ObamaCare problems and solutions

“A government which robs Peter to pay Paul, can always count on the support of Paul.” — George Bernard Shaw

“If you like your health care plan, you can keep it.” Do you remember that promise? President Obama spoke those words dozens of times. Well, it wasn’t true – and he knew it. His own Department of HHS estimated and published in the Federal Register in 2010 that 93 million Americans would have their policies canceled in order to meet the requirements of ObamaCare. For the next three years, Obama continued to tell people they could keep their plans, even though he knew it was not true.

The fact checking organization, PolitiFact, rated Obama’s statement as “Lie of the Year” for 2013. The Washington Post’s Fact Checker gave it four Pinocchios and also ranked it “Lie of the Year.”

New Hampshire’s Senator Jeanne Shaheen and Congresswoman Carol Shea-Porter joined in Obama’s lie of the year, repeating it many times. It is possible that they did not know it was a lie, but they certainly should have known it.

Then last year, cancellation letters went out to some 4 million Americans. Millions of people were perfectly happy with their plans, but the ObamaCare law did not allow them to keep their plans. Virtually every major NH newspaper has run stories about the turmoil caused by ObamaCare-mandated cancellations.

People lost the plans they liked, may have lost their nearby hospital, may have lost the doctor they’d been visiting for decades. In New Hampshire, the one and only insurer on the ObamaCare exchange nixed 10 of the 26 New Hampshire hospitals. In parts of the state, you may have to drive 2 or 3 hours, halfway across the state to go to a new hospital, driving right by your old, much closer hospital. Some people had to give up the doctor they have been seeing for decades and find a new doctor perhaps hours away.

Even worse is that the new ObamaCare policies don’t cover care in hospitals outside NH. Some of the best doctors and hospitals in the country are in Boston, but NH citizens cannot go there. The Union Leader reported about a woman who was told by her Nashua hospital that her cancer was untreatable. Under her old insurance she was allowed to go to a Massachusetts hospital for treatment and now three years later she is doing well. Under her new ObamaCare insurance she would be dead.

And then there are the premiums and deductibles. I have talked with people who say the combination of higher premiums and higher deductibles is costing them an extra $1,000 per month. I asked an insurance agent if her clients were seeing increases like that. She responded that most were not quite that high, but she could believe that some were paying that much extra. Another insurance agent told me that his clients were seeing up to a 100% increase but the average was about 20% to 40% increase. 

Nationally, Aetna’s CEO reported that premiums have increased an average of 30% to 40%. He also reported seeing lower employment overall and more part-time employment. A large union similarly reported seeing a shift to part-time work by companies seeking to avoid ObamaCare’s requirements. The Congressional Budget Office recently predicted that ObamaCare during the next ten years will cause job losses equivalent to 2.5 million people.
 
It’s no surprise that a recent Gallup poll found that more than twice as many Americans say that ObamaCare has hurt them or their families compared to the number it has helped. It might be a surprise that most (63%) say it has made little difference but that is only a matter of time. Most people get their insurance via their employer and that part of ObamaCare has been delayed and delayed – for political reasons.

As the New York Times reported, “[The recent change] is designed to provide political cover for Democratic senators facing tough re-election campaigns.” The law as written would have had millions more cancellation notices going out a month or two before Election Day. So with a stroke of his pen, without any authority granted to him, Obama decided to change the law so that the cancellation notices would go out AFTER the election.

The Wall Street Journal notes that “if [ObamaCare] were really working the way it should, senators who voted for it wouldn’t be running away from it, and the administration wouldn’t be forced to choose between enforcing its provisions and protecting the Democratic majority.”

As much as nervous politicians are shying away from ObamaCare, so also are the uninsured. The Washington Post reports that “The new health insurance marketplaces appear to be making little headway in signing up Americans who lack insurance, the Affordable Care Act’s central goal, according to a pair of new surveys. Only one in 10 uninsured people who qualify for private plans through the new marketplaces enrolled as of last month.”

The first step in fixing a problem is recognizing that there is a problem. NH Democratic leadership seems oblivious to any problems with ObamaCare, jobs, and the economy. NH Republicans know that there are problems and that we can help solve those problems. The guiding principle is that people should be able to choose what they want, not what some politicians in Washington tell them they should want.

Poll: jobs, economy, government most important problems

From Gallup:

Three issues — jobs, economy, and government — have been at the top of the “most important problem” list since the beginning of the year.

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Americans are about equally likely to name unemployment and dissatisfaction with government as the most important problems facing the U.S., with the economy in general following closely behind. These issues have ranked at the top of the most important problem list since the beginning of 2014.

Nearly one in five Americans still cite government itself as the nation’s top problem.

Independents name as their top four problems:
  • Dissatisfaction with government
  • Jobs
  • Economy in general
  • Poor healthcare

See the full poll here.

Simple invention can save thousands of lives

Hospitals are dangerous places. Some 75,000 patients die each year of hospital-acquired infections. Now two Canadian doctors have stumbled on a solution that could save 10,000 lives a year – and that is just in Canada. Worldwide, it could save hundreds of thousands of lives.

The doctors discovered that a mixture of ozone and peroxide can kill 100% of the bacteria in a hospital room. They have built a gadget that spreads the bug-killing mist through a room. It is the first product ever that completely cleans a room tainted with drug-resistant bacteria.

A hospital in Belleville, Ont. used it on a contaminated ward and seven months later not a single patient has been infected by MRSA, a bacteria that kills about 2,200 patients in Canada every year.

 

Real health care reform (not ObamaCare)

“Learn from the mistakes of others. You can never live long enough to make them all yourself.” — Groucho Marx

It’s no laughing matter – well, actually it is. The late night comedians have found lots to laugh about in what otherwise would be a tragedy. ObamaCare that is.

Most of us have heard the horror stories about the so-called “Affordable” Care Act. The least of the problems is the web site that doesn’t work. Much worse is the huge increase, sometimes even doubling or tripling, of premiums and deductibles for many people. Perhaps worst are the millions of people who have suffered cancellation of the health plans they liked.

ObamaCare is a disaster. This year when the employer mandate takes effect, tens of millions more people are likely to find that the plans they like are canceled to comply with the dictates of big government. But there is hope. Real health care reform is coming – not from politicians, but from doctors.

One surgeon wrote in the Wall Street Journal about a patient who needed a fairly simple operation. His bare-bones insurance would easily cover the cost of the surgeon, the anesthesiologist, and, they thought, for the operating room, nurses, etc. But when the patient went to check in, the hospital wanted an additional $20,000 from him above and beyond what the insurance would pay.

The patient canceled the operation and returned to the surgeon. Dr. Singer told his patient an open secret: that hospitals and other providers will usually negotiate a much lower cash price for people who don’t use insurance. The doctors are happy to take a lower fee now instead of paying office staff to wade through the insurance paperwork for reimbursement much later.

Dr. Singer made a few phone calls; the anesthesiologist accepted an upfront cash price, a different hospital charged a reasonable fee for its services. The patient had the operation the next day with a total out-of-pocket charge of a bit over $3,000. He saved $17,000 by not using his insurance.

Most people don’t shop around like this because they have no incentive to do so – their insurance picks up almost all of the bill. But with insurance deductibles becoming higher and higher, more people are beginning to shop around. That’s not easy to do because most hospitals keep their prices a secret.

One hospital that is very public about its prices is the Surgery Center of Oklahoma, a for-profit facility that offers first-rate care at low prices. About five years ago, they posted their price list for more than 100 common procedures. And those prices can be as low as one-tenth the prices at other hospitals.

Compare the cost of a “complex bilateral sinus procedure” performed at a nearby non-profit hospital, to the cost performed by the same surgeon at the Surgery Center. The other hospital charged $33,505, not including the surgeon’s or anesthesiologist’s fees. The Surgery Center charged just $5,885 total for the entire procedure.

The other hospital delivered a four-page bill with detailed cost items for such things as $360 for a steroid that wholesales for 75 cents, and a total of $630 for three pills that cost about $1.50. The Center’s bill was a single line with every cost item included in the published fixed price.

The Surgery Center is able to keep its prices so low partly because it takes cash upfront; it does not accept insurance. But what about people who can’t afford several thousand dollars for an operation? In many cases, the Center’s total price is less than just the co-pay and deductible would be at another hospital.

The Surgery Center pays “tons of attention” to making systems more efficient. One surgeon reports that he can perform twice as many surgeries per day at the Center because it operates so efficiently. At the other hospital, he spends half of his time waiting around for the patient to arrive and then for the equipment to arrive.

As one measure of efficiency, the Center has no administrative employees. At the other hospital, the eighteen top administrators are paid an average of $413,000. At the Center, all of the staff except a small clerical staff are involved with patient care. The head nurse does double duty as chief of human resources and building maintenance.

The Surgery Center of Oklahoma might have been the first to provide transparent pricing but they are far from the only ones. One commentator described the movement toward transparent pricing as a “fever pitch … pretty soon [all providers] will be fully transparent.”

The effect of published cash-upfront pricing is nationwide and even international. Canadians who could get “free” treatment at home are flying to Oklahoma to save months or even years on waiting lists. Other patients are taking a firm price quote from the Surgery Center along with an airline ticket for Oklahoma City, and are challenging the local hospital to charge a competitive price.

Much lower prices, higher quality, whether it is Direct Primary Care or surgery, physicians are producing real reform, effective reform. Politicians think reform means forcing more people to buy insurance they don’t like. Doctors know that real reform is to get insurance out of the way, to let nothing come between doctor and patient. My money is on the doctors.

Health Insurance is not Health Care

Tammy Bruce opines that ObamaCare is not just a train wreck, because after all, once a train wreck is over, it is over. It doesn’t keep on going. No, ObamaCare is more like a cancer, growing and destroying everything.

A California man bought insurance on the ObamaCare exchange, then called a doctor for an appointment. He called every single doctor who was listed as being in-network, but none of them actually was.

In the normal world, this would be called “fraud.” In Obama’s America, it’s called a “snag,” and on a national scale, the Obama regime labels it “Shut up, Fox News!”

After all, isn’t the goal getting everyone insured? Who cares if you can’t actually see a doctor or get health care, because everyone will get a terrific piece of paper that says “health insurance policy.” Equality, at last — everyone’s got the same thing; namely, nothing at all.

A woman cancer patient enrolled in ObamaCare, then went to see her oncologist, only to be greeted by a sign at the door announcing that they did not accept any of the ObamaCare plans. She says that she is, “a complete fan of the Affordable Care Act, but now I can’t sleep at night.”

When the Congressional Budget Office forecast that ObamaCare would cause 2.5 million people to lose their jobs, the White House responded that those people were just a “small percentage of the economy.”

Back here in New Hampshire, Jeanne Shaheen and Carol-Shea Porter say that they would vote for ObamaCare all over again if they could. Whose side are they on?

Medicaid is a cruel program

“If we wish to be compassionate with our fellow man, we must learn to engage in dispassionate analysis. In other Walter E. Williams

Would you believe that many politicians over-promise and under-deliver? They promise you that a new law will fix some terrible problem, but usually it does not fix the problem, and often it makes the problem worse.

Too many politicians look only at the stated goals of a program. They believe so much in the goals that they refuse to believe any harm could result. They don’t look beneath the surface for possible unintended consequences. Even when other people do find bad side-effects in the bill, the true believers ignore the potential problems.

Thus is the case with expanded Medicaid. The same politicians who thought ObamaCare was a good idea and promised us that “If you like your health insurance, you can keep your health insurance”, those same politicians now tell us that expanding Medicaid is a good idea.

Sadly, Medicaid is a cruel program that hurts the very people it’s meant to serve. One commentator wrote: “Imagine a government-run health care program in which medical access is severely limited, that is racked by uncontrollably rising costs, and that in many instances results in demonstrably worse health outcomes than having no insurance at all. Such a program isn’t a mere hypothetical; it already exists, and it’s called Medicaid.”

More and more doctors are refusing to accept Medicaid because the system doesn’t pay enough to cover their expenses. Would-be patients spend hours on the phone trying to find someone willing to treat them. If they do succeed in finding a doctor, the appointment is, on average, three weeks later than someone with private insurance.

And it gets worse…, multiple studies have shown that Medicaid patients are more likely to die from surgery than privately insured patients and sometimes even more likely to die than uninsured patients. A Univ. of Pennsylvania study of colon cancer found that the mortality rate for Medicaid patients was 27% higher than for uninsured patients. A Florida study found that Medicaid patients were more likely than uninsured patients to have late-stage prostate cancer, breast cancer, or melanoma.

On broader measures of health, the Oregon Medicaid health experiment found no significant difference between Medicaid patients and uninsured patients in objectively measured physical health outcomes. Put simply, Medicaid did not make patients any healthier, though it did make them feel more financially secure.

Expanded Medicaid has been tried and has failed. The state of Maine expanded their Medicaid program ten years ago. Every predicted benefit failed. Politicians said it would reduce the number of uninsured. Wrong. Politicians said it would reduce emergency room visits. Wrong. Politicians said it would relieve uncompensated care. Wrong. The only significant change was that thousands of Mainers switched from private insurance to Medicaid.

There was one absurd result from Maine’s Medicaid expansion: Since the eligibility rules differ for expanded Medicaid and regular Medicaid, 10,000 able-bodied, childless adults received benefits while 3,000 elderly and disabled were put on a waiting list.

A pernicious aspect of Medicaid is that it traps people on the edge of poverty. The eligibility rules make it very difficult for someone to escape poverty and move up the ladder of success. A young person entering the workforce, earning $14,856 gets free health care. But if he or she earns just one dollar more, then that same young person not only loses the free coverage, but becomes obligated to purchase coverage or else face a penalty. This is a terrible incentive that encourages people to stay poor.

Isn’t it a good thing to learn more skills, get a better job, work more overtime, earn more money, save toward the future? Medicaid and similar entitlement programs punish people who try to better themselves and become self-sufficient, not dependent on government. Why should we encourage people to be involved in such a terrible system?

Proponents of expanded Medicaid rarely, if ever, discuss the adverse health outcomes for people on Medicaid. They never talk about the perverse incentives that can keep someone trapped in near-poverty forever.

What proponents mostly talk about is getting “free” money from the federal government. It is as if the poor are mere pawns for collecting more money. But does anyone really believe that the money is “free”? The federal government is running gigantic deficits. It has borrowed trillions and trillions of dollars. Our children, grandchildren, and their grandchildren will be stuck paying off this debt.

And the money isn’t free even in the short term. The feds talk about paying 100% of the cost for two years, but can we really believe that promise? And the federal budget negotiators are already talking about reducing the 100% promise because the costs keep going higher and higher and higher.

Many opponents of expanding Medicaid worry that the ever-increasing costs to NH taxpayers will lead us inevitably toward a sales or income tax.

The ObamaCare Medicaid expansion is bad for the people it claims to help, bad for the taxpayers, and bad for the future of New Hampshire. We should fix the broken system, not expand it.

Could people regrow lost limbs?

Many species can regrow limbs or even more. A flatworm can grow a replacement head and brain. A Mexican salamander can regenerate everything even its spinal cord. And young humans can grow back a sliver of a fingertip.
Michael Levin thinks that humans someday will be able to regrow limbs. Levin is director of the Center for Regenerative and Developmental Biology at Tufts University. His research specialty is bioelectricity and he has had some amazing results in developmental biology.
The work of his team has so far been with amphibians such as tadpoles. This spring they will start working with mice. If the techniques work on mammals, the research may someday turn into drugs and medical devices that let humans regenerate limbs, eyes, etc.
H/t Instapundit.com

Real health care reform

Forget the disaster of ObamaCare. Real health care reform is coming from doctors around the country. They are providing better health care at lower cost. The better care is due to not letting an insurance company come between doctor and patient. The lower cost ditto.

More and more doctors are refusing to accept insurance, including Medicare or Medicaid. That lets them do what they think is right for their patients, not just what an insurance company (or government agency) will allow. These doctors refuse to sign contracts requiring them to spend no more than 7 1/2 minutes per patient. They now spend more time per patient, not just solving a current problem but teaching patients how to be healthier. These doctors don’t have to phone an insurance company to determine if a certain treatment or medicine is covered. They prescribe what they think is best for the patient.

The result for Dr. Brian Forrest: “We are in the top 5% nationally for control of hypertension, lipids, diabetes, and hospitalization rates based on an independent ongoing 3rd-party audit of our charts, which resulted in our being designated as one of 33 Cardiovascular Centers of Excellence in the US.”

A Direct Primary Care (DPC) practice has much less overhead than a traditional (insurance-based) practice. A traditional practice has 4.5 employees “primarily dedicated to billing, coding, and working with payers to get reimbursement rather than actual patient care.” By not having to process insurance paperwork, Dr. Forrest was able to reduce his overhead by 80%, cut his prices, and spend more time with patients.

Dr. Forrest charges less than traditional practices. “Occasionally, his charges wind up being less than just the co-pays for Medicare or private insurance. He’s negotiated deals with a lab company to reduce his patients’ costs for tests. The lab loves being paid on the spot for services rendered and allows Forrest to charge his patients $30, for example, for a prostate-cancer screening test that the company bills to an insurer at $184. He’s found other doctors happy to join in, such as a cardiologist who’s willing to give discounts of 80 to 90 percent to his patients if he’s paid cash up front.”

But how can his patients afford to pay him without insurance? One might turn that around and ask how can insured people afford to pay high premiums, high deductibles, and high doctor’s bills? Half of Dr. Forrest’s patients do not have insurance. Eliminating overhead allows him to charge lower than all doctors who do accept insurance.

Better quality, lower costs, and improved access – isn’t that what everyone wants in health care reform?

via Daniel J. Mitchell, The Way Healthcare Should Function

Who should make decisions for you?

“Politics is the art of looking for trouble, finding it whether it exists or not, diagnosing it incorrectly, and applying the wrong remedy.” — Ernest Benn

There was a time when there were “company towns”. The company owned all the land, all the buildings. The company provided food and housing; the company doctor provided health care; the bar and general store were company-owned. The employer made all decisions about food, housing, clothing, liquor, etc. Employees had no other choices because the nearest town might be a day’s ride away.

With one major exception, employers no longer decide for us what we will consume. Our employers pay us cash then we go out and buy food, clothing, housing, cars, entertainment, vacations, college educations, etc. We each make our own decisions, not our employers. The one exception is health insurance. In most businesses, the employer chooses our health insurance and we have very little, if any, say about the insurance.

But why? Why should our employer decide what health insurance is best for each of us? Our employers don’t choose the best auto insurance, fire insurance, or life insurance for us. Why should they choose the best health insurance for us? Wouldn’t it be simpler just to take the cash they are sending to an insurance company, give it to each employee, and let each of us decide what is better for us?

If you think it is a good idea for your employer to buy health insurance for you, would you also like your company to buy your food, clothing, housing, and automobile for you? After all, by buying in bulk the company should be able to get a better price on all of your family’s clothes. Isn’t that a good reason for the company to make decisions for you? No, I didn’t think so.

But, you say, it’s “always” been that way; most people get their insurance from their employer. If it ain’t broke why fix it? Well, it is broke. Employer-paid insurance is a major cause of problems with our health care payment system. (Our health care system is excellent; our payment system is terrible.)

Employer-paid insurance is not portable from one job to another job. If you switch jobs, you lose your old insurance and have to get new insurance, probably with a whole different set of conditions. Same problem if you are laid off or the company goes out of business. Contrast this with your home, auto, or life insurance. You pay for those. It doesn’t matter if you switch jobs or lose your job. You don’t lose your insurance.

The problem of pre-existing conditions largely disappears when you own your own health insurance policy. With self-paid policies you might keep the same insurance for years no matter how many times you switch jobs. With employer-paid policies you get a new policy every time you have a change of jobs. If you develop a medical condition after you have had a policy for just a few months, the insurance company can say, “That condition existed before you signed up for this policy, so it is not covered.” But if you have had the policy for years, then the condition started on their watch and they must cover it.

Employer-based insurance suffers from the one-size-fits-all problem. What is right for one employee might be not at all right for another employee, but at most companies they both get the same insurance. If employers simply paid the employees directly whatever amount they were paying the insurance companies, then each employee could choose the kind of policy that is best for him and his family.

Now consider the not uncommon case of both spouses working and both receiving employee-paid health insurance. One of those insurance policies is useless, a waste of money. If something happens they can’t file claims under both policies. If instead, their employers paid them cash, they would buy just one policy; they might take the extra cash and put it into an HSA account.

If you have employer-paid insurance, you probably have no idea what the cost of that insurance is. Your employer pays the cost and doesn’t tell you what it was. When you don’t know the price of something, it is hard to be a smart consumer. It is even harder when you won’t benefit from any cost savings that you undertake.

If you buy your own insurance using money that your employer would have paid to buy his choice of insurance, then you can often greatly reduce total health care costs by shopping around. The Wall Street Journal reported on one surgeon who managed to reduce his patient’s out-of-pocket cost from $20,000 down to $3,000 with a few simple phone calls to an anesthesiologist and nearby hospitals.

So with all of its disadvantages, why do so many of us have employer-paid insurance? It is due to ill-thought out tax policy that gives an incentive for employers to buy insurance instead of paying that same money to employees and letting them buy insurance. (Did you think that politicians and bureaucrats never made bad decisions?) ObamaCare only exacerbates that same bad policy.

Real health care payment reform would give to individuals the same incentive given to businesses to buy health insurance.

The joys of government-run health care

Canadian Rose Oxford needed cataract surgery. The good news is that it would have been free. The bad news is that she may go blind before she finally gets the surgery.

Her October appointment was cancelled because the hospital exceeded its quota of surgeries; it was 200 procedures over budget. She now has a standby date in December, more than two months after her ophthalmologist detected the problem.

 

NY doctors avoiding ObamaCare like the plague

44% of New York MDs refuse to participate in ObamaCare; 33% are unsure whether they will or not. Of the 23% who are participating, three-quarters said it was because they were contractually obligated, leaving a mere 6% who actually want to join in ObamaCare. Those are some of the results of a poll reported in the NY Post.

Even more telling are some of the doctors’ comments.

  • “This is so poorly designed that a lot of doctors are afraid to participate.”
  • “I plan to retire if this disaster is implemented. This is a train wreck.”
  •  “The solution is simple: Just say no.”
  • “I am seriously considering opting out of all insurance plans including Medicare because of [ObamaCare].”
  • “OBAMACARE is a disaster. I have already seen denial of medication, denial of referrals,”
  • “I get screwed from insurance companies already. I refuse to get screwed any longer.”

The politicians can force companies to provide insurance for their employees; they can force individuals to buy insurance. But they cannot force doctors to provide actual health care.

 

Eliminating the Middleman

Everything that is really great and inspiring is created by the individual who can labor in freedom. — Albert Einstein

Lower costs, improved outcomes, better consumer experience – isn’t that what we would all like in health care? That’s not just a dream – it is the actual result of a growing number of physicians you might label “Do-it-yourself Health Reformers”. They haven’t been waiting around for politicians to fix the broken health care payment system; they have been implementing new models for the practice of health care.

Improved outcomes? How about 91% of patients achieving their target blood pressure within 6 months? (Compared to a national average of less than 50% of patients.) How about being named one of only four Cardiovascular Centers of Excellence in the state?

These physicians focus on keeping patients healthy and out of the expensive parts of the health care system, such as specialist offices, emergency departments, and hospitals. ER visits are down 62%, specialist referrals are down 55%, advanced radiology down by 48% and surgeries down by 73%.

The net result of better primary care was a savings of 20% to 30% in overall health care costs. Customers of this new model of health care delivery provided their employees a better health benefit and also saved 20% compared to what they had been paying. How often do you hear about health care costs actually going down?

Or consider this case. A diabetic woman had been spending $5,000 per year on medical care. When she switched doctors, her new doctor reported that “When she arrived her HGBA1C was 11.9 – meaning very poorly controlled. One year later her A1C was 6.8 (well controlled) and she had only spent about $450 for an entire year of care with us – including the annual physical, all of her follow-up visits, all of her lab work and ancillaries.”

So how do these doctors deliver better health care at lower cost? The answer is surprisingly simple: They eliminate the middle man between doctor and patient, i.e. the insurance company or government (Medicaid or Medicare). Removing the bureaucracy from the mix cuts 40% of fat out of the process. Not just money, it saves paperwork and frustration, leaving more time for the doctor and patient.

A traditional primary care practice has a large staff just to deal with the paperwork. The national average is 3.9 non-medical staff members per doctor or nurse. A typical Direct Primary Care (DPC) practice has just one staff member for two doctors. Some have zero staff. This reduction in overhead allows a DPC physician to charge much lower fees yet still spend more time with each patient.

Many DPC practices provide lab services in-house, further reducing costs and providing better service to their patients. Most negotiate with lab companies. The lab companies offer huge discounts for avoiding the time and hassle of billing insurance companies or the government. One DPC physician reported that he could get a cholesterol test for $3 versus the $90 the lab would have billed an insurance company. An MRI was $400 compared to a typical rate of $2,000.

In addition to primary care, most DPC offices also provide urgent care such as stitches or casts, handling many of the same problems as an emergency room. They provide treatment for about 80% of health care needs.

Most DPC providers operate on a mixture of monthly membership fee, typically $75 per month, and per visit charges. Members receive an annual exam, a discount on fees, and access by phone or email. About a third of the patients are uninsured, some because they cannot afford insurance premiums, others due to preexisting conditions such as diabetes. Ironically, uninsured patients at a DPC practice receive better service than insured patients at a traditional practice.

Insurance is a terribly inefficient way to pay for most health care. Primary care, even including occasional urgent care, is relatively affordable – much more affordable than the insurance premiums. It is more economical to pay the doctor and nurse, than it is to pay the doctor and nurse, and pay their non-medical staff to process paperwork, also pay the insurance company staff to process paperwork, and also pay the insurance company profits.

The most sensible way to pay for health care is with a high-deductible catastrophic policy that we hope we never need to use, put the huge savings in premium cost into a Health Savings Account (HSA), then pay a DPC physician via a debit card from the HSA. There is much, much less overhead, the DPC practice spends more time keeping patients healthy, resulting in lower costs for specialists, surgery, or hospital care.

What doctors enjoy is interacting with patients, solving problems, helping their patients stay healthy. What they hate is paperwork, overhead, and a bureaucracy pushing them to spend less time with patients. They are so frustrated by middleman-governed health care that 9 out of 10 are unwilling to recommend health care as a profession.

DPC eliminates the paperwork, overhead and bureaucracy, leaving doctors happily working to improve their patients’ health. These doctors say “I am finally back to practicing medicine the way I was trained.” And that is the major reason that surveys show that 16% of primary care physicians plan to move to DPC or other retainer-based practice.

Starvation, dehydration – marvels of government-run health care

Nearly 1200 people died of starvation in Britain’s National Health Service (NHS) hospitals because “nurses are too busy to feed patients”. Four times as many suffered from dehydration. One patient was left unwashed for 11 weeks. “Patients were left begging for water.”

Similar reports:

And yet, with all the incompetence on display in our federal government, there are still some true believers who think the government should run all health care.

 

Down in Concord

“Politicians are interested in people. Not that this is always a virtue. Fleas are interested in dogs.” — P.J. O’Rourke

Every so often someone writes yet another column asking “Why can’t Republicans and Democrats get along? Can’t they talk to each other, work together, find a compromise?” The short answer is “We do, most of the time.” A second answer is “There are times when we should not.”

The simple truth is that NH legislators do work together, are very civil to each other (with rare, though well publicized, exceptions), and often become life-long friends. Anyone who says otherwise either has not observed first hand how the legislature works or is trying to make a political point. All too often, it is a mixture of both. Someone starts a narrative about the mean old nasty so and so party, repeats it over and over again, then people with no first hand knowledge come to believe it. (After all, politicians never lie.)

Let’s start with some anecdotal evidence, then some numbers. Earlier this year I went down to Concord to testify against a bill. It happened that one of my former colleagues, a very left Democrat, also testified against that same bill and he happened to go first. Later, when I testified, I remarked that this was the first time in two years that he and I had agreed on a bill. Later, we met out in the hall and laughed together. We encouraged each other to convince other members of our two parties. (The bill was eventually defeated with a bipartisan vote.)

Last session, a hard left Democrat and a hard right Republican worked closely together on a particular bill. Coincidentally, the two were geographically on the far left and far right sides of the state. They both worked very hard to pass their bill; they managed one of the rare instances of overturning a committee recommendation on the House floor. I was happy to work with both of them on that bill. Later the two of them worked together on another bill.

Now let’s look at some numbers. This year the House and Senate passed 281 bills. A full 188 of those bills, were passed by the House on the Consent Calendar. For those who may not have read my previous columns, suffice it to say that bills on Consent have all but unanimous support. Two-thirds of all the bills that were passed, were unanimous. (And of the bills that were killed, many, perhaps most, were also unanimous.)

So any time you hear complaints about legislators being mean and nasty to each other, not working together, please realize that it is almost always someone trying to stir up trouble for partisan advantage. The truth is that they DO work together, usually in a collegial, respectful atmosphere.

But there are times when they should not compromise. Suppose a Democrat and a Republican decide to drive down to New York City. For those who are geographically impaired, NYC is mostly South and a little West of us. Now let’s suppose that the two politicians approach an intersection. The Democrat wants to turn left and head North; the Republican wants to turn right and head South. Should they compromise and head East?

On some issues the division is just as stark as the choice between driving North or South – it makes no sense to compromise on East.

Republicans, generally speaking, want to cut taxes; Democrats want to increase taxes. This year Democrats pushed hard for an increase in the gas tax of 15 cents. They later offered a compromise of 12 cents. Why should Republicans compromise on any increase at all, when what we really want is to reduce taxes?

Democrats for the most part want bigger, more powerful government. Republicans want smaller, limited government. How can the two sides compromise when they are such opposites? (Historically, Republicans have compromised on a little bigger here, a little bigger there – which is one reason many people think there is little difference between the two parties.)

Affordable health care is a nice goal. The two parties have opposite solutions. Democrats thought the solution was to write a 2,000+ page bill, write tens of thousands of pages of regulations, hire 10,000 IRS agents. Now even many of the original supporters realize that Obamacare is a train wreck in progress.

Republicans know that the solution to more affordable, higher quality health care is a free market, with many providers competing to find the best solution at the best price. This approach has proven to work and is working today in those places where government regulations allow it.

Some Democrats call for compromise on so-called “gun safety.” What they fail to understand is that the criminals don’t obey the existing 10,000 laws and won’t obey one additional gun law. Republicans understand that the only thing that stops a bad guy with a gun is a good guy with a gun. Republicans believe that self-defense is a fundamental right, that a woman has the right to choose whether to carry a handgun to protect herself against a rapist. Would Democrats compromise and allow any woman for her safety and the safety of her children to carry a concealed weapon without a permit?

Democrats and Republicans do compromise on a large majority of bills, but on some issues they cannot and should not compromise.