Health care in the United States of America is a national disgrace
by Don Koenig - 2006
This article has little to do with Christianity other than that Christians in the United States ought to be concerned about the state of health care in their nation. If Christians do nothing to change abuses in this country, they will reap living in a country where greedy scoundrels will pick their pockets until they get every last red cent. I think I can speak on this subject of health care since I am fairly well informed and I also have some inside information because my wife is a primary care physician. Understand that this article is speaking in broad generalizations. It is not meant to be a scientific study of health care in America and is not offering mathematically precise scientific solutions. This article is meant to get people to think and question the current state of health care in America and for them to envision what might be possible. That is, if they can envision and demand changes from their government representatives that are anywhere near comparable to the ones I suggest.
For over a decade now, health insurance costs and health costs have been going up about 10 percent each year while incomes are increasing only 3 percent. I have one of the best health insurance plans available because I get mine from the US government and the pool for this insurance plan is huge. Those that get sick that run up large medical bills are taken care of by the vast majority of healthy people who pay into the health insurance pool. This is what insurance is all about. I can speak about my health insurance plan but I know other similar plans are likely to be even more costly than mine since the government is in a position to bargain for rock bottom prices for its employees. Between what I pay and the share the Government pays, about $1000 a month is paid for health insurance for my wife and I. That does not include any co-payments or deductibles. For those with chronic illnesses these co-payments and deductibles could add thousands of more dollars each year. The dental plan within this plan is a joke so there is no point of even mentioning the meager benefits they offer and the plan does not cover optical or cosmetic. Spending over $12,000 a year for medical insurance for two people is quite a bit of money. Those with many kids fare better, in the final analysis, in this socialist system those without children pay a good part of the medical expenses of large families. As a result, if you are in a group health plan you already have some aspects of socialized medicine incorporated into the system.
For the average families without insurance or government assistance the cost of the same health care I receive will average out to be well over 20,000 a year since standard cash payers do not get discounts. Instead, the cash payer pays more for a visit than those with insurance or Medicare because of set fees by insurance companies and the government. They only pay a percentage of these set fees while the cash customer must pay in full. Some cash customers might find a sliding scale or a free clinic but those services are certainly being subsidized by someone.
Medicare is a government health plan for those over 65. It recently has come up with over a hundred different fee based sign up programs to help with drug costs for the elderly. Few over 65 have any clue what the government is actually saying in this complicated program and even less know which plan is best for them. Private insurance plans and government health plans are getting so complicated in the United States that we will have to hire advisers to help us figure it out, as many now do for the unreadable endless income tax code.
Private insurance, Medicare, and Medicaid cause poor health care in America.
Government and insurance pen pushers untrained in medicine tell doctors how to practice medicine and tell them which tests and drugs they are allowed to prescribe. The paper work and regulations alone that are forced on medical practitioners increases the office staff and overhead of the typical medical clinic by about 20 percent. They delay payments to the provider, sometimes they do not pay and if doctors are to be included in their insurance plan they must accept payments about a third below the customary charge. Many only pay what government Medicare pays. Many clinics simply lose money on government fixed rates that continually decline when measured against inflation. Let me make something everyone ought to know perfectly clear – Most clinics actually lose money on every Medicaid and Medicare patient because they do not even pay for the overhead! Many providers have stopped taking Medicaid and Medicare patients and there will be many more that will join them! How is paying providers less than they need to receive to stay in business going to help those in these programs when nobody will take them?
The increased overhead burden and declining revenues from government and insurance programs puts pressure on hospitals, medical groups and clinics to require their doctors to see more patients per day. Thus, the quality of health care deteriorates for all because adequate time can not be spent with patients. More and more hospitals, health care groups and clinics now pay medical providers according to how many patients they see and/or how many procures they can charge to each patient. Many doctors who really care enough about their patients to spend the time it takes to diagnose and treat them correctly make lower salaries than they did seven years ago. On the other hand, there are greedy medical providers that see two or three times the average number of patients per day. These greedy providers are then patted on the back and held up as examples to emulate for the more responsible medical providers who are often labeled as unproductive and threatened or even fired.
Thus, some medical plans and clinics are left with mostly greedy doctors who will - line em up and move em - out like cattle in the old "Rawhide TV theme". In addition, in many cases, instead of seeing a well trained board certified physician you will see a far less trained lower paid nurse practitioner. If you are treated like cattle when you go to a clinic you have the government, private insurance and the greedy doctors working for maximum take home pay to thank. We really can not put much blame on the administrative organizations who manage the clinics for their lack of concern for the public because falling reimbursements from insurance and government along with higher overhead costs forces them to get more production out of their medical providers or they will soon be out of business. Very few hospitals, groups or clinics are making money.
Contrary to the beliefs of some, it is not physicians salaries that are driving up the price of Health care. Most primary care physician salaries have not gone up in the last seven years even though medical costs in general have gone up by about 70 percent in this period. The exceptions are the salaries of greedy doctors who see 35 to 60 patients a day. These doctors really should be charged with patient abuse instead of increasing their pay and patting them on the back as examples for more responsible doctors to follow. Of course, for some of them the result of this patient abuse is negligence lawsuits that only increase the costs of medical care even further for the responsible physicians. Further, high volume doctors often are pill pushers that get numbers by requiring their patients to come in often for prescription refills. Then these same physicians do not take the time it requires to go over the patients history. Many just enable their patients to become pill dependent addicts.
Not only are doctors put on piecework, but in many cases the hospitals, groups, and clinics can not afford to hire qualified support staff. They often hire poorly trained high school graduate office managers and put them in charge of the clinic containing highly trained medical providers. They run or should I say miss-run the clinics by inefficiency and by hiring a staff of unqualified or minimally qualified people and cronies. Some office personnel now actually hinder medical providers in their work and make mistakes that can be critical to the well being of their patients. Yet, the primary medical providers have little influence over who is hired or fired at their clinic. Again, the unprofessional near minimum wage office staff are the result of low government and insurance reimbursements.
I have been told that clinics could offer medical service to cash patients and make profits on them by charging them two thirds of the standard rate. However, by law providers are not allowed to charge less to cash customers if they take Medicare or Medicaid. Medicare and Medicaid reimburse less that two-thirds of the amount billed, thus, a cash paying customer has to pay the doctor more than the government pays the doctor, or the doctor can be prosecuted for fraud for trying to give uninsured working poor people who do not qualify for Medicaid a break. Therefore, either a provider has to take only cash payments and take no Medicaid or Medicare at all or they have to charge the working poor cash patients the same rate as they do the others. Yet, even if they could charge less they would still collect more from the cash paying customer because what they charge Medicaid and Medicare and what they actually collect from them are two different things.
Many working poor do not come to see doctors unless they are literally dying because they could not afford to. In response to this problem there is a government program which provides funds to sets up government clinics with sliding fee scales based on income in "under served" areas. All this says wonders about what the real cost of medicine would be if you got insurance companies and government Medicaid and Medicare overhead out of the way. If you had a cash only medical program with sliding scale fees for the poor the average medical fees in this country could be at least a third lower.
Why do medical costs keep going up?
The paperwork requirements and the need to keep revisiting charts for follow ups on insurance and government paperwork claims slows down the providers so they either do not have time to see as many patients as they could a day or they see the patients and do the paper work after closing. These long hours drive many doctors to look for new jobs. Every time a physician is replaced, there are large recruitment costs that patients pay for in their fees.
The requirements and overhead of medical insurance and government programs probably has increased the cost of health care in the United State by a third. Someone has to pay for all their huge buildings that are filled with staff that create enough paper work requirements to drive most medical providers to the point of distraction. Of course, with insurance, the corporate executives get large salaries and stockholders have to get a decent return on their investment. We pay for all that as overhead on the costs of health care. Nevertheless, even insurance and government bureaucratic cost burdens do not explain the ten percent rise in health care per year that has gone on now for well over a decade.
Medical equipment is certainly a big cost problem. Every hospital now has to have the latest very expensive high tech equipment even though only a couple of these devices might be needed in any metro area. Every time you have a procedure in a hospital, you pay for this high tech equipment.
The cost of medical liability insurance is a major cost factor that is passed to the patient. In addition to the liability insurance premiums themselves, physicians routinely order expensive medical tests that in many cases they do not deem necessary. They must order them to protect themselves from lawsuits. These seldom-necessary tests on low risk patients can add hundreds of dollars to one's bill. When providers feel they must order a series of high tech tests for nearly every complaint to cover their butt, do not fall for some delusion that medical costs will stabilize any time soon.
Those that come to emergency rooms without any insurance are a cost factor because they by law can not be turned away. The expenses of caring for them are passed to those who do pay. This is one reason why a visit to an emergency room will cost you three times what a visit to an urgent care clinic or doctors office will cost. Of course, equipment and the staff required at the emergency room is another cost factor. It really makes little sense for Medicaid and uninsured poor people to go to emergency rooms for treatment of common colds and rashes other than the fact that they know they will be seen and they know they will never pay the bill. Emergency rooms in hospitals lose money and for this reason, you will see less and less of them in the future.
Drugs are another major cost; drugstores make huge bucks by charging the suggested retail price from the drug companies when they actually get the drugs for a fraction of the retail price and could charge less. The drug companies themselves are greedy. They waste a lot of money on advertisements and sometimes needless educational dinners and seminars for medical providers. If advertising in the major media were stopped and the number of drug representatives with their large expense accounts reduced, drug costs could be reduced by a third, as are drug costs in countries that do not allow most advertisement or these practices. Do we really need custom made commercials designed to brainwash TV junkies? The talking drug heads on TV brainwash the junkies to tell board certified doctors in medicine what drugs they should be allowed to experiment with after their next visit. If anyone really wants to find out medical information and drug treatment for their condition apart from a trained professional, they can find this information on the Internet or in the library. Do we really need these very expensive media ads telling everyone what we should ask our doctor to prescribe? The drug companies are not doing this as a public service folks; they are doing it to sell people new expensive drugs or to sell expensive brand name drugs over less expensive generic drugs. The greedy non-responsible doctors are only too willing to oblige TV junkies cravings because for a 2-minute prescription renewal visit they can charge for a full office visit.
Price gouging by some medical providers drives up the cost of health care for all. I recently had an estimate for a cap on my tooth. The dentist's estimate was $1750. With the root canal the procedure will take 90 minutes. In that period of time the dentist may also be doing some other minor procedures on others that he may also charge for. With the mark up on the cap I figure this dentist is charging at least $750 an hour. Thus, this dental clinic charges a rate two to three time higher than the normal urgent care or family practice clinic.
Another major factor in health costs are Herculean efforts to keep someone going in the last days of their life when there is simply no chance for their recovery. If physicians actually can prolong their patient's life a few days or a few weeks, it is in a near vegetative state with tubes in every orifice. Often the decisions made by family members are driven by the guilt they carry from poor family relationships, or the selfish motivation to postpone their own grieving. Doctors, by law, must abide by the relatives wishes unless the patient can speak for himself or has a living will in place. Most of the patients themselves would refuse these "treatments" if they were able, but they failed to put their wishes in writing while they were still able to do do so. Half of the hospitals in the United States could be closed if all these Herculean efforts stopped.
Those are just some of the major factors that have driven health care cost through the roof. All these practices have certainly made health care in the United States at least a third higher than it should be.
So health care in the United States is expensive, but why is it a national disgrace?
Twenty-five percent of the population of the United States has no health insurance at all or only catastrophic coverage because they simply can not afford a reasonable health insurance plan. Yet, the percentage of gross domestic product (GDP) spent for health care in the United States is more than one third higher than it is in other developed nations who provide all medical care for 100 percent of their people. The US spends over 16.2 percent of its GDP on Medical care compared to about 10 percent of GDP in most other developed nations, This is projected to go to 20 percent by 2015. There is no evidence that the quality of life is better in the United States than in the other developed nations and the life spans of the people in these nations reflect this. Therefore, we are simply paying much higher medical costs than we need to for adequate care for all people in our nation. The only conclusion one can come to is that the whole health system is broken and is a national disgrace and it needs fixing.
One national disgrace is that those who know how to play the system can get free medical care while those who do not go without medical care. Those on charity (Medicaid) get free medical care while the working poor are lucky if they can even find a clinic that has a sliding scale. Many working families who have large medical bills are then forced to declare bankruptcy but now new bankruptcy laws recently enacted have even taken away this avenue for the poor to get out from under large medical bills.
When People in the United States need to go to other countries to get drugs made in the United States because they are cheaper, this is a national disgrace.
When bureaucrats and high school graduates not trained in medicine tell physicians what they are allowed to do to treat the health of their patients this is a national disgrace.
When elderly on fixed incomes have to chose between heat in their homes, food or medicine it is a national disgrace.
When politicians are bought and paid for by drug and insurance company lobbyists so they pass laws that rob the poor of the US it is a national disgrace.
When good physicians are leaving medical practice because they can not endure the direction medicine in the US has taken, it is a national disgrace.
When greedy medical providers who care more about the almighty buck than their patients are flaunted as role models for responsible providers, it is a national disgrace.
When enrollments in medical schools are dropping because fewer can see a future in medicine, it is a national disgrace. Soon there will be a shortage of primary care physicians and more and more people will be required to go to a nurse practitioner or physician's assistant for diagnoses and treatment at the same cost as seeing a physician who has far more schooling and hands on training.
I could go on and on but even a blind man should see the main focus of medical care in the United States is to support insurance and drug companies. The rest of the developed world has socialized medicine for all people in their nation. These plans have their own problems but they certainly are cheaper and provide more universal coverage than what you see in the United States. Medical insurance and government just adds huge overhead costs. Insurance company staff works for the best interest of the corporation and not for the best interest of the patient.
Is the answer to our national disgrace socialized medicine?
I am no socialist because the only socialism that will work is done voluntarily out of a loving heart. However, even socialized medicine would be an improvement over what we now have it this country. Nevertheless, I do see a much better way.
Obviously, the politicians have brainwashed the people to believe there is no easy solution to this problem but that is because they can not ever see taking the insurance companies out of the picture or regulating the drug companies because these corporations pay for much of the cost of their political campaigns. I am no expert, but if I can give a very simple plan of action to get total medical costs down at least a third in this country while providing universal medical care for everyone in the nation, then why can not the real experts?
First and foremost, to get health costs down we must do away with private medical insurance, Medicaid, and Medicare. You replace it with a tiered system with protections built in for the poor and that contains catastrophic government health insurance for all.
All medical costs with the following exceptions would be paid in cash by the individual who incurs the costs. This will allow medical providers to charge one third less because of reduced overhead. They would no longer be paying staff to do paper work requirements to satisfy insurance companies and the government. If your visit used to be billed at, $75 the cash cost to you would now be $50. Those who are too poor to pay would pay the fee based on a sliding scale adjusted to the fee of the provider they choose and their annual income. The difference would be paid from a national fund. (I will describe that system below). The sliding fee would be based on an individual or household's prior three years income tax records. The IRS will automatically mail the sliding scale percentage to all taxpayers and households each year. Those who do not make sufficient income to normally file tax returns would be required to fill out a very short IRS tax form so they could receive their sliding scale percentage. The sliding scale would be determined by a congressional mandated formula. (The sliding scale documentation could easily be computerized and the sliding scale percentage could even be allowed to be accessed through the Internet by the medical providers by permission of the citizen). When a person receives medical service, what they pay and what the government is billed would be based on this sliding scale. The government would electronically pay the portion billed to them out of a pool of funds immediately. (I will later speak of where this pool of funds will come from.)
Catastrophic medical coverage would be provided for all United States citizens from birth to death. No person or family would pay more than a congressional set determined percentage of their income in medical expenses per year. This set amount would also be based on their three-year average adjusted gross income and the IRS will automatically send it to each household each year. For example, if the catastrophic coverage is set so no one will ever pay more than 10 percent of their average annual income, someone who made $10,000 per year would stop paying for any medical services when their total annual expenses exceeded $1000. Those who had an average income of $100,000 would pay for all medical costs out of their own pocket until they paid $10,000 in medical expenses for the year. All medical expenses should also again become tax deductible so this would lessen the excessive weight on the wealthy but not eliminate their capability to carry more of the social burden of their fellow man. This might sound like a lot of money to those that now have health insurance - but think about it. Those paying health insurance premiums are already paying more than $5000 a year with their cost of insurance premiums, co-payments, deductibles and additional medical expenses not covered like vision care and dental. Now all this will be tax deductible and in most years most will be paying far less than their catastrophic limit. In addition, fees for services will be at least a third less then they are today.
The funds to pay for this sliding scale and catastrophic coverage pool would come from the expenditures now budgeted for Medicaid and Medicare and costs to the government for non-service connected veteran's medical coverage. Medical coverage would still be provided at no cost for service-connected disabilities and for retired military personnel. Medicaid and Medicare with their large staff and bureaucratic mess would be totally done away with. All Americans would be under the same laws. All moneys budgeted for federal medical programs and their huge staffs would now be funneled into a national health insurance pool. The Medicare tax on payroll deductions would have its name changed and would also go into the catastrophic insurance pool. In addition, federal funds given to county and state medical programs would no longer be needed--they also would go into the insurance pool. All employers would pay five percent of a worker's wages into this pool in lieu of paying large sums for private health insurance. The pool of funds for all these programs would also be soundly invested to collect interest.
Drug costs would be included in the catastrophic limit. Those who can not afford a prescribed drug would also be sold the drugs on the sliding scale. Drug companies will not be allowed to advertise prescription drugs except in medical professional journals to help educate providers. This alone will reduce drug costs significantly. Drug companies would also have to justify the costs of their drugs. A qualified professional government board of various professional experts could overrule the price drug companies charge to pharmacists. There would be no price gouging. In addition, a percentage of each of the drug company profits would go into a pool for development of unprofitable drugs. Suggested retail prices by drug companies would be removed and drug stores would be free to charge lower prices. All patients would be given generic drugs unless their physician advises the pharmacists as to why the patient needs the brand name drug. I believe these simple steps will reduce drug costs by at least a third and nobody will be paying more for drugs in any given year above their catastrophic ceiling.
All Medical fees for those who can not pay the entire cost of medical care would come from the catastrophic pool. Those who go over their catastrophic amount would also have their medical payment come from this pool. If the funds are not sufficient in the pool to pay for the nation's medical care the employer's 5 percent contribution or the 1.45 percent payroll tax on wages could be adjusted upward (or downward) until there is a balance. I do not think any increase will be necessary but let the experts do the figures. There would also have to be some oversight of the system to prevent waste, fraud and abuse.
When people have to pay for the first costs of their own medical coverage there will be far less abuse of the system. Most people will not be coming to see a doctor because they have a common cold. They will weigh the expense against the need. Thus, some of the burden put on the system will be immediately lifted. I think there probably will be 20 percent less office visits if people had to pay more up front. Insurance companies know this and that is why many of them now charge $20 co-payments.
Doctors and dentists that charge high fees will see less business when people have to pay for much of their services out of their own pocket. Those on a sliding scale will have to pay their percentage of the sliding scale and higher fees will mean they pay higher bills. In addition safeguards will need to be put in place to make sure that people do not load all routine and elective medical procedures into one year to get over the catastrophic limit. I am not sure about the best way to go about this but I believe a way can be found.
Legislation would be enacted so that trained medical professionals on the staff of the major medical associations would arbitrate legal action against health providers. The accused would have the safeguard of a right to appeal. The board would have the authority to pull the medical license of any abusive doctor in all states or even close down a hospital. All costs to determine the outcome of the arbitration case would be charged to the loser. Lawsuits could be pursued if a party will not submit to this binding arbitration but the party losing the case would be required to pay for all lawyer and court costs on both sides. The government would initiate a board of professionals from several fields to determine set cash awards for pain, suffering, and loss of income and incurred and future medical problems and expenses. They would also set reasonable punitive damages for negligence.
Medical licenses would be standardized and valid in all US States and Territories. Requiring new medical licenses in every state is an unnecessary expense to providers that is passed on to patients. It also hinders critical movement of physicians to shortage areas and it required state staffs and boards that do nothing but duplicate what has already been done in other states.
Hospitals in metro areas will set up coordination teams that will insure adequate equipment for treatment but they also would make recommendations to eliminate unnecessary duplication of expensive equipment.
All health care would be included such as vision, dental and hearing but cosmetic medicine for enhanced appearance not related to traumatic injury would be paid in full by the patient and would not be added to their catastrophic base. All health care procedures that are above the level of standard normal procedures determined by a board of experts would have the increased costs paid by the patient and this increase would not be added to their catastrophic base. For example, LASIK corrective vision eye surgery would be included but Custom LASIK using Wavefront Technology would only be included up to the cost of the basic LASIK. This would also be the case for all medical procedures that in the view of a board of experts is not required to live a healthy life.
All patients upon admittance to a hospital, nursing home, hospice etc. would be required to fill out a standard short form that would contain a legally binding living will containing life support instructions that are desired by the patient. Hospital physicians could overrule any of the instructions on this living will form if the person is not expected to survive to go home to live without unwanted life support in the professional opinion of three physicians. Physicians could also overrule the living will if the will stated no life support but two doctors in their professional opinion believed the patient would survive with life support and go home and be able to live out their life without ongoing life support. Not all will have living wills due to sudden illness and accidents. Therefore, those patients without living wills that are determined by three physicians diagnoses to have no chance for survival without any opposing physician diagnosis would be made comfortable but would not be put on certain life support systems. Those families asking for Herculean efforts against the advice of these physicians may do so if there is no living will against the practice but the patient would pay all medical costs and it would not be credited to their catastrophic base.
The national disgrace of health care in America can be changed.
I am sure there are some holes in my proposal for a better health care system but nothing that could not be closed by real experts if they really cared about the cost of health care to the American people. If I can think of these ways to reduce the cost of health care by 30 to 50 percent and cover all Americans with universal coverage with a few hours of thought, then it is only greed, power and corruption that keeps the politicians from coming up with their own program. Do not buy into the argument that reducing health cost is so complicated. It is only complicated because politicians, insurance companies and drug companies want it to be complicated. We do not need socialized medicine. What we need is to get rid of the governmental and insurance organizations that take their piece out of the pie first. It is time that the whole pie to be given to the United States citizens instead of first giving one third of the pie to bureaucratic vultures who contribute nothing but their droppings.
It is time that people in the United demanded a better health care program. We now have by far the most expensive health care system in the world and it only covers three fourths of the United States population. This national disgrace needs to be addressed and changed. People in the United States need to inform their representatives that the status quo is not acceptable and if they want to get reelected they better start listening to the people they claim to represent.
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