Sunday, July 05, 2009
Testing a recipe for health care
Editorial commentary
Recent contributions
- Can we be a two-trolley town?
- Striving for civility
- School funding no fantasy
- Pesticide board's work will continue through merger
- Commentary archive
From the RoundTable blog
Read the latest entries
Robert Roth
Roth is a retired surgeon living in Wirtz.
The national health care policy stock-pot is on Congress's front burner. President Obama promised during the election campaign it would be there by summer '09. He clearly elucidated that reform is needed, generally accepted by 70 percent of Americans. Working the recipe in Congress could make for a satisfying healthy meal for most people, but may become a watered down gruel: expensive and tasteless.
The mix for the stock-pot to assure success must include:
n Preventive medicine -- individual annual "health report cards" with more frequent follow-ups for people with avoidable health problems, i.e. obesity, smoking, drug and alcohol abuse, etc. Premium adjustments up or down as an incentive.
n Secure e-medical records: histories, labs, X-rays/scans, readily accessible to avoid needless repetitions, reduce paper.
n Free choice for every American, who seeks coverage for self and/or family, to guarantee competition between private health insurers and a public insurance plan, modeled after Medicare. Those who like their current insurance are free to stay with it.
n Free choice of physician and hospital.
n Leverage similar to the VA and Medicare systems (except Medicare D, blocked by a Republican Congress from bargaining over costs) to accomplish cost containment.
n Encourage training of family practitioners, physician assistants, nurse practitioners. They can very well diagnosis and manage 75 percent of health problems.
n Stringent fraud policing of private and public servers.
n Malpractice protections/caps and use of arbitration boards to reduce insurance premiums and unreasonable settlements.
To understand how complex the recipe can be, the above are but a few healthy meats, potatoes, veggies and nuance seasonings. The crucial ingredients are prevention (long term) and savings for those who choose a public insurance plan (increased savings with time). On tastings, some ingredients may need increase, decrease or elimination. In "reform," yes, change of change happens whenever there is a work in progress. The White House is focused on progressive change, not status quo.
Cost? Plenty! Take your pick: $1 trillion, $1.2 trillion, $1.6 trillion, $2 trillion over 10 years. It could be any of these scenarios, depending on the pot's recipe and quality of food stuffs put in. In congressional debates, Republicans emphasize the inflated worst in hopes of bill defeat, the Democrats stress the deflated least in hopes of success.
Funding is yet to be established. Hard to do, since the target is blurred, covered by political smoke screens, financed by lobbyists.
The secret for financial success by private insurers and a competing public insurance plan is control of administrative costs (low overhead) and bargaining power with suppliers. Private insurance plans' overhead runs 20 to 30 percent. Based on current Medicare overhead, a public insurance plan will be 3 to 5 percent
In food fights over costs, the one figure not mentioned is the aggregate compensations of CEOs and upper-echelon private insurance management. I have read or heard that salaries are ranging from six, seven, eight and, in one instance, to nine figures. As noted in the banking and financial industries, it seems compensations of this magnitude are necessary to "retain the best." The paradigm: "Top company officers are accustomed to and deserve it -- no matter what." But wake up. Congress is talking about life-and-death health matters. No one wants deficit and credit card financing. Real funding sources are needed.
One source: It costs an average American family $12,000 annually in private health insurance premiums. A common CEO's $1 million salary plus benefits means potential coverage for 83 families. A slightly less common $5 million CEO compensation translates into coverage for 417 families. And $100 million can cover 8,340 average families. Now think in terms of people on the lower end of insurance premiums, say $3,000 annually. A nine-figure CEO compensation could cover 33,333 annual premiums.
I am not saying private insurers' management should start wearing barrels. I am suggesting that competition between private plans and a government Medicare-like public plan (as proposed by the White House) will expose excesses that the new marketplace will modulate. More than 1,000 private plans in the U.S. are hiding huge potential savings in excessive compensations. Let the new marketplace sort it out. Congress should pass the free choice public plan. Let them know your thoughts.
The president said it best: "If private insurers say that the marketplace provides the best quality health care, if they tell us that they're offering a good deal, then why is it that the government, which they say can't run anything, suddenly is going to drive them out of business?"
