Do you believe in Miracles?

The following letter is in response to a question I was asked in regard to what a "public option" would be like. More specifically, I was asked if the public option was going to be like Medicare.

Sorry it has taken me so long to respond to your question. I have been very busy at the surgery center. My understanding is that the "public option" is one of several health insurance products that will be made available to individuals and small business that currently don't have or provide health insurance. The details have not been fully worked out, but I think the end product will be similar to Medicare in that the government will "outsource" the administration of the public plan to a third party as it currently does for Medicare. Hopefully, that will be the only similarity.

There will need to be some major changes in the current Medicare system to make a public option viable. I have outlined many of the necessary changes in previous posts on the Blog Health Care NOW. Specifically, reimbursement must be increased in order for providers to accept patients participating in the public option, and payroll decutions must be increased to pay for the public option.

One method of increasing reimbursement is to allow providers and their patients negotiate balances. I have suggested a two pronged approach where the current CMS reimbursement is increased 15--20% AND the difference between the providers fee and CMS reimbursement is negotiated with the patient PRIOR to the delivery of the health care service or procedure.

Further, an increase in the Medicare payroll deduction must also take place. This increase should be 10--15%. This increase pales in comparison to deductibles and co-payments currently in existence. This is doable since worker's and self employed people will have choices for their health insurance products and costs will decrease naturally with competition.

This is also true for the NON public plan options. Competition will drive the costs down because providers as well as insurance companies will be competing for patients and policy holders.

One other thing of note. Unfortunately, in the USA, health care is treated as a commodity. It shouldn't be, but it is. If this attitude were to change, private insurance companies would go out of the health care business which would be the best thing ever to happen in health care. It is the insurance industry along with the pharmaceutical companies and medical device companies that are raping the system. These are private companies that must be accountable to shareholders.

That means they MUST make money. This has been the case since the 1970s and at the expense of the patient and provider. Remove the necessity to make corporate profits off of health care and that money can be used to PROVIDE HEALTH CARE. Further, the costs would plummet since there would be NO health insurance premiums, no costly utilization review, no denial of health care, no delay of obtaining health care, no fighting for reimbursement, all of which costs billions. Further, denial often times ends in death, and delay ends up costing more than if treatment were authorized when requested. Remove all this nonsense, and we would all be healthier and health care costs would be significantly reduced.

Remember, health insurance companies DO NOT PROVIDE HEALTH CARE. They broker health care which is a nice way of saying they are pimps for executives and shareholders.

Tort reform should also drive down some of the cost and needs to be looked at carefully. There is not a lot of evidence showing that tort reform will reduce mal practice insurance premiums. Again, the insurance companies must make a profit and they will sell anything at the highest price they can get. No regulation is equal to highway robbery for the insurance industry. Only competition will drive down the costs of mal practice insurance.

The result of removing corporations from the health care system would be a single payor system in the USA. We are the only industrialized country in the world that does NOT have this for all of their citizens. Personally, I think that is shameful that people go bankrupt because one major illness cost them their life savings and assets in the wealthiest industrialized country in the world. This is ONLY because corporations must make a profit on health care.

Should be an interesting next couple of weeks. The senate finance committee should have legislation ready to present to the senate in a few days. I just hope our president has the balls to stand up to special interest, conservative democrats, and republicans on this issue.