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A contrarian's view on health care

Sunday, August 5 at 12:00 AM

This Speakout has not been edited.

Perhaps it comes from years of management consulting, but I tend to be a contrarian on things like health care.

Health care costs have risen sharply over the past two decades and it has become nearly impossible for 15% of Coloradoans to afford the $10,000 a year family health insurance entails.

Everyone, including those with coverage, is concerned where these trends will lead. Whether you feel that the root cause is government meddling or the increasing costs of new drugs and technology; it matters little if you are one who has to declare bankruptcy from medical bills.

By my way of thinking, health care crossed a great divide in the 1970s, in that it finally began to deliver on its promises. Improvements in diagnostics, surgery and drugs became cornerstones in a foundation soon to be completed by genetics. But, like the costs back in 1914 of abandoning your $50 horse for a $500 automobile, the economic picture for health care has also changed dramatically. In my mind, our failure comes in refusing to accept the fact that we are now in the 21st century, not the 20th. We need to quit trying to drive forward looking out our rear-view mirror.

Health care is now a 16% overhead burden in the economy, but it has the promise of being an export industry, far greater in magnitude than any industrial sector of the past. There are six billion people on the planet who need more and better health care. If we can somehow sufficiently discipline the health care industry to become more efficient and effective, we should be able to export advanced drugs, medical equipment and genetic-based treatments and therapies. It will become our economic engine rather than the exhaust out our tail-pipe.

Second, although our founders did not anticipate modern health care, I am sure they would agree that it should be some kind of a right, along with education, food and shelter. But, they would also insist on far greater individual responsibility along with those entitlements. That includes buying insurance, adopting a healthy lifestyle, and being an informed, rational consumer.

I therefore, buy into the unwritten assumption driving Colorado’s 208 Blue Ribbon Commission that Colorado citizens should be required to have health insurance and stop using emergency rooms to shift costs.

Massachusetts, who has a population of 6 million, greater than Colorado’s, has had to subsidize only 130,000 so far to get the uninsured enrolled in their plan. Even if we had to subsidize 150,000, it would still be cheaper than the current system.

So, I say, let’s go for it. Mandate coverage, subsidize based on ability-to-pay, but insist on personal responsibility. We also need to take the steps to assure that the health care system is more competitive and more transparent in terms of reporting costs and quality. And, health plans need to be more focused on prevention than fixing broken bodies.

Colorado’s governor and legislature are now controlled by a single party we can hold accountable and they should make bold moves to assure that the new University of Colorado Health Sciences Center at Fitzsimmons repositions Colorado as the bio-science epi-center of the 21st Century.

California has had the Silicon Valley, but Colorado should lay claim to bio-science.

I believe our failure in the past has been in the naïve notion of letting the market work organically hoping it would produce all the results we want. It seems that the same people who believe in creationism promote laissez-faire evolution when it comes to economic development. But, the rise of Germany and Japan after WWII, and now, India and China, have shown that government support of strategic, visionary policies, guided by intelligent design, can, in ten years produce impressive results. That’s what Colorado needs right now—inspired leadership and sustained progress.

Fran Miller is a management consultant.

READER COMMENTS

Tree Hugger,

I was comparing the prophets of doom on car insurance to t hose same ignorant government pushers who tell us only the government can provide good medical insurance.

My experience under some of the worst insurance companies has convinced me that shopping for medical service will mean better treatment at a l;ower cost. We can also determine that the people in theinsruance business will not be happy to find competition so they wilol object to many of the things that will reform insurance plans. The most important element is to return the primary responsibility for insurance to the individulal. We wil need to make tax chages, attitude changes and, most of all, governmental changes. Right now we have to fight to get the right to a Medical Savings Account. Another poster here revealed that it's impossible to buy catastrophic insurance. We can trace back the beginning of the upward spiral in health care to three things. First there is the beginning of Medicaid which gave basic medical care to seniors who had lost health insurance upon retirement. The second was the tremendous upswing in the number of small businesses which were too small to afford health insurance for employees. Lastly we have the greatest increase in medical science in a short time. More drugs and treatments have increased the lifespans of people. As these people age they get diseases that have not had cures or treatments before now. The treatments are costly and some, especially in one payer systems, are considered too expensive and, even if offered, usually require a longer period for approval and more often than not the unspoken intention is that many wll give up (or die) before treatment is provided. Many cancer treatments are most effective with early detection so a delay in diagnostic proceedures can result in more expensive treatmenst being necessary. In Canada basic breast cancer diagnois can be delayed with a wait of up to a year. In that year there will be a large number of people who just give up. For those who have an abnormal test it may end up taking six months to begin treatment. This from actual reports made by Canadian government officials evaluating their system. How many die because the delay discouraged them from diagnosis or treatment? Not intentional denial but iut still serves to make the system look bad. Unfortunately it isn't anything that won't be repeated here. A finite amount of care exists and when people think healthcaer is free they will overload the system. Many who are forced to wait will suffer no ill effects from the delays. What if you, or a loved one is not so lucky. Even under a government plan there will be an advantage to those who pay attention and are willing to work on it. Let's make that the basis of a new health care plan. It will work. And the prophets of doom can go elsewhere and be gloomy.

Posted by momma y on August 8, 2007 07:27 PM

Momma Y,

You are comparing two different things when you talk about health care insurance and auto insurance.

While you can go through your whole life and never need auto insurance, I guarantee that you are going to eventually need some kind of health care. (Unless you are "fortunate" enough to die a sudden and unexpected death. And even then, you'll probably take an ambulance ride to an emergency room someplace.)

Posted by Tree Hugger on August 8, 2007 10:31 AM

...."The only way to realistically increase the quality of care and address out-of-control prices is through government intervention."

Our of control prices start and never end with the government putting its inefficient paws in anything. War on poverty spent how much? What progress do we have to show for it?

Original estimates for medicare, the beginning of government provided general healthcare, were very low. Most estimates were based on the perceived benefits and savings from preventive care and used the average costs of the care at that time. Sound familiar?
They didn't factor in the number of people who would use the service and perceive it as free. Nor did they even consider the problems created by the care providers not having to compete for customers. (My doctor's fee for an office visit was 30 dollars in 1986.)
Real problem with government health care is that the problems it seeks to solve don't exist in the forms that will be solvable with either the corporate or the bureaucratic thinking processes.

The statistics we are hearing are arrived at by adding up all those without healthcare during a set period of time. They get those numbers from many sources.
Example 1
My grand daughter was on medicaid.
When she qualified to be covered under our insurance we paid for her inclusion and dropped her from the medicaid. We have since received three phone calls and a monthly letter informing us we can cover her under SCHIP and we get a call the first week of the month from Medicaid to "let you know" that she can be re-instated with the documents on record.
Each of these agencies gave us phone numbers to call so I called and asked a few questions. First SCHIP got her name from a list compiled by Social Services and had included her in the "unisured children" totals they reported. She had also been added to the unisured totals on Social Service's lists. The same overcounting flaws exist in the counts for all reports on uninsured people.

"But, but, but...some people (I can hear the sputtering now) really are uninsured. People who can't afford it and need it because they are really sick."
Yes, there are uninsured people who are sick who don't have access to insurance providers because their jobs don't offer it or they don't have the funds.

OK.
Example 2
I don't really like auto insurance and have NEVER filed a claim. (My husband had 1.5 million miles without an accident or a ticket before someone ran into the side of his truck. The other driver got the ticket but the rules for being accident free mean he had to start counting again.) He's never filed a claim either. We must buy car insurance whether or not we need it, want it or can afford it. State Law.

A few years ago the no-fault insurance mandate sunsetted out. Common comments about car insurance were that if we lost the no-fault insurance mandate from the state we would pay more and get less. Well our insurance rates did go up this year. They are now about HALF of what we were paying under no fault. Just what the people who know markets and insurance predicted. Exactly the opposite of what the government nannyism pushers predicted.

In health care the same prophets are screaming that only the government can fix this one.

Any solution based on individual choices, personal responsibility and other means of saving and making ends meet we use in all other areas of our lives has been rejected by these experts.

There is now a desperate attempt to rename it to something more acceptable. I, and those who oppose these plans, call it socialized medicine because that is what it is. Most people with experience or knowledge of socialized services have little liking for them.

The different proposals for health care solutions we have available now don't address the central problems that limit healthcare. They just mix in government money, government management and governmental decision making and hope all will be well.
"We're from the government and we're here to help you."

First problem is that most private health insurance is tied to employment. The government offers tax incentives for employers and denys them to individuals. By creating a health care tax credit for working people/couples the government can help the working poor afford insurance, perhaps by allowing them to apply the credit to Medicaid and thereby qualify for that service which is already in operation. The non-working poor already have access to health care. Adding tax deductions for the middle class will increase the ability of people to obtain their own insurance. Let the government also offer plans for purchase if you like. That will allow the insurance companies to have cheap competition because the claims are that the government can do it cheaper.
Any plan that permits individuals to choose for themselves will succeed. Any plan that relegates all but the rich into the one size fits all world of government health care will fail and the only ones who will benefit are those who will get the government created jobs of determining what is approved and what isn't.

I'll save the other points for the next fifteen letters begging us to please save the poor sick people. I guess we're supposed to save them from being poor and sick but since we can't we'll just throw government money at them and trust the government to spend wisely.

Posted by momma y on August 7, 2007 08:53 PM

Hank,

I don't like unecessary government interference any more than the next guy -- but health inusrance providers are not going to look out for our best interests voluntarily.

Hospitals, doctors, insurance companies and HMOs are in the business of making money as efficiently as possible. Unfortunately, this is often done by discouraging needed tests and providing the cheapest and most expedient (not the best) solutions to people's ills.

I remember the "good old days" when you could get sick and actually see a doctor on the same day. Now, I have to call a "nurse advisor" who tells me if I am sick enough to make an appointment or not.

Then, in addition to sky-high premiums, most of us now pay hefty co-payments for the doctor visits and prescriptions and follow-ups. Heaven forbid if you need a second opinion, an expensive test procedure or an appointment with a specialist.

The only way to realistically increase the quality of care and address out-of-control prices is through government intervention.

Posted by Tree Hugger on August 6, 2007 12:55 PM

Get the states out of mandating coverages by insurance providers! State and Federal government mandates distort the market.

I think the "consultant" that wrote the letter might want to study economics a little more.
Catastrophic coverage only (which by law cannot be offered) would greatly reduce healthcare costs for those that want more.

The 15% that is quoted about Coloradans not being able to "afford" health I believe is erroneous. Of that 15%, how many are between jobs, between the ages of 21 and 35 (the invincibles) that wouldn't purchase it anyway.

We already have catastrophic care in our emergency rooms and we treat illegal aliens there for "sniffles".

If you think that the total overhead is high a 16%, just wait until you "mandate" healthcare coverage......the cost will sky rocket. California is about to find out...as Canada, as England, as France, as Germany as.....

How many failures does it take?

May God Bless,
Father O'Malley...

Posted by Father OMalley on August 6, 2007 08:15 AM

"If we can somehow sufficiently discipline the health care industry to become more efficient and effective..."

Wrong. The discipline starts with getting the government out of our business and more individual accountability and responsibility. Each and everyone of us needs to spend our own money as we "shop" the system in our own best interest. That's a 35% cost/price reduction for starters.

The minute you start to interfere with free markets via some form of discipline--controls--you kill the profit incentive and the stream of new life saving drugs. If you do that, then you will have to rely on the same folks who run the post office for your healthcare.

Posted by Hank on August 5, 2007 03:44 PM

So long as ER's must provide free-to-the-patient [EMTALA] medical care, they will remain a preferred provider for those not willing or able to pay for health insurance. No insurance plan, public or private, can compete with "free." Therefore, insurance revisions will not result in improved health care while EMTALA remains.

Posted by Brooks Imperial on August 5, 2007 10:12 AM