HORIST : More money will not fix health care

For political reasons, the Obama administration lied to pass health care legislation that promised to cover all the uninsured at reduced premiums.  Those covered could keep their doctors and their preferred health plans.  This was never possible even with forcing young people to pay premiums or penalties for coverage they did not want or need — and that carried deductibles so high they essentially had no insurance at all.

For years, Republicans have promised to repeal and replace Obamacare with a program that would provide better coverage at lower premiums and be available to all Americans.  While that is appealing campaign rhetoric, it, too, is impossible – at least not without other drastic reforms to the medical system.

History shows that once government is a provider of almost anything, it becomes politically toxic to take it away.  In promising state sponsored medical coverage, we have finally reached the point that the benefits promised will overwhelm and destroy the once strong American economy.

Our American founders gave warning against practices that would destroy the amazing republic they established.  In this case, it was Benjamin Franklin who wisely said: “When the people find that they can vote themselves money that will herald the end of the republic.”

While we seniors pat ourselves on the back as the “greatest generation” for making the world “safe for democracy” – a worthy accomplishment, to be sure – we are also the greediest generation in the history of the world, having consumed more natural and financial resources than any other.  

Unfortunately, we did not earn enough money to pay for all the things we voted to give ourselves.  It is not only medical care and welfare, but expenditures that brought us the strongest military in the world, your local tertiary treatment plant, college educations, parks, housing, medical research and all those subsidies that gave us our fancy cars, cheap gas and the best roads in the world.   Today, every American is being subsidized by Uncle Sam and his progenitors in every state and municipality.

We have figured out a way to circumvent the motto of the American Revolution penned and promoted by James Otis. “Taxation without representation is tyranny.”   Our enormous national debt, now to be the burden of citizens yet unborn, is the greatest taxation without representation in world history. That tyranny is our legacy to our children – and to theirs for generations to come.

Medical services are just the latest example of how we, as a society, have reversed the concept of sacrifice – taking less so our children can have more – into a policy of greed – taking more and giving them less.  The national debate over health care coverage – meaning who pays for it – is the latest and arguably the most egregious example of that greed.

With America being the gold standard of medical services throughout the world, we simply have better (ergo more expensive) diagnostic and treatment options than we, as a nation, can afford.  If American healthcare was an automobile, we would be producing Rolls Royces and offering to subsidize one for every citizen.  It would be an unsustainable plan just as Obamacare is unsustainable.

The issue is not scheming to find ways to pay for all the coverage we have and the more we want, but to reform the excessive, dysfunctional, inefficient and wasteful system of health care we currently have – and there are ways.

Reduce corruption and abuse.  The most obvious initial action would be to wring out the billions of dollars in outright waste and fraud.  Just recently, the press exposed a large number of so-called “sober houses” in Delray, Florida where recovery addicts provided samples for thrice weekly urine tests.  In one case, the folks running the sober house pocketed $10 million a year for the past seven years.  In Another case, the taxpayers were billed $30,000 for a dozen tests.  To use the expression, the government is pissing away our money.  

Since the advent of publicly funded healthcare, we have seen thousands of reports of patients, doctors and clinics ripping off the system.  It has included everything from conveyor belt clinics to fake diagnoses.  

A major problem is false or exaggerated accidents or workman’s compensation claims.  After a minor accident injury, a doctor advised me that I would automatically receive three times the medical costs in the insurance settlement, and that he would be happy to see me “as often as my lawyer would like.”  Such fraud is as common as the common cold.

Then there is medical overuse.  We need to establish limits on the unnecessary – and I mean unnecessary – over-use of medical services.  We have allowed our well-placed devotion to preventative medicine to create practices of excessive doctor visits and testing.  According to a report from the Robert Wood Johnson Foundation, over use is a factor in an astounding 30 percent of all medical services.

I see it in my own case.

Since the beginning of 2017, I have had nine lab blood tests prescribed by five doctors.  In one case, the phlebotomist drew nine vials of blood for three doctors during the same visit – each billed to the insurer separately and causing me three co-pays.

General practitioners, or family doctors, once handled ninety percent of a patient’s healthcare needs.  Today, they operate like referral services, sending patients to an array of detailed specialists.  In one case, I was referred to an artery specialist for one issue and a vein specialist for another.

Even though I am in pretty good health for my age, I have one general practice doctor and two specialists who each like to see me every three months.  I am generally referred to a variety of specialists every year or so.  Just ten years ago, I saw one doctor once a year or so – and in my younger days, I would not see a doctor for several years – and not unless I had an issue.  

The insurance companies themselves provide all kinds of unnecessary services in the name of preventative medicine.  In my own case, I get a call at least once a month to review my prescriptions.  I get a “free” house visit from a nurse twice a year – and each time I get a $15 gift card for using the free service.  Due to diabetes, I also get an annual home visit from an eye doctor.  Once a quarter, I get a fancy health magazine that I toss in the recycle box.  My monthly premium in Florida for all these services over and above the regular medical coverage is zero. While I pay nothing, of course, Medicare is paying a lot.

Over use is seen on television every day in those advertisements that offer all kinds of medical devices at no cost.  Every time a person signs on for a free knee or back brace that was not prescribed by their personal doctor, the taxpayer gets billed.  These companies are ripping off the system.

Then there are all those law firms using television advertising to solicit people to sue the drug and medical appliance companies in an updated version of the once unethical practice of “ambulance chasing.”  The medical profession has proven to be an easy target for the lawyers, and the result is astronomical premium rates for medical malpractice insurance.  Personal injury and class actions suits have become a multi-billion dollar industry for the law firms.  

One of the more sensitive and controversial issues is the exorbitant cost of senior and end-of-life care. Statistics confirm that extreme and largely ineffective efforts to prolong life are carried out literally at “all costs” – often to the point of bankruptcy for the estate or family.

To address this issue, we need to change our cultural thinking and develop a “right to try/right to die” policy.  Simply put, when a person is determined to have a terminal illness, they should have the ability to take experimental drugs or procedures not yet approved by the Federal Drug Administration.  These could make a difference, and the plan would provide valuable medical research to determine the efficacy of the treatment.

Right to die is more controversial.  In certain categories of terminal illnesses, the patient should have the right to end his or her life whenever they choose – even before they are immobilized by pain or in a vegetative state.  Recently, I had an 81-year-old friend commit suicide.  He was, as they say, in poor health and received a grim report over the quality of his future life.  In addition, he had a $5 million dollar life insurance policy that would have lapsed during the time he would have barely survived.  We should not think of such a rational decision as offensive, but as an honorable and sensible option – his right to die.  

We need to develop free clinics for the indigent.  Unfortunately, Obamacare resulted in the closure of many free clinics.  We need to restore, encourage and expand those facilities.  Of course, they are not really free, but at least free from most government involvement.  

Chicago had a number of free clinics that were supported by the local hospitals, medical schools, foundations, drug companies and some insurance coverage from patients who had policies.  In the two clinics with which I am familiar, a prospective patient had to establish a need. Once that was verified all medical services, from routine appointment to advanced diagnostics, were available without charge to the patient.  Drugs were dispensed on site.  There were no co-pays, period.

With the growing trend of the uninsured using emergency rooms as the medical facility of first choice, many hospitals developed a triage approach in which the less serious cases (non-emergencies in the traditional sense) would be handled in a walk-in clinic – reducing the cost of the services.  

Of course, these costs were paid for by the insured users of the hospital.  While many see that as an abuse, we should think of it as a private sector subsidy that seems reasonable in addressing a limited problem.  After all, when a restaurant gives seniors a discount for a meal the non-senior customers are underwriting the cost, actually picking up the tab for a lot of people who do not need the subsidy.

Much has been written about the cost of prescription drugs.  There are two issues in addition to cost that need to be addressed – over prescription and that obnoxious “donut hole.”  We need to remove the incentive to over prescribe.  The opioid epidemic is a case in point, but over prescribing.  Overuse goes far beyond one or two drugs.  While some drugs, such as thyroid medication, perform a necessary function, many just treat symptoms.  

Another option is to recycle drugs.  Billions of pills go down the drain literally because laws bar their use by others.  We should recycle drugs like paper and scrap metal.  They can be shipped back to the manufacturers for quality retesting and reissuing.  These could be distributed by those free clinics.

Finally, we need to have open competition across state boundaries among medical insurers.  Creating regulated monopolies or oligopolies run by state-based government regulators increases costs – pure and simple.  

In short, we will never have cheaper health coverage for more people until we drive out the corruption, waste, abuse and excessive use.  We have to understand that no matter how much medical care CAN be provided, we still have to live within our ability to pay for it.  Until we understand that and deal with it, all the national debate over health insurance is meaningless.

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Editor’s note: We have written about this many times. There is a lot we can do, throwing money into Obamacare is not it. See below for more information on how to replace Obamacare.

Larry Horist is a conservative activist with an extensive background in public policy and political issues. Clients of his consulting firm have included such conservative icons as Steve Forbes and Milton Friedman, and he has served as a consultant to the White House under Presidents Nixon and Reagan. He has testified as an expert witness before numerous legislative bodies, including the U. S. Congress and lectured at Harvard University, Northwestern University, Florida Atlantic University, Knox College and Hope College. An award winning debater, his insightful and sometimes controversial commentaries appear frequently on the editorial pages of newspapers across the nation. He can be reached at lph@thomasandjoyce.com.