The Patient Protection and Affordable Care Act Will Do Neither
PPACA will not protect patients and it won't make care affordable. It adds 2,000-plus pages of legislation, hundreds of thousands of pages of regulation and enough lawyers, consultants and actuaries to fill fleets of large cruise ships.
The system we have today is not sustainable and neither is PPACA. The marketplace has two years to find a solution. What follows is opinion:
Traditional systems of health care and health care financing are structurally flawed. In the past individual and institutional responsibility and accountability were minimized.
Traditional health care and health care financing are houses divided. The patients using care want it all. Premium payers and taxpayers funding these costs are looking to reduce expenses. Typically, 5 percent of the population consumes more than 50 percent of the costs.
Third-party reimbursement (Medicare, Medicaid and insurance) has insulated and isolated the users from the direct cost for care and the spreading of the premiums and taxes over nearly the entire population allowed "payers" to ignore the problem we have.
Providers are paid for sickness instead of being rewarded for wellness. Defensive medicine and malpractices issues encourage more care than is necessary. Patients have bestowed a "god-like" power to practitioners and so they rarely challenge the provider of services about the costs or necessity of care.
Our system has evolved from a holistic "Marcus Welby" model to a system of "organs du jour." Our cultural desire for instant gratification seeks care immediately, not allowing the body to heal itself (which it often does). Super-specialization offers some advantages but this comes at a substantial cost.
There aren't enough MDs to meet tomorrow's needs yet the politics of yesterday is limiting the ability of other qualified professionals to maximize their expertise and help fill this shortfall.
As individuals we are made up of mind, body and spirit. The majority of illness and many accidents originate in the head. This includes issues of stress, addiction, mental and nervous conditions, hypochondria, loneliness, distraction, etc. Studies also show clear evidence of the healing power of prayer for those that believe. Our delivery and financing systems were built to reward treatment of illness with few incentives for wellness, limited reimbursement for issues of the head and ignored the soul.
Obesity and diabetes are epidemics. Most times, these are self-inflicted "injuries." Many seek chemicals and cutting (gastric bypass) as a fix. Nutrition, activity and behavior modification are a better cure.
There is more than enough money in our health care and health care financing systems today to provide universal quality care. We spend about $7,500 per capita on health care. This is about 50 percent more than Norway the next closest "big spender." We could easily insure every man, woman and child with "Cadillac" health and long-term care coverage for $5,000 annually. Multiply that $2,000 annual savings by 310 million people and consider the possibilities.
If you believe government can project and control costs consider that when Medicare was established in 1965 the projected annual cost for this program in 1990 (25 years later) was to be $9 billion. The actual cost in 1990 was $106 billion. In 2011, the total cost for Medicare was $551 billion. Medicaid was $398 billion. Together these approach $1 TRILLION.
The government consistently under-reimburses hospitals and many practitioners for the care they deliver through Medicare and Medicaid. This forces cost shifting to the private sector (insurance companies and their premium payers). The Fed then blames these same folks for the high costs.
If you want "hope and change" here it is:
The baby aspirin is the most effective technology in all of HC. It's natural and inexpensive. We can find more natural cures. Innovate. Innovate. Innovate.
Running the health care system with pencil and paper is incredibly inefficient. There are huge cost savings available in a virtual world.
Create systems that reward responsible behavior and outcomes. Compensate for the health of a population not individual transactions.
Leverage technology to accumulate all relevant data and transition this to useable information and actionable knowledge. If the government would build an information superhighway, the marketplace could leverage this to make care better and affordable.
Use evolving technology to deliver care and oversight at the patient's home rather than requiring the patient go to the doctor, hospital or emergency room. Home monitoring and IBM's Dream Coat are positive innovations that may help that process along.
Integrated and collaborative medicine is gaining broader acceptance in the marketplace and will give patients more choice, better results and reduction of costs. Let each practitioner utilize their skills at the maximum level of their training not the minimum. Get the politics out of licensing and hold all professionals accountable to clearly articulated standards and the results they produce.
We -- the people -- can get this country on "the road to well." The government can't!
May 30, 2012
Copyright 2012© LRP Publications