antipaucity

fighting the lack of good ideas

health care “reform”?

The problem with health care in America is NOT that too many people don’t have it.

And it’s NOT that it’s too expensive (though it is expensive).

The problem with health care in America is that there is no reason for people to pay for what they can get for “free”. And if something goes wrong, you’re just a phone call away from heaps of cash (after the 35-50% that goes to the lawyers, of course).

I see people using the Emergency Room as their Primary Care Facility. Not because they think it’s better than a doctor’s office, but because if they can’t pay for it, the hospital can’t come after them.

The bill that passed the House last night, supporting President Obama’s “Hope and Change” agenda is going to cost taxpayers hundreds of billions of dollars.  The only way of paying for that, since the government never CUTS spending (except for President Clinton who cut our defense budget in the 90s), is for taxes to be increased.

As it stands now, someone earning $40k in the US (depending on the state) pays about 9% to Social Security and Medicare. Another 0-10% to their state. And 10-20% to the IRS. That’s a total of 20-40% of their income being taken from them. Add on top of that the sales taxes that [almost] every jurisdiction in the country charges (4-10% from where I’ve been, except OR and DE). Also add-in fuel “surcharges”, phone taxes, etc – and the typical American is paying about 50% of their income to various taxes.

Yes, I do understand that government services are paid-for with taxes. And I understand there are a host of taxes available. Some people even manage to pay [almost] no taxes. Due to earning too little, there are a host of Americans who benefit from government services who never pay into them (other than sales taxes).

Should citizens benefit from their government’s provided services? Of course. Should citizens contribute (something) to benefit? I believe that is also a resounding “YES“.

Should citizens be forced to pay for things they are not using? That’s where this health care “reform” bill has me against it. It’s where most of the state and federal budget items have me upset.

Property taxes supposedly pay for education in most areas. Except, of course, for where there are “educational” lotteries. If lotteries pay for education, why are property taxes still as high as they are? And if property taxes pay for them, then the lotteries are just get-rich-quick-schemes taking advantage of people who can’t do math. (Personally, I think if you can derive $1 of entertainment from a scratch-off ticket, then it’s ok; it’s when someone looks to the lottery as a “way out” of their current economic situation that I have a problem – they’ll keep coming back and back and back, because “you can’t win if you don’t play”.)

Fuel taxes supposedly pay for road maintenance and expansion.

Income taxes (personal and corporate [and capital gains and taxes on interest earned etc]) pay for pretty much everything else.

The current federal budget is about $3 trillion. I have no idea how much money that is. No one does. If you split it evenly over the population, it’s about $10000 per person (man, woman, boy, and girl) in America. According to the BEA, Americans earned about $5 trillion in personal income last year (excluding the $1 trillion governments paid in salaries). Additional to that was another about $1 trillion earned by proprietors of businesses. After all is said and done, that comes out to a per capita earnings of about $35000.

Estimates I have seen so far put the cost to the federal government (and therefore US – taxpayers: it’s where the “government” gets its money from) in the range of about $1000-5000 billion ($1-5 trillion) over the next decade. That’s an additional $100 billion per year – just over the next 10 years. That’s an increase to our national budget of about 3-15% per year. As a percentage, the bottom of the range is not big (but the top is huge). As a “real” number, the whole range is huge.

Various reports put the number of “uninsured” in America at 30-45 million people, or about 10-15% of the population. Why is it important that these folks become insured? What percentage of those “uninsured” actually NEED coverage? Why do they not have it? Is it truly because they cannot afford it (they earn too little, etc)? Is it because they DO NOT NEED coverage? I went without health insurance for 4 years. I’ve had it since January 2007, and haven’t needed it yet. It would be far far cheaper for me to not have health insurance and just pay my doctor once a year when I go for a checkup than it is to pay for insurance. (Yes, if I *did* need it, it would be nice to have.)

What costs are actually associated with health care? How much of that $200 you pay your doctor per visit is really associated with “care”, and how much goes to overhead costs, such as staff and their OWN insurance in the event the patient decides to sue them? The medical practice I used to use employs two doctors and three nurses. Let’s say for sake of argument that the nurses are paid $20 per hour for 40 hours per week. That’s $160 per day and $800 per week per nurse. So, if 4 patients come in on Monday, their office fees have paid one nurse for the week. Four patients in a day seems low based on every visit I’ve ever made to a doctor’s office: it seems to be typically about 2-3 per hour (or more), which is about 20 per day. Twenty patients times $200 are $4000 a day (gross) that the practice is charging.

Some amount of that goes towards utilities. Other goes to security. Some is used for supplies. Some chunk is paid directly to the government in the form of taxes. And some noticeable amount is paid to a liability coverage company to protect the staff in the event a patient sues them for malpractice (real or imagined).

I read that twenty years ago, a neuro-surgeon in Australia only had to carry $100000 in liability coverage because lawsuits are capped in Australia (except for gross malfeasance, which carries criminal penalties as well as civil ones). At the same time, US-based general surgeons had to carry $1 million in coverage, and neuro-surgeons $5 million. That’s 10-50 TIMES the coverage – at a MINUMUM! And that did not guarantee that if the surgeon was sued, he would be able to cover the costs of the lawsuit with his liability insurance.

That means that two, otherwise identical, surgeons, practicing the same type of work, had to have a ~50x difference in their insurances due to litigation law.

America is a very litigious (lawsuit-happy) country.

Only in America could you have someone sue their microwave manufacturer for not telling them not to use it to dry-off their hamster.

Only in America could someone sue McDonald’s for spilling hot coffee in their lap and burning themselves.

Only in America would a family sue Ford for the death of a wife and mother when she was backing her car on the interstate (patently illegal), and was rear-ended.

Only in America can a home-invader/thief/mugger sue the very family he was attacking because he got injured while trying to escape.

Only in America would a physician be required to carry millions of dollars in liability insurance, order “unneeded” tests, get extra opinions, etc: just in case the patient (or their family) decided that something wasn’t perfect in their care and therefore the doctor should have to pay.

What America needs is not “health care” reform. What America needs is “attitude” reform: we need to not be a country of victimhood, a nation of folks who think it’s someone else’s job to pay for their needs, a citizenry who all participate in the betterment of their nation, a society that is not afraid of mistakes – the society and citizenry that described America during its founding all the way through the early/mid-20th century.

I’m sure most of the folks who use ERs for their PCF aren’t trying to game the system. I’m sure many of them truly can’t afford the cost of going to see a doctor preventatively. I’m positive the percentage of those gaming the system is small.

The problem is that even a small percentage of a big population is a big number. If only 1 percent of 1 percent of the population were in the “gaming” category, that would be about 30000 individuals. Spread across the fifty states, it’d be merely a few hundred per region. If that was the percentage, health coverage would not need be so expensive.

Instead, and whether they intend to “game” or not (and I’m positive the great majority do not), the number of uninsured is 10-15% of the population. The number of insured, then, is 85-90%.

How many of those who have health coverage abuse that coverage? How many never go to a doctor, never use the insurance they pay for, and only have it just-in-case? How many go to the doctor every time they have a sniffle?

Forcing all Americans to have health coverage will cost taxpayers hundreds or thousands of billions of dollars.

Capping and limiting lawsuits would cost little more than passing yet another law.

Health care providers need to not be afraid that an honest misdiagnosis will land them in the poor house. Patients need to realize that there is no perfect diagnosis – sometimes even the best teams and techniques won’t determine the cause of their malady. Maybe it’s imagined. Maybe it’s real. Maybe it’s never been seen before. Maybe it’s just that the doctor you use doesn’t know what he’s looking at when he reads the X-ray. Maybe he’s new. Maybe he’s tired. Perhaps it was just your loved one’s time to go.

Forcing yet another trillion-dollar measure down the throats of hard-working Americans won’t cure the ills of the system.

How often does merely throwing money at a problem solve it?

How often does throwing people and ideas and a healthy attitude at a problem solve, mitigate, or refocus it?

Once good ideas, attitude, and people are working on a problem, money can be directed well. We won the first space race because we put all the best people we could find to work trying to solve the problem – and gave them fiduciary resources to make their visions happen.

Everything we as a nation have ever won has been because those with the vision, courage, and ideas to make somethign happen have gotten out there and done it.

We can reform health care once we remove [most] fear from the system.

Fear cripples any environment: doctors fear being wrong, so they order more tests; they fear patients suing them, so they are hyper-cautious in evaluations and diagnoses. Insurance companies fear lawsuits, so they charge customers lots of money for even the most basic of services. Patients fear the costs of insurance and that their doctor may not be perfect, so they use the ER for their doctor – or they sue for a misdiagnosis or “wrongful” death.

Doctors are human. They can make mistakes. Health care professionals don’t make many mistakes – ever. It’s one of the few professions where everyone is expected to be flawless. And it’s one of the few professions where the vast majority (I’d venture to say >99%) are flawless. From drawing blood and giving shots to replacing livers and hearts: medical professionals daily turn out not only their best work, but exceed the expectations of any reasonable person.