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Whether we like it or not, money drives our society, including the medical system. How to reform our health care to get the most for our medical dollars is the real question in the debate about health care reform.

If we are going to have any real reform, there are certain basic facts that need to be addressed with both Democrats and Republicans in cooperation.

  • Our current system gives essentially a monopoly to about a dozen insurance companies, who operate to make money for their shareholders, not to provide health care. They set their rates, which go up yearly. They decide which doctor their customers can see. They set the doctor’s fees. They decide if and how long the patient can stay in the hospital. They withhold payment from the providers with unlimited bureaucracy and paperwork. It is estimated that about 20 cents of every dollar they receive goes for their profit, administration, political activities and so on. Health care comprises about 10 percent to 15 percent of the economy of our nation, thus giving millions of dollars as profit to a very self-serving group and taking away millions more to provide medical services.
  • Tort reform (lawsuits and medical liability laws) is a must. Virtually all medical providers order excessive laboratory and imaging studies (x-rays, CAT Scans, MRIs and so on) in order to be prepared for their legal defense when they get sued. It is very likely it will happen sometime in their careers. In the end, the public pays the bill. The doctors and institutions must increase their charges to cover the cost of their malpractice insurance while these excessive and medically unneeded tests hike the cost of medical care and insurance. Tort reform, which has been repeatedly blocked in Congress, needs to be national, not just statewide.
  • Standardized billing for medical services should be instituted. The current billing system is a fiasco. Almost never is the first bill accurate and in most cases it takes months to get the payments, co-payments and deductibles correct. All of this uncertainty in payments confuses everyone – both the patients and the providers of medical care.
  • Portability of medical insurance should be nationwide. It should not be lost when changing jobs or moving to another state.
  • Access to the medical community must be available. This means providing money and emphasis on training of enough doctors, especially primary care physicians. This takes money provided by the government for training. But to get doctors to choose primary care careers, there must be a change in the fee structure. Under our current system, most specialists will earn from two to six times the annual income of primary care doctors. Of course, there is a great tendency for young doctors to go into specialties or even super-specialties, where the money is better and the working hours are usually shorter.
  • Access to the medical community also means access to choices in health insurance plans. There must be competition between hospitals and insurance carriers, which will help the services, costs, availability and quality of care. Nothing deteriorates the quality of care and at the same time increases the cost as much as any institution having a virtual monopoly of the medical market. In our current system, few people have a choice in their medical insurance. The choice is made by their employer, who makes contracts with medical insurance companies on a financial basis, and not necessarily in the best interest of the patient.
  • Preventive health care should be a must in medical reform. Preventive health care is less costly than trying to treat or cure a disease. Treating hypertension (high blood pressure) is less expensive than treating its complications (heart disease and strokes). Finding breast cancer early via mammogram and curing it early is less costly than treating advanced cancer. Immunizing against influenza is not as expensive as care of the complications, such as pneumonia. Good prenatal care is less expensive than treating premature and brain-damaged infants.

Thus far, everything I have mentioned is either a “cost saving” or is at least “cost neutral.” But partisan politics and self-serving financial interests stand in the way of these reforms. The attitude of “we’re OK so keep everything the same” is in opposition to reform. But nothing as complicated as medical care and its delivery is so good that it cannot be improved, which is what reform is supposed to be.

Now for the touchy point: Expanding medical care will cost money, lots of money. Is it worth it? The answer depends on a person’s viewpoint of what governments should do. Historically, governments just tried to provide peace and protection for its citizens, such as law enforcement and firefighting. Then additional services were added, such as clean water and sewage disposal. Over time more money was being spent by the government on public education and public work projects – roads, dams and so on. Eventually social projects, such as public housing, food stamps, public hospitals, agricultural price supports and so on became part of our society’s expectations and government policy. But the costliest social projects have been Social Security and Medicare/Medicaid. The current question is if we are to provide more medical care to people – and how to finance it.

Should we expand our medical care to those who do not have adequate resources? How about requiring insurance coverage for those who have pre-existing problems? Should we allow insurance companies to drop coverage on patients that have multiple claims or have expensive chronic diseases? Is health care a right or a privilege? Is it a social issue, a moral issue or a political issue? Virtually all religious groups recognize a moral obligation to assist the sick and helpless.

Economically, a healthy population is more productive. Medically, allowing all people access to affordable care (via insurance or otherwise) will help relieve the strain on our emergency departments caused by the uninsured. Institutionally, providing some form of payment for the poor will help the general public because hospitals would not have to “soak the rich” (meaning those who pay their medical bills) to make up for the losses from those with no financial resources.

So how do we pay the bill? I leave that to the professional politicians who seem to find money for the other necessary government functions. Certainly, a nation at peace has more resources than one that is spending multiple billions of dollars fighting two wars.

But regardless of the method used to provide for our nation’s most needy, the problem should be addressed. And even if this problem of providing additional medical coverage is not solved in the current political climate, there is still no excuse not to begin instituting some or many of the reforms listed previously.

Sherman Hope is a retired physician, having practiced family medicine in Brownfield, Texas, for more than 40 years.

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