Saturday, October 21, 2006

Back To Your Health, America.

I do not believe a government run single payer system is right for American healthcare. It would, however. solve the crisis of the uninsured and therefore, if all else is ignored for too long, it will probably come to that. I believe there is an alternative to that vast change of the system, and to the pointless and toothless minor plan changes the conservatives try to foist upon us whenever there is an outcry that the government is ignoring healthcare reform. Meaningful reform can keep what is best about our system: free markets, competition, innovation and vitality while wringing out huge swaths of cost and unfairness. We are going to examine some broad concepts here. I hope you will be able to journey with me soon into the intricacies of the situation by holding a book written by me and read by you. That still remains to be seen. So.... Since I believe that government run plan would be lethal to some because when the payer is so vast and stands above regulation by enforcing it, you will see rationing and no culpability when there are nasty results. Look what the government wrought just by implementing rules in ERISA to allow HMO's to deny care without being sued. They did this to basically allow HMO's to flourish, since this was the basic tenet of HMO's--controlling costs. The problem of the HMO's, much like for a government payer, is when you are very sick, and they can either keep paying for care or deny it and hasten your death...from a profit, or cost reduction perspective, what would you do? I think every health plan should be required to supply their policy holders with life insurance too, thereby creating an incentive to keep you alive! (I'm being facetious, by the way, because they would merely create a securitized pool for that risk and spin it off of their books and thereby circumvent the spirit of the act). Anyway, you can see that I do not believe that the core of saving money and cutting costs in the healthcare system is by denying care. And yet, together, we will journey into a basically free market plan that will cut far more costs then many in governemnt ever thought possible. Ihave worked in healthcare and created a plan for the uninsured. I have worked with a lot of providers. There is waste and unintended opportunity for profits out there for independent practitioners. There are incentives to deny good medical care built into managed care. So where do you go for good affordable medicine? Hospital clinics. Practitioners that feel they are using the resources of their own organization and being watched by experienced administration with healthcare backgrounds can walk the fine line between wasteful and miserly care. Utilizing work flow and six sigma process improvement techniques; adopting technology, utilizing professionals such as RN's and Physician Assistants, we can design clinics that run efficiently and in a timely manner without sacrificing all the good elements they bring to the table. Government oversight and auditing is also streamlined in this realm. I am not advocating we abolish independent practitioners or we restrict their access in the plans. I call for the design of copayments to be structured to make it less costly to go to the clinics, and you would pay more for the option to go to the independent practitioner of your choice. In this way, you would pay some of the difference in savings your plan would lose by your choice of practitioner. We will continue to look at straight medical care for a while before returning to Mental Health which requires a somewhat different reorganization. And Dental, which will see some changes as well.


Bruce said...

Using economic incentives to tweak toward a clinic system is interesting. How would you pay to build [or build up] those clinics?

Many hospital clinics are already overburdened, so you'd probably need new facilities.

Larry said...

That is an excellent point, and in rural areas it will be an infrastructure issue that needs to be addressed with some government assistance. However in most urban areas and many suburban, it is a matter of redeploying assets that are already underutilized. There is no doubt in the short run a cost to doing this, but I believe it is manageable in the context of what needs to be done or else the skyrocketing costs of healthcare will lead to further financial difficulties and unacceptable rationing of services. I do not believe effective and rational healthcare reform will come without costs and difficulties, but I believe it can be done better than the weak and ineffective conservative ways of putting band-aids (and that is being charitable) like MSA's and putting more of the burden on the backs of the middle class, and the liberal measures of a one payer government takeover. We will continue to explore these issues regularly here, although we make take a brief respite as the election grows nearer.

Bruce said...

A compelling idea. Middle class patients might balk at the notion of attending a clinic-like setting...and I'd worry about eroding the already eroded doctor-patient relationship.

However, clinic-style medicine does not necessarily have to give up continuity of care [seeing the same doc]. And such a system [if the docs are paid well] may shift private practice docs to consider salaried already hate the business end of things. Most went into medicine to take care of patients, not to nurse the ever complex billing problems.

Larry said...

Yes, and while it is certainly not always the case that an independent physician will do things that inherently raise costs or waste resources, it is also true that the forces that drove physicians to independent practice have shifted as well. Between lower reimbursements, the costs of billing and follow up with the various payers, and dealing with utilization review committees at the various insurers, it is hardly an "independent practice" anymore, anyway.