Editor’s Column – November 2009

The Charlie Smith award banquet will have happened by the time you read this. But I have a problem; it […]

scott-adams-nov-2009The Charlie Smith award banquet will have happened by the time you read this. But I have a problem; it hasn’t happened before I’m writing this. So I can’t offer you any solid information about how the celebration went, but I feel confident it was excellent. I know that we had more RSVPs than we’ve ever had. We had our first silent auction; and we had a new and bigger location. I hope that by the time you read this, you joined us, and we all had a great time. Next month I’ll fill you in on all the fun details.

For decades, almost every state and national legislative session has introduced new bills to reform some portion of our health care system. But since the mid-1960s, when Medicare and Medicaid were introduced, there has been no substantial medical reform legislation approved at the federal level. During the Great Depression, with its severe challenges to our economy, we passed the Social Security Act, even with strong opposition from both liberals and conservatives. The economic situation we find ourselves in now, as difficult as it is, may be again a perfect time for some new comprehensive reform. And wouldn’t it be something if consumers who have saved money on medical care could have cash to add to our economic recovery?

While the drumbeat of opposition to health care reform keeps sounding the note of “increasing costs and deficits,” in fact there are lots of interesting ideas floating around on how to save money on our health care. I recently read a report, ” Administrative Waste in the U.S. Health Care System in 2003, by Himmelstein, Woolhandler and Wolfe. It argued that administrative costs associated with U.S. health care are generally estimated to be 15 to 25% of total expenditures. The authors suggest that if the U.S. were to adopt a single-payer system like Canada’s, administrative cost-savings alone would amount to nearly $300 billion per year-far more than any estimates of what it would cost to insure all uninsured people.

Even without a single-payer system, what if all the insurance companies would standardize their benefit packages, making it easier for consumers and employers to compare (and save) costs? That’s an obvious cost-reduction called for by Professor Kenneth Thorpe of Emory University. And what if all insurance companies had standard co-pays and deductibles, and a way of equitably assuming responsibility to insure people with pre-existing conditions? What if all the companies had to agree on what tests would be pre-approved, and what medications and durable goods would be standardized for approval? Couldn’t we save a lot by cutting out unnecessary multiple visits, but adding greater depth to the interactions among patients, doctors, hospitals and insurance companies? Of course, we all in the disability community have reason to be concerned when we hear talk about standardizing. But something has to change. We may have to consider the greater good along with what is best for each of us as individuals.

I’ll probably get in trouble from some of my doctor friends for suggesting this, but how about limiting unnecessary care and taking away the incentives for a physician to increase income by increasing the number of tests and procedures ordered? A real simple answer would be to put all physicians on a salary system; 30% of U.S. physicians are already on a salary. I know, I know what many will say: quality would erode! But would it? Or would the only casualty be greed and competition? On the physician’s side, there is no question that in any health care reform package, there will have to be some malpractice lawsuit reform as well. While we need to create a system that better serves all of us who need health care, we also need to have a system that lets physicians and nurses do their jobs to their best abilities, correctly and cost-effectively.

Our legislators have some tough decisions to make. The one thing I’m sure about is that I’m glad I’m not a politician. But I can’t be just a critical bystander, either. This may be the most important public policy debate of our lifetimes. Time to read, think, talk, write. Then do it all again.
I hope that all of our articles on the flu (H1N1) have played a part in keeping you healthy. Have a good month and let us know what you’re thinking.

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