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Archive for April, 2010

Now that the health care reform law has been passed, it’s time to get serious about tackling the problem of the cost of health care to our nation, which, if not controlled, will threaten to bankrupt our economy.

Since World War II, we have witnessed an unprecedented development of technology that has increased our life spans and helped conquer many life-threatening diseases. This improvement of health care has come at a tremendous financial cost and continues to grow.

Last year, spending for health care in the United States was $2.4 trillion. That total is about 17 percent of the gross domestic product and more than four times the amount spent on national defense. Health care costs are rising at more than two times the rate of inflation. Since 1999, employer-based health insurance premiums have increased 120 percent, while inflation has risen 43 percent and wages have risen 30 percent.

The way I see it, our health care system comprises the following groups: doctors, patients, hospitals, medical insurance companies, drug companies and the government. Every one of these groups will have to make some major sacrifices and adjustments to its status quo to help bring down costs. Their willingness to do so will be the key to success.

Here is my opinion of what each group needs to do.

Doctors: Health care providers need to change the way they are reimbursed. Fee-for-service compensation — that is, receiving payment for each patient seen or each procedure done — has worked well for many years, especially when costs were a fraction of what they are now. The medical profession is now developing evidence-based practices that provide guidelines for the best, as well as the most economical, treatment for patients. There also needs to be an emphasis on and compensation for a new focus on preventative care.

Patients: The people of the United States have, for the most part, been privileged to receive some of the best medical care in the world, without regard to price or value. There will need to be some form of sensible rationing of health care, and I’m not talking about the infamous “death panels.” As it is now, we function under a “blank check” mentality, where the doctor can provide any and all care possible, no matter what the cost. Patients have naturally come to accept and expect this system, which is all too expensive.

Also, billions of dollars could be saved if patients took more responsibility for their own health. Our existing insurance model does not encourage patients to take care of themselves. Doctors can only do so much, but often, patients choose to continue to smoke, drink too much alcohol, gain too much weight, exercise too little or just keep up an unhealthy lifestyle.

Hospitals: We’ve all heard horror stories of exorbitant hospital charges. Hospitals must contain costs. The new health law should help them cut costs, because most people will now have some form of insurance to pay for their care. Hospitals will no longer have to compensate for the money they lose on uninsured patients by charging more for those who are insured. Hospitals also need to consolidate services and resources to eliminate the wasteful duplication that often exists. Our medical centers must be run more efficiently.

Medical insurance companies: These companies spend a lot of money on administration, and they earn excessive profits from high premiums. If they cut back on their costs of operation, they could lower premiums.

Drug companies: This group has, over the years, been a key player in the tremendous improvement in our health over the past 70 years. The drugs they have developed have improved, prolonged and often saved our lives. However, non-generic drug prices have risen all too rapidly and need to be fairer and more competitive. Some patients in the United States have been forced to go to Mexico and other countries to buy drugs, because they are cheaper in those countries. Drug prices in the world should be equal, not higher in the U.S. Our government and insurance companies need to insist on lower drug prices.

Drug companies also must immediately stop direct advertising to patients. They are only promoting expensive new drugs, when equally effective alternatives are available at a fraction of the cost. Doctors are uniquely trained to determine which drugs are best for their patients.

Government: This entity must help and encourage doctors to find the most beneficial and yet cost-effective treatments for patients, without overstepping the doctor-patient relationship. Government must work with and not against the medical establishment.

Government must also help regulate the medical malpractice question. The existing system of multimillion-dollar awards, with windfall profits to attorneys and patients, must change. Too often, huge awards are given with no correlation to actual malpractice, while there are other instances of actual malpractice that result in no compensation for the patient. To keep from being sued, it is estimated that doctors spend up to $200 billion practicing defensive medicine. In place of the existing malpractice court system, I would recommend a mediation system, wherein trained judges and panels of experts in medical and legal issues would award just and adequate compensation to deserving patients who have suffered true malpractice.

With the suggestions listed above, and with doctors implementing effective cost-containing measures, I believe we can save our health care system without lowering the quality of care.

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I have been asked by numerous people about my view of the recently passed health care reform law.

First, as someone who tends to lean more to the conservative side, I have always been leery of a government-run health care system, because I feared that “big brother”’ would come between and interfere with the important concept of the doctor-patient relationship. I have very serious concerns about what could happen to the quality of medical care in such a system.

In reality, the government already provides health care for a significant percentage of the population in this country through Medicare, Medicaid and the Veterans Affairs health program. Whether these systems are the best they can possibly be is a matter of opinion.

Given the fact of the existing level of government-run insurance, I think the best scenario would be that the majority of us not covered by the government would continue to obtain private health insurance and that such insurance would be affordable and be made more competitive, compassionate and cooperative.

I am of the opinion that our health care system is one of the best in the world, but it has had its major problems.

One problem was that, although the majority of U. S. citizens had health care coverage, millions of people did not. This seems to have been remedied by the new law, which should really be called a “health insurance reform law,” because health insurance coverage was its main objective.

Another problem with our system is that the rate of national spending on health care is staggering and unsupportable. It cannot continue its pace without bankrupting our economy.

The new law has done nothing to lessen the rapidly increasing cost of health care — in fact, I fear it will increase spending, adding to the national deficit.

No political party until now has achieved this level of change in an attempt to improve our health care system, even when it was well-known that changes were necessary. I see this new bill as a step in the right direction, even with its flaws, because it will force us — patients, providers and government — to make important changes. Time will tell how well it works.

The things I like most about the new bill are:

• It provides expanded health insurance coverage for those who have none.

• It ends health insurance company abuses, such as denials based on pre-existing conditions or the ending of coverage after one becomes ill.

• People who are satisfied with their health insurance plans can keep them.

• It allows parents to continue coverage for their children up to age 26.

My concerns about the new bill are:

• The cost to implement this bill will be staggering and will be unable to be supported by increased taxes on the wealthy and the proposed “Medicare savings.” This will lead to increased taxes for all or a restriction of health care.

• Those who have health insurance, both private and Medicare, will pay higher premiums to cover the expanded care provided by the new bill.

• Although the law has provisions to increase the number of primary care doctors, there will not be enough providers for the millions of new patients seeking care.

• There is no provision to decrease the rapidly escalating cost of medical care, which, if not brought under control, could be disastrous for our economy.

The bottom line as I see it is that something needed to be done to shake up the health care system to provide for its long-term healthy existence. The new bill has major flaws, but it is a beginning to promote the necessary changes.

Now, what is absolutely imperative is to develop a plan to rein in the cost of health care. In my next column, I will share my thoughts on how to bring this about.

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