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To reduce medical costs just say 'no'

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John Reiniers

More Than Words

Published: October 18, 2009

It isn't rationing. It's logic. We have to reduce medical costs. Proposed legislation has the cart before the horse. Expanding coverage will increase costs. We don't have the money. Those who will benefit from these proposed changes couldn't care less. Let somebody else pay for it.

Realistically, medical cost containment requires someone to say "no," whether the evil insurance company or the government (if government-run) or yourself, if you are the person paying for medical services.

Managed care does control costs. The first time I experienced a reduction in medical insurance rates, was when my group insurance rates went down in the 1980s, and then stayed flat for several years. Why? Our company shifted from fee for service to managed care. Their insurer took what they thought was fat out of the bills for as long as they could. They just wielded an ax and said "no." It can get ugly. I recall being in my doctor's office when they were in a huge fight with an insurance company representative. That success was short lived and only served to create more rancor between health care professionals and insurers, which continues today.

Another effective way to reduce costs is to have a government single-payer system - public option. They can accomplish medical cost containment by force of law, which insurers cannot do, but the process is still the same - regulators practice medicine and "ration" health care. They just say "no."

But the greatest medical cost control scheme has been around for centuries. That was when we, the consumer, had to pay for our own care out of our own pocket, assuming we had the funds or the credit. This morphed into employer-provided health care after World War II, and then Medicaid/Medicare in 1965. Our family has returned to the good old days with a Health Savings Account. It is not savings. It is self-taxation. The deductible is so high, we have to pay for health care out of pocket, which means rationing care for my wife and son. We are the guys who say "no."

Of these three approaches, the government single-payer system will likely be the end result over time. "Democracy" said Karl Marx, "is the road to socialism. We've been on that road since the New Deal. President Barack Obama recognizes that socialism is not a political system, but simply a way to distribute or redistribute money, goods and services. The same government that bailed out Wall Street (redistribution of your taxes to the wealthy), but not you or small business, can "distribute" health care services. The VA is an example of government-run health care.

Even if we are on the road to socialism, health care reform is moving too fast and being rolled out by a Congress that has had a decades-long reputation for never doing anything right . Investors Business Daily reports congressional job approval ratings at 21 percent on Oct. 6.

Appalling.

Congress has virtually ignored primary care physicians in their deliberations. No pun intended, but doctors know where the bodies are buried - expansion of costly diagnostics, waste etc. I have argued that change has to be driven by the doctors in the trenches, not the politicians and the AMA etc.

You go to a doctor for medical treatment - not your congressperson. They know who the abusers are among the health care providers, including hospitals and other doctors. They know who the patients are who over-utilize the system because a third party is footing the bill. Doctors will have to buy in to any solution for it to work, and right now they are unhappy.

Investors Business Daily also reports that two-thirds of doctors say they oppose the proposed government expansion plan. It is disturbing that four out of nine doctors said they would "consider leaving their practice or taking early retirement" if the Democratic majority prevails.

The Massachusetts universal health care experiment was supposed to reduce health care costs by 25 to 40 percent, but in reality premiums rose by 7.4 percent in 2007, 8 to 12 percent in 2008 and 9 percent this year, compared to a nationwide increase of 5.7 percent for the same years. So health insurance in Massachusetts now costs a family of four $16,897, well above the national average.

There are doctors in the U.S. who support government-run health care, and there are many who do not in countries with socialized insurance/medicine. Likewise, health care costs are now a challenge in all countries - no matter what health care system they have adopted. Why didn't the Congress appoint a nonpartisan fact-finding commission of professionals to interview other health care professionals and administrators in all countries with government-run systems?

One Canadian administrator spoke before the Economic Club in Toronto and said the Canadian system is not sustainable; that "We're in the midst of an aging population and there are newer and more expensive treatments," in 10 years, provinces will spend "70 cents out of every dollar" on health care with little left for education, infrastructure..."

That sounds like us.

The Web site Telegraph co.uk says that the British NHS "is failing patients despite record funding." One government official warns that "unless the situation improves dramatically the entire future of the NHS is in jeopardy ... The service could prove to be too expensive to sustain ..."

Switzerland provides another useful system for us to study. Health care costs are at 11.5 percent of their GDP, second only to the U.S., and it is market-oriented with 40 percent of the Swiss buying supplemental insurance, and a family of four paying $13,600 a year in premiums and an out-of-pocket of $1,350. Pricier than the U.S. Swiss insurance companies - which are for profit - have more clout than U.S. companies, which has made for unhappy Swiss doctors.

There is no single model for national health care systems. There is some evidence of an ongoing shift from public to private provision for health care in countries with socialized medicine; the thought being that the answer lies with other reforms, not more government control.

Underlying this shift is an instinct that reducing costs requires someone to say "no." Our system is unsustainable, but we need to move with deliberation and learn both from the successes and failures of other health care systems. We need to remember that the British National Health Care system was created in 1948, and is still a work in progress with unsustainable costs.

Congress could learn from Eddie Cantor who quipped, "It took me 20 years to become an overnight success."

John Reiniers, a regular columnist for Hernando Today, lives in Spring Hill.

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