Health Care Reform Becomes Insurance Mandate

After all the hullabaloo about public options, socialized medicine, death panels, and employer mandates, yada yada, it all comes down to this, judging by the bill the U.S. Senate is poised to pass:

You must buy health insurance or go to jail. Or pay a fine. Or get a government subsidy. Or thumb your nose and see what happens (probably nothing).

WINNERS: Insurance companies.

LOSERS: Just about everyone, as this will no doubt raise premiums sky high even as services are reduced to cover new, unserviceable demand.

PREDICTION: If Obama and the Democrats survive in power after 2012, look for the public option to come back in full force as they once again demonize the insurance companies, when in truth it's Medicare and Medicaid that are driving the system bankrupt and unaffordable.

What the Public Option Will Mean to Your Wallet

If the Democrats succeed in creating their "robust public option" of health insurance for those who currently don't have any insurance, there will be blood. Well, maybe not actual blood, but the color of blood--red--all over the budgets of people and entities from coast to coast.

Consider this:

A study by the actuarial firm Milliman calculated that public programs, such as Medicare and Medicaid, currently shift $88.8 billion in costs onto private payers per year, increasing the typical American family's annual private health insurance premium by $1,512. Can you imagine the cost shift if 103.4 million more Americans were on a government plan?

Pretty frightening, huh? And since the "public option" will be just as underfunded as Medicare/Medicaid, you can chalk up another $37 trillion in unfunded liabilities over the next 50 years or so.

But the Democrats will forever be able to charge at election time that "the Republicans will take away your health care" and thus presumably win votes.

However, since they'll also have to ration and deny health care just to be able to pay 80 percent of what private insurers do (in order to make the public option "affordable"), taking away one's health care won't amount to a whole lot. You won't be able to get any medical services anyway, so what will there be to take away?

Painting 'The Doctor' Far From Today's Reality

Sir Luke Fildes lost his eldest son Phillip on Christmas Eve 1877 while a doctor spent a compassionate vigil at the child's side. In commemoration, Sir Fildes painted "The Doctor" (above) in 1891 to depict "the physician in our time."

This same painting was used by the American Medical Association (AMA) in 1949 to stop President Harry Truman in his attempt to nationalize health care. The message was "Keep Politics Out of This Picture."

The AMA can't use this picture or tactic this time around. Things have changed too much.

Some of us who've lived long enough can actually recall how doctors once did make house calls and could even be reached on weekends and evenings for emergencies. (Today, you get a voice recording commanding you to "Dial 911.")

To say the least, we've come a long way in our medical care, and in one sense Obama is correct--the system is broken if you're looking for compassion and home visitations.

But it's not really broken, just adapted to a new reality. We're now a nation of 300 million people with nowhere nearly enough doctors to even treat all of us, let alone make house calls (though some still do and swear by it).

Medical care is now like visiting an auto mechanic. "Doc, it hurts here." "Let me take a look." A few small probes and examinations later, and the doctor is ready. "Fortunately, nothing is broken. I'll prescribe you some painkillers. You should be fine in a few days."

Okay, so I've simplified things here a bit (I left out the two sets of x-rays and follow-up MRIs), but the general picture of "sick care" in America is just that. It's like taking your car into the shop, except it's your body--and your life.

Paucity of time and doctors can account for our new reality, but the biggest contributing factor to what Obama calls our "broken" health care system is Medicare and Medicaid.

Since most doctors won't accept the payment structure of Medicaid, leaving that to emergency rooms, your family doctor is modelling his or her practice on the Medicare payment structure--the more procedures he or she can perform, the more the office can bill for your visit. ("I also notice your car's belts are getting worn. We'd better replace those for $125 before you get stuck on the freeway." Get the analogy?)

So, the next time you hear politicians' bemoaning our "broken" health care system, remember it's only broken because Medicare made it into an assembly-line industry, with each nut, bolt, worker, and procedure along the line being billed for and paid separately.

This is the typical pattern with government: First break it, then blame it on others and come rushing to the rescue to garner votes for the next election, reality be damned.

Politicians just created the housing and credit crises by pushing banks to create "affordable housing." Now they're blaming the bankers and everyone one else in the Fannie Mae/Freddie Mac food chain and claiming to have the solution with "more regulation."

If they really wanted to "fix" health care, all they have to do is fully fund Medicare and come up with a payment structure that rewards healthful results rather than procedures. That'll stop the cost-shifting to private insurers and build some efficiencies into the system.

Instead, they'll give us more regulation (read "rationing") and expand Medicare, the very cause of the crisis in the first place.

Health Care Reform: Ending Hospital Readmissions

You have to really dig hard to find out what the government is doing to make health care "affordable," one of the goals everyone from Barack Obama on down cites in undertaking health care reform.

But I bet you didn't know that Medicare wants to end hospital readmissions, especially in the 30 days after the first hospitalization. CMS, the Centers for Medicare and Medicaid Services, is looking at various carrots and sticks to bring down the 18-percent average rate of readmissions in the first 30 days. Lowering readmissions by 75 percent would save $12 billion a year, CMS claims.

Carrots include paying bonuses to hospitals that cut their readmission rates, and sticks include reducing or denying payment for certain readmissions deemed to be the hospital's fault.

Now, all this gets scary if you read my posting from yesterday about how hospitals in Great Britain removed wheels from gurneys so they could call them hospital beds and avoid looking like their emergency rooms were clogged and inefficient.

I'm trying to think of clever ways hospitals here could bring down the readmissions rate. One doctor I read even suggested just keeping everyone in the hospital for 30 days.

Perhaps hospitals could create a readmissions clinic and call being there something other than an admission. I've got it--put patients in gurneys in the ER so you don't have to say they've been "admitted" or "readmitted" to the hospital! What was Britain's curse could be our hospitals' savior.

Anyway, on a more serious note, hospitals have had some success by assigning coaches to each patient leaving the hospital. Coaches keep in touch with the patients--and even visit them at home--to make sure they take their medications properly and follow all parts of the regimen assigned them, including diet, rest and exercise.

With my cynical mind, however, I can still see hospitals coming up with some way around the rule, just like their cohorts in Great Britain did.