The narrow lens that reformers since the Great Depression have viewed the health care issue through is distorting, to say the least. This is an attempt to make a somewhat holistic assessment of the unspoken myriad problems driving up costs in our system.
Historically, big business has been the fall guy during hard times, and often, rightfully so. Now, it's no different - big corporations, including insurance giants and large for-profit hospitals, are easy targets in the reformers' crosshairs. They charge too much. They're greedy. They're deceptive. They're discriminating. Their overhead costs are killing us. Certainly, there is fat to trim and changes to make in both the healthcare and insurance industries.
However, the left ignores many serious issues outside the corporate realm. The issues surrounding the “usual suspects,” insurance companies and hospitals, have been well-documented and well-argued. Now, let’s do an honest, nonpartisan assessment of some of the “unusual suspects” that plague our system and drive up costs:
First, that giant elephant in the room, tort reform, that the left has desperately tried to brush under the rug. Some form of tort reform needs to happen for substantive health care reform to both get passed and, in the long run, work. Those on the left decry the scorched earth forecasts of zealous tort reformers and those on the right blame fear of litigation as the biggest culprit in rising costs. Both sides are dealing in unreasonable extremes. Adopting a "loser pays" awards system, in which the loser of the suit pays all court costs, legal fees, and damages (if applicable) is great in theory, but not practical in reality. A definitive answer is admittedly hard to come by, but something needs to be done to mitigate the problems our litigious society has brought on our medical industry.
Fraud in both private insurance companies and our current public health care systems is another “silent assassin,” siphoning money from state Medicaid and federal Medicare coffers and insurance company bottom lines. Typical losses to fraud are estimated to be at about 10% of annual health care expenditures. Yet, you never hear this staggering estimate or the overarching issue mentioned at all. Medicare fraud alone steals $60 billion annually from the federal government. Private insurance companies are victims too, but they typically employ in-house “fraud squads,” comprised of forensic accountants, legal staff, and sometimes, former law enforcement agents to zero in on fraud attempts. According to the federal government, Medicare and Medicaid are the easiest targets for scam artists.
It costs money and time, precious time to become a licensed doctor in the United States. According to the AMA, the average medical student debt load upon graduating is $139,517, while the average resident salary is $43,266. The AMA does not account for possible undergraduate debt load. In addition, the time investment to join the American medical profession is longer than most other countries. In South Africa and Germany, for instance, one can become a doctor in as little as five years. The medical training is completed during one’s undergraduate studies in most other countries, Canada notwithstanding. In the U.S., it typically takes eight years to graduate from undergraduate and medical college. A mandatory residency for most practitioners is next, where the compensation offered makes paying off school loans a distant pipe dream for the time being. Indeed, in many other countries, tuition costs are much lower or even non-existent. One can hardly fault an American doctor for demanding handsome compensation for investing well over eight years of her life and taking on six figure debt loads. Moral absolutists who implore doctors to answer their first and foremost call, “to help people” above all else, are ignoring the financial realities of life here where they are inclined to use them zealously elsewhere (i.e., crippling medical bills, inability to receive care).
20 million of the estimated 45-48 million uninsured are illegal aliens. This clear drain on the medical system needs to be plugged. America, for all its present problems, is still the most desirable place to migrate to for many foreigners, especially for our neighbors south of the border. This makes our problem uniquely American and uniquely unwieldy in comparison to other countries’ immigrant issues. Absolutists who view health care as an absolute inviolable right can object to this argument. But, assuming comprehensive health care is passed, I suspect most Americans will be hard-pressed to accept that 20 million non-taxpaying aliens are receiving care that their tax dollars are financing. Unfortunately, neither argument has been approached, because the overarching issue is ostensibly a non-issue to those in charge of the reform discourse.
Tort reform, fraud, the “costs” involved in merely becoming a practitioner, and the illegal alien drain on the medical system should be and need to be addressed in order to even begin unpacking the complicated mess that is health care reform. Simply trusting the government to assume control without addressing some underlying problems would be the proverbial band-aid on a gaping wound.
An exhaustive discussion of the insurance industry is well outside the scope here, but discriminatory enrollment and enrollment rates are about to end, allowing many more people to enroll in highly effective private plans even if they have pre-existing health conditions. Private plans have proven far more effective than Medicaid and Medicare. Under the former federal plan, you often are simply underinsured and won't receive treatment from many doctors, and under the latter, you are often forced to purchase supplemental “doughnut hole” insurance to plug your own underinsurance problems. Clearly, enrolling in a private plan would be favorable.
Fixing the underlying problems mentioned here while addressing the most unconscionable institutional problems endemic to insurance companies and hospitals, like discriminatory enrollment, will deliver the greatest good to the greatest number of people. Perhaps I will expand on the reasons why in a future post.
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