The news is full of unoriginal clichés. We hear about the 43 million people who are uninsured and how medical costs are skyrocketing. Then we hear about all of the savings to be had if we just had universal coverage. Sitting in my small office, I wonder if the bureaucrats have actually looked at the problems surrounding our health care.
Nobody is denied emergency or basic care regardless of income. However, the quality of care is better for those with coverage. What you do not hear is that if everybody had insurance, quality of health care would not improve. To begin with, our health care system is already overburdened. Even with money to spend on health, it takes at least a week to get an appointment with a doctor. How would your accessibility change if everybody had good insurance? Our doctors can see no more people than they do already. Most work long hours and their patient schedules are full. The burden on the medical community is also the reason for the long waits in emergency rooms. Simply put, there are already more patients than the doctors can treat in a timely manner. Appointments can be as long as a month for a specialist, a week or more for your family physician, or several hours in the emergency room.
To become a doctor, it takes years of training. Some of these doctor want-to-be students go through the years of training because they just want to serve their fellow man, but what motivates most is the prospect of building a private practice and having financial security. Yes, it is the good old profit motive.
Health care is a market driven business. That means, if you have enough money, you can have access to the best care that is available. But the best care is in limited supply and not everybody can possibly get the best care. So would a change in that system be good for anybody? I go back to the years it takes to become a doctor. How do you think that removing the profit motive will affect the number of young people entering medical school? Removing the motivation to become a doctor would be disastrous and lead to even more mediocrity and health rationing.
As stated, the best treatment is in limited supply. Do you remember when you were in school? There were the nerds who always made good grades, then there were the regulars who made satisfactory grades, and last were the dullards who just barely got by. Well, doctors are like that also. A third of all doctors graduated from the 'dullard' section, another third from the regular section, and then the elites of the class came from the top third of the class. It is literally and physically impossible for everybody to be treated by the top third of the class. So, only a fraction of patients has access to the smartest and most knowledgeable of our doctors.
It is also true that not all doctors treat the sick. There is a huge market for 'vanity' doctors. Vanity doctors are doctors that do the boob jobs, sexual reassignment operations and tummy tucks. Aesthetic cosmetic surgery, not to be confused with reconstruction plastic surgery, siphons off the supply of doctors who would otherwise treat our ailments. In 2007 there were 12 million cosmetic surgeries performed. The five most common were breast augmentation, liposuction, nasal surgery, eyelid surgery, and abdominoplasty.
Doctors doing vanity surgery specialize in that field and do not treat the sick. Not only does cosmetic surgery yield higher income, but only limited record keeping and insurance filings are necessary which drastically reduce office costs. Higher fees plus reduced cost makes cosmetic surgery highly attractive to doctors.
Some of the data available is revealing if people would take the time to inform themselves. Let's look a little closer at health care and health care dollars in the United States.
To begin with, basic health care is available to everyone. If you go to a state funded hospital or any emergency room, you will be treated regardless of your ability to pay.
Look at the statistics on the uninsured. In 2007, 45.7 million people did not have health coverage. 21% or 10 million of that total were full-time employees and 59% or 27 million were part time employees. 20% or one-fifth of the uninsured population could afford health coverage, but decide for their own reasons not to. 38% or 17.3 million of the uninsured lived in households making $50,000 or better.
According to the Census Bureau, 36 million or 78.7% of the uninsured were legal citizens while 9.7 million or 21.2% are non-citizens.
A large part of my writings have always been about solutions that are not well thought out. Americans are sold the glittering part of an idea but never the darker side. Computerizing our medical records may help with some costs, but there will also have to be staff enlargements at the doctor's office to put the data into the computers. Every visit has details that get recorded. Normally, the doctor would just write out the details of your visit and file your record. But by computerizing the data, we need yet another layer of personnel to enter the data into the computers. Office costs go up. That money has to come from somewhere, I wonder whom.
A doctor's office also has to retain a person(s) to do insurance filings. This person makes sure the codes are correct and that your provider is legitimate. There is no reason why we as patients and customers of our insurance companies can't file our own insurance claims. Doctors still take money for their services and it would reduce the health care cost if this added burden weren't added to the doctor's office expense. Insurance filing could be simplified with a method of verification so that you could file your own claims. By filing your claim, it would give more assurance to the provider that the doctor's office is not gaming the system.
By far the largest elephant in the room is lawsuits. Doctors are human and they make mistakes, some of them tragic and stupid. But I can't remember the last time that I met a doctor who wanted to make a mistake or hurt his patients. But for protection against lawsuits, doctors have to order unnecessary tests, pay huge insurance premiums, and regard every patient as a possible threat to his livelihood. Tort reform would help this situation but is not a part of the plan that congress is considering. Litigation and the threat of litigation substantially increase the cost of health care.
Another subject that I won't dwell on much is the rules and regulations of building a hospital that drive the costs up substantially. Local, state, and federal regulations that do nothing for patient safety or health, menace every part of the construction of new facilities. It is the little things like hospital grade sockets and plugs. Hospital grade outlets mandate that you need at least a four pound pull to dislodge the plug from it. Most sockets that you buy meets and exceeds this rating. But the contractor has to purchase 'hospital rated' outlets to comply with the code. That special rating comes with a special price.
There are literally thousands of other examples of rules that are written at the local and state level just for the benefit of certain individuals. All of which increase the cost of providing health care.
I want to say that I am for honest change but not political change that just redistributes how we pay and ration our health care. But sadly, the bill before congress does not accomplish anything useful, unless you do not plan on getting old.
Cheers,
-Robert-
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