Friday, July 17, 2009

5 Steps to Better Health Care

President Obama has launched his Class Warfare Health Policy Initiative. Economists, many Caregivers, and non-Socialists are understandably aghast at the proposal to spend over a trillion dollars, tax the "rich" at 45%, and let loose a system of bureaucracy-controlled health care services. But we need to do more than yell "NO!" We need to acknowledge the problems that do exist; propose solutions that address the problem; and do so within a context that has broad political support from the ideological 'middle' of the country.

With that in mind, I suggest the following parameters:

1) First, we must acknowledge that there *is* a problem in terms of affordable access to health care for many Americans. With 10% of the Labor Force out of work (and youth, stay-at-home parents, part-time workers, the disabled, many immigrants and the homeless are NOT included in the figure), estimates range from 30 to 50 million Americans living without health insurance. That means somewhere between 10% and 15% of Americans.

2) It has been demonstrated that those with a lack of access to health care delay treatment until their conditions require critical (and far more costly) attention. This adds to the expenses Providers incur (and often absorb) and the strain on existing government programs (and thus, increase cost to taxpayers).

3) We must agree that compassion and the political climate both dictate that a, "hell, tough on them!" approach is not an acceptable response.

4) Having said that, the solutions must address the problem. At my office (an Academic institution), one often hears people singing the praises of a Single Payer System. They frame the problem as the 'lack of a single payer system.' However, this response falls apart when weighed rationally. If 85% of Americans had affordable access to supermarket food, and 15% were lacking basic nutrition, we would never suggest that all 100% of the country have access to free food at the supermarket, with the bill sent to The Government. We all know intuitively that the result would be a run on food, a shortage of goods in the supermarket, wasted resources, and a broke country. And yet, that is precisely what the Single Payer Cheerleaders want for health care. If the problem is access for 15% of Americans, than the solution is a way to find access for 15% of Americans.

5) Insurance is both a blessing and a curse: it allows people to access health care (the blessing), but also permits non-emergency situations to crowd hospitals and ER rooms with unncessary service, as consumers receive thousands of dollars worth of treatment for a small copay of $10, $25, or $50. True Health Care Reform must acknowledge objective, observable economic realities and not be bases on some hand-holding kumbaya approach to human nature.

6) The provision of care must be centered on the Doctor-Patient relationship, NOT on insurers' profits or government bureaucracies "one-sized-fits-all" approach of form and process and procedure and approval.

7) We must acknowldge that the American health care system is the best in the world, bar none. Those who point to Canada forget that there is not a single modern machine in Canada capable of removing kidney stones. Those who trumpet Britain forget that Britain has closed 40% of her hospital beds since the 1940 NHS was enacted. Those who point to Scandinavia forget that it is the American doctors who win the Noebel prizes, the American researchers who have made all the modern major medical breakthroughs in the last century, and it is America that attracts doctors from all over the world. a nutshell: we need a system that helps those without affordable access to gain that access, in a way that protects and enhances the doctor-patient relationship, lowers costs to consumers and providers, and continues to support a profitable - and successful - health industry.

With all of those as 'context,' here are my 5 Proposals:

1) Permit community groups to form for the purpose of buying health insurance. Sounds simple, isn't it? But it's illegal. Individuals can *not,* under existing law, form 'groups' whose primary purpose is purchasing insurance. (Groups may form for business or fraternalh purposes, and then choose to buy insurance as an incidental benefit, but they can not form for no other reason than to buy insurance). End this prohibition, let the market dictate rates, let competition ensue, and there will be no need for a Federal Government-related Insurance Bureaucracy. Take it one step further: end State Monopolies on insurers. The Federal Government (not States) has the authority to regulate Interstate Commerce, and since people may have an accident *anywhere* and request their insurer to cover it, this is clearly federal jurisdiction. Blow open the lid on Insurer Competition.

2) Enact Tort and Medical Malpractice Reform NOW. It was reported 5 years ago that an OB-GYN doctor in Massachusetts has to deliver EIGHTY-FIVE babies just to cover his malpractice insurance premiums for a year. Worse, 5% of doctors are responsible for 95% of malpractice claims, raising all doctor's and hopistal's premiums. Limit Malpractice Awards, raise the negligence standards (so hospitals dont need to run unnecessary tests), and relieve the 95% of decent doctors from paying the premiums of the 5% convicted of malpractice.

3) Eliminate the FDA's requirements that drugs be safe AND EFFICACIOUS. Currently, the FDA requires that pharmaceutical companies prove that their drugs meet two tests: they must prove safe, and they must be 'efficacious,' that is, they must be proven to cure the condition they claim to address in virtually 100% of patients. This is a costly and unnecessary test: Many people react differntly to different substances. The Peanut Butter that fed me through high school will kill someone with an allergy. Let *Doctors* decide what to prescribe, with the understanding that the idiosyncracies of individuals means that results WILL be different with different drugs. A drug that doesnt work, will not be prescribed. On the other hand, if a doctor determines that medical marajuana is more efficacious and cost-effective than morphine, so be it. Eliminate tiered coverage that allows Insurers to cease to cover necessary, but expensive, pharmaceuticals.

4) Engage in Multi-national agreements with other nations to accept their pharmaceuticals. The refusal of the US FDA to permit the importation of Canadian pharmaceuticals is insane. An individual can come to the US from France, or Britain, or Mali, or India, and providing only a driver's license from their own nation, get behind the wheel of a 6,000 pound rental car and take off minutes after landing - even if they don't speak English or have never driven on the right side of the road. And yet, if a pharmaceutical company goes through hundreds of thousands of tests in Germany, or Britain, or Canada, the results are not considered 'valid' in the US. Now, realistically, which is more dangerous: the driver, or a drug produced in Canada?

5) Permit every American to have a Medical Savings Account. Currently, Government workers and some self-employed people can utilize a Medical Savings Account which permits them to cover medical costs using a credit-card-like card. These citizens have a certain amount of money deducted from their paychecks, and go into an account for medical expenses: prescription drugs, eyeglasses, dental work, and even over the counter remedies. These deductions are pre-tax, meaning it lowers the person's gross income, lowering their tax and even possibly dropping them into a lower tax bracket. Better yet, these workers can 'borrow' against future deductions if they incur expenses early in the year at no interest expense. If government workers are allowed these accounts, why not ALL Americans?

These proposals will not solve all of our problems, but they will go a long way to providing access for those who do not have it, lowering costs for everybody, and enhancing the doctor-patient relationship.

Friday, July 10, 2009

Medical Marijuana: Gov. Lynch continues his shuffle of cowardice and shame

I'm sorry, but it's a sad day when a life-long Republican such as myself continues to be more Progressive than the Democratic Governor.

That we should be discussing decriminalization or legalization of ALL marajuana use is a given: the cost of incarceration to taxpayers; the repurcussions to kids smoking a substance that has clearly been established to be less dangerous than either alchohol or tobacco; the irrefutable evidence of the failure of Prohibition and the hardened crime it causes; and the personal experience of the majority of citizens and voters born after 1950, all suggest this is a no-brainer.

But to veto a compassionate bill (and yes, my father experienced the pain of esophagal cancer as he died, and the only relief was morphine, which took his lucidity away far more than marajuana would have), that the Governor himself helped craft (pulling the same psycho-drama as he did during the Marriage Equality process) is absolutely intolerable, inexplicable, and inexcusable.

Shame on you, Lynch!