An Effortless Observation about Reform

"Now, maybe I have a simplistic mind, but frankly I don't understand why health care and insurance companies keep appearing in the same sentences." (Fisher, W. Truthout  10/25/09)

In "A Simpleton Tries to Understand the Health Care Debate" William Fisher, PhD (81 years young) offers a sage and effortless observation—that the healthcare debate is less about health and more about the process by which legislation is crafted and adopted.  It is also mostly "about money - money headed for so-called health insurance companies." 

After all, the priorities, the modus operandi, if you will, of the health care and 'health insurance' industries are different: In fact, "insurance companies are not in the health care business at all; their business is the management of risk business" and they "don't do a thing to make you well if you're sick. That's the work that's done by physicians, nurses, hospitals and clinics. And these two groups - health care professionals and health insurance companies - are far from buddies. In fact, they're pretty intense enemies [because they, the insurance companies] do whatever they can to reduce their risk" [emphasis added – jgk]—denials (especially for preexisting conditions like having been a victim of domestic violence, having had a C-section, having a baby that's too fat or too thin), rescission, bureaucratic hurdles, waiting periods, etc.

The main loyalties of these insurance companies are "to their shareholders…. who've seen a run of great profits, based on ever-rising premiums, based in turn on generous government subsidies and an almost total lack of competition among all these companies. Furthermore, Congress has given them an antitrust exemption that means they can fix prices (even as insurance premiums escalate). Despite these advantages, it's like a fixed deck—we are spending more than most other countries and "our health has gotten steadily worse."

Example: We rank 19^th among industrialized countries in preventable deaths in such conditions as diabetes, epilepsy, stroke, influenza, ulcers, pneumonia, infant mortality and appendicitis.

Original Source: Nolte E, McKee CM. "Measuring The Health Of Nations: Updating An Earlier Analysis." Health Affairs, 27 , no. 1 (2008): 58-71 (World Health Organization)

In addition our health care costs more than other countries with more waste and less return on investment: 

"U.S. Healthcare System Wastes Up to $700-$800 Billion a Year"   

• That's 1/3 of the nation's healthcare bill 
• "Unnecessary care such as the overuse of antibiotics and lab tests to protect against malpractice exposure makes up 37 percent of healthcare waste or $200 to $300 billion a year.
• Fraud makes up 22% of healthcare waste, or up to $200 billion a year in fraudulent Medicare claims, kickbacks for referrals for unnecessary services and other scams.
• Administrative inefficiency and redundant paperwork account for 18 percent of healthcare waste.
• Medical mistakes account for $50-100 billion in unnecessary spending each year, or 11 percent of the total.
• Preventable conditions such as uncontrolled diabetes cost $30-50 billion a year.
• The average U.S. hospital spends 1/4 of its budget on billing and administration, nearly twice the average in Canada."
• [Note: I could not confirm the next and final quote or verify its assumptions.  Indeed, others have stated that Dr. Steffie Woolhandler's figures and assertions represent overestimation and, moreover, Canada squeezes the salaries of its doctors to reduce costs.  See: "The Costs of Health Care in the United States and Canada--Questionable Answers to Questionable Question" by Henry J. Aaron, PhD (economist)].  Nevertheless, here's what Dr. Woolhandler is attributed as inferring: "American physicians spend nearly eight hours per week on paperwork and employ 1.66 clerical workers per doctor, far more than in Canada.''  [Ref.: New England Journal of Medicine (2003) paper, which I assume to be "Costs of Health Care Administration in the United States and Canada "by S. Woolhandler, T. Campbell and D.U. Himmelstein.]

 

_{From: Fredrick (MD, PhD, JD)}

_{Date: Oct 26, 2009 2:03 PM}

And they didn't even mention the 25-30% of healthcare premiums that goes to insurance company profit and mismanagement.  If the cream-skimming by these so called "Health" Insurers and the obfuscation by the meddling medical managers go away with a public outcry and a public option, that would be a fortuitous lagniappe, wouldn't it?

 

Before closing....

Americans are very concerned that changes in our health care system will "limit their choices" of physicians, hospitals, insurance plans, and/or diagnostic testing or treatments. However, in a recent JAMA commentary, we learn (and I agree): "there is arguably more choice" in Canada as compared to the U.S. [emphasis added].

Ross JS, Detsky AS. "Health Care Choices and Decisions in the United States and Canada," JAMA. October 28th, 2009;302(16):1803-1804. 

What I want to know is how to attain maximal value or benefit, how to guarantee access and that people (patients) are treated fairly, and that they have reasonable choice; what I care less about is the insurance company shell game, the focus on "who," rather than "what," and/or how to squeeze.

See, also, HCPLive.com's "Reforming Healthcare & Managed Care," my blog, "An Effortless Observation about Reform."