Food For Thought
Unlike most I have finally finished reading HR 3200 and it is absolutely terrible for our nation. Just over 1000 pages of the same thing offered by the Clinton administration. And if what is written in those pages isn’t bad enough Congressman Gene Green admitted during a Town Hall Meeting in Houston that the Amendments have not been added yet. They will be expected to pass the Bill without even reading the Amendments. In it’s final analysis (by me) this is not a health care plan at all but rather it is a national insurance plan. If the day comes when congress says ” we will accept the same plan for our health insurance needs and pay the required taxes to own it” then you might have something you can believe in.
You may not be interested in the Health Care Bill but I feel compelled to now give you a Health Care Plan put together by a Texan for Texas that is easily understood, will not increase taxes and increases health care and it would be done in Texas for all Texans. Mr. Collins admits he doesn’t have all the answers but invites all Texans to join in to complete the final phase of who does what. I look forward to my input.
Collins: What health care crisis?
Pt. 3, an alternative proposal
by Tim Collins
There are numerous examples throughout the country of the success salaried medical professionals have in delivering increased levels of patient focused care. They achieve this success because they answer to medical outcomes, not a “piece work” schedule of payments.
Posted on August 3, 2009
Editor’s note: This is the third of a series. Click here for part 1 and here for part 2.
In the last two parts of this series, I presented lots of numbers regarding private health insurance. I discussed salaries for executives, premiums, lawsuit settlements, taxes paid to support public health care and concluded, for me at least, that private health insurance provided very little if any value for its cost.
If you look at all the proposals for “reform” put forth by the Federal government, no matter which party they come from, they all offer more of the same. Preserve private health insurance, but add a public competitor.
To fund the public option we are offered increased taxes (ok only on the super rich if you believe the pronouncements), and reduced reimbursement rates from Medicare and Medicaid. The assumptions for all these proposals are twofold: 1) Health care should be dealt with by the Federal government and 2) maintaining the existing third party model, including health insurance companies is required. Estimates for the cost of this reform can’t be nailed down with any degree of reality, but one trillion dollars over 10 years appears quite often. The goal of the Federal proposal, as far as I can tell is universal health care insurance.
More of the same is not exactly what I want from health care “reform”. I don’t know about you, but what I want is to quit being afraid, angry, and disappointed.
Why am I afraid? I’m afraid because I am going broke paying for private health insurance. I am afraid that with the current Federal government proposal I will be paying even more and receiving even less. I’m afraid to even use the health insurance I have because every time I have, it has been followed by a large bill anyway. I’m afraid that after paying for health insurance my entire working career, in the end I will go bankrupt and leave nothing for my children as my savings are taken to pay for medical care as I lay dying.
Why am I angry? I’m angry at the health insurance company that takes over $8,000 per year out of my pocket and seemingly provides little in return.
I’m angry because I was foolish enough to study this topic. My study showed me just how much profit these health insurers are making, and how much of that profit is spent on lobbying politicians, bloated salaries for executives, fines paid for denying legitimate claims, and hundreds of other things that do nothing to reduce my premiums or improve the care I receive.
I’m angry because despite the billions of tax dollars dedicated to health care for the poor and the elderly, we still hear about millions that do not receive adequate health care. I’m angry because everyday I read of the games played by health care providers to dump the uninsured onto the public system and of the public system delaying and denying services simply to keep their system running. I’m angry with health care professionals gaming the system to increase their reimbursement rate (in the worse case), or to make the required treatment fit the restrictions of the health “plan” that will cover the cost. I’m angry with the government bureaucracy with its ever decreasing reimbursement rates and complicated accounting system that push providers to do so and add administrative costs to the whole system.
Why am I disappointed? I’m disappointed because it is obvious to me that our elected officials are listening more to the lobbyist for the doctors, insurers and lawyers than they are actually debating what is the right thing to do. I’m disappointed that the debate has devolved into name-calling and personal attacks, instead of reflective and informed debate on the best way to achieve or even define a shared objective that benefits the nation. I’m disappointed that so many everyday citizens are blindly following the political partisan positions and dividing along class lines on this issue. I’m disappointed because I always thought that as a nation we were smarter than this “debate” has shown us to be.
I’m afraid, angry, and disappointed because my own government is offering more of the same and calling it reform. I’m afraid, angry and disappointed that partisan politics has framed the discussion into one camp arguing everyone has a “right” to health care and the other screaming “socialism”.
I’m afraid, angry and disappointed that neither side sees that we can achieve the goal of improved access to health care for all using existing infrastructure and at the same time not bankrupt the nation or add additional monetary burdens on anyone. I’m afraid, angry and disappointed that the interest of the health insurance and legal lobbies in profits is being put ahead of the interests of the citizens needs.
Why not try a different approach?
I previously stated and will repeat here because to me it is the crux of the issue: Health care is not an individual right; but providing needed medical care is a moral obligation of a just society. So how do we build a system that provides the care required by all, and not bankrupt the nation or any individual? We don’t.
What if I told you that every state in the union already has such a system, they just need to be expanded and integrated? What if I also told you that we could expand these systems, save you money, and reduce the cost of operations? What if I told you the biggest loser in going this route would be the private health insurers? What if I told you the end result would be universal health care – not universal health insurance?
How about a state based approached using existing and expanded health care infrastructure and a pre-paid, mutually funded, non-profit, health care approach instead of insurance?
I know it sounds either crazy or socialist depending on your perspective, but why rush immediately to a national approach that continues the health insurance financing model? Do we really need to rush to a solution without discussing alternatives? If I can ask your indulgence, hear me out before dismissing me as a socialist dreamer.
What is required for health care delivery?
It really isn’t that complicated a question. To deliver quality health care you need: property & equipment (infrastructure), people (health care professionals and administration), and money (funding). Let’s take an inventory of how we stand in these areas in Texas.
Property & Equipment
According to the Texas Department of State health Services (DSHS), in
2008 there were 267 hospitals in the state designated as Medicaid Disproportionate Share Hospitals. Of these 81 (30.3%) were directly owned and operated by the public, 152 (56.9%) were non-profits and 34 (12.7%) were for profit institutions. As you can see, the facilities are already in place and operating. This does not even count the number of neighborhood and rural medical clinics throughout the state.
Let’s think a little broader in our definition of a medical care facility.
How much and what kind of space and equipment is needed for primary, non-emergency, care and diagnosis? Seems to me a decent size office and examination room should fit the bill, perhaps include a simple x-ray machine. Where could we find such space already owned by the local government? How about our schools?
Think about it. One of the major issues in health care delivery is the flooding of emergency rooms with non-emergency patients, for the most part uninsured. Now how many these “emergency” patients have a school in their neighborhood? How many of these patients are actually school aged children, or their less than school age siblings? How many of these schools already have a nurse’s office? How many of our schools still have countless “portables” left over from the pre-construction bond days?
If we use existing buildings for this use, would we not make primary health care more accessible, even in our rural areas? Obviously we would have to provide the required medical equipment and “tools” as well. I don’t have the expertise to define what that requirement would be, but I am certain we have the people with that knowledge in our public medical community. In the area of property and equipment we are most certainly not starting from square one with an empty pantry.
How many medical professionals do we need to provide care for all? How many do we currently have working in the public hospitals that exist today? How many more are working in other non-hospital settings operated by state and local government?
In the school system we have nurses, counselors, speech and language pathologist, physical therapists, psychiatrist and psychologists and who knows what other medical or medical related professionals. I know for a fact that Ysleta School District here in El Paso makes affordable dental care available to its students.
In our Department of Public Safety we have Emergency Medical Technicians, and disaster response teams.
In our Department of Health and Human Services we have similar professional staff as we have in our schools.
We must literally have thousands of state and local government employees already engaged in providing health care to “financially” qualified citizens.
How many more do we need to provide care to all? How much more and more efficient care could we provide if we coordinated our efforts better and broke away from the county based delivery system?
How many administrative professionals does state and local government currently employ to meet the reporting, inspection, regulation, and accounting for health care provided throughout the state?
How many aspiring future medical professionals are sitting in our classrooms today that could easily fill our future needs, if the cost of the needed education was not an immovable obstacle?
Again, in the area of people, we are not starting from square one; our pantry is not empty.
As previously discussed, funding for existing health care services ($29,681,049,686 in 2008), is provided through taxes of all types, including property, Medicare/Medicaid, sales taxes, workers compensation, and private charitable giving. In 2008 this expenditure was only second to what we expend on education in Texas, in previous years health care was the largest single expense at the state level. Add to that amount the money every property owner in El Paso, and I am sure every Texas county, contributes through their property taxes to schools and county hospitals.
So before you start yelling “socialist” and “socialism”, consider that we already have extensive publicly funded health care and for the most part it is provided for and to those without private insurance, or those of limited financial means and “paid” for by those of us more financially fortunate.
How much more money could be made available if each of us stopped paying our health insurance premiums to a private carrier and instead made even 50% of that amount directly to a government owned health care delivery system? While writing this story I received notice that my out of pocket premium for health insurance rose 21% with my latest paycheck. I am now paying roundly $796.00 per month for health insurance, on top of what I pay the state to support health care efforts. Think about it.
How much are you paying and who benefits the most – you or that health insurance CEO bringing home a multi-million dollar salary? Many who oppose a government health care program complain that such a program would give the government an unfair advantage over the for profit insurers. Profit it is said is the heart of our free market system and eliminating the profit motive eliminates the motivation for advancement and innovation. What many fail to mention or perhaps understand is that profit is calculated after salaries are paid. I make no apologies; when it comes to providing affordable health care, profit cannot and should not be the measure of success. Patient care and the quality of that care is the only measure that matters.
As with property & equipment, and people, we are not starting from square one with an empty pantry. The money we need to reorganize, expand and deliver quality health care to a larger population of citizens is already in the market. We do not need a trillion dollars of new expense or debt to improve the access, quality and delivery of health care.
The bottom line
The current proposals under development in Washington, D.C. are unacceptable. They cost too much, provide little actual “reform”, are designed to appease well-funded special interest groups, and in the end will do little to improve actual health care provided. The assumption that this issue must be addressed at a national level is wrong on many levels.
There is a role for the national government, but it is not a controlling role, it is a supporting role. Health care, like education is best addressed and delivered at the local and state level.
The current health care system is based on a “piece work” payment structure. Payments are made based on a schedule of services that an insurer (whether private of government) establishes. Payment levels are adjusted frequently and usually downward, practically forcing health care providers to figure out a way to work the system to increase their payments. Medical services are not the same as garment production and should not be compensated in a similar fashion. There are numerous examples throughout the country of the success salaried medical professionals have in delivering increased levels of patient focused care.
They achieve this success because they answer to medical outcomes, not a “piece work” schedule of payments. Don’t believe me? Google The Mayo Clinic and read their annual report. This should be the model for building a state level system.
In the next part of this series I will offer my thoughts on the specific roles for Federal, State and Local governments in meeting this challenge.
For now I ask only that the reader consider what I have proposed and bombard me with your questions, comments and concerns. I freely admit I do not have all the answers to this challenge and welcome your help in developing my position and proposals.
Tim Collins is a business development manager, and calls himself a fiscal conservative and social liberal Independent voter who proudly has called El Paso home since 1999
Just food for thought. I shall try to bring you the next part of the series. In the meantime if you believe this is a better way to go let your Congress man know.