By Walter Sorochan Emeritus Professor: San Diego State University
Posted August 1, 2012, revised August 16, 2012; Updated April 06, 2016. Disclaimer
Part 2: Cost effective medical care solution for United States
So what is a cost effective medical care system solution for all of United States?
Well, everyone is debating about Obamacare and universal health care. Obamacare [universal health care] tries to do two things --- provide everyone with medical care access and secondly, it attempts to bring private insurance costs under control. The rest of the anticipated reforms are in the 'on-hold' bin! A glance at the Patient Protection and Affordable Act, H.R. 3590 reveals the following:
No reference is made to reform the many subsidies in farming that are suspected of contributing to chronic diseases and poor health. An attempt is made to require some transparency in the FDA, as in requiring limited labeling on food products. Carrying out childhood obesity demonstration projects is not directly attacking the already known issues related to obesity. Instead of enacting better anti-toxic environmental laws, Obamacare is going to provide more medicare coverage for certain individuals exposed to environmental health hazards. Obamacare will develop a plan for promoting healthy lifestyles and chronic disease self-management for Medicare beneficiaries; evaluate community prevention and wellness programs that have demonstrated a potential to help Medicare beneficiaries reduce their risk of disease, disability, and injury by making healthy lifestyle choices. But non-Medicare persons appear to be overlooked! No mention of cultural reinforcements to help individuals adopt good life style habits. And Obamacare will allow the broken medical care system house to wrought! Obamacare: Original Bill 2011
Overlooked are the long-term cultural values of how medicine is practiced and how government subsidies in agriculture and industry contribute to faulty life style habits that create a sick culture. There’s a near-universal sense that the U.S. health-care system is an expensive heaving mess, rife with errors and injustices. The sensitive, unpopular and controversial things that need fixing are not being discussed. This article identifies the sensitive issues that need reform and suggests cost effective ways of fixing both the medical care system and the personal health care system.
Need a fresh philosophy of medical care and life: Philosophy is a way of life --- how we live. And how we live is directed by our values and morals. It is our values that help guide us to make good decisions. We need to re-examine our values in order to fix our medical care system, our government and how we live as a society.
We need to fix what all previous presidents were unable to do and what President Obama is trying to do! We need to fix our dysfunctional government, the broken medical care system, change our philosophy of health-medical care and how we live. Buntin: modernizing hea care 2009 The question is which should we fix first? The chicken or the egg --- fix the dysfunctional government or the total medical-health care system? The entire country needs to adopt a fresh new philosophy of medical care and personal health care. As a country, we are living in an economic-social system that does not advocate a healthy life style. Unless we reform the many other aspects of how we live and practice medicine, the current attempts to fix our medical system will fail in the long run. We are running around free, like a boat drifting in an ocean, without a rudder to steer it!
Below are the many values of our life style that need to be fixed!
Obamacare fails to fix the broken medical care house of 1910. Attempts to fix the medical care system since 1910 have been band aid approaches that were stifled by poor original design. Current amendments are nothing more than a camouflage for an old medical house with rotting floors and a crumbling foundation. We need to salvage the good aspects of the existing system and start from the beginning with an entirely new health-medical care foundation that can support a functional, efficient and cost-effective quality medical care system. We are bolstered by recent medical-technology advancements to build a new medical care house! Obamacare postpones doing this!
Intent of medical Care: Seldom if ever discussed is the intent of medical care! Is it to provide medical care for the sick, those in emergency need of care, prevent diseases, keep costs down, or make money for the insurance providers?
The current medical model is modeled on profiting off the sick.
s it proper or just for a medical care provider to profit from serving a sick or dying person? Is doing so any different from a funeral director selling a funeral casket to a distraught and mourning relative of a dead person, thereby taking advantage of the relative’s emotionally vulnerable status? A sick person grasps for straws while struggling to make informed decisions and stay alive. Where is the justice in profiting from a sick person? Is it just to ignore giving health care when the sick person cannot pay for it; thereby perhaps infecting others with his/her malady?
Obamacare temporarily overlooks the issue of whether it is just to make money from sick persons!
Competition in a free market: There have been arguments made that the existing mix of over 400 private medical care insurance companies are a free market system. Also that universal medical care is not a free market system and does not allow supply-demand system to work. This section offers some information on both of these issues.
Market failure is at the root of the medical care system’s dysfunction. Kelly: myth of free med market 2011 El-Sayed: Fallacy heacare market Krugman: markets can't cure healthcare 2009 The American Medical Association [AMA] and the federal government, with good intentions to improve the quality of medical care, created an unequal playing field for the medical market as early as 1910. Since 1910, the relationship between providers and consumers gradually drifted into a monopoly non-free medical market that today is manipulated by medical care corporations.
Markets work well for goods and services that can be comparison shopped, be easily packaged and sold, which is not the case for health care. Even under competitive conditions, markets may fail to produce socially optimal quantities of a commodity or service. Hence, in the face of these realities it is more appropriate to view medical care differently than a typical consumer product. Karsten: private vs public good 1995 This kind of thinking will no doubt be challenged. Hyde: creating hea reform market 2009
"One illusion which exists is that "medical care" can be most efficiently provided by the competitive market. This is hardly the case. Providers of medical care services do not operate like firms in settings of market structures resembling perfect or monopolistic competition." Karsten: private vs public good 1995 Kelly: myth of free med market 2011 El-Sayed: Fallacy heacare market
"Health care laws function differently than in other supply industries. Demand is relatively elastic in response to supply growth and, when patients are insured, is largely price-sensitive. Furthermore, scarcity of price information in the public domain, and information asymmetry with physicians make it difficult for patients to base decisions on value for money. On the supply side, providers of health care largely dictate the quality of services offered, and, given largely elastic and price-insensitive demand, suppliers tend to innovate at the high end of the market rather than introduce innovations that could lower cost." Farrell: accounting for cost of US health care 2008
In 1963, Kenneth Arrow, a Stanford University economist, later a Nobel laureate, decisively demonstrated in a groundbreaking paper that the usual rules of the market can never govern medical care. Arrow: patient health uncertainty & complexity of med services Krugman: markets can't cure healthcare 2009 The subject is the medical-care industry, not health. The causal factors in health are many, and the provision of medical care is only one. Particularly at low levels of income, other commodities such as nutrition, shelter, clothing, and sanitation may be much more significant. It is the complex of services that center about the physician, private and group practice, hospitals, and public. Arrow argued that doctors and patients interact as highly atypical buyers and sellers; thus the price and extent of care provided to the sick should be determined according to standards intrinsic to medicine and not those of business. Since an individual’s health is so variable and largely unpredictable, it should follow that attempting to value and insure it as a commodity, like a car or a house, is antithetical to the practice of medical care and, therefore, is not an appropriate model. Arrow: patient health uncertainty & complexity of med services
Medical care is not a commodity or product: Ancient China provides us with an example that medical care is not a commodity. Ancient China doctors were paid a fee once a year to keep a family well and actually lost their salaries when the patient got sick. Doctors were not paid when treating sick persons. In the earliest acupuncture text, the Yellow Emperor's Inner Classic, written circa 500 B.C., it is stated that the superior physician prevents the family from getting sick. Ancient Chinese doctors did not make money on sick persons! We need to explore such a medical care system. The philosophy of how we practice medicine and healing is reflected in the cost of medical care and how we manage our medical care system.
Conclusion: Based on the current medical care system, even with President Obama's reforms of 2012, there is no free market for medical care. An individual's demand for medical services is not steady in origin as, for example, for food or clothing, but irregular and unpredictable. Illness itself is unpredictable. Medical services, apart from preventive services, afford satisfaction only in the event of illness, a departure from the normal state of free commodity market affairs. Most patients, as consumers of medical care, choose their physicians and not the care they receive. Consumers of medical help have very little knowledge about appropriate medical treatment compared to care providers or the 'real' expertise of the available pool of doctors. This makes it impossible for consumer patients to be able to make good informed decisions about finding low cost and appropriate medical care. With all these unknown circumstances of illness, the patient who may get sick, and the medical care needed, it is impossible to have a free medical market. There is no equal playing field in the Obamacare medical care market --- the medical care market is tilted toward the providers. Budetti: Market justice in US Hea Care 2008 Arrow: patient health uncertainty & complexity of med services Krugman: markets can't cure healthcare 2009
Health as public good: There is controversy about the idea that individual health is a public good! Do people prosper as a society, as individuals or both?
This is a complex idea. Basically the point being made is that someone has to provide an infrastructure that all members of society use to function as children, adults and entrepreneurs. In economics, a public good is a good that is both non-excludable and non-rivalrous in that individuals cannot be effectively excluded from use and where use by one individual does not reduce availability to others.Wiki: public good Examples of public goods include fresh air, clean water, knowledge, lighthouses, open source software, radio and television broadcasts, roads, street lighting. As Adam Smith, J. B. Say, and others recognized, people are prosperous not as individuals but as members of a prosperous society. Gordon: health care a public good Karsten: private vs public good 1995
This is a complex idea. Basically the point being made is that someone has to provide an infrastructure that all members of society use to function as children, adults and entrepreneurs. In economics, a public good is a good that is both non-excludable and non-rivalrous in that individuals cannot be effectively excluded from use and where use by one individual does not reduce availability to others. Public good
A good medical care system can be categorized as a tax supported public good because it provides opportunities for healthy individuals who can use the infrastructure as a place to prosper and do business. The result is that individuals use the conveniences of public goods to prosper, thereby making society more prosperous. The successful Warren Buffets and Bill Gates' of this country are successful because they had access to public infrastructure and also access to healthy consumers of their goods ---- in a healthy environment. Entrepreneurs share the infrastructure --- clean water, roads, education, good food and sanitation much of which has been paid for by public taxes.
The bigger issue in medical care that is related to cost of the delivery system is a philosophical one: who should be served by the medical care system: the masses, the healers or the profiteers? This is a philosophical issue and it has been overlooked by Obamacare.
The medical care system debate needs to start with some common sense philosophy and not trivial tad-bits!character and health The ancient Greek philosophers would have an entirely different approach to this debate. They would define the terms and seek to find strength in the justice of a medical care system.
The Greek Philosopher's Nature of Justice. "The question which opens this immense dialogue is: what is justice? Several inadequate definitions are put forward, but the most emphatically presented definition is given by a young Sophist, Thrasymachus. He defines justice as whatever the strongest decide it is, and that the strong decide that whatever is in their best interest is just. Socrates dismisses this argument by proving that the strong rarely figure out what is in their best interest, and this can't be just since justice is a good thing." For more info: Plato: justice justice Analysis:Plato on justice
So what is the substance in health care? This research-author would argue that the substance is justice and fairness of a health care system. In the case of this health care system debate, the economic, medical and political aspects of the health care system would be without real strength, or Greek substance, for no concern was made about whether either health care system functioned in a justifiable and fair manner. Such substance would ask the hierarchical questions of who the system would serve? Is it a just health care system for the few or the many? Who takes priority …. the few or the many? These questions need to be answered first before dealing with the cost issues! The realistic approach to medical care has to be a philosophical basis of doing the most good for the most persons. This approach carries more weight and is more important than the minor points in a debate about a good medical care system.
Blaming a political system for a failing medical care system, whether it be democracy, socialism or dictatorship, is a moot one. From a Greek point of view, the need is to focus on the country’s civic responsibility for its people. The state’s responsibility to its populace is similar to that of a parent to its children. Is taking care of a family’s children any different than a government taking care of it’s people? The state, like a parent, has a parallel obligation to protect the health of its citizens.
Now let us put the shoe on the other foot: Should a citizen have the right to expect good medical care from society? Does a worker need good health to be productive? Does a country benefit from a healthy citizenry? What are the justifications for such expectations? The ancient Greeks would love this part of the debate! So what is the real incentive for a country to maintain a healthy society? The answer is very simple: Healthy workers produce more goods for a longer time, pay taxes and in turn, have money to buy the necessities of life and bolster a healthy national economy. The Gross Developmental Product [ GDP ], a measure of the wealth of a country, goes up.
Find causes of health problems: We need to really focus on identifying the causes of our problems and less so on the symptoms! Our doctors relieve symptoms by prescribing medication for most of our health problems. This does not fix the medical problems; instead it is driving health costs up.
Fix medical-doctoring system: The philosophy of how doctors heal needs to be changed! Doctors learn the art and science of medicine from their peers in medical school. It would be prudent to overhaul the medical school curriculum, Meyer: overhaul med curriculum 2012 although most curriculum upgrades are more concerned about accreditation and keeping the status quo than focusing on relevant patient health.
Medical schools and the AMA have created monopoly --- a lop-sided medical market in favor of providers. For example, the restrictions on entry to medical schools is itself not part of a free market supply-demand system. The high cost of medical education in the United States is itself a reflection of the quality standards imposed by the American Medical Association since the Flexner Report. This has resulted in a high cost of medical education that has been subsidized and both the quality and the quantity of the supply of medical care have been strongly influenced by this none free market. Arrow: patient health uncertainty & complexity of med services Medical schools and the AMA have both imposed licensing laws and standards on medical-school training that limit the possibilities of alternative qualities of medical care and the number of practitioners. Theoretically, a supply of more doctors would increase the pool of available doctors competing for medical care jobs and thereby lower the cost of physician care services. But this is not the case in United States. Indeed, medical schools also control the number of students allowed to enter medical schools so graduate MDs can get high salaries. These type of restrictions do not meet the criteria of a free supply-demand medical market system. Obamacare deferred reforming this aspect of medical care at this time.
Some aspects of the medical curriculum itself are questionable, like the glaring lack of legitimate courses on nutrition. A survey of medical doctors by Anderson revealed that physicians believe their training did not adequately prepare them to: Anderson: Medical economics 2007
Most of today's medical practitioners did not take a 'real' nutrition class as a medical requirement to get a medical degree, Huff: MDs lack nutrition 2012 yet display their ignorance about vitamins and minerals while attempting to advise their patients on nutrition and health. Many patients know more about nutrition than their doctors. Knowing medicine is not the same as knowing about health! Obamacare overlooks this reform at this time.
Doctors change habits: The medical system is also dragging behind the computer-internet technology. Buntin: modernizing hea care 2009 Most doctors and hospital systems are still without patient electronic medical records [EMR] that have been available for over 20 years. The CDC reported that the EMR adoption rate had steadily risen to 48.3 percent at the end of 2009. Wiki: EMR Obamacare has no mandate to provide electronic record keeping incentives to motivate instant adoptions of EMR.
In an attempt to control costs, managed-care organizations have attempted to measure the process of medical-care delivery, rather than identifying physicians who keep their patients healthy. Managed care has failed to contain costs or improve doctor care.
Doctors need to focus less on defensive practice and more on making the patient well. e.g. Doctors also need to change the small habits of how they practice medicine ---- by minimizing patient waiting time to see a doctor and sharing information directly with patients via e-mails. Doctors need to do a better job of monitoring their patients who are on prescribed medications. Young: 100,000 die from drug Perdomo: Drugs kill 100,000 each year
Streamline Lab tests: Lab tests being ordered as defensive liability medicine [ to protect the doctor ] need to be supplemented or replaced by body information relevant to patient health [ such as vitamin-mineral-pH levels, co-factors and mineral ratios ]. Medical technology is now available to help patients instantly monitor their health status [ blood pressure, nutritional status, diabetes, heart rate ] at home instead of traveling to doctor's offices. Lab tests need to focus more on health promotion --- keeping patients healthy than on treatment tests. We need a test that confirms bioavailability of nutrients being delivered to somatic cells and not just presence in the blood stream. Obamacare does not have economic incentives for implementing new patient oriented health technology that would save money. Cutler: Containing hea care costs 2012
Fix FDA: Many experts who advise the government on drugs often have financial conflicts that may sway some of their votes on approving drugs and other health-medical care issues. The classic example is the revolving door connection between Michael Taylor , current head of the FDA and his previous employment at Monsanto, the company that has engineered genetic plants. Taylor exemplifies the revolving door between the food industry and the government agencies that regulate it. Kenfield: Michael Taylor revolving door 2009 Another example, a JAMA study underscored how pervasive the conflicts are: In 73 percent of drug advisory committee meetings, at least one panelist reported a financial conflict of interest. NBCNews: FDA conflict of interests 2008
Research data submissions from drug companies to the US Food and Drug Administration (FDA) may be worse than in other countries, since the agency doesn’t actually require any data. Their policy says that biotech companies can determine if their own foods are safe. Anything submitted is voluntary and, according to former Environmental Protection Agency scientist Doug Gurian-Sherman, PhD, “often lack[s] sufficient detail, such as necessary statistical analyses needed for an adequate safety evaluation.” Health risks of genetically modified foods
Obama needs to overhaul how the FDA selects persons with no vested drug interests and how the FDA works! Rodreguez: FDA is broken 2011
Need real research on consumer health and not drugs:
Much of the research done at universities and funded by the federal government is questionable research. Moorel: value of research It subsidizes university professor's salaries, often discovers little useful information and seldom benefits society. We need more research on how healthy bodies should work. We need to do more preventive research that is useful for patient-consumers. Rothbard: Gov med insurance 2012
Obamacare needs to redirect research funding. The U.S. is the world’s leader in medical innovation because our government pumps tens of billions of dollars into health research each year through the National Institutes of Health [ NIH ]. In fact, many of the drugs, medical devices, and clinical tests that ultimately get marketed and sold by private sector medical companies originated in NIH-funded labs across the country. El-Sayed: Fallacy heacare market But the funding for products that cannot be patented and copyrighted, like vitamin and mineral supplements, and how nutritional co-factors work, get almost no funding.
Drug companies have a huge influence over what gets researched, how it is researched, how the results are reported, how they are analyzed, and how they are interpreted. NBCNews: FDA conflict of interests 2008 Obamacare needs to take drug research out of the hands of drug corporations. We need to focus more on funding independent research, outside the realm of drug corporations, to find out how the very young and the elderly can take better care of themselves, with a minimum of help from the health care system; thereby reducing dependence on the medical care system. Perhaps the most significant need is for someone finding the time and funding to research on how benefits from common everyday lifestyle affect health; like how foods and proper eating habits may more effectively enhance the individual biochemistry of individuals than medications. Such focus needs government reinforcement for health promotion as well. Medicine knows very little about maximizing the nutritional well-being of all age groups.
Dealing with the terminal last days of life:
We need the government [ NIH, CDC, FDA ] to focus on where the largest amount of health care money is spent in the shortest period of time on people. This would be on the terminally ill. Public health measures like improved sanitation and housing, better nutrition and safer drinking water have eradicated many communicable diseases and allowed all of us to live longer. Living longer brings us face to face with the diseases of age. It isn't lifestyle changes and drugs that are keeping senior citizens alive – it is machines and doctors doing a lot of the heavy lifting in order to grant us those precious extra days or months. These extra few months of extended life are very, very expensive. We need more and better research and incentives on how to help terminal elderly live out their lives in dignity. We need to change our perceptions about how and where to die. And yes, we need to fix how we all deal with "end of life!" Obamacare does not do this!
Update water treatment facilities:
The treatment and distribution of water for safe use is one of the greatest achievements of the twentieth century. Before cities began routinely treating drinking water with chlorine [ starting with Chicago and Jersey City in 1908 ], cholera, typhoid fever, dysentery and hepatitis A killed thousands of U.S. residents annually. Drinking water chlorination and filtration have helped to virtually eliminate these water borne diseases in the U.S. and other developed countries.
Chlorine was chosen in the early 1900 as the best way at that time to purify water for drinking purposes. As with many novel chemical innovations, however, what was once thought perfectly harmless has turned out to be poisonous. Over the past 25 years, scientists have discovered that while chlorine is killing microbes, it is also reacting with organic matter already in the water to form toxic chemicals called organochlorines [ also known as disinfection by-products or DBPs ].
To date, several hundred known organochlorines have been found in drinking water but many times that number are chemically unidentified. Federal government monitoring programs show that many U.S. cities have elevated levels of organochlorines at the tap --- concentrations substantially higher than most public water systems. This is especially disconcerting because numerous of these organochlorines [ DBPs ] are known carcinogens and mutagens. Epidemiological research by Morris has directly linked chlorinated drinking water to cancer and possibly miscarriages. Fleckenstein: unsafe drinking water 2001
Although chlorine kills all germs, it is a poison to our bodies. Chlorine is a goitrogen ---- it interferes with iodine absorption in the body. Iodine is an essential nutrient for not just the thyroid gland but every cell on the body. The halogens chlorine, as well as fluoride [ added to drinking water to prevent dental caries ] and bromide [ used as herbicide in agriculture] easily interfere with iodine absorption. When iodine is replaced by the more active chlorine, fluoride and bromide, the body absorbs less iodine and the population is then at increased risk to goiter and other diseases and disorders --- including silent health problems. Abraham: Orthiodinesupplementation Drinking Water Chlorination
Finally, the U.S. General Accounting Office reports that there are serious deficiencies in water treatment plants in 75% of the states. According to a study conducted by the Natural Resources Defense Council, more than 120 million people may get unsafe drinking water. Pure eEarth technologies
Several alternatives to traditional chlorination exist, and are being used today in many countries. Ozonation is used by many European countries and also in a few municipalities in the United States. Due to current regulations, systems employing ozonation in the United States still must maintain chlorine residuals comparable to systems without ozonation. Wiki: chlorination
Municipal water treatment plants are part of our deteriorating infrastructure. Our people cannot live without a supply of safe drinking water. Obamacare has postponed fixing the outdated public water system that may be contributing to illnesses and diseases.
REDUCING ADMINISTRATIVE COSTS
Spending on medical care administration is much higher in the United States than in other countries, and is much greater than any analyst suggests is needed. For every office based physician in the United States, there are 2.2 administrative workers; in Canada, there are half as many. U.S. hospitals have 1.5 administrative workers per bed; that is 40 percent more than in Canada. Cutler: Containing hea care costs 2012
Our medical care system is driven by a profit motive rather than a focus on helping people get well and stay well. Independent journalists recently compared the number of staff in the billing department of a hospital in Massachusetts and another in Toronto, Canada. The US hospital had 300; the Canadian facility had just three. Changing the idea of making money from medical care to helping people stay well would cut administrative costs! Alberti: Admin price differences 2012
Poor-quality problems in the United States health-care system cost an additional $700 billion per year in wasted payments. Jarvis: no hea care fix 2012
Regulating medical care providers to control health care costs: Medical care providers should be more realistically viewed as enterprises which exercise "monopoly power." Today insurance and drug corporations not only buy politicians with their campaign monies and lobbying influences, they are also in a position to significantly influence supply and demand conditions, pricing and output decisions, excess profits, and also tend to generate inefficiencies. These entities disrupt an equal playing field for consumers!
Consumer Reports estimates that "roughly 20 percent of the money we now spend could be saved with no loss in quality of care" and also save about 50 percent of administrative costs. Karsten: private vs public good 1995
The General Accounting Office found that those prescription drugs that were marketed and made in the U.S. but also marketed in Great Britain, tended to carry a 60 percent higher price tag, on the average, in the U.S., with some drugs selling at five, or even eighteen times the prices charged in England. Karsten: private vs public good 1995
How much profit should private insurance companies make? According to a study by a pro-medical reform group, the nation's largest five medical insurance companies posted a 56 percent gain in 2009 profits over 2008. The insurers [ Wellpoint, UnitedHealth, Cigna, Aetna and Humana ] cover the majority of Americans with medical insurance; not health care which is health promotion. Wiki: Hea insur in USA This excessive amount of profit, when compared to less than 10% profit that other businesses expect in order to stay in business, is a good reason to bring private medical insurance companies under control! Thank President Obama for doing just that!
Paying for health care:
All the above issues would be incomplete without addressing how medical care should be paid for. Obamacare inherited a dysfunctional insurance system, and stumbles in a mix of insurance sponsored schemes that contribute to confusion, controversy and continued expensive coverage. The implementation of employer sponsored insurance happened more or less by accident, without good planning nor design. Jaslow: employer-sponsored health insurance 2011 The system of employer-sponsored insurance is not well designed to deal with the problems of the costs and quality of medical care in the United States. Blumenthal: Employer-Sponsored Insurance This is a complex issue and we need to briefly review how we pay for medical insurance.
Employer-sponsored medical insurance is paid for by businesses on behalf of their employees as part of an employee benefit package. Most private [non-government] medical coverage in the US is employment-based. Nearly all large employers in America have been forced to offer group medical insurance to their employees.
Typically, employers pay about 85% of the insurance premium for their employees, and about 75% of the premium for their employees' dependents. The employee pays the remaining fraction of the premium, usually with pre-tax/tax-exempt earnings. Wiki: Hea insur in USA
According to a 2007 study, about 59% of employers at small firms [3-199 workers] in the US provide employee medical insurance. Most of the businesses employ fewer than 50 persons and the initial plan had difficulties covering such wage earners. Also this plan did not provide medical insurance to those who were not working. In spite of all the legal adjustments to make this plan work, it sputters today. Wiki: Hea insur in USA
Effective by January 1, 2014, the Patient Protection and Affordable Care Act will impose a $2000 per employee tax penalty on employers with over 50 employees who do not offer medical insurance to their full-time workers. In 2008, over 95% of employers with at least 50 employees offered medical insurance. Wiki: Hea insur in USA
Buchmueller and Monheit studied the “goodness of fit” of Employer Sponsored Insurance [ ESI ] in the current economic and medical insurance environments. Their findings: Buchmueller: Health insur reform 2009
Although Obamacare attempts to avoid "rocking the boat" and continue using the mix of existing employer insurance systems, the problems of such a convoluted way to provide medical insurance coverage will continue. There is doubt that employer insurance systems will survive or that these may even reduce costs of medical care. Blumenthal: Employer-Sponsored Insurance Kelton: Hea care crisis 2007 The major problem of employer based medical insurance that is overlooked is that the employers pass on the cost of medical insurance to the products they make. This makes their products less competitive on the global market.
National medical insurance dramatically lowers costs of medical care and in turn, allows US businesses to be more competitive in the global market.
Adopt from other systems: Although there is no single best medical care system in the world today, some systems work better than others and these are cost effective. We can learn from rich [ Canada, Germany, Switzerland ] and poor countries on how to best reform the medical care system. Contrary to common perceptions, the German health insurance system, "is not government run, in either its financing or its delivery. "The government prescribes policy but private parties finance and deliver services." It functions "to mandate, specify, authorize, referee, consult, collaborate, regulate, monitor, and supervise." Karsten: private vs public good 1995
Summary on reforming the medical care system:
There is no shortage of ideas about fixing the medical care system. NMSS: Health care reform principles Barron: medical failures 2008 Farrell: accounting for cost of US health care 2008 By now you, the reader, have your own suggestions about fixing our broken medical care system. The cartoon below also has a suggestion!
Almost every president since President Roosevelt in the early 1930's has failed to provide medical care legislation. We need to commend President Obama for attempting to do the impossible with a dysfunctional congress and senate. Although Obamacare has many empty holes in it, getting everyone insured would be a gigantic step toward a sustainable medical care system.
The nature of the medical care system aside, the real medical problems are not medical doctors, medical care providers or hospitals. Instead, we have an invisible cultural problem of faltering morality in politics and how we live --- about doing good instead of harm. Other sensitive problems are the out of control medical - industrial complex and the behaviors of people --- their lack of self discipline to exercise and eat properly. Seventy percent of all health-medical expenditures in the United States are devoted to treating chronic disease; only 4% of the medical care budget is focused on primary prevention. Cohen: Making health care healthy 2010
It should be evident by now that the majority of people have bad behaviors and habits and lack the acumen to make wise choices. Our American culture has spawned a disease culture and poor life style.
To view 10 things medical doctors must do to reform medical care go to: Barron: medical failures 2008
There will be no real success in real medical care reform until the political system is reformed and congress and senate begin to function on behalf of the people. Government attempt to “reform medical insurance for all or Obamacare” before fixing the dysfunctional congress and senate is putting the cart before the horse.
To return to main program: Freegrab
Your feedback is most appreciated: E-mail to: Author Walter Sorochan
Abraham Guy. E. M.D., Jorge D. Flechas M.D. and John C. Hakala R.Ph., "Orthoiodosupplementation: Iodine Sufficiency Of The Whole Human Body," Abraham: OrthiodinesupplementationAgency for Healthcare Research & Quality, "The High Concentration of U.S. Health Care Expenditures," AHRQ, June 2006, Pub. No. 06-0060. AHRQ: hea car expenses 2006 Mark W. Stanton, "The High Concentration of U.S. Health Care Expenditures," AHRQ, Research in Action, Issue 19, 2006. Stanton: hea care expenses 2006
Alberti Mike, "Health insurance maze a major financial burden on hospitals, doctors, businesses," Remaping Debate, June 20, 2012. Alberti: Admin price differences 2012
Alemayehu Berhanu and Kenneth E Warner, "The Lifetime Distribution of Health Care Costs," Health Serv Res. 2004 June; 39(3): 627–642. Alemayehu: Lifetime hea care costs 2004
The distribution of health care costs is strongly age dependent, a phenomenon that takes on increasing relevance as the baby boom generation ages. After the first year of life, health care costs are lowest for children, rise slowly throughout adult life, and increase exponentially after age 50 (Meerding et al. 1998). Bradford and Max (1996) determined that annual costs for the elderly are approximately four to five times those of people in their early teens. Personal health expenditure also rises sharply with age within the Medicare population. The oldest group (85+) consumes three times as much health care per person as those 65–74, and twice as much as those 75–84 (Fuchs 1998). Nursing home and short-stay hospital use also increases with age, especially for older adults (Liang et al. 1996).
Anderson Gerard, "Chronic Conditions: Making the Case for Ongoing Care," Harvard School of medicine, November 2007. Anderson: Medical economics 2007
Arrow KJ., "Uncertainty and the welfare economics of medical care," The American Economic Review. December, 1963, 53:5. Arrow: patient health uncertainty & complexity of med services
Auerbach D. I. and A. L. Kellermann, “A Decade of Health Care Cost Growth Has Wiped Out Real Income Gains for an Average US Family,” Health Affairs, Vol. 30, No. 9, September 2011. $ 17, 040 Auerbach: Heacare costs per family 2011
Barron Jon, "World's Greatest Medical Failures," The Baseline of Health Foundation, July 21. 2008. Barron: medical failures 2008
Blackwell Syd, "Health Care in Uruguay… An OU Quick Guide," OFA Uruguay, November 10, 2010. Blackwell: Hea Care Uruguay 2010
Blumenthal David, "Employer-Sponsored Insurance — Riding the Health Care Tiger," NEJM, july 13, 2006. Blumenthal: Employer-Sponsored Insurance
Buchmueller Thomas C. and Alan C. Monheit, "Employer-aponsored health insurance and the promise of health insurance reform," National Bureau of Economic Research, April 2009. Buchmueller: Health insur reform 2009
Budetti Peter P., "Market Justice and US Health Care," JAMA, January 2, 2008—Vol 299, No. 1. Budetti: Market justice in US Hea Care 2008
Buntin Melinda Beeuwkes and David Cutler, "The Two Trillion Dollar Solution Saving money by modernizing the health care system," Center for American progress, June 2009. Buntin: modernizing hea care 2009
"Economics is not politics. One is a science, concerned with the immutable and constant laws of nature that determine the production and distribution of wealth; the other is the art of ruling. One is amoral, the other is moral. Economic laws are self-operating and carry their own sanctions, as do all natural laws, while politics deals with man-made and man-manipulated conventions. As a science, economics seeks understanding of invariable principles; politics is ephemeral, its subject matter being the day-to-day relations of associated men. Economics, like chemistry, has nothing to do with politics."
Code Blue Now, "Comparison of Health Care Systems." CodeBlue: Comparison of Health Care Systems
Cohen Gary, "Making health care healthy," Social Entrepreneurs What Matters, April 6, 2010. Cohen: Making health care healthy 2010 Seventy percent of all health expenditures in the United States are devoted to treating chronic disease; only 4% of the healthcare budget is focused on primary prevention.
Cutler David M., "TESTIMONY OF DAVID M. CUTLER Before the Committee on the Budget United States Senate," February 29, 2012. Otto Eckstein Professor of Applied Economics, Harvard University Cutler: Containing hea care costs 2012
Daley Alex and Doug Hornig, "How health care can cost so much, despite technology," Casey Research, July 12, 2012. Daley:longer living costs more 2012
Docteur Elizabeth and Robert A. Berenson, "How Does the Quality of U.S. Health Care Compare Internationally?," Timely Analysis of Immediate Health Policy Issues 11, August 2009. Docteur: US hea Care compaision others 2009
Edmonds Molly, "10 Health Care Systems Around the World," How Stuff Works. Edmonds: hea care around world
El-Sayed Abdulrahman, "The Fallacy of Free Market Healthcare," Politics, Health Care."El-Sayed: Fallacy heacare market
Farrell, Diane, Erric Jensen, Bob Kocher, Nick Lovegrove, Fareed Melhem, Lenny Mendonca and Beth Parish, "Accounting for the cost of US health care: A look at why Americans spend more," McKinsey Global Institute, December, 2008. Farrell: accounting for cost of US health care 2008
Fleckenstein Paul, "Cancer on tap: The risks of chlorinated drinking water," GreenSense, May 18, 2001 Fleckenstein: unsafe drinking water 2001
Free rider (or freeloader) is someone who enjoys the benefits of an activity without paying for it. The free rider may withhold effort or resources, or may impose the costs of his or her activities on others. Free-riders in health care are those persons don't have health care insurance but use emergency hospital medical services when they are sick. They pass their medical costs on to others. Hospitals and government programs pay for their medical expenses; thereby increasing the cost of health care to others. Many free riders in society wait until they get sick to buy insurance. “Free-rider” has a romantic feel to it. He rides through the West on his Harley, fearless and free, unconcerned about the cost of putting him back together when his Harley meets a tree." Read more
Frontline, "Sick around the world - Five capitalist democracies & how they do it," April 15, 2008. Frontline: how 5 countries do it 2008
Gawande Atul, "Getting There from Here - How should Obama reform health care?" The New Yorker, January 26, 2009. Gawande: hea care reform 2009
Giles Allen, "What makes a good healthcare system?: comparisons, values, drivers," Radcliff Medical Press, United Kingdom, 2003. Giles: what is good hea care
Gordon Geoffry B., "Is health care a public good?" MedpageToday Kevin MD.com. Gordon: health care a public good
Guttman Nathan and Nathan Jeffay, "Israel's Health Care Outpaces U.S.," The Jewish Daily, Published June 28, 2012, issue of July 06, 2012. Guttman: Isreal-US compared 2012
Houchens Paul R., "Measuring the strength of the individual mandate," Millman Research Report, March, 2012. Houchens: Flaws in Obamacare 2012
Hyde Stephen, "The proper role of government in health care reform -- Part I: Market failure," Hyde on Health Care, November 12, 2009. Hyde: govt role in health care 2009
"Health care constitutes a massive opportunity for an enlightened government regulatory role that will allow markets to cure all its problems of cost, quality, and access. Currently, health care is the only one of our five fundamental human needs not being met by well-functioning markets (the other needs are food, clothing, housing, and transportation). Yet health care, like the others, is what economists call an economic good, having both the scarcity and the discernible prices that normally allow markets to self-develop to become the optimal medium of production and distribution.
"Health insurance works according to the Pareto Principle, more commonly known as the 80/20 rule. At any given time, about 20% of the people consume 80% of the medical care. Thus, an insurer’s customers must include 80% who are healthy in order to assure payment for the 20% who aren’t. Imagine an intellectually-challenged entrepreneur who opens a comprehensive, 24/7 health insurance supermarket that works like a food market or a clothing store. Any customer can walk in, take an insurance policy off the shelf, and pay for it at checkout. But who will actually shop in this supermarket? Right, sick people. Healthy people will stay away until they get sick, thus depriving the entrepreneur of the healthy 80% necessary to pay the bills. An economist might say that, because this adverse selection causes one person’s decision to purchase (or not) health insurance to increase another person’s price for it, there is a negative externality that results in a Pareto sub-optimal allocation of resources, or more simply, a market failure. Or, as the unfortunate entrepreneur might put it, “My God, I’ve gone broke!”
"Although such insurance supermarkets can’t work, wiser entrepreneurs figured out a long time ago that there are two—and only two—natural markets for health insurance: large employer groups and healthy individuals. Large employer groups are inherently insurable because they fit the 80/20 rule (and not because of a WWII tax ruling that excluded employer-provided health benefits from federal taxes). That’s also true for healthy individuals, as long as the insurer is allowed to confirm their healthy status before agreeing to insure them. Unfortunately, however, there are no natural health insurance markets for the elderly, the disabled, the poor, or for sick individuals. This is the result of the above-described health-insurance market failure that no “free” market will ever correct. Why is health care the exception? Free-market advocates claim it’s because of decades of government interference with programs like Medicare, Medicaid, and SCHIP that prevent markets from functioning properly. But that’s not the reason. Those programs are simply a response—a poor response to be sure—to a fundamental market failure arising from the fact that no natural, self-organizing market will ever provide the necessary health insurance that everyone needs for protection against the risks of unaffordable, necessary medical care."
Hyde Stephen, "The proper role of government in health care reform -- Part 2: CREATING A HEALTH CARE MARKET, Hyde on HealthCare, November 18, 2009. Hyde: creating hea reform market 2009
Huff Ethan A., "Doctor admits that most MDs know nothing about nutrition, health," Natural News, October 04, 2010. Huff: MDs lack nutrition 2012
Jarvis Joseph, "Obamacare Will Not Fix Health Care!" City Weekly, May 23,2012. Jarvis: no hea care fix 2012
Jaslow Ryan, "Is employer-sponsored health insurance on life support?" Health Pop, August 24, 2011. Jaslow: employer-sponsored health insurance 2011
Kaiser Family Foundation, "US Global Health Policy, Customized Data Sheet," Customized health data 2011
Karger Jim, "American Medical Care Is Terminal," Whiskey and Gunpowder, July 5, 2012. Karger: Medicare is terminal
Karsten Siegfried G., "Health care: private good vs. public good," American Journal of Economics and Sociology, April, 1995. Karsten: private vs public good 1995
Kelly Kel, "The Myth of Free-Market Healthcare," Mises Daily, March 09, 2011. Kelly: myth of free med market 2011
Kenfield Isabella, "Monsanto's Man in the Obama Administration - The Return of Michael Taylor," CounterPunch, August 18, 2009. Kenfield: Michael Taylor revolving door 2009 [ "The Vice President for Public Policy at Monsanto Corp. from 1998 until 2001, Taylor exemplifies the revolving door between the food industry and the government agencies that regulate it. He is reviled for shaping and implementing the government’s favorable agricultural biotechnology policies during the Clinton administration." ]
Kelton Stephanie, "An Introduction to the Health Care Crisis in America: How Did We Get Here?" Center for Full Employment and Price Stability (CFEPS), September 2007. Kelton: Hea care crisis 2007
Krugman Paul, "Why markets can’t cure healthcare," The New York Times, July 25, 2009. Krugman: markets can't cure healthcare 2009
Lubitz J, Beebe J, Baker C., "Longevity and Medicare expenditures," N Engl J Med. 1995 Apr 13;332(15):999-1003. Lubitz: Longevity and Medicare expenditures 1995
Mayer David, "The Need for Medical School Curriculum Overhaul," Florida International University, July 9, 2012 Meyer: overhaul med curriculum 2012
McVay Douglas A., , "Annual Causes of Death in the United States." Drug war facts. McVay: drug war causes Drug War Facts is sponsored by Common Sense for Drug Policy.
Miller Talea, "Comparing International Health Care Systems," PBS NewsHour, October 6, 2009. Miller: Int Hea Care Systems 2006
Moore1 Gary E., "Significance" of Research in Vocational Education," Journal of Vocational Education Research, Vol. 17, No. 4, 1992. Moorel: value of research
Moss Robert, "Fixing the American health care system," Wofford College Community of Scholars, Summer 2010 Moss: Fixing USA hea care sys 2010
National Healthcare Single -Payer Association, "What is Single-Payer Healthcare?" Single Payer System
National Multiple Sclerosis Society, "Health care reform principles," NMSS: Health care reform principles
National Health Care Reform Principles:
NBC News, "FDA drug panels rife with conflicts of interest: Study finds money influences federal experts' decisions on medications," April 26, 2006. NBCNews: FDA conflict of interests 2008
Obama Barack, "Obamacare: Delivering affordable health care," Jun 29, 2012. Obamacare: U-tube 2012
O'Brien Sharon, "Baby Boomers Not to Blame for Rising Health Care Costs," Senior Living. O'Brien: overtreatment causing costsOvertreatment and chronic illness are leading factors in high health care costs.
Owen David G., "Dangers in Prescription Drugs: Filling a Private Law Gap in the Healthcare Debate,"CONNECTICUT LAW REVIEW, February 2010, VOLUME 42 FEBRUARY 2010 NUMBER 3, University of Connecticut School of Law, Owen: Dangers in Prescription Drugs & legality
"Once information on these side-effects (of drugs) became known to the public, the manufacturers of each of these drugs stopped selling them and, eventually, paid millions or billions of dollars to settle claims for resulting injuries.10 Merck, for example, having withdrawn the profitable Vioxx drug11 from the market in 2004, settled nearly 50,000 Vioxx cases in late 2007 for $4.85 billion.12 In 2009, Eli Lilly agreed to plead guilty and pay $1.415 billion in criminal and civil penalties for promoting its antipsychotic drug, Zyprexa, as suitable for uses not approved by the Food and Drug Administration (“FDA”).13 These cases may be among the more prominent, but they represent just the tip of the iceberg of damage caused by prescription drugs."
Nate, "Supreme Court upholds ObamaCare mandate as a "tax" in 5-4 decision," 2012 Election central, June 28th, 2012. Nate: Supreme Court decision 2012
Obamacare, "Bill Summary & Status 111th Congress (2009 - 2010) H.R.3590 All Information," The Library of Congress Thomas Obamacare: Original Bill 2011
Obamacare, "Patient Protection and Affordable Care Act 2010 --- Basic Requirements," 2012. Obamacare 2012
OECD, "Health at a Glance 2011 - OECD Indicators." November 23, 2011 OECD: health indicators
"The Organization for Economic Cooperation and Development (OECD) tracks and reports annually on more than 1,200 health system measures across 30 industrialized countries, ranging from population health status and nonmedical determinants of health to health care resources and utilization."
PBS Newshour, "Comparing International Health Care Systems," October 6, 2009. PBS: hea sys comps 2006
Perdomo Daniela, "100,000 Americans Die Each Year from Prescription Drugs, While Pharma Companies Get Rich," Alter Net, June 25, 2010. Perdomo: Drugs kill 100,000 each year
Private vs public goods:
Private goods may be defined as those which carry a price, which can be easily withheld from those who are unwilling or unable to pay for them (exclusion property), and whose benefits are rival in consumption to those of other goods. While health insurance may fit this simplistic definition of a private good, the commodity "health care" does not. For one, it cannot be easily packaged and marketed as is the case with an ordinary consumer good. Even were this feasible, it would be considered to be "unethical." Second, the benefits derived from "health care" do not rival those of another commodity, such as between buying a TV or a stereo set. Third, the exclusion principle is not fully applicable to health care. Karsten: private vs public good 1995
Quality assurance is the process of measuring performance against a defined standard and seeing how it compares.
Reid T.R., "Does universal coverage mean socialized medicine?" Frontline, April 15, 2008. Reid: socialized medicine
Rodreguez Juan, "Juan Enriquez Eviscerates the FDA," Central Science, December 6th, 2011. Rodreguez: FDA is broken 2011
Rothbard Murray N., "Government Medical "Insurance," Mises Daily, June 29, 2012. Rothbard: Gov med insurance 2012
Roy Avik, "Why Switzerland has the world's best health care system," Forbes, April 29, 2011. Avik: Switz best health care 2011
Roy Avik, "Obamacare's Dark Secret: The Individual Mandate is Too Weak," Forbes, July 09, 2012. Roy: Obamacare flaws 2012
Singer Natasha, "Fixing a World That Fosters Fat," The New York Times, August 21, 2010. Singer: fixing fat world 2010 “We have made it more expensive to eat healthy in a very big way,” says Dr. Popkin,
who has a doctorate in agricultural economics and is the author of a book
called “The World Is Fat: The Fads, Trends, Policies and Products That Are
Fattening the Human Race.” Soderlund Neil, James Kent, Peter Lawyer, and Stefan Larsson, "Progress Toward Value-Based Health Care Lessons from 12 Countries," Boston Consulting Group, June 06, 2012. Soderland: value based hea care 2012 Squires David A., "The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations, Issues in International Health Policy, July 2011. Squires: 12 countries compared 2011 Steinreich Dale, "100 Years of Medical Robbery," Mises Daily: Thursday, June 10, 2004. Steinreich: brief history govt intervention 2004 Adopted from Dale Stein, "100 Years of US Medical Fascism," Mises Daily, April 16, 2010. Stein: 100 years of US heacare 2010 Taiwan Government, "Public Health," Government Information Office, 2005. Taiwan: Public health 2006 Tanner Michael D., "Bad medicine A guide to the costs and consequences of the new health care law," Cato Institute, 2011. Tanner: bad law 2011 Terhune Chad, "Average annual healthcare cost for a family tops $20,000," Los Angeles Times, May 15, 2012 Terhune: Hea Care costs equal new car 2012 Universal health care is determined by three critical dimensions: who is covered, what services are covered, and how much of the cost is covered by
WHO, "World Health Statistics 2012 - Part III Global health indicators." WHO: health indicators 2012
Wikipedia, "Electronic Medical Records." Wiki: EMR Wikipedia, "Health care reform debate in United States." July 9, 2012. Wiki: hea care debate 2012 Wikipedia, "Health care reform in the United States." July 8, 2012. Wiki: Hea care reform in USA Wikipedia, "Health insurance in the United States." Wiki: Hea insur in USA Wikipedia, "Patient Protection and Affordable Care Act." July 9, 2012.
Wikipedia, "bamacare act 2012."Wiki: Obamacare act 2012 Wikipedia, "Public good," Wiki: public good Wikipedia, "Universal Health Care." Wiki: Universal Health Care Young Terrance, "Facts on Prescription Drug Deaths and the Drug Industry," The Conference, August 21, 2011. Young: 100,000 die from drug Over-the-counter drugs also cause many deaths. For example, every year over 15,000 patients die in North America from ordinary aspirin and Ibuprophen. Ordinary Tylenol is the cause of thousands of hospital admissions and hundreds of deaths annually in North America. Safety Management systems with regards to prescription drugs are decades behind other industries like transportation and nuclear, which both have independent regulators.
Singer Natasha, "Fixing a World That Fosters Fat," The New York Times, August 21, 2010. Singer: fixing fat world 2010
“We have made it more expensive to eat healthy in a very big way,” says Dr. Popkin, who has a doctorate in agricultural economics and is the author of a book called “The World Is Fat: The Fads, Trends, Policies and Products That Are Fattening the Human Race.”
Soderlund Neil, James Kent, Peter Lawyer, and Stefan Larsson, "Progress Toward Value-Based Health Care Lessons from 12 Countries," Boston Consulting Group, June 06, 2012. Soderland: value based hea care 2012
Squires David A., "The U.S. Health System in Perspective: A Comparison of Twelve Industrialized Nations, Issues in International Health Policy, July 2011. Squires: 12 countries compared 2011
Steinreich Dale, "100 Years of Medical Robbery," Mises Daily: Thursday, June 10, 2004. Steinreich: brief history govt intervention 2004 Adopted from Dale Stein, "100 Years of US Medical Fascism," Mises Daily, April 16, 2010. Stein: 100 years of US heacare 2010
Taiwan Government, "Public Health," Government Information Office, 2005. Taiwan: Public health 2006
Tanner Michael D., "Bad medicine A guide to the costs and consequences of the new health care law," Cato Institute, 2011. Tanner: bad law 2011
Terhune Chad, "Average annual healthcare cost for a family tops $20,000," Los Angeles Times, May 15, 2012 Terhune: Hea Care costs equal new car 2012
Universal health care is determined by three critical dimensions: who is covered, what services are covered, and how much of the cost is covered by WHO, "World Health Statistics 2012 - Part III Global health indicators." WHO: health indicators 2012
Wikipedia, "Electronic Medical Records." Wiki: EMR
Wikipedia, "Health care reform debate in United States." July 9, 2012. Wiki: hea care debate 2012
Wikipedia, "Health care reform in the United States." July 8, 2012. Wiki: Hea care reform in USA
Wikipedia, "Health insurance in the United States." Wiki: Hea insur in USA
Wikipedia, "Patient Protection and Affordable Care Act." July 9, 2012.
Wikipedia, "bamacare act 2012."Wiki: Obamacare act 2012
Wikipedia, "Public good," Wiki: public good
Wikipedia, "Universal Health Care." Wiki: Universal Health Care
Young Terrance, "Facts on Prescription Drug Deaths and the Drug Industry," The Conference, August 21, 2011. Young: 100,000 die from drug
Over-the-counter drugs also cause many deaths. For example, every year over 15,000 patients die in North America from ordinary aspirin and Ibuprophen. Ordinary Tylenol is the cause of thousands of hospital admissions and hundreds of deaths annually in North America.
Safety Management systems with regards to prescription drugs are decades behind other industries like transportation and nuclear, which both have independent regulators.