Friday, August 14, 2009

Hey, Here Are Some Ideas on Medical Care!

A couple weeks ago, I was watching a panel of med students on TV discussing the Obamacare issues. They were asked questions by the moderator about their studies and fields they were pursuing. Interestingly they had genuine concerns about how it was going to affect them when they begin their careers and practices. Incidentally, one female student identified herself as a recipient of "full-ride" financial assistance from the government to specifically to study family medicine. Others on the panel were going into fields like oncology, research, etc.

This prompted me to begin thinking. I'm no expert by any means on this extremely complex topic, so I know I'm speaking way out of my knowledge base, but perhaps there's some sense to be found in my thoughts.

First of all, we have to.... let me restate that.... we have to get tort reform into the final bill.

Second, Obama is a "gung-ho" proponent of volunteerism and community involvement. Take that and combine it with the government incentive for medical students to study and pursue careers in family medicine this way. Let's say that Obamacare required that these medical students who were "on the dole" for their family medicine education to link up with hospitals where they would work off their education indebtedness as a hospital's in-house family practice and take the hospital's emergency room's off-the-street cases which aren't true emergencies. These hospitals could be given a tax credit for establishing and running these family practices to offset expenses.

The hospitals would pay these young family practice doctors a salary, of course, but I would imagine that it would be far less than the expense of utilizing the entire emergency staff and facilities for simple sutures and runny-nose and coughs type cases, and so. (Clearly, there are many implications that I'm not taking into consideration here, such as overall cost to run the emergency room or to develop a side family practice business.)

And then let's take it a little farther to benefit the entire community. Let's make the hospital emergency rooms real emergency rooms or trauma centers. Again, it seems to me that the newly minted trauma centers should make a lot more money without having the uninsured using their facilities for minor maladies - perhaps even more than enough to offset the cost of these new family practitioners. Of course, I'm not a hospital administrator, so I can't determine that; but logically, it sounds feasible. (And in my own defense, I think this is as thought-through as much of the HR3200 has been.)

I can't help but feel that this makes a whole lot more sense than trying to insure illegals or dismantling an entire healthcare system that for millions upon millions is working. In fact, it seems that this type of plan I have started describing here would be a whole lot easier to oversee than that which has been outlined in the HR32oo healthcare bill. It certainly wouldn't take all the bureaucracy that is outlined in this bill to implement because it could be overseen at the local level primarily with a "dotted line" to DHS in Washington.

If we took this healthcare thing and implemented it a step at a time rather trying to implement it as a whole, by the time Obama leaves office, we could have an excellent health program that benefits every American citizen. And, it certainly would also keep the government involvement out of private doctor-patient relationships.

Again, we need to stop frivolous and irrational lawsuits against doctors. This would bring down cost of malpractice insurance for the doctors and they could pass on the savings to the patients who would have more to buy insurance with.

High drug prices have also driven up the patients' insurance costs. So, Step Two is to get all drug costs under control. Again, by eliminating frivolous law suits against drug companies, costs can be dramatically reduced and should be passed on to the consumer. Research for drug companies is expensive, for sure. But what I am opposed to is their very lengthy patents. My opinion on this is not just for a research cost recovery that these patents are so long. I believe these drug companies charge extremely high prices for many, many years on these patented medicines to drive up their company's profits unfairly.

I've also struggled with pharmaceutical advertising to the public, primarily because I think I'm among the few who actually read the fine print at the bottom of the TV screen, or listen to the fast talker at the end of the commercial describing the horrific side effects that are scarier than the diseases! I think it might be best if they spent their advertising dollars to educate the physicians and prescribers on the new drugs so they're up to speed on the latest medicines and let the medical professionals who know their patients and who could benefit from the newer drugs make the appropriate recommendation to the patients.

With drug prices so high, those people without drug coverage or who have high deductibles and/or co-pays will opt to not pay for these drugs. What they need is alternatives to the high-priced namebrands to be made available much sooner. If they don't want to relinquish the patent completely because they would lose all the profit in those final years of the patent life, why can't the drug companies do generic production at the same time and when they reach the "breakeven point" take advantage of both tiers of the market. At the end of the patent years, they could continue their own generic production or sell off that portion of the business.

So, drug cost is the second thing that needs to be addressed.

Third thing, is insurance coverage, I don't think that there should be such a difference in premiums cost between those in a large group of people and an individual seeking coverage. Once you get the cost of doctors' care and drugs within reason, you could have levels of insurance coverage that can be made available to everyone at affordable cost. I think group insurance was probably used as an incentive to get big businesses on board to sell more policies at one time. However, businesses have been cutting way back on these kind of benefits once used to lure people into employment because of the pressure on their own bottom lines.

I'm saying that all people should be able to pay a reasonable price for basic insurance coverage for basic medical needs. Our car insurance policies and most life insurance policies aren't tied to employment. So, if the cost of doctors' care, and drugs costs come into a more sensible balance with actual costs, then perhaps insurance coverage should be "untied" to employment and group policy price structuring, meaning those who are employed or unemployed have the same access to the same coverage at the same rates.

Medical costs must come down... and they can if some of the steps discussed previously are implemented. Insurance companies could still offer their "cadillac" version for those who can afford it and who want it. They could also offer a mid-level option to the general masses. If offered through employers, the patient pays a percentage and the employer pays a percentage according to their agreements. (I believe that this is where most policy holders fall anyway.) And finally, they could offer a restructured catastrophic care coverage that would help keep people from being totally devastated. So, if healthcare costs are brought down because of changes in litigation laws, patent laws, and advertising costs, then more people who wouldn't have previously had insurance will more likely be able to afford insurance or pay for basic healthcare.

I don't personally know anyone who has not been able to get any health insurance coverage because of a previous or existing condition. I'm sure there are plenty. Regardless of any previous conditions, basic wellness checkups and preventative care should be covered regardless because illnesses caught early are less expensive to treat. A person who has had a devastating illness with no recurrence or symptoms within five years should be able to once again have full coverage. Pre-existing conditions should not be an automatic uninsurability either.

I don't know anyone with a pre-existing condition and I haven't studied up on this issue, but surely there is a way to offset the costs of care for the individual. These people have other medical care needs that may not have any correlation to their particular pre-existing condition. They still need wellness care coverage and general medical care that they could be covered on. There could have a disclaimer paragraph inserted into "special situation" policies for those with pre-existing conditions which is much easier to do than it is to write a whole new healthcare bill! In order to cover everyone, it makes sense to me that with the absence of frivolous lawsuits, without exorbitant profit-making, insurance companies should be able issue policies that everyone could afford. And just how few words that would take.... not 1000+ pages!

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