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Thursday, July 02, 2009

Americans Need to Know: It's Likely Your Health Care Is Already Governnment Run- Any Complaints?

If you're an American with health insurance, it's about a 40 percent chance you are enrolled in a government benefit plan. Beneficiaries of Medicaid, Medicare, Tricare, Veterans Health Care, Government Service (GS) workers like the US post office employees or other federal positions, the United States Congress, the executive and judicial branches of government, workers at the Centers for Disease Control, the Public Health Department and the National Institutes for Health (NIH), the disabled on Supplemental Security Income (SSI), people on kidney dialysis, and Native Americans living on reservations are part of the government run health care system.

Are these millions of beneficiaries complaining about their choice of provider, or the cost, quality and/or access to care in their health coverage? Of course not.

It seems to me, President Clinton and now President Obama missed their communications messages when they failed to point out how much of our US health care is already federally managed - which includes the management of the cost of care. Rather than consumers, it's actually providers and insurers who are terrified of a government run health care system. Why? Because the government can use the volume of services it purchases as leverage against costs. In other words, the more health care the government buys, the greater the influence over reducing the cost.

Physicians point out that Medicare reimbursement does not cover their costs. Nevertheless, most physicians continue to care for Medicare patients. Why? Because of simple multiplication. Although each patent's bill does not cover the cost of the care provided, the number of patients seen in a day multiplied by the payment for the total number visits in a day can generate a small profit margin in a well managed and efficient physician's office. Consequently, Medicare is parsimonious when looking at increasing physician reimbursement because the economies of scale compensates for the low per unit cost paid for a visit.

This is one example of how the government keeps costs under control.

There is no perfect health care system. A single payer system can easily become inefficient for lack of competitive controls. For example, if all health care is paid for by one source, i.e., the government, then providers in highly efficient systems risk being financially burdened by the less efficient systems receiving the very same reimbursement from the single payer. There must be incentives to providers who provide efficient care with demonstrated quality outcomes.

A universal health care plan offered by competitive insurers is a good idea if people can also choose a public option; but the cost of receiving a benefit plan must include the requirement for insurers to take high risk clients with expensive pre-existing conditions. On the other hand, if these high risk-high cost patients are offered the public plan as an alternative, then the tax payers will be paying for their expensive care. Nevertheless, this already happens with kidney dialysis patients. Insurance companies pay very little for kidney dialysis because these high cost patients are, generally, automatically eligible for Medicare regardless of their age. Do you think private insurance plans supported this humane rule for kidney dialysis patients to opt for a Medicare plan? You bet they did! They put the high cost-high risk patients clearly on the government health care benefit.

Health care reform is already costly. The scary figure of $1 trillion dollars to fund health care reform, recently calculated by the GAO, neglected to mention how this money is already being spent. It's spent in the cost of caring for the uninsured and charity care. Moreover, it's also spent in the profits private insurance companies make by taking your premiums and not paying for the care you received until months after you obtained services. How many hospital patients continue to receive bills months and years after being discharged from care? Lots. Where is this money you paid in premiums which is not going to the hospitals? It's in the insurance companies profit/loss reports, written in black ink.

Americans and our policy makers must get to the issue of health care as a right rather than a privilege. Of course, this raises another set of ethical issues not relative to this commentary.

Meanwhile, when it comes to the cost of a government run health care system, just look around you. Tag! It's quite likely you are it.