Monday, Nov. 02, 2009

Health care woes fixable

We would like to weigh in on the partisan bickering and disinformation being widely disseminated, as a national health care bill winds its way through Congress.

1. We have a Health Insurance Crisis, not a Health Care Crisis. If you enter a hospital door, you will receive the best medical care in the world. But we tolerate one of the worst health insurance systems in the world. Its most egregious deficiencies include caps on maximum lifetime coverage, exclusions for pre-existing conditions, loss of coverage if you lose your job, nontransportability across state lines, denial of coverage and rising premiums based on age.

2. Health Care Rationing: We spend more money on the first and last year of life than on the remainder of a person's life. We all accept the fact that certain care should not be covered - discretionary cosmetic plastic surgery is an example. But often doctors are told to "do everything possible for Grandma," who may be in a vegetative state, as long as someone else is paying for it. Expecting unlimited and unrestricted care for everyone is unrealistic and a sure way to bankrupt the country. Placing reasonable limits on end of life care has been demonized as rationing, but it is absolutely necessary. Although the truth is repugnant, death is inevitable; we do not live forever. If coverage is denied, we can still pay for the care ourselves, if we consider it essential

3. Mandatory Insurance for Everyone: Cost Shifting by hospitals is now well-recognized. Each time a patient enters the hospital without insurance, the cost of care is borne by paying patients who may be charged more than twice their actual costs to cover the uninsured. Physicians who render this care are usually uncompensated, and are forced to accept this as part of the "cost of doing business."

Young healthy adults often dismiss insurance as an expensive luxury unlikely to be needed; they mistakenly think they can wait until illness strikes to obtain coverage. By requiring insurance for everyone, costs are more equitably distributed to everyone.

4. Patient Accountability and Responsibility through Deductibles and Co-pays: If there is absolutely no expense to the patient, there is the risk of abusing the health care system. By requiring the patient to pay a portion of the bill for each encounter, fiscal responsibility is encouraged in each health care encounter and costs are reduced for everyone.

5. Government Insurance Option: People act like this is a new concept. Government-run Medicare is the largest health insurance provider in the country. We wonder how many over-65 Americans, who rail against a Government Public Option, would be willing to burn their Medicare cards.

Over the last half century, the health insurance system has deteriorated under the control of the private sector. A work force of insurance employees have insinuated themselves between the patient and the doctor, denying claims or demanding justification for countless procedures. Doctors' offices and hospital administrators in turn have hired cadres of their own full-time employees, just to handle the absurd demands of the health insurance industry.

The recent change of heart by the health insurance industry is telling. After 50 years of mismanagement, it is time for the government to offer a public option to compete with the private sector.

6.Means Testing. When Bill Gates turns 65, he should pay more for his Medicare insurance than the patient who lives below the poverty line. Our government assumes that all over the age of 65 are impoverished and deserve assistance. In truth, 75 percent of our nation's wealth is in the hands of those over 55. This concept has not received much attention, but deserves consideration.

Obama has made a convincing argument that the time is critical to address this issue. We agree. Once legislation is finalized, it is unlikely we will ever be able to go back. Dr. Sal Rini retired after 29 years in practice in Ob-Gyn in MB. Dr. Bill Greene retired after 26 years in practice in Urology in MB.