Knowledge is neither created or destroyed. It is simply revealed to the human mind through the school of time.
Monday, July 06, 2009
Reflections of Medical Town Hall
I was invited to the TownHall held by Senator Cornyn of Texas. Senator McCain and Senator Mitch McConnell were in attendance. It was held July 30 2009 at 10AM CDT on the 8th Floor Conference Room at the main MD Anderson Campus building in Houston.
My thoughts and views:
1. The republican party seemed very opposed to the Democratic plan primarily based on the fact that government will run healthcare resulting in a decline in what we have today - "the worlds best healthcare". I do not believe we have the world's best healthcare simply because we are the only industrialized nation that does not provide full access to every citizen. In fact we leave over 10 percent of our population without any healthcare. So how can our healthcare be the world's best when we have 45 million Americans without coverage. It is a false notion to think that because we have the best technology that it somehow translates to the worlds best healthcare. There is a thought that maybe we are one of the worst - especially in primary care and preventive healthcare considering that we have the worst obesity and other industrialized nation diseases.
2. Many Doctors expressed their disgust over insurance companies. There was consensus that the Insurance Companies are colluding in the pricing of insurance and that regulations are causing unnecessary burdens. Plus insurance companies take over 25% of the premiums as profit - which sounds very high!
3. Senator McCain claimed that his proposal of widening the insurance pool by providing connectors for small businesses and tearing down state barriers where insurance companies have to operate within a state and that they cannot cross sell is one way to help reduce cost. I tend to agree that by nationalizing healthcare insurance rules (removing each states own insurance regulation industries) you can have a private carrier be one national company that can underwrite a group like small business association across multiple state lines and widening the risk pool. This would also allow for Federal regulations preventing insurance companies from creating biased smaller risk pools which creates sharp increases in premiums unnecessarily. As a small business owner for the past 20 years, I have spent most of my professional life getting healthcare by paying cash. Insurance has been prohibitive because as an individual I am unable to pool together using connectors to help diversify my risk across many others like me. This defeats the very meaning of insurance. Part of the culprit here is greed on the insurance companies side and partly it is caused by each state having its own regulation body.
4. Universal single payer Vs Multiple providers - I am unsure about this. Part of me wants healthcare to be like national defense. We only have one military so why not one healthcare provider. We all need to bite the bullet and say that healthcare is not an industry but rather a government service. But then part of looks at all the good things our medical system provides (and yes there are good things) and I do not see a reason to completely dismantle the machine. I believe a hybrid approach is necessary. I tend to think that allowing the government to be one of the providers where you can have a way to pool in or to drop barriers for pooling is one way.
I think that there is no one way to solve the issue. A comprehensive reform is what I think is necessary. Here is my wish list for what I feel would significantly change the way healthcare is delivered in our country. Only if all or most of the below is done, then I believe we will be on our way to controlling this spiraling beast.
1. Drop the red tape and tangling of state by state regulations and create a national Federal Healthcare regulatory body. This will allow insurance companies to reduce their overhead. Aetna will not have to create 49 subsidiaries to serve each state, instead they will have one underwriter for the country - like the government.
2. Significantly reform our liability and tort process around healthcare. Healthcare is not an exact science - it is an art form. Hence the practice itself is not perfect. Remove as much as possible the defensive medical aspect. Create a more cognitive consultative environment and allow doctors to practice medicine rather than order a battery of tests every time you complain of a headache. Are doctors test orderer or are they medical doctors?
3. Provide the ability to pool into a large group via a government plan or other connectors for small business owners and individuals without insurers. Require everyone to get insurance one way or the other.
4. Empower the consumer by bringing a level of responsbility and education and information to the consumer. Too many times consumers have absolutely no idea of what they are getting from the doctor. Part of it is because Doctors do not take the time to explain what they are doing, part of it is because insurance pays and consumer does not care as long as they pay $10 co-pay, and part of it is because the system wants to hide this information to bring the God Complex of medicine to themselves. Yes not all can use this information but just because some do not use it does not mean more should not be empowered to make this decisions. This country was built on personal responsibility and self empowerment, why is medicine not practicing this?
5. Incentivize the consumer to practice preventive care and empower them to "shop around" to make this happen. Tax credits for preventive wellness care that is not tied to insurance but rather some kind of health savings would create a win win situation. Insurance should kick in after a certain amount every year to take care of catastrophic and major issues. But for the sniffles, for the annual checkup, for the child visits - I would love the ability to shop around to get the best care and value and I would love to see Medical Doctors offer packages that gives me the best care and advise. We should examine why the CVS, Wal-Mart and corner small clinics that only accept cash do well. I have visited them and I feel the care and advise they provide is perfect for primary care. More of that! They advertise on $45 visits, no lines and a doctor who actually takes the time to examine you and see what is going on. - Plus I get to shop for the best care. You combine this with portable electronic medical records and now you remove the dependecy into one doctor and truly create a competitive environment.
6. Which brings me to the final point - national electronic medical records standard. The consumer needs it, the doctors need it and all stakeholders need it. Liek your credit report, your healthcare records need to be standardized. This can be done - I do not know how, but my brother who lives and breathes this stuff (he is in this business), tells me it is a travesty how heathcare is light years behind here. Again part of it is because Doctors can't let go! They feel that these records is their power....let go people, stop holding on to this shit.
The time has come....the gravy train for those suckling at the tit of this cash cow has crippled this nation. 25 percent of our GDP!!! That is ridiculous. No wonder Starbucks spends more on healthcare than coffee - think about it! Let's end this crisis before it becomes another tsunami like the financial crisis.