The Economics of Disease (Part 2)
What an appropriate time to be discussing the can of worms that government-run healthcare programs have become! The general public does not understand that this can is actually a huge bucket with ties into all aspects of government bureaucracy. The current wrangling in Washington about healthcare has not yet mentioned Medicare, which was the first invasion of government into health-care. The Medicare entitlement program is the elephant in the room.
In the 1980s, under the well-meaning administration of President Reagan, Diagnosis-Related Groups, or DRGs, were created to reign in the costs of fee-for-service billing by hospitals. That bill (Gramm-Rudman-Hollings Act) was eventually repealed in part due to inherent unforeseen ramifications. Such ramifications are very common in Washington when you meddle in things you do not fully understand. Think of a pie chart and imagine each slice of that pie is a disease or disease category and all treatments that can be necessary to solve acute/chronic issues of the disorder. Then assign an amount of money to cover the projected costs of each piece of pie. When new diseases become recognized and treatable, more pieces of the pie are added. When better technology and drugs become available, and when more people develop the disease than anticipated, or when people live longer and their disease burden multiplies and worsens, then rationing of care is inevitable, along with reduced payments for all types of services rendered.
The ability of the medical profession to provide what Medicare patients have come to expect and desire is becoming strained. Rationing is being enacted by bureaucratic guidelines which use such terms as unreasonable, unnecessary, duplicative, and inappropriate. These guidelines and standards of care are reducing the payments to doctors and health-care facilities. Many times the denial of payment comes after the service has been rendered. Moreover, the guidelines themselves add paperwork and record-reporting which is driving up the cost of medicine. The margin between income and expenses in a medical practice has become so narrow that facilities are closing, and doctors are dropping government-paid programs. And yet, the overall cost of medical care keeps rising. Here is but a fraction of the alphabet soup of government regulations causing the out-of-control healthcare cost increase. These are unfunded regulations/programs that do little to improve care/outcomes/or cost-effectiveness of care at the doctor-patient interface. The government manages and enforces the PACE, the EMT & Active Labor Act 1986, HIPPA 1996, Medicare Prescription Drug Improvement and Modernization Act 2003, Patient Safety and Quality Improvement Act 2005, Health Information Technology for Economic and Clinical Health Act 2009, ACA of 2010, CLIA, PQRS, ICD, CPT, R-DRGs, AP-DRGs, S-DRGs, APS-DRGs, APR-DRGs, IR-DRGs, and so on to fill up the page. When the government manages patients’ medical care, they feel that they must have multiple programs including the Federal Employees Health Benefits Program, the Indian Health Service, the Veterans Health Administration, Tricare, Medicare, Medicaid/SHIP, and CHIP. These programs have been so successful and efficient that our government is now going to formulate another brand-new system which is going to handle most all of us. I will spare you my sarcasm! Burdensome inefficiency is what happens when multiple organs of bureaucracy write reams of script in order to earn their own pay and benefits under the all-time Cadillac health plan called the Federal Employees Health Benefits Program (FEHBP). Why can’t we all just have FEHBP healthcare coverage like our Federal representatives and workers? The reason is that it’s wildly expensive and would bankrupt the government. Only government workers are eligible.
It is now under consideration that reimbursement payments be determined by outcomes measures. How crazy is that!! Providers are to be responsible for “lifestyle” decisions of their patients like missing medication, not adhering to diets, and not making appointments for check-ups, etc. When a patient is older and likely more severely affected by a disease process such that the outcome of his treatment is not expected to be speedy or complete, that patient will not be welcome in any individual doctor’s practice that is worried that this one patient will reduce the overall practice “outcome”.
The free market needs to be allowed to level out costs for the majority of Americans, by the use of HSAs for routine office visit care, and the old-fashioned Major Medical policies for catastrophic care. We need to implement true medical prevention. We need to give a choice to even the Medicare-eligible Americans who do not want government medicine and are discriminated against due to their age. Buying medical insurance across state lines and participation in patient pools for lower costs are two examples of sane maneuvers to drive quality up and costs down.
As the economy improves and more Americans get back to work, hopefully they and their employers will be able to purchase medical care. Bigger pools of individuals being enrolled in health insurance will reduce the costs for each individual. More employers being able to afford the cost of health care benefits will also increase the tax base necessary to support Federal programs for those requiring aid for their health care. We need to change the mindset tendered by big government supporters who believe that medical care is a right rather than a service and products which must be chosen and purchased individually, not just with dollars but by good lifestyle choices to prevent disease and vigilance to catch an illness early by participating in more and better screening programs. We need to release the NIH and FDA from the influence of big Pharma and return their attention to research for the true underlying causes of disease, and how to prevent that disease, whether or not there is a profitable drug to be developed.
Government Healthcare is as much an oxymoron as bureaucratic efficiency. In fact, they are the same oxymoron. All one has to do is turn on the TV set and listen to the rancor in the healthcare debate. Less government interference in health care can lead to a more patient-centered health care system.
