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Monday, July 20, 2009

Indisputable

Indisputable. That's the word the President used today about the need for health care reform. The need is indisputable.... I think I'll dispute him anyway.
The need for minor reforms is indisputable. Ask anyone. The need for a major overhaul, basically being done in the middle of the night, with no time to read the bills before they are voted on is disputable.
If indeed health care reform is the major issue that must be tackled to save our country, shouldn't we be taking our time to come up with plan? Shouldn't we be open about it, and let everyone know what's in it? Shouldn't the folks in Congress who are voting on it have time to digest 1,000+ pages of legislation before it gets to a committee vote?
Well, if you believe the President the answer is no, it has to be done before the August recess, even if it means ramming it through before Congress even knows fully what's in the bill.
Want to see the cost of health care go down? Ask companies like Whole Foods how they've done it, and had satisfied employees. Ask Mayo how they are doing it. Don't let a bunch of policy wonks and bean counters make the decisions.
The folks at Mayo are doing a lot of work with treating of root causes, instead of symptoms. Sounds like common sense, but in the insurance/Medicare run medical business it's not. In the short run Mayo's approach costs a little more. In the long run it saves patients, and their insurance companies tons of cash.
Whole Foods uses health savings accounts to turn their employees into consumers of health care, instead of consumers of insurance. Suddenly both employee and company costs went down. Right now most folks get an MRI referral and go to the place their doctor recommends, and don't worry about the cost, because insurance picks it up. The folks using HSA's ask the price, and shop around for the best deal. Many doctors and clinics give a reduced cost to HSA patients because of the reduced paperwork load they have to deal with.
Medicare is a big part of our health care problem, yet congress wants to use it's failed policies as the basis for reform. Because the way Medicare contains costs is to just reduce payments to doctors, they find themselves ordering every test that can be justified for any ailment. If they order enough they can break even on medicare patients. When they can't, then they raise rates for other patients to make up the difference.

Get Medicare back to it's pre-1992 method of payment, the prevailing rate in a location, and doctors would be passing less costs on to the rest of us. Don't believe it. Look up the numbers, every year Congress has lowered the Medicare reimbursement rates overall health costs have seen a spike for non-medicare patients.
Insurance needs some reform, too. Unfortunately everything being discussed in congress right now basically means that the 81% of us happy with our coverage will probably lose.
Insurance is a risk pool, yet congress would like it to treat everyone the same. I'm a 45 year old, overweight out of shape, chain smoking (the links are hard to light), couch potato. I should pay more than the guy up the street who's the same age, doesn't drink, or smoke and who spends his free time bike riding and at the gym.
I should pay more because of my high blood pressure and cholesterol, and family history of heart attacks, yet some folks see that as "unfair". It's perfectly fair. I chose to take health risks, and should be punished by higher premiums. If I get off my ass and on the bike, and toss the Camel's, then give me lower rates.
Want to reform insurance? Make it possible for me to shop across state lines, which is currently illegal. Let a company in California decide it wants to take on high risk folks in Illinois at a discount and see how they do.

Require insurance companies to standardize their paperwork so doctors can get rid of a few of the admin assistants needed to process forms from 1300 insurance providers.
Require insurance companies to publish their grading criteria for underwriting policies, so that consumers have an idea of what's going to drive up their rates with which company, and so companies can find niches to fill when they realize others don't or won't cover certain things.
If the President wants to make a promise that everyone in America will stand up and cheer for, he should promise to veto any bill that doesn't require Congress to use the same system everyone else does. If he'd do that he could probably get the population to support a single payer plan payed for by selling off everyone's first born.

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