Posted on 11/14/2005 10:59:00 AM PST by B-Chan
Problem: The High Cost of Medical Care
The healthcare system in the United States is in crisis. The cost of private out-of-pocket medical care for even routine illnesses is far beyond the means of most working-class families; as for catastrophic care, any medical issue requiring specialized services, significant therapy, or long-term hospitalization is a ticket to financial ruin. Private insurance is no solution; outside of employer-provided insurance plans, the cost of even the most basic health insurance is incredibly high; for the chronically ill (or those with the dreaded "pre-existing condition"), private health insurance is unavailable at any price. Contributing to this high cost of healthcare is the out-of-control expense of the medical malpractice insurance necessary to protect providers from financial ruin at the lands of trial lawyers and their clients.
Lacking private healthcare coverage, the only recourse for most Americans is indigent care -- i.e. the emergency room at their local public hospital. This is an unacceptable state of affairs that we as a nation must address if our future is to be one of morality and prosperity.
Causes of High Costs
The laws of supply and demand apply in the healthcare marketplace as any other: in the final analysis, medical care is expensive because the supply of health care resources (both in terms of providers and facilities) is insufficient to meet the demand of those who need care. The five major factors in this supply/demand equation are these:
1. Firstly, the supply of providers is kept artificially low by the AMA's monopoly on accreditation of medical schools and the restrictiveness of state licensing boards.These five factors together combine to make healthcare something available to the wealthy and upper-middle classes only.
2. Secondly, the high cost of medical education, which forces doctors into debt early, further reduces supply.
3. Thirdly, the high administrative costs that providers must incur in order to process private insurance claims forces doctors and hospitals to charge more; it costs serious money to maintain the large staffs needed to deal with record keeping, administration, and collection.
4. Fourthly, the high cost of malpractice insurance in our litigious society has become formidable.
5. Finally, the care of the indigent is our most serious health care problem -- a nightmare created by the vast numbers of illegal immigrants with no insurance and no money in this country who have turned our county hospital ERs into basic healthcare providers.
1. With this in mind, my first prescription for the failing healthcare system in this country is to enlarge the population of healthcare service providers. Licensed Medical Doctors are the main providers of American healthcare services, but no law of nature says that this must be so. The fact is that most people do not need the services of a licensed M.D. for everyday sneeze-and-sniffle care; the long experience of the military services, in which unlicensed medics, corpsmen, and Pharmacist's Mates provide the bulk of routine healthcare services, demonstrates this. For everyday care of healthy adults and children, the expertise of Registered Nurses, Paramedics, and Physician Assistants would be more than sufficientI believe that the federal government should take steps to force state licensure boards to allow RNs, PAs, and EMTs greater latitude in practice. Allowing these providers to prescribe drugs, perform basic exams, deliver children, treat common illnesses, and provide general care on a strict cash-and-carry basis in a clinical setting would dramatically lower costs. Why pay $200/hour for the services of an M.D. when one really only needs the $50/hour services of an RN? In my scenario, RNs and PAs would be permitted to provide outpatient care for everyday ailments. In addition, action should be undertaken to increase the number of medical schools in the United States. The AMA's viselike grip on accreditation should be relaxed (by Congressional action, if necessary) and its recognition of alternative healthcare providers increased.
2. The high cost of medical education is another factor restricting the number of healthcare service providers. Accrediting more providers is one way to increase their supply. Another is to decrease the costs of medical education by creating a national health care service at the federal level to allow those unable to pay for medical school to become doctors. I believe that the example of the Reserve Officers Training Corps is one that could be adapted to make medical education a more attractive option for college students: just as our government currently funds the college educations of students in exchange for a term of military service, an ROTC-like program of medical education could be established where students receive government-paid medical educations in exchange for a term of public health service.
My program would work thus:A. Establish the United States Public Health Service (PHS) as the guarantor of medical services to all Americans. Congress would create and fund the United States Medical Service Corps as a division of the Public Health Service.The federal government would train and educate hundreds of doctors, nurses, and other health care professionals free of charge in exchange for at least five years of public service. Essentially, the PHS/NMSC would allow students to attend medical/nursing school on the taxpayer dime, and in return agree to do five years of national medical service in the Corps (at military pay scale) after licensure. Private and public medical schools, nursing schools etc. would offer these ROTC-like medical scholarship programs; in addition, a United States Medical Academy -- a uniformed service academy similar to Annapolis or West Point -- would be established, to which talented high school students could apply.
If accepted, the students would become National Medical Service Corps Cadets for four years; upon graduation, each graduate would receive a Bachelor of Science degree and a commission as a Health Service Officer in the PHS/NMSC at the same pay as their military grade counterparts. At the end of five years of service, the officers (now fully-licensed MDs, RNs, or PAs, or EMTs) would be free to reenlist and continue to serve in the PHS at the neighborhood clinics, or leave the service and begin private practice free of debt. (Private insurance and private practice would of course still be permitted.) Graduates would agree to go where the PHS/NMSC sends them and perform whatever tasks are assigned for the duration of service.
B. Establish Neighborhood Clinics. In each community, PHS/NMSC would establish a Neighborhood Clinic (NC). These clinics, not hospitals, would be the ordinary person's most frequent point of contact with the medical profession. Each NC would be staffed by PHS/NMSC personnel serving their five years of national medical service by providing basic and emergency healthcare (including mental, OB/GYN, and other medical services) free of charge for the citizens and legal residents in their communities. The NC would also offer immunizations, monitor the status of any communicable diseases present in the community, collect healthcare data, and act as part of their community's disaster management team. The power of the internet would be used to leverage the care available at each NC; EMTs would be on call for trauma support, a Doctor of Pharmacy would be available by internet for consultation regarding prescription drugs, and surgeons and other specialists would remain on call via the Net at local hospitals. Should more serious cases (broken bones, infectious disease, surgery, etc.) be presented at the NC, the patient would be transferred to a regional major-care facility (also operated by the PHS/NMSC) for treatment.
3. The overhead created by the keeping of medical and billing records by providers is a major factor in raising the costs of providing healthcare services. My solution is to lessen administrative costs by putting record keeping in the hands of the patient. Under my system, every citizen and legal resident of each state would be issued a Health Service Card. This "smart card" would be a machine-readable chipset data card (activated by the bearer's thumbprint) which would bear the patent's biometric identification data and medical records and readable by machine at each NC. (These cards would of course be accepted by most private healthcare service providers as well.) Backups of the data on each card would be kept on PHS mainframe computers in case of loss or damage to the card (or for other legal reasons, such as criminal investigations), but access to this backup data would be available only in cases of life-threatening emergency, patient request, or at court order. Unauthorized access to or use of patient medical data would be strictly punishable by law.
4. As civil servants, PHS/NMSC personnel would be immune from litigation over malpractice; private providers, however, would still run the risk of being sued for damages. To reduce the burden of expensive private medical malpractice insurance for healthcare service providers in private practice, the state governments would be required by federal law to establish risk pools for malpractice insurance coverage under my system. Since the population at risk would be large, premium cost for each individual policyholder would be far lower than those required by private insurers, thus enabling providers to pass on less cost to the patient. In addition, state law would limit the size of any award at equity assessed against the risk pool, discouraging chiselers and professional victims from attempting to "milk" the medical malpractice system in a given state,
5. But what of indigent care? Under my proposed system, there would be no "indigents"; medical care would be available to all citizens and legal residents with no out-of-pocket expense, thus eliminating the need for indigent care. For this system to work, we would of course need to institute a system of national citizen/legal resident identification. Those persons with no legal right to be here would not receive a Health Service Card; instead, upon presenting at an NC or other PHS/NMSC facility, they would be medically stabilized, detained by Immigration police, transported to a Federal prison facility for further treatment, and deported upon recovery. By eliminating illegal aliens' access to healthcare, the attractiveness of illegal immigration would be dramatically reduced on a cost/benefit basis.
Conclusions
Health care cannot be treated as an ordinary commodity; the risk of infectious disease alone is too great to allow people with no money to go without medical care. Furthermore, we know from experience that people with no cash or insurance are not simply going to "squat under a toadstool" and quietly watch their children suffer and die when a big, shiny hospital is sitting down the block. It is plain that our current method of providing indigent care attracts illegal immigrants while relegating their care to a lowest-common-denominator basis. Finally, we as a Judeo-Christian society are morally obligated to care for the sick and suffering regardless of their ability to pay for such care. Human lives can never be made the subject of mere market forces. For all these reasons, it is plain that we must create a new system of ensuring that all Americans have access to health care without regard to cost.
I believe the steps outlined above could if implemented do much towards achieving this goal. By allowing more people (RNs, PAs, and perhaps pharmacists) to provide everyday health care and advice, we can increase supply relative to demand and slash health care costs. By creating a Federal medical service, we can offer talented youths an opportunity to gain a medical education in exchange for their service to the nation. By establishing state-run risk pools for malpractice insurance, we can lessen the burden on healthcare service providers of paying for such coverage. And by instituting a digital voucher system for indigent care, we can further control the cost of providing basic health care, keep patient information in the hands of the patient, and free our healthcare service providers of the burden of providing basic care to illegal aliens.
All this done well, we may safely avoid the disadvantages of socialized medicine, while at the same time guaranteeing that health care services are available to all citizens regardless of ability to pay.
the main driver of high health care costs is the amount of money pouring into the system. that's read: government money.
expanding government pouring money into the system cannot help but drive up costs still more.
Paul Harvery once said "The best way to drive up the cost of something is to make it free".
has socialized medicine ever worked? anywhere?
2. Secondly, the high cost of medical education, which forces doctors into debt early, further reduces supply.
Exactly right on both scores, but the two are not unrelated. You have to pay doctors to teach, and that costs a lot of money because there is a shortage of doctors. The result is that you've got to charge more for medical school.
Furthermore, we know from experience that people with no cash or insurance are not simply going to "squat under a toadstool"
No, they just go to the emergency room and we pick up the bill!
The high cost of medical care is mostly due to hospitals, litigation, and beaurocracies and not providers...anyways would anyone want an NP/PA to be a primary provider..., not I
The "problem" is that the quality of healthcare is too good, which makes it expensive.
Cry me a river.
The words "national health care service" makes the hair stand up on the back of my neck.
Has private insurance worked everywhere? No. A strict free-market medical care society would be a Dickensian nightmare, with people dying in gutters and plague-carriers roaming the streets. Such a society would be both an immoral and dangerous place in which to live.
Human life cannot be made subject to market forces. Ideology cannot be the basis from which we address questions of life and death. To do so is to court disaster, both political ( = revolution) and spiritual. Human beings are beyond value and price.
A perfect system cannot exist. My proposed system would not work perfectly; neither would any other. As a Judeo-Christian civilization, we are obligated to serve the sick regardless of ability to pay; as free men, we are obligated to see that those who serve the sick are paid for their service. My proposed system is an attempt to satisfy both obligations. I would be interested to read your counter-proposal, if any.
I once heard someone note that the share of GDP devoted to transportation soared in the 1920s. Not due to a "transportation crisis," but because of the Model T. Health care is to a great extent like that, and the strengths of the American system are in my view substantially underrated.
The indigent care does need to be addressed.
We provide care for free anyway to the indigent, but it becomes a tax on the rest of us, when we need care. The end result is that it drives up the cost of our labor while subsidizing illegal immigrants.
The playing field needs to be equalized again as much as possible.
Getting the indigent and illegals taken care of is quite important.
My point exactly -- which is why we have to do something about indigent care.
Come the Last Day, I'm sure the Lord will be impressed with your steely dedication to free-market economics.
A man wished that he could wake up in bed with three women. The next morning, he woke up with Lorena Bobbitt, Tonya Harding, and Hillary Clinton. His penis was cut off, his knee was broken, and he had no health insurance.
TR is correct. Participating providers get the incentive of network patients at the cost of a percentage of their fees! This goes for hospitals as well as doctors.
What about Medicaid? It's been paid by NHIC for eons. That's Perot's company, remember? You don't think there's Medicaid fraud? Yup, just like Medicare. In some cases, providers have brought this on themselves (the ones who hike their fees based on ICD-9 codes, for example.)
I don't know about the rest of you, but we have plenty of doctors in TX who got lower cost educations elsewhere, such as Guadalajara.
The cost of malpractice is a problem and so is indigent care. But about a third of Medicaid expenses are for illegal aliens! That's the REAL horror!
The problem with Medicare and Medicaid as "guarantees" is that they cost a great deal while "guaranteeing" nothing. We can do better.
The words "Patients Without Insurance Will Not Be Treated" makes the hair stand up on the back of my neck.
The uninured cost us an average of $900 per year per family in additional premium costs. People do not understand health insurance. It is nothing more than financial protection.
It is affordable. Example, 44 year old male and 13 year old son. $3 million lifetime coverage each. $167/month.
I live in an area that has the highest median income in the nation, and have no rating on my policy.
If you can't afford or won't pay $167/month, how do you pay for a $50,000 medical bill??
People think this should be an entitlement because years ago it was paid 100% by employers, those days are gone.
Judeo-Christian? I thought our society couldn't speak the word, "God," let alone "Christ."
While some of your "problems" exist, I'm not sure your solutions are the best. Any solution which involves more government, not less, is not the answer. History has proven this over and over. Perhaps we need to encourage more people to be givers rather than takers. Gee, I wonder how we could do that?
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