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Saturday, January 23, 2010

Can Health Care Reform Be Saved?

If you regularly read my irregular blog posts, you are probably wondering about this one, considering the title. I've written a number of things critical of what's going on in Congress concerning health care reform, most of it unflattering to Congress.

The truth is, we do need some reform, which I've occasionally mentioned. What we didn't need was the House's wholesale take over, or the Senate's hodge-podge of payoffs and hush money to get anything passed. We need some common sense things done.

Now that political reality has set in for Nancy Pelosi, it might be possible. Tuesday night she was telling us that Scott Brown's election did nothing to change what was going to happen. Then she talked to her caucus and pronounced the Senate version of health care reform dead in the House. That was really the only way they were getting anything to the President's desk before his State of the Union address.

So, how do they save Health Care Reform? The best way would be to get 4 Senators and 4 Congressmen from each party together and work on ideas they can all agree on. Here's a few that shouldn't cause too much pain.

1. Portability. Decouple health care from the job, and to the person. Allow employers to pay for it if you wish, but have the insurance follow the person.

The "insurance exchange" idea would actually work for this. Employers buy from the exchange, in the employee's name. When they leave the company the insurance goes with them. The next employer can pick up the tab, if they wish, or the individual can do it on their own.

2. Taxes. Give employees the same break as employers when it comes to paying for health insurance. It's a crazy thing that if I get my own insurance unless I meet a threshold I get no tax break, but if my boss pays he gets a big one. Now if the person from example 1 decides to leave to start their own business, they aren't penalized for buying their own insurance.

3. National coverage standards. Right now we have 50 states with 50 different coverage standards. A minimum coverage policy in Kentucky is about 400% less than in New York. Set a national standard for coverage, so that insurance isn't locked into what state you are living in. We've become mobile, our insurance should be too.

4. Pre-existing conditions. They should be covered. The problem with both the House and Senate versions is that they want to exist in a fantasy world where your pre-existing condition shouldn't mean you pay more for coverage. It's funny that two bodies will one day lecture the banking industry about their fiscal irresponsibility for getting into hedge funds, and the next chastise insurers for charging more to people who it costs more to service.

5. Tort Reform. This gets the Democrats skin crawling, because trial lawyers are one of their biggest donor groups. The truth is that there needs to be some reform. A basic one that would be hard to vote against would be limiting the amount the lawyers in malpractice cases can be paid. Democrats would throw a hissy fit, but the truth is, if it's okay to limit bankers pay and bonuses, as they'd like to do, why not lawyers?

Mandatory arbitration in front of a panel of experts would also be a nice spot to start. Lawyers would be less likely to file frivolous malpractice suits if a group of doctors were going to hear the case first, instead of a jury of laymen. Make the results eligible for appeal to a judge and jury, but also make the panel's findings usable as evidence.

6. Uniformity of paperwork. Want to have fun, go to a doctors office with two different insurance policies. Watch the admin folks twitch as they try and figure out which is primary, which is secondary, and what form to use for each.
Want a headache? Have them get it wrong.

Insurance companies should be able to come up with an industry wide standard for claims forms, so that a doctor or clinic doesn't need two file cabinets and an extra person to chase paper. A standard system for policy numbers, similar to the VIN on your car would also be helpful. Then it would be pretty easy to develop software that works reliably for any companies claim.

None of this is really rocket science, and except the argument you'll get over tort reform, none of it is horribly controversial. However, it would all lower costs, make insurance easier to get and keep, and result in a happier, probably healthier public.

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Blogger Michael Kirsch, M.D. said...

Your comment re tort reform is worthy of discussion. Indeed, any new version of the medical liability system would be an improvement over the status quo. I am one of those physicians who has been unfairly victimized. Leaving physicians aside, the patients suffer by receiving billions of dollars of defensive medicine, tests they don't need. see www.MDWhistleblower.blogspot.com

6:19 AM  
Blogger Crazy Politico said...

There are folks, including the president, who are firmly against any tort reform, and it's too bad. I know my wife's former OB/GYN paid nearly $500,000 a year for malpractice insurance in a jackpot jury state. His insurance cost more than his staff and facilities combined. Something is wrong with that.

8:43 AM  
Blogger Michael Kirsch, M.D. said...

Dear Crazy, I hope you are spreading the word, as I am trying hard to do. We had a huge win in Massachusetts, following upsets in NJ and VA. I am hopeful that this November that ordinary folks will speak their minds and be heard.

9:01 AM  
Blogger Matt said...

Why would we allow the government to cap what two private individuals can be paid? Bankers took govt. money, thus are subject to the strings attached to that money. But if, for example, I wanted to hire you to do something for me, should the government dictate how much I can pay you?

As for your wife's former OB-GYN, I'd be interested to know what state he/she was in, and if you ever actually saw the premium bill. Most of these stories are apocryphal. Physicians' versions of the Stella Awards.

I'd do a little closer fact checking before I bought into them. Most non-partisan claims of disappearing docs and other claims have been found to be bunk. In fact, malpractice premiums typically are less than 10% of a physicians' overhead. You can find more accurate information than physician hearsay on their premiums here:


You'll note the average premiums cited by specialty. 55 companies were surveyed, and on average the data represented 77% of the premiums paid in each state. Nowhere will you see anything near $500,000.

10:20 AM  
Blogger Crazy Politico said...

Matt, if you look closely at the data you provided, under the surgical specialties you'll notice that providing abortions is not included in either of the sets of stats.

I'm pretty sure that the reason it isn't is the high cost of insurance for doctors who provide that service.

His practice was in California at the time, in a zip code (91915) that isn't in the data, either.

10:18 PM  
Blogger Matt said...

"His practice was in California at the time, in a zip code (91915) that isn't in the data, either."

If your friend's practice was in California, then it's quite certain that tort reform wouldn't change his outcome. Tort "reform" has existed in California for nearly 4 decades now, and according to your example clearly has little to do with how much your friend pays in insurance.

4:18 PM  

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