70% of Americans have little faith in the federal government. 71% want the government to spend a lot of effort in reducing the deficit.
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
“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.
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.
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.
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.
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.”
- patient left screaming in pain when his ribs were broken during a botched attempt to hoist him
- patients having their food taken away before they can finish
- patients lie in their own excrement
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.