We keep hearing that 46 million Americans don’t have health insurance and need it. This number includes people who already qualify for existing government programs. It also includes people who simply choose not to buy health insurance but could otherwise afford it. The true number, I’ve read, is left at about 16 million uninsured. I wanted to get that out of the way first for two reasons: 1) You’re being deceived, and 2) It’s intriguing but somewhat irrelevant to what follows. By “irrelevant” I mean it doesn’t matter to me how many people can’t get the medical attention they need; something needs to be done to reign in the cost for those people. Obama just has no clue how to do it correctly.
Yesterday, President Obama gave a speech to the Americal Medical Association, pleading for their support regarding his healthcare plan. He outlined a number of modifications to the current system that would supposedly be “deficit neutral.” I guess to Obama, shifting the deficit to another party is remaining “deficit neutral.” The details of his plan as of now will only put hardship on the people in the trenches: the healthcare providers. I’m not talking about health insurance companies. I’m talking about the people who actually have the skills to cure our cancers and bandage our boo-boos. The doctors, nurses, and other medical staff of this country are doomed.
Consider Obama’s plan for incentivizing doctors to cut costs. He intimates that doctors spend too much time and money ordering useless tests and procedures when in the end, with the advantage of retrospect, it would have been just as efficient to skip them. Counterintuitively, he suggests that the only (silly little) reason they do this is to prevent themselves from being sued for malpractice if they were to miss something of vital importance. He goes on to say that he does not favor putting a cap on malpractice suits. Is any of this starting to sound ridiculous? Being a nation of litigation as we are, doctors will be sued at the drop of a hat for any minor detail, but Obama wants them to stop thinking about that. They’re not supposed to be worried about being sued; they’re supposed to be worried about healing their patients. That’s it. You tell me how a doctor is supposed to operate under those conditions. When there is a high percentage chance that your patient is going to try to sue you anyway, how can you be expected to treat him without that fear?
Some people say medicine should not be practiced for profit. While that’s a dreamy proposition, it’s just not practical or fair. Few people know or understand what it takes to become a doctor. It is a high-risk venture. The effort and sacrifice is more than most people could handle. The biggest risk-takers should be able to reap the biggest rewards. If you don’t want to take the risk of hundreds of thousands of dollars in student loans, don’t be a doctor. If you don’t want to risk neglecting or even losing your family and friends, don’t be a doctor. If you don’t want to risk having zero quality of life, working the longest hours for an ungrateful herd of freeloaders ready to litigate, don’t be a doctor. Now, Obama proposes that if you don’t want to be subjected to government mandates while you deal with all of the above, don’t be a doctor. What kind of doctor is this going to produce? I thought we wanted to encourage people to become doctors. We need our brightest minds in the field, but those minds will go elsewhere if they think doctoring will be a dead-end job.
Phase 1 of my plan: limit litigation. I think it is unfair for people to expect perfection from doctors. Everyone who sees a physician should be aware that there are always risks. Too many people run to the doctor for every little thing as it is, many just want their doctor to screw up once so they can cash out. Where’s the personal responsibility for your own care? Stop trying to make other people responsible for your life. If you want to be protected from medical malpractice incidents, purchase AD&D or disability insurance. Don’t make doctors pay to protect themselves against you. They’re trying to help you after all. Are you getting a liver transplant? Guess what: something might go wrong! Putting caps on malpractice payouts is just a start. Frivolous litigation bogs down the entire system and sends ripples of fiscal irresponsibility through everyone’s wallet, including yours and mine. Medicine for profit? The patients do it every day, and they don’t even need a degree.
Let’s discuss the “freeloaders” I mentioned. I’m sure you are aware that no one can be denied healthcare for lack of health insurance or ability to pay, right? Every day people abuse this policy. Hospitals are overcrowded with people who will simply never pay (and some who will never leave.) Obama wants to cut costs by reducing the amount the government reimburses hospitals for treating uninsured patients. He justifies this by saying that as people move onto the public policy, the number of uninsured patients will go down. There is no incentive for healthcare providers here. There’s not even a choice! Say your hospital currently gets $100 (an arbitrary example for the sake of easy math) per uninsured patient. Now say Obama’s plan wants to reduce that to $75 right off the bat (this is not any figure he has given as far as I know, just a random number to continue our example.) The number of uninsured patients in your hospital has not changed at this point, but you are already getting less reimbursement for them. “Deficit neutral” is now a 25% deficit for your practice. Obama wants healthcare providers to take over even more of the burden of paying for your free health care.
Phase 2 of my plan: limit free doctor visits. This may sound a bit draconian, but if you actually knew the rampant problem that is hospital freeloading, you might be inclined to agree with me. It’s not just the litigation profiteers. It’s also the drug-seekers. It’s also the people who just want to be serviced as if in a hotel. It’s the hypochondriacs. It’s the people who needed an ambulance ride to an air-conditioned building or to buy cigarettes at the gas station next door. If you think I am exaggerating, then you are too far removed from the problem and have no insight into what I’m talking about. These are real first-hand examples. These are the people draining the system. Stop blaming the doctors. They are trying to help you in spite of yourself!
Health insurance is a pain. I know. The stranglehold the insurance companies have on the industry is bewildering. However, they get their cues from programs like Medicare and Medicaid. “If the government only pays this much, that’s all we’re going to pay,” they say. When you see a doctor you have no idea how many other people or services are going to be added onto your bill. There’s no way to know for what your insurance company will pay and what you will pay. One doctor may charge this much, and the next doctor that looks at your chart adds this much more. The person who carries your chart down to the lab may not be part of your network and cost you however much out of pocket just for the short walk down the hall. The idea of getting healthcare can be frightening when you have no clue how much it is going to cost even when you have health insurance.
Phase 3 of my plan: transparent billing via doctor-patient decisions. Patients should be able to see upfront how much their treatment will cost them, alternatives to that treatment if any, and how much will be covered by insurance. It should be no different than ordering off the menu at McDonald’s. Patients will then make treatment decisions with their doctors and only with their doctors. There will be no interference from any bureaucracy. There will be no denial or preapproval necessary from the insurance company because if the doctor and patient agree that it is the best treatment, insurance has to pay up. You will pay one agency only. You will not have a separate bill for labs and rehabilitation. One treatment plan equates to one bill for one payee. This also fits nicely with my limited litigation plan because an informed patient has less recourse for litigation. When you and your doctor are left to make decisions together, you become responsible for your own care and cannot reasonably be allowed to sue the doctor trying to help you.
It’s a complicated issue; I know. There’s no panacea, but I believe my plan is better than Obama’s, which is to throw everyone’s cash at the problem. Hopefully the AMA will cut some new teeth and really fight back with a better plan. It’s insulting really. I do wish the most unfortunate of us had a way to get treatment, but the reality is: they do. Go to the hospital. They can’t turn you away. That’s the system that needs to be fixed. It’s not the fact that people don’t have insurance; it’s the fact that they don’t need it and someone else is already footing the bill. Be careful when you get on Obama’s plan. He’s going to tell you what you can and can’t do from now on. Forget asking your doctors for help. Remember, they were the ones trying to help you to begin with. From now on, you report to the Medicine Czar.
