Sunday, June 14, 2009

Cost is missing from the health care debate

The Democrats are pushing hard for health care "reform" by which they mean everyone gets health coverage and Uncle pays for it. Problem is we cannot afford it.
Right now, with millions of uninsured, we spend 18% of GNP on health care. We cannot afford that. Insure the uninsured and the health care slice of the economy will go up, and we can't afford that either. The US spends twice as much on health care as any other country on the globe. 18% of GNP means 18 people out of 100 are providing health care. Each health care worker only cares for 5.5 patients. This is insane. US products sold abroad cost 18% more just to pay the workers health care. We have to compete with the rest of the first world that is only paying an 9% health care markup. Companies move production off shore to avoid US health care costs.
We need to cut costs, by a half, to be competitive. Adding tens of millions of people to health care insurance isn't the way to do it.
The US spends as much as it does on health care because health care is free. The bulk of us have company paid health care that pays for everything. So whatever the doctor orders in the way of tests, procedures, imaging, motorized wheelchairs, prescriptions, and office visits, we do. Doesn't matter how outrageous the bill is, we don't care, it's paid for. And the bills ARE outrageous. Like $500 for a 50 minute office visit or $1023 for prescription drugs that can be had at Walmart for $48.
Only way to fix the excessive amounts of care and the gouging on the bills it to have us patients pay for it out of own pockets. Insurance ought to only pay for major catastrophes beyond any ordinary patient's purse. Routine stuff ought to be paid for out of pocket.
Then we could clamp down on the tort lawyers that sue for malpractice at the drop of a hat. A lot of testing and scanning and such is done to cover the ass of the doctor against a possible malpractice suit. Do something about predatory lawyers and costs would go down.
We need to clamp down on drug costs. The sky high prices charged for on-patent drugs goes not to research and development, but into marketing. Big drug companies have fancy salesmen, wearing suits, visit every doctor in the country every couple of weeks to peddle pills. Not quite sure how you deal with this but I'm sure there is a way. Allowing drugs in from Canada might be a start, taxing marketing expenses might be another.
Allow more competition. Allow insurance companies to sell insurance in every state of the union. Get a license in one state and you have the right to sell the same insurance policy in every state. Right now states won't allow out of state companies to sell insurance instate.
Drop state mandated support of every strange condition. Plenty of people would be happy to skip support for drug addiction, chiropody, contact lenses, dental coverage, gender change, and who knows what else, in return for a lower insurance premium.
Something like 30% of health care costs are incurred in the last year of the patient's life. At end of life, there is always something that can be done, even if it won't help much. It may not help, but the doctor and the hospital can bill for it and Medicare will pay for it. This isn't health care, it's making money. One fix might be to have a law that says "Death cancels all medical bills. If the patient dies, clearly the medical treatment was ineffective and will not be paid for."

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