I can see this. Perhaps, what needs to be done is to assure the people of Massachusetts that they will have no cost increase to their existing health care plan. Here is a report from the Commonwealth Foundation about the reasons for increases in health care.

From Nathan Benfield
Commonwealth Foundation

On average, consumers’ out-of pocket healthcare costs increased 6.7% each year, while national healthcare expenditures increased by an average 9.8% each year. Increases in expenditures by private insurers, Medicaid and Medicare accounted for the majority of this excess cost growth; since 1965 private insurers’ spending has increased by an average 10.8% annually, Medicaid spending has increased by an average 15.4% and Medicare spending has increased by and average 15.6% each year.

The difference between what people are feeling in increased costs and what is actually happening is masking the crisis. The people in Massachusetts are experiencing cost increases and do not want to be a part of a bail out when they are doing the bailing and other states are watching.

Wednesday, January 6, 2010

Twitter Health Care Reform #HCR House - Senate Compromise

What will it take to pass the House-Senate health care compromise? There are three strategies that will target six states and three groups.

1. You can win moral legislators by tightening up regulations on abortion in specific states.
  • In Nebraska Ben Nelson
  • In Arkansas Blanche Lincoln
  • In Louisiana Mary L. Landrieu
2. You can attack your own party’s supporters which will be perceived as compromise. Senators who attack their own political capitol may find it more desirable to retire, than to run again. Senators like Christopher Dodd and Byron Dorgan are good examples.

  • Create incentives for Trial attorneys to reverse defensive medical practices.
  • Tax organized Labor’s Cadillac benefit plans.
  • Donut Hole Medicare Advantage enrollees
3. You can offer health care subsidies to states that are struggling financially from the recession.
  • California
  • Florida
  • Nevada
Nancy Pelosi is the Speaker of the House from California. Harry Reid is the majority leader from Nevada. Florida has some of the highest percentage of senior citizens in the country. A combination of all of these strategies will win comprehensive health care reform.