Thursday, January 21, 2010

Great Scott! 9 Healthcare Fix Ideas

Stunning news out of Massachusetts this week: the grip liberal Democrats have held on what they considered to be Ted Kennedy’s Senate seat has been broken by a Republican.

Now, before we get ahead of ourselves, how many long-time Republicans hold Senate and House seats that they consider to be theirs? A lot of office holders – and their constituencies – have developed a taste for career politicians, which has only jacked up the amount of pork and imperious attitudes that are stifling our great country.

So, if the Senate seat being “returned to the people” in Massachusetts had been one that a Republican held as long as Kennedy did, then I’d probably be similarly pleased; not that a Democrat had won out, but that the political machine there had finally ground to a halt.

You already know I don’t consider myself a Republican or Democrat, and I’m growing more mindful of the fact that, as my good Heritage Foundation friend likes to remind me, one can be a Republican without being a conservative. Still, I am conservative enough to recognize the giddy opportunity Scott Brown’s win provides sane thinkers in Washington to call a time-out on President Obama’s wildly off-track healthcare legislation.

We’ve been told that the federal government’s overhaul of America’s healthcare system served as one of the crowning glories Ted Kennedy pined for when he wasn’t boozing it up, carousing with other men’s wives, and trying to ingratiate himself with New England’s stoic blue bloods who never bowed to what the press claimed was America’s royal family. (I’m sorry, but I’ve given up trying to feign respect for the Kennedy's.)

So much the sweeter Brown’s victory is! At the 11th hour, an opportunity has emblazoned itself across DC’s sky, sending the brick-a-brack of bribery-laden, heavy-handed, pie-in-the-sky dripping-with-pork-fat legislation that Democrats have the temerity to call healthcare overhaul back for a re-think.

Quit Playing Politics With Healthcare

If it’s any consolation for Democrats, Republicans don’t deny that things need to be fixed in our healthcare system. Costs have risen steeply, employers are drowning under the paperwork, and doctors are abandoning (or being pushed out of) their practices. A significant crisis has developed in hospital emergency rooms, where patients can wait hours for care, defying the very meaning of “emergency”.

What many Americans are saying is that plenty of things can be changed and improved without “overhauling” the system at the federal level. I believe conservatives are correct in saying that Obama’s coy term “efficiency” is a code word for "takeover". Let’s face it: our government doesn't do many things efficiently, and a takeover of our healthcare system will mean higher taxes in exchange for reduced quality – and quantity – of care.

For proof, simply consider the colossal mess of our current tax structure, the atrocious waste inherent in Medicaid and Medicare, the institutionalized poverty perpetuated by sprawling welfare programs (an upcoming topic in my blog, btw), and the increasing inability of our armed forces to respond adequately and quickly to changing warfare scenarios. Americans have a right to be concerned: do we really want government to now handle our healthcare?!

A dear cousin of mine in Finland thinks that we Americans don’t understand how inefficient our healthcare system is right now. However, with all due respect, Finland and the other European Union countries have much smaller populations, share much more homogeneity, and still have to tax themselves silly to run their healthcare systems.

By virtue of its population’s sheer size and diversity, the United States does not function like our fellow democracies in Europe. There is little that is homogeneous in our society. People even think and act differently in distinct geographic regions of our country. We have significant sub-sets of people groups that have different physical makeups and wellness tendencies. And yes, there's about 400 years of individuality that makes us inherently suspicious of big government.

None of that means our current heathcare system doesn’t need fixing. So, let’s gather a collective breath, relish the borrowed time we’re working under because of Brown’s win, and think about the rational possibilities:

1. Stop the Hemorrhaging at Medicaid

For starters, we all know Medicaid and Medicare are systemically corrupt and need to be completely overhauled – so if Obama wants overhaul, let’s put some sound business practices in place here. The problems stem not so much from the patient side but the provider and billing sides; every day brings a new scam. Don’t software systems exist that can match vendors with reimbursables, coordinate authorization schedules, and deploy other controls? We’ve learned the FBI can’t network itself, but maybe Medicaid can.

2. It Ain't Called A "Practice" for Nuthin'

Some states have experimented with limiting malpractice jury awards, and this idea should be extended nation-wide to protect all doctors and healthcare providers. We seem to have forgotten that medicine is a practice. It is not perfect, humans will continue to make honest mistakes, and we have to live with the consequences of all sorts of things. Surgeons who amputate the wrong leg should still be subject to lawsuits, but calculating damages needs to be more refined.

3. Consult Your Physician, Not Madison Avenue

One of the easiest ways of reducing the cost of medicine is restricting the currently-bloated marketing budgets of pharmaceutical giants. Do we really need so many perky business school grads strutting around doctors’ offices in designer suits giving away football tickets? Does appealing directly to patients through slick TV ads mean that doctors can’t judge the merits of a particular medicine on their own?

4. Pending Patents Cost Time and Money

I understand pharmaceutical companies aren’t in business just to help people – they also want to make money, and as long as they do it responsibly, that’s fine. One area in which these companies spend tons of money is their research and development of new medicines and equipment. I have no problem with them being able to protect the investment they’ve made in this time-consuming, costly process. I think the FDA should streamline their process for approving new medicines through better co-screening with similar agencies from other developed countries. I also think pharmaceutical companies should enjoy enhanced protection for their research and products. Knowing that they can benefit from their efforts over a longer period of time may help spread out the cost of developing new products and also better reward companies for their investments in products that may take time to prove themselves.

5. Take the Consequences

Personal responsibility needs to take a greater priority in one’s personal health. Healthcare providers and payers should be able to penalize customers who engage in habits and practices that are indisputably unhealthy or pose major health risks. These practices could include smoking, alcoholism, and even hobbies like skiing. People who make no effort to lose weight, aside from contributing factors like prescription medicines or ancillary health issues, should also be penalized. I’m not saying people can’t smoke, eat anything they want, or should give up their trips to Colorado. I’m just saying they should have to pay more if they want to engage in risky behavior.

6. No Legal, No Free Healthcare

Healthcare providers should deny covering healthcare costs of illegal immigrants except in life & death cases. For example, Hispanic families frequently cross the border illegally and pop out kids left and right in our maternity wards, and we get to pick up the tab. I say no. You’re making a mockery of American citizenship by birth.

7. Drive Like Your Health Depends On It

We should shift a greater burden for hospitalization coverage for motorists from their general healthcare insurance to their auto insurance coverage. If drivers know that they personally share a greater responsibility for their healthcare costs when they’re behind the wheel, hopefully they’ll become more careful drivers, and injuries from auto accidents will decline. Of course, we’ll have to actually enforce laws already on the books requiring drivers to carry car insurance. Remember that driving is a privilege, not a right.

8. Jump In the Pool

I do agree with many employers: why should they get stuck managing healthcare programs for their employees? Company health insurance started as a way to attract and retain good employees, but now that everybody does it, how much reward is there for the employer? Wouldn’t insurance work more effectively if it was offered to large pools of customers regardless of employer? What are the difficulties in having insurance companies set up their own pools, maybe based on geopolitical boundaries like counties or clusters of counties, and allow individuals to join regardless of their employer? An employer could cover part of the health insurance cost, but they wouldn’t need to administer a healthcare program. Would that lower heathcare costs?

9. Rainy Day Healthcare Fund

Regardless of whether or not insurance is handled by employers, the IRS should expand employee participation in tax-free healthcare programs. Basically, employees should be allowed to have deducted from their pay a certain amount each pay period that is automatically transferred into a tax-free holding account. Whatever isn't used that tax year gets dumped back into their income account and is taxed normally. This practice is already widely used, but the rules can be confusing and should be streamlined.

Do you see that we've got a lot of things already that we can try before throwing up our hands and saying the federal government is our only hope!

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