Fixing the Health Care System

This post was originally written on 3/29/2012

I'm getting really tired of listening to all the ignorant people bitching and complaining about Obamacare.  And by that I mean the ignorant people on both sides- the forget about everyone else, live your life for yourself, pay your own damn way Republicans as well as the bleeding heart, puppies and sunshine, everything should be free for everybody except rich folks Democrats.  All of them are addicted to bitching and complaining, and not a damn one of them has offered up a better idea, so I'm just going to do it my damn self.

     As I see it, we've got some serious issues going on with our health care system.  Living in one of the most technologically advanced societies in the damn world, and the best thing our politicians can come up with to do is argue about freaking birth control.  Ridiculous.  Here's a little newsflash, you want to know what the problem is with our health care system?  It's called the damn Health Care Industry.  That's right- Industry, as in big business that is really freaking expensive, and everybody who decides that they are going to grow up and get involved in it thinks that it is supposed to be their ticket to an expensive country club membership.  Bullpuckey.

     Anyone who has read my stuff before already knows that I think the idea of health insurance is crap.  The rise of health insurance as we know it today pretty much directly corresponds the rise of modern medicine, and the ability of doctors to do more than just lance boils and set broken bones.  Health insurance companies are nothing but legalized gambling, with a bunch of people laying their bets on there being a huge profit to be made off of people who want to protect themselves from the devastation of getting sick.

     Once the health insurance industry stuck it's big ol nose into the mix, that's when bills started to go through the roof.  Before that, doctors had to actually consider what their patients could afford to pay when setting their prices for medical services.  Hand someone a bill for 1/4 of their annual income just for telling them that you don't know what is wrong with them, you can be damn sure they won't be coming back.  When that bill goes to their insurance company, well, they'll give you a thanks anyways doc, at least you tried.

     Once the amount of profit to be made off of medicine was realized, the cost of becoming a medical professional went through the damn roof too.  No wonder doctors and nurses want to get paid the big bucks, they'd like to be able to eat something better than Ramen some time before they reach retirement age.  Not too many people with a brain in their heads are going to be willing to take on a debt load for their education that exceeds five years or so worth of their earnings once they are actually qualified to do their jobs.  That would be like someone paying $18,000 a year to get a bachelor's degree that would qualify them to run the fryers at McDonald's.  Then they have to buy malpractice insurance so that the insurance industry can gamble and profit a little bit more.

     To add to all this profiteering, we've got the companies that make medical devices and prescription drugs all wanting a piece of the pie.  Without the stuff that they make, doctors can't really do any more today than they could 60 years ago, which was make guesses as to what was wrong with you, and then cut out the problem if it was in an easily accessible spot.  We're taking it up the rear in the costs associated with all of the equipment and meds that our doctors use to diagnose and treat our illnesses.

     So who should have access to all of this amazing new technology and information that our health care system has to offer, and who should be paying how much for it?  It's not like this is some fancy new doodad like a boat or a computer.  Those things are always marketed to the elite first before a cheaper knockoff version comes on the market for the middle class- poor people just have to deal with the fact that they aren't fancy boat or computer type people.  We're talking about saving and prolonging lives here, isn't life one of those inalienable rights?

     When it comes to health care, you have your different types of health care.  You have your preventative and wellness care, you have your maintenance care, you have your basic patch it up and move on care, you have your whoa something is seriously wrong here care, and you have your end of life care.  I think that the problem we have is we're trying to address all of these different types of care for all the different people with one plan for paying for it.  Since people can generally be counted upon to be stupidly optimistic whenever money and bad things are involved, nobody wants to think that they need to support a health care system that takes care of all these issues, pays off the bills for training medical professionals, provides new tools and medicines for diagnosing and treating all the illnesses people can have, and makes a tidy profit for everyone involved.  Frankly, there is some merit to that argument.  Instead of everybody kicking in to throw money at all the different problems, we should instead try FIXING all the different problems, then sorting out what everybody should be paying under a better system.

TRAINING COSTS
     First things first, we need to address the issue of how much training for the medical field costs.  I'm pretty sure that we already have a military service option to receive medical training.  That's a good deal there.  Agree to serve in the military, live through it, and get trained to be a doctor, nurse, surgeon, whatever.  Keep that up.  But there needs to be a way for civilian medical providers to work off their debt as well, and this is the perfect opportunity for a useful Government program.  Perhaps even a for profit government program, cause our government needs it's own damn paying job so that they can stop always asking us for cash to go to the movies with.

     Every single county in the US should get a hospital that is large enough to meet the basic needs of that counties residents.  The cost of building and maintaining that hospital should come from tax money raised- 70% from the county, 20% from the state, and 10% from Federal.  These hospitals should be equipped to treat all of the day to day illnesses and injuries that people are commonly faced with.  Broken bones, concussions, heart attack, stroke, dog bites, delivering babies, etc. etc.  Not the really fancy give people a new heart stuff, but the standard stuff that most doctors can expect to see routinely throughout their careers.  Every doctor, nurse, surgeon, etc coming out of their residency program should be given the option to go and work in one of these county hospitals for a living wage, say $40,000 a year for doctors, $20,000 a year for nurses, something like that.  Basically work and live cheap for a few years after school and they can consider their medical or nursing school debt paid.  US Federal Government picks up that tab.  If they can afford to pay their own debt and they would prefer to go straight into private practice or work for a private hospital, then let em.  If they can't hack it and quit, then they're on the hook for their debt again, and they can pay it off on their own.  Common man gets some affordable medical care, doctors and nurses aren't paying off student loans for decades.  These county hospitals can still charge reasonable rates for their services, but the profit that is made goes towards paying off the debt of the staff.  These people are going to become your basic care providers- your general practitioners, your OB GYN's, your orthopedists, all the doctors that most people see during their lifetimes.  Once they've been working in these county hospitals, hopefully they'll get to like it in the towns around them, and that's where they'll open up their private practices and clinics if that is the route they choose to go when they are debt free.

     Make sure that you keep some incentives for some doctors to stay on staff at these county hospitals after they've worked off their debt by letting the best and brightest compete for permanent positions running the different departments and training the new doctors for a wage that is comparable to what they could get in the private sector.  Your fancy specialists will of course choose to go straight into private practice, cause that's where the money is at, and they are the risk takers.  Private hospitals are still going to exist, cause people who are willing to pay more for the same damn thing are always going to be out there thinking that a fancy label makes something better.  They should also get to corner the market on the hot shot cures and cutting edge medical procedures.  Take the bigger risk, get the glory when it pays off. 

MALPRACTICE INSURANCE
     So we've got the medical training costs addressed.  Now let's deal with malpractice.  Stop letting lawyers take malpractice suits on spec and keep 1/3 of the winnings if they manage to convince a jury of 12 average citizens to feel sorry for the victim.  Yes, doctors need to be held accountable for their mistakes, especially when they do something stupid like cut off the wrong leg or operate drunk.  Handing someone a boatload of freaking cash because they managed to look really pitiful in court is ridiculous though.  For one thing, judgements need to be capped at $750,000 per case, cause that is the most that any person can expect to earn working a minimum wage job for the 47 years between ages 18 and 65.  Seems like a reasonable assumption that the best anyone can be sure they or their loved one would have managed is that.  It's not going to bring back a dead relative, or pay for lifetime care of someone who is rendered helpless, but it is an amount that is going to the person getting it to keep their bills paid while they figure out a plan B.  Every medical procedure includes risk, and patients need to not be treating a bad outcome like a lottery win.  Every single malpractice suit should be peer reviewed (by peers who share their specialty but don't actually know them), and the cases decided by a judge who is given the opportunity to read the peer review panel's findings.  Any doctor found guilty of medical malpractice automatically loses their license and has to go find a new line of work too.  This should bring down the malpractice insurance rates.

MEDICAL EQUIPMENT
     We've got a whole lot of fancy medical equipment now that we didn't have back in our grandparents day.  Everything from cool little thermometers that you can just run over someone's forehead to CAT scans and MRI machines.  The cost of making them is fairly high, but the cost of hospitals and doctors offices to buy them is even higher, and the cost that patients get charged when they are used is insane.  Whether all of them really do a better job of accomplishing the task they are used for is anybody's guess.  My doctor never asked me whether I was willing to shell out more for a digital scale and high tech thermometer or not, but I'm definitely paying more now that he's got them.  One thing that strikes me about the equipment thing is the huge disparity in pricing.  Take the MRI machine for example.  A few years ago our family ended up needing two MRI scans.  One on my husband's knee, and another on my daughter's head.  Hubby went to an MRI center here in town, total cost to insurance plus co pay was about $600.  Daughter had to go to a children's hospital in another town to be given happy drugs and knocked out for hers, total cost to insurance (luckily she's double insured so no copays) was over $10,000.  What the ****?  I understand that daughter's bill included charges from every single person that laid eyes on her the entire 2 hours that we were at the hospital, and we also had the happy drugs on that bill, but come on!  There cannot be that much difference between firing up the ol MRI machine to take some pictures of hubby's knee and firing it up to take some pictures of kiddo's melon.  As it turns out, hubby's pictures actually identified the problem with his knee, while kiddo's just told us that "It's not a tumor"  Yeah.  So what you're telling me is that my insurance company just spent an assload of money to not find out what is causing my five year old to have migraines that leave her screaming and vomiting on the bathroom floor.  Thanks.

     Maybe, just maybe, the reason for the price difference is because the MRI center only does MRIs!  Perhaps not having to subsidize all the other things that the hospital does (not to mention the 12 different people who each sent a bill for the kid's visit) keeps the damn cost down because knowing that someone might not choose their MRI service keeps the costs a little more realistic.  I know I sure felt a lot better when I didn't see any luxury vehicles in the parking lot at the MRI center as we were pulling out.  It was nice being able to just pull out my debit card and be done with dealing with the paperwork on that one too.

    How about getting some realistic numbers on what all the equipment costs?  How about not paying $3 for a bandaid when you're at the hospital.  I have bandaids at home.  I'll bring my own, thanks.  If a machine costs a hospital $1 million dollars, plus $50,000 worth of maintenance to keep it running for it's ten year life span- and in that 10 years it's going to be used to take pictures of the insides of say, 10,000 people, what about charging each of those people $500 for their picture.  Still gives the hospital a healthy profit of $385 per patient to put towards the purchase of a new machine, and it's not going to break the bank for parents whose kid took a hit to the head on the football field.  Also, the cost of having the test results read should be included in the price.  Why would someone bother having a test if they didn't want the results?  That's like ordering a burger at McDonald's and then having them ring you up separately when they find out you'd like them to cook it and put it on a bun.

PRESCRIPTION DRUGS
     The drugs, man, the drugs.  Talk about a big time money sucker there.  I already mentioned in my manifesto that there really isn't a way to avoid having the Government involved in subsidizing the drugs.  Like I suggested though, the Government should be getting some stock for those subsidies so that we get something back from the Viagra's and stuff like that.  Here's an even better idea.  How about making the drug companies reimburse the Government for the subsidies that they got when the drug that results isn't a big time health fixer?  Something like "Hmm, all this one does is make a pee pee stand up and salute, which is fun, but not advancing the cause of immortality or curing cancer.  We're gonna use part of our profits to pay back that loan we took out from the government to research this one." or "Wow, this one cures cancer in some people!  That was a worthy investment that the government made, so we're gonna let them buy some of it at a discount to give to poor people with cancer!"

     Drugs that actually keep people alive should be affordable to the people that need them.  How about capping the price that can be charged on those drugs at 5% of the poverty level or something, then let the rest of them go (your viagra, acne cream, allergy pills, stuff like that) for whatever the market will bear?  If NOT taking a pill means that you are going to fall over and die, I think that access to that drug at a price someone could actually afford to pay off eventually is pretty important and falls under the common interest thing.  Either offer prescription insurance to everybody that is going to charge you a flat rate copay for whatever the prescription is that you need, one price for brand name one price for generic) or let it be a free for all with the drug companies having to find a price point that people are willing to pay for the drugs they don't really have to have.

HEALTH INSURANCE VS PAY AS YOU GO
     Now we're down to the biggie- health insurance.  The health insurance industry really hasn't been around that long in terms of history.  It was offered to the wealthy as far back as the late 1800's, but your average person never dreamed of paying for something on the off chance that they MIGHT need it until much later.  The first medical policies available to your average Joe were policies that were purchased by people to replace their lost wages if they were sick and unable to work, kind of like today's disability coverage.  It wasn't until the idea of actual hospitals came along (with the high costs of building, staffing, and maintaining them) that people started looking for ways to manage the medical bills, and health insurance was born.

     Blue Cross Blue Shield was the first big insurance provider on the scene, and offered a variety of plans to cover the different expenses that people were feeling the pinch from- everything from hospital stays to physicians charges.  They got a big break from the government from the very start because they were deemed to be in the best interest of society.  What a very liberal idea...

     Problem is, people stopped viewing insurance as being a plan against disaster and started viewing it as something that is supposed to take care of all a person's medical needs a long time ago.  Now people expect their insurance to cover every medical expense that they have while they are paying for insurance, instead of paying into that fund so that we're covered for expenses that we absolutely can't handle ourselves.  This is a problem, and it's the problem that needs fixed if we're going to bring costs down.  Especially since people are more likely to USE their health insurance when they don't really need to just because they HAVE health insurance.  For things like the common cold.  Which doctors are charging out the wazoo for because people will actually pay their copays on stuff like that, because they like being able to go to the doctor for stuff like that.  They don't like having to go when something is really wrong, and those bills they just kind of throw their hands up about and say "Woe is me, I can't afford these unexpected medical costs!"

     So we need to get away from this system of having one health insurance plan that covers everything from the common cold and immunizations to cancer and heart transplants.  Here's my plan:

THE PLAN
     First you have to get people away from using health insurance for preventative and wellness care.  The stuff like annual physicals and screenings and immunizations and stuff.  Once doctors know that they aren't going to be able to send in bills to the insurance companies for people who aren't even sick, their pricing for these services is going to go down so that they can draw people in who are willing to pay for this type of preventative maintenance.  Patients are also going to ask more questions of their doctors about whether their personal risk really justifies the expense of the different tests that their doctor is suggesting they have.  This is your oil change type medicine.  When you buy a car, you know that you're going to have to get the oil changed every so often.  And unless you're buying a fancy expensive car where the dealership throws in oil changes while you sip coffee and eat donuts for free, you know you're going to keep paying for those oil changes regularly as long as you own your car.  Immunizations need to continue to be mandatory in the interest of the common good, but schools should start working with health departments to offer them at cost to parents of school aged children.  If our government is going to mandate that everyone do something for the good of all, then they should be using their clout to make it equally available to all without some jackass profiting off of some of us for it.

     Next you have your maintenance care.  This is the stuff like chronic conditions, recurring problems that require long term medication, and stuff like that.  This would be your diabetics, your high blood pressure sufferers, anyone who needs to see their doctor on a regular basis to monitor an existing condition.  These folks still don't need health insurance, but they do need to be able to negotiate some kind of a package deal with their doctors to maintain their level of health with regular visits, tests, meds, etc.  Here we need some regulation.  Something like "Thou shalt not charge people more than 10% of the federal poverty line to get in to see their doctor to have their high blood pressure controlled"  This covers your birth control type stuff too.  Decide, based on your doctor's recommendation, what kind of recurring care you're gonna need, then set up a payment plan that spreads the cost of that care out over the year.  Then you pay for it.  There's a credit program called Care Credit that is available in Dentist's offices that would be good for something like this.  Someone who can afford to pay more and wants to negotiate with their doctor for more visits or whatever can do so.

     What a lot of people need is patch it up and move on care.  This is stuff like Johnny fell off the swing and broke his arm, or Jane got food poisoning and thought she was dying so she went to the ER care.  The government requires all people to be treated in the ER regardless of their ability to pay, which is great, but that doesn't mean that no one should pay for an ER visit.  These types of medical care should be available and affordable for people to pay off in a reasonable amount of time.  Again with the Care Credit thing.  Come into the ER, get treated, then either pay your bill or take out a loan for that bill.  Pay it off over time.  Or you can pay for an insurance plan that will cover those costs if you ever need to use those services.  The cost of that type of plan should be pretty reasonable since almost everyone faces the same amount of risk that they are going to need a patch up job at some point or another.  The other type of thing that should be covered by this type of coverage is maternity coverage.  Unless you are paying for birth control or missing out on the joys of sex during your childbearing years, chances are you're gonna pop out a baby or two.  pay a little bit into a group plan designed for maternity coverage while that type of coverage might apply to you, and then you're covered if you need it (men who are enjoying the nookie while firing live rounds should have to split the cost of this coverage too).  Prefer to see a specialist? Knock yourself out, but pay for it yourself, in advance if that is what the specialist prefers.

     The area where we all need to be paying for health insurance and sharing the burden is in the area of catastrophic illness or injury care.  This is the really expensive care that only gets used by some people, but that costs an insane amount of money if you need it.  This is where the Medicare money should be going for those of us who are under age 55 should start going.  Everybody pays a small percentage of their income, say 3%, towards a plan that is designed to pick up the costs of treating stuff like cancer, heart attack, stroke, ebola virus- the stuff that's gonna kill you dead if you don't fix what ails ya.  Every person in the US knows of at least one other person that has had their life threatened by one of these devastating illnesses, and we all need to be helping other folks try to survive them because we'd want the same thing for ourselves if it were us.  So we have an insurance plan that is paid for by every single person to pick up those costs that no average family could possibly pay off in their lifetime, and we hope we never have to use it ourselves.  We still have the charity organizations that raise money for research in hopes of finding a cure, or to help families be with their loved ones who are battling these illnesses without losing the house, but we don't let anyone have to worry about the bills while they are also worrying about whether the treatment is going to work or not.

     Finally comes the end of life care.  Eventually we're all going to have to face the fact that we're going to die, or that we can't take care of ourselves for the time that we have left.  This is something that everyone should have to be putting money back for throughout their lives.  If you want to do that by purchasing an insurance plan, then go ahead.  If you want to bank the cash, then you should be able to do so in a tax free account that can't be touched until your physician signs off and says you're in the home stretch.  But everyone should have to do it, and show that they have contributed a reasonable amount of their income towards it when they file their taxes each year.  Say 3% of your income.  That means that if you start at age 18, then by the time you reach that last 2-3 years that can be considered "end of life" you'll have banked 225% of your first year's wages at least to pay for whatever care you'll need.  Hopefully that is enough, cause anything over and above your savings the taxpayers are going to pick up the tab for.  If you die suddenly and don't need it, then your heirs can split it, or you can arrange for it to be donated to the fund used to care for others who outlive their end of life care savings.  Any year that you don't show proof that you're planning ahead, you get hit with a penalty that equals the amount you should have set aside, and that money goes into the end of life care fund.

     Life is a risk for everybody, and we all have to get back into the mindset of bearing the cost for our own risks when it comes to health care.  After all, we're the ones who reap the rewards when that risk pays off.  But life is also a right, and each person has the right of access to the same health care that is available to everyone else when trying to stay alive.  Health care is not something that can just be reserved for those wealthy enough to pay for the best it has to offer.  It isn't a boat or a private plane.  This is life that we are talking about.  It's fine to say that you've got to save up for a boob job or chin implants, but you can't just tell someone that there is a way to keep them or their loved one alive or ease the pain that they are suffering, but unfortunately it isn't available for people in their income bracket yet.  We can fix them- we have the technology.  Now let's stop arguing about whether a woman's place is in the kitchen or not and get busy figuring out how to pay for it.