Tag: health care

State

A Novel Approach

Warning: Undefined array key "adf" in /home4/hpvcxhmy/public_html/wp-content/plugins/similarity/similarity.php on line 69

Warning: Undefined array key "sim_pages" in /home4/hpvcxhmy/public_html/wp-content/plugins/similarity/similarity.php on line 70

As the clock starts in our efforts to reform out Utah health care system I was encouraged by this Op-Ed in the Salt Lake Tribune.

Making health insurance affordable – forcing carriers to offer so-called “affordable plans” – will not result in affordable health care. . . . our priority must be to restore the health-care provider/patient relationship by providing the patient with cost and performance information and making him responsible for his own care. The government does not tell its citizens what house, car or flat screen to buy, but there is an assumption that when it comes to choosing a health-care service, we are incapable of intelligent decision-making and need intermediaries.

Only when the patient is armed with relevant information regarding cost and a providers performance will that patient be able to make informed decisions. Armed with such information, a patient will shop quality and price, which will drive down costs. (emphasis added)

What I really love about this is that it comes from a completely unexpected source – this article was written by the executive director of the Utah Association of Health Underwriters. Along with her valuable diagnosis, Ms. Smith also offers this idea as a possible approach to explore:

For example, an insurance company might give the patient a benefit credit equivalent to the average price of a knee replacement surgery and the patient would shop around with the information given. Based on this data, he might choose a surgeon with a long record of solid outcomes and a lower price than the benefit credit his insurance has given him.

The insurance company could allow him to keep the change in his Health Savings Account for future health-care needs. This practice is already happening on a small scale in several areas where a hospital lists a global price for a heart bypass and gives a 90-day warranty. No extra charges for pain medication, Band Aids or physical therapy – all are included.

This does not require a mandate for our citizens, and might serve as an incentive to bring some people into the insurance pool. It also allows for comprehensive health insurance plans that keep the patient as the one making decisions about how the insurance money gets spent.

As if that was not enough, Cameron drew my attention to an Editorial in the Deseret News written by a doctor talking about how he improved his practice by dropping insurance plans. Though the article is not explicit on the point, it sounds like he eventually dropped all insurance plans and now only deals directly with patients.

{Many physicians} feel that it’s their mission to serve as many patients as possible rather than to provide the best care possible. Most significant, today’s doctors are preoccupied with the bureaucracy of insurance companies. . .

To be sure, physicians are not entirely to blame. With insurance companies dictating how much doctors can charge for services as diverse as a routine checkup or an appendectomy, a doctor has only one route to more income: increase volume.

Does anyone else want to help ensure that these perspectives do not go unnoticed by our illustrious task force?

Tags connections, economics, health care

State

Repeat After Me

If there was one thing that I would like to accomplish related to the health care issue it would be to highlight the fact that having health insurance does not equal having decent, or even basic, health care. The Deseret News perpetuates the falsehood of equating the two:

The task force will begin the design phase of rebuilding a health care system that will ultimately ensure all Utahns have access to basic health care — nearly 300,000 Utahns don’t have insurance now.

Not having insurance is not the same as not having access to basic health care. The dangers of buying into this false association are illustrated later in these words:

Top on the list of priorities is getting everyone into the insurance pool, i.e., the chronically healthy to the chronically ill.

Is there anyone who has not heard the adage “if it ain’t broke, don’t fix it?” Forcing the chronically healthy to get into the insurance pool is a case of fixing what “ain’t broke.”

Tags health care, myths

State

Myth Perpetuation

Just as our Task Force is getting started, NPR has a story on John McCain’s perspective on the issue. They outline his preferred approach – which seems generally right, and then they perpetuate one of the myths that might sink any meaningful reform.

“The problem is not that most Americans lack adequate health insurance — the vast majority of Americans have private insurance, and our government spends billions each year to provide even more,” McCain has said. “The biggest problem with the American health care system is that it costs too much.”

McCain wants to get people to buy their own insurance, rather than get it through their jobs. NPR’s Julie Rovner reports that McCain would accomplish this in a variety of ways: giving people tax credits, encouraging more people to set up tax-advantaged health savings accounts, and letting them buy insurance policies across state lines.

And no mandates for McCain. If you don’t want health insurance, you don’t have to get it.

What do you think of this plan? Would tax breaks encourage you to buy your own insurance? Is a mandate to have health care a good or bad idea? (emphasis added)

A mandate that everyone be insured is not a mandate that they have good health care (it would be impossible to mandate that everyone have good health care). Health Insurance ≠ Health Care. So long as we confuse the two the insurance industry will sway the debate in their own favor. Giving everyone insurance, no matter what method you use, will not guarantee that they have good health care.

As our Utah task force held their first meeting (which I could not attend) I was worried that they would not actively try to include consumers among their stakeholders, leaving the influence to industry professionals and lobbyists. I was very encouraged as I listened to the audio of the meeting when Senator Killpack listed consumers among the five major stakeholders for the task they are tackling.

Tags health care, myths, NPR

State

House Members on the Task Force

Post author By David
Post date April 12, 2008
No Comments on House Members on the Task Force

I wrote to the co-chairs of the HB133 Task Force asking for a full list of the task force members. David Clark responded with a list of all the task force members from the House. My current list of task force members is now:

David Clark
Roger Barrus
Brad Daw
Merlynn Newbold
Patrick Painter
Jackie Biskupski
David Litvack
Sheldon Killpack
Merlynn Newbold
Plus non-voting members Wayne Niederhauser and James Dunnigan

Now if Senator Killback would respond with the last two senators I would have a full list.

Tags health care, Utah

State

Health Care Task Force

I’m ready to start focusing on the issue of health care for Utah citizens. The legislature created a task force to study it. The Deseret News addressed the issue in an editorial today. I would like to know who is on the task force. So far I know the following:

David Clark
Sheldon Killpack
Merlynn Newbold
Plus non-voting “special masters” Wayne Niederhauser and James Dunnigan

All of those listed above are Republicans. According to the bill, at least one senator and two representatives on the committee must be Democrats (unless we have any independent or 3rd party elected officials that I don’t know of).

Citizens are already likely to be shortchanged by the task force when, as Bob Huefner notes from reviewing the bill, “The burden is being put on the patients and the enrollees and the insurance protection is being given to the industry.” That does not bode well. I will be looking at the bill myself and see what else I can glean from it’s text in the next few days.

Tags health care

General

Defining “Rights”

I liked this very succinct argument about why health care is not a right.

With one exception, the right to representation in court and a trial by jury, {the rights safeguarded in our Constitution} require nothing of any other citizen but that they recognize your rights and not interfere with them.

Your “right to health care” would require some other person to give up a portion of their life or their property to either treat you or to provide you with drugs or medical implements. The Constitution does not provide for another individual to be indentured to you in this manner.

Therefore, you have no “right” to health care.

What I really like is that this argument provides a plausible framework for distinguishing between fundamental rights and the manufactured “rights” that make for such good campaign promises. Does anyone else have any perspective on this argument (in general or specific to health care)?

Tags Constitution, health care, rights

State

Rigging Universal Health Coverage

Post author By David
Post date April 2, 2008
5 Comments on Rigging Universal Health Coverage

Devising a system of universal health coverage in Utah is a high priority for our governor (I’d say it’s second to expanding our state economy). As usual, Scott is pointing out the glaring flaws in the approach the governor is taking.

I find it more than a little disconcerting that a task force made up of people who make their money on health care are being put in charge of coming up with ideas. It should not be surprising that such a group would encourage a mandate on individuals. If we should have a mandate at all, shouldn’t it be a mandate on those who make their money on health care, perhaps a mandate that insurance companies must offer a broad array of plans, or that health care providers publish their prices (these are very preliminary ideas, just suggesting that a mandate on individuals is misguided).

I also think that the task force should include some people who are not already insured – at the very least they should spend a lot of time talking to people (insured and uninsured) to find out what kind of plans would attract more people to purchase insurance. That should be the basis of any policy decisions and, if necessary, mandates for the insurance companies.

In my experience, one of the reasons that doctors and clinics don’t want to publish their prices, is that they charge different prices depending on your insurance. They accept that when they want to charge someone $100 for a visit the insurance company will return the bill saying that they will only allow them to charge $88 for that visit and that they will pay $73 of that (leaving a $15 copay).

It seems to me that the pricing system is upside-down. Doctors should publish their prices and insurance companies that will accept that doctor will agree to pay that published price (of course allowing for the copay structure). Doctors who charge higher prices would not be accepted by as many insurance companies and insurance companies who would not pay enough to cover the costs to doctors would not be able to offer access to as many doctors. People without insurance would also be able to make informed choices on the services they use. If my experience is any guide, the option of health savings accounts combined with a high deductible policy (sometimes called catastrophic coverage) would look much more desirable to more people.

Tags health care

National

Anti Universal Coverage

This came along before I started reading the Cato blog regularly but I am definitely a member of The Anti-Universal Coverage Club.

Health policy should focus on making health care of ever-increasing quality available to an ever-increasing number of people.
“Universal coverage” could be achieved only by forcing everyone to buy health insurance or by having government provide health insurance to all, neither of which is desirable.
In a free society, people should have the right to refuse health insurance.
If governments must subsidize those who cannot afford medical care, they should be free to experiment with different types of subsidies (cash, vouchers, insurance, public clinics & hospitals, uncompensated care payments, etc.) and tax exemptions, rather than be forced by a policy of “universal coverage” to subsidize people via “insurance.”

That does not mean that I am opposed to everyone having access to health care, but a mandate that every person buy insurance or that the government will pay for insurance (by taxing “the rich” naturally) is contrary to the principles of individual liberty and personal responsibility.

Tags health care, responsibility

National State

Buyers of Medical Services

Post author By David
Post date February 23, 2008
9 Comments on Buyers of Medical Services

Reach Upward nails it again when he talks about Serving Medical Customers.

One of the primary rules of economics is that suppliers do their best to supply what buyers actually demand. Who are the real buyers of medical services? Not you. Unless you pay for everything yourself or have only catastrophic insurance, you are not the buyer. . . The real buyers — the real power entities in purchasing medical services —are the government (via Medicare) and insurance companies.

Since suppliers provide what buyers demand, let’s ask ourselves what the real buyers of medical services demand. Do they demand the best possible medical outcome for each patient? Nope. It’s not possible for them to do that. So they design systems that aspire to that lofty goal. These systems seek to demand proof that proper procedures are being followed and tightly control what procedures will be covered.

Of course, to administer these systems, the government and insurers spawn massive bureaucracies of paper pushers. Medical practitioners actually serve their buyers quite well, supplying the desired paperwork. They report procedures that will bring payment. . .

Electronic Health Records (EHRs) have been touted as a way to improve the medical system. But it turns out that EHRs do not improve actual medical outcomes. This is because they are only a more efficient way of pushing paper around through the bureaucracy.

Every time I read anything about our health care system I come to the same conclusion – the best kind of insurance we could have would be catastrophic insurance that has incentives built in to reward consumers who avail themselves of preventive care. With the current push in Utah to provide universal coverage we cannot emphasize this issue too much. If we want to make the system better we must attack at the actual systemic problems (the shifting of the buyer role from individuals to corporations and government entities) rather than simply trying to massage the current system to assuage some acute and visible symptoms of systemic problems (the cost of health care and insurance).

Tags economics, health care

culture

Conspiracy of Confusion

Diet is about as far from my normal topics as I can imagine. Part of the reason for this is that I generally follow the world’s simplest diet:

“Eat food. Not too much. Mostly plants.” (Michael Pollan January 28, 2007)

I have followed that basic idea for years without knowing anything about Michael Pollan or what he had written. Today I stumbled upon An Omnivore Defends Real Food and could not help but make some connections between the confusion surrounding nutrition (as opposed to the apparent simplicity of the dietary plan above) and the confusion surrounding so many other social, economic, and political issues.

I would not make the argument that everything could be simplified as much as that maxim on diet (or even that everything should be so simple in a perfect world) but the thing that struck me, and the very purpose of my advocacy for liberty, is that we need to be free to our own level of complexity or simplicity in most things. With diet I can choose to ignore all the advertising about the latest health fad, or I can choose to test or follow any given news about the dangers of whole milk or the virtue of Omega3 fatty-acids. On the other hand I am not free to opt out of social security and many politicians are talking about making it illegal for me to choose not to have health insurance.

The argument is that if I don’t get health insurance and something happens to me then I become a financial burden to society as I use government funded health care. The same argument is applied to whether I am allowed to pay in to unemployment taxes – what if I lose my job. The real problem is that government has created a system whereby people can freeload on the system so it does not matter how much someone protests that they won’t. Personal responsibility is a thing of the past because Uncle Sam can/will bail you out. Personal liberty is also reduced because everyone is required to participate (at least on the paying in portion – you can opt out on the receiving benefits side of most programs).

I can’t think of any of the entitlement programs that the government runs that would be a bad thing if they were based on voluntary participation. The universal problems they share are their coercive nature and the complexity that makes themboth inefficient and exploitable.

Tags diet, government, health care, New York Times