Vocal Protests at town hall meetings about health care reform
(c) William Brown
Why does it cost
Virtually every expert agrees that the root of our runaway health inflation is the fee-for-service approach. Every visit, every test, every exam, is money in the bank for each serving doctor, hospital, and test center, so there is an incentive to do more and more of them. That is how doctors get paid -- and how they get protection from lawsuits. The cheapest malpractice insurance for a physician seems to be ordering multiple tests or CAT scans.
We have volume without value. There is no direct correlation between good health and higher hospital costs, higher doctor's payments, higher drug prices, and higher administrative costs.
The crisis is real. When we contemplate the pitiable scenes in
We must learn from our history, specifically from the birth pains of
What does history teach us? Califano answers: "The only sure way to bend the curve and curb the rate of increase in healthcare costs is to keep people out of the sick care system, to put as much profit in prevention as there is in acute care, and to put financial gain and pain into how individuals take (or don't take) care of themselves."
The Obama healthcare program has failed the American public on this critical standard. The independent Congressional Budget Office recently released a bombshell evaluation of the reform bills pending: They'd increase the federal deficit by at least
Obama envisages financing his revolution in part by cutting
It is a fatal flaw of the pending bills that they fail to control costs. They also shore up an anachronistic employer-based system that fails to give the mobility required when the average person has changed jobs 11 times by age 40.
The CBO could not have been clearer when its head,
You wouldn't know this by listening to President Obama. His reform, he says, will insure the uninsured, control runaway health spending, subdue further budget deficits, preserve choice, and improve the quality of care. As
Even the president's objective is off the mark. He says any bill should be revenue neutral. But "neutral" won't do it. We have to radically reduce costs that are bankrupting us and pricing more and more people out of care. Revenue neutrality leads us down the same path to insolvency that Obama himself has said is the problem and is unsustainable -- unless, of course, you compensate for the increased costs by raising taxes. But those very revenues must be kept available if we ever are to close the looming structural budget deficit that is such a threat to the long-range health of the economy and has created so much anxiety in the American public. And, by the way, the deficits are even larger on an ongoing basis because
This may sound pessimistic, but it's a pessimism that is widely shared among experts, including former Secretary of Health and Human Services
Obama has also failed to address the insane costs and arbitrary awards of the epidemic of malpractice suits. The Democrats' lust for large donations from the trial lawyers does not justify its consequence. Doctors order tests and procedures for no reason other than to defend themselves from lawsuits. Defensive medicine wastes billions of dollars without benefit to the patient, raising the cost of healthcare by as much as 18 percent. Nor has the president kept the healthcare negotiations an open process. It was recently revealed that the administration cut a backroom deal under which the drug companies will ante up a maximum of
We simply must take a different approach. We want detailed, specific proposals for cost-effectiveness. Why is it that 74 regions give high-quality care at lower cost? What mix of penalties and incentives can be built into the system to make the high-cost regions reform themselves? The costs in
The public cannot go on underwriting whatever therapeutic projects are chosen by patients and revenue-minded physicians, irrespective of whether they yield a proven benefit.
And a dose more imagination, please!
Califano recommends requiring insurers to pay for preventive services like regular physical exams and vaccinations for flu and pneumonia, as
We cannot give everything to everybody so that every choice and every procedure will be available in a fee-for-service delivery model. We must increase consumer sensitivity to costs instead of implying to most Americans that they are getting a better healthcare system for free and then making one small group pay for improvements. We must migrate from the fee-for-service reimbursement model and try models with pay-for-performance adjustments and audits to review their effectiveness and prevent undertreatment. We must aim to have patients copay for expensive elective diagnostic tests and optional surgery, with means testing so that poorer patients will not be disadvantaged.
So here it is: The Obama administration's rush into expanding coverage verges on the reckless. We must first change the structure of healthcare and then look to expanding coverage. The American public has come to realize that having too much debt in the form of mortgages or credit cards has consequences; and a majority now feels they would rather not enter a healthcare reform program if it is going to expand the national debt. A recent Rasmussen poll has 53 percent opposing Obama's reforms (44 percent strongly) and just 42 percent supporting them (26 percent strongly).
The priorities have to be reversed. Cost containment should come first.
The number of Americans without health insurance the Obama administration and Democrats have used for more than a year now ranges between 40 million and 46 million -- at the upper end, that would be somewhere between 1 in 6 and 1 in 7 Americans. So, how many Americans are truly uninsured?
Health Reform Fattens Big Insurance and Taxes the Young
Insurers agreed months ago to clean up at least some of their hated practices, such as denying insurance for prior illnesses and canceling coverage when someone gets sick. In return, they stand to get some colossal plums: a mandate not only that every American buy health insurance but that the mandated insurance be "comprehensive," another word for expensive.
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Healthcare - Why Obama's Failing Big on Healthcare Reform
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