Physicians, Business, Professional and Information Technology Communities
Networking to Develop the Ideal HealthPlan for the USA
HPUSA Quarterly Newsletter, October, 2003
Join the Medical/Professional/Business Gatherings on MedicalTuesdays. On the Extra Tuesday Each Quarter, We Review the Ideal HealthPlan for the USA and by Extension for All Countries.
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In This Issue:
1. The Major Current Problems in HealthCare, Solutions and Benefits.
2. Innovate! Can We Think Outside of the Box?
3. California’s Political Volcano
4. Diet and Stop Smoking or Lose Your Free Medical Care in the UK
5. Our Quarterly Review of HealthPlanUSA
6. Affordable Health Care
The Major Current Problems in HealthCare
The $1.4 trillion health care industry is the only segment of the economy that is failing, and there is nothing the employer, insurance carrier or government can do about it.
Health care is the only product or service (outside of public education) that has consistently grown worse over the past 30 years, with decreasing customer (patient) satisfaction. Every other product and service in our economy has improved in quality and grown less expensive over time, with increasing customer satisfaction.
Health care is the only sector of the economy where prices have been steadily increasing since the end of WWII. Every other sector of the economy is reaping the benefits of Moore’s Law which states that the cost of digital technology decreases by 50 percent every 18 months. In health care, although the Length of Stay (LOS) for delivery of a child has decreased from five days to two days, the hospital cost has more than doubled. The LOS for gallbladder surgery has decreased from five days to one day, but the hospital cost has nearly doubled. The surgeons' fees have remained level or even decreased during this time.
The HealthPlanUSA Solution
HPUSA is the only true Market-based Health Plan that uses the Internet and Digital Information Technology to bring the Insurance Carrier, Service Providers (Hospitals, Surgicenters, Physicians, Pharmacies, Diagnostic and Treatment Centers), Patients and Credit Providers together at the same interface, allowing data, information and fund transfers to occur in real time.
The patient takes an interest in making an informed decision at every step of the health care process when he or she has a financial obligation in all decision-making processes–which doctor to see, which hospital to use, which pharmacy to utilize, which laboratory to draw blood, which x-ray facility for diagnostic testing. The financial stake is proportional to the cost incurred without limit. Thus, each service provider will provide the best service for the money in order to assure a continuing customer (patient) base.
• Healthcare costs are reduced making it more affordable and available to all Americans, thus eliminating the uninsured concerns.
• Quality is increased by cutting down delays in patient care, thus decreasing unnecessary patient suffering and premature death.
• Efficiency is increased by cutting the time between providing medical services and payment to service providers: hospitals, surgicenters, physicians, pharmacies, laboratory, x-ray, CTs, MRIs and other diagnostic and treatment centers. (Although experiential data is currently not available, some actuaries have informally estimated that this is a 20-50 percent decrease in business office costs for hospitals, physicians and other providers.)
• Choice is unlimited as patients make their own choice on the basis of cost, quality and efficiency. Unless they improve, poor or incompetent providers will be eliminated more efficiently than any HMO, insurance plan, PEER Review, government, FBI, Medical Board or other overseeing or policing agency can do, thus saving multiple bureaucratic costs and further decreasing health care costs. (Although accurate data is elusive, some actuaries have informally estimated that this is a 40-60 percent decrease in administrative and bureaucratic costs.)
• Spectrum of a customer market base is increased to insurance and credit providers by the direct digital interface with the patient and service providers.
• The nation’s $1 trillion privately funded health care costs (of the $1.4 trillion total) will be significantly reduced. Although accurate data is elusive, conservative estimates by actuaries suggest the nation’s health care costs should be reduced by at least thirty percent making health care affordable to all Americans that fall between the Medicaid and the Medicare programs. As Medicare goes bankrupt and eliminates 66 and 67 year-olds, progressing higher as it follows social security benefit restrictions, HealthPlanUSA will easily be able to absorb these unfortunate Americans who have lost an unrealistic unfunded coverage base.
The above 60-second presentation can be copied and pasted into your email signature line, sent to all your friends, or printed out to give to folks you think are interested or should be interested in the problems of health care.
Totalitarians Usurp Control over Human Lives. Single-payer health insurance evolved two centuries ago as totalitarian regimes sought ways to obtain allegiance for their control of human life. Health care seemed the perfect mechanism since there was enough mysticism and anxiety in those striving for health that it produced the obedience that Marx, Stalin, Hitler, Mussolini, Napoleon, Bismarck and others needed in their quest for absolute power over human lives. These dictators have all disappeared. The social welfare state they used to enslave their citizens continues even today as a goal for misled freedom-loving democracies. Many voters do not fully appreciate how they are giving up the control of their very personal, physical, mental, sexual and spiritual personhood in the process. Why are we still in this two-centuries old failed “Government Box” in this computer, electronic, telecom age of the twenty-first century?
Innovation Requires a Struggle. Our forebears fought the revolutionary war to separate from our motherland and create the innovation in government that provides individuals the freedom to develop their God-given talents in the quest of life, liberty and the pursuit of happiness. In the eighteenth century, Americans were able to think outside of the “government box.” In the nineteenth century, while Americans developed the greatest democracy and societal advancement in history, parts of Europe were being medically indentured. Meanwhile, some fifty years ago, the British allowed this regressive thinking to cross the channel and the National Health Service (NHS) was formed. This has resulted in third-world health care. After a half century of failures, there are attempts to privatize health care in the UK and Sweden. However, with the infrastructure of private health care destroyed, they are having difficulty in getting out of the “NHS Box.” Once, on a train ride from London to Edinburgh, I conversed with a British Accountant who had nothing good to say about the NHS. In fact, he would not trust them with his health or life; he had his own private health insurance and only went to private doctors. Did he want to get rid of the NHS? No. He said it would be there just in case he ever needed it. He had a lot of colleagues that felt the same way. If all those that pay taxes for this free service start using the free service, what would happen to the poor folks in the waiting queues desperately needing care? What a waste of resources–a lifetime of expenses for non-use–by continuing to think “In the Box.”
Political Innovation in The United States. In 1879, California tore up its original constitution and started over. The state adopted the tools of direct democracy with the recall of elected officials, including the governor. This has become the cornerstone of our political system. It was put to the test in the twentieth century with Proposition 13 that limited property taxes to one percent. This was a humane benevolence to senior citizens so that they would not have to sell their homes in order to pay property taxes on their homes that were increasing in value while incomes decreased in proportion. The same principle is being put to the test in the current recall of our governor being watched by the entire world. California may escape from the “Political Box” and become more innovative–even later today. There is even talk about reversing the universal medical coverage law our governor recently signed should he leave office tomorrow.
A Political Volcano. According to Daniel Weintraub in the Sacramento Bee, Kevin Starr, the preeminent California historian serving as the state librarian who has written three volumes of California history, initially looked down on the recall with Harvard snobbery. Since then, he sees the eruption of a political volcano, a legitimate citizen movement reacting to a disconnect between those that govern and the governed. The governed are connected through the internet and thinking “Outside the Government Box.” No matter what happens on the recall later today, voters will demand the structural reform that the experts have been discussing for years. But politicians, wedded to competing interest groups, have refused to act outside “Their Box.” Maybe tomorrow they will peak out.
MedicalTuesday, that connects the Medical Profession with interested Business, Professional and Digital Information Tech communities, is busy designing an innovative HealthPlanUSA using modern digital informational technology based on the best ideas in medical informatics in order to allow Health Care to get out of the “box” that European countries placed it in two centuries ago. Will America be successful in the HealthCare Frontier and pave the way to reclaim innovative HealthCare just as we were in 1776 in our Freedom Frontier? Join us in the exciting venture to straighten out the rugged path through the backwoods of government bureaucracy.
(We hope the proponents of free care in Oregon, Vermont, California and elsewhere who not only want to include unnecessary care in the single-payer initiatives, but also aroma and herbal therapy, are listening.)
Affordable Health Care
Question: What categories of health care have actually decreased in cost over the past 10 years, and what do they have in common?
Answer: Laser Eye Surgery, Liposuction, Breast Implants and other Cosmetic Surgery
Reason: None are covered by employer or government-sponsored health plans; patients have complete control and responsibility for their use.
Why Health Care is Expensive
Question: Which categories of employer or government-sponsored health care have decreased in cost over the past 10 years?
Reason: For more than 50 years, doctors, insurance carriers (including HMOs) and patients have ignored the laws of economics in making health care decisions
Laws of Health Care Economics
Doctors and patients are no more above the laws of economics than pilots and skydivers are above the laws of gravity. Every decision is an economic decision.
By Defying the Laws of Economics, HealthCare
• Costs have increased 124 percent over and above CPI since 1957
• Technology is assumed to increase costs rather than decrease costs
• Quantity is decreasing with shorter hospitalization (LOS) but costs still increase
• Time waits for patient, physician and payment all continue to increase
• Choices are decreasing for patients and physicians
• Trust is virtually nil for patient, physician and HMO
Public Health Care vs. Private Health Care
Private Goods: Everyone chooses what they want, when they want it (food, clothing, etc.)
• No one suffers from another’s choice
Public Goods: No one chooses; everyone gets the same thing in the same way. In fact, your input is not wanted, not appreciated and ignored. (roads, laws, public schools, health care)
• Everyone suffers from other’s gluttony or irrational choices: The I don’t know and I don’t care philosophy
Responsibility: The 1990s Managed Care Model
• Physicians are incompetent and even dangerous
• Physician profiling by actuaries, accountants and Utilization Reviewers
• Managed care — “Medical care managed by people with no knowledge of medicine and who have no contact with the patient”
• Capitation — “Actuaries, trained in risk management, tell doctors how to practice medicine, while doctors, trained in medicine, are forced to manage risk”
The Muda of Managed Care
The great Toyota production engineer, Taiichi Ohno, referred to any activity that adds cost but does not add value as muda. There are seven categories of muda. As applied to healthcare, they are as follow:
• Delay: Idle time waiting for pre-certification
for hospitals, consultations, tests.
• Movement: Unnecessary physician visits for referrals and lab tests.
• Oversight: Having one worker watch another worker as in utilization review.
• Inspection: Having one worker inspect the work of another worker after it has been completed as in HCFA retrospective case review.
• Rework: Performing the same task twice as in second opinions or refiling claims.
• Overproduction: Requiring unnecessary products as in defensive medicine or processing unnecessary information, e.g. as required by HIPAA.
• Poor or Defective Design: Design goods that do not meet customer needs, such as HMOs, Government or Employer-sponsored health care, and requiring RBRVS, CPT, DRG, and ICD-9 coding schemes.
Simple Solutions For a Complex World
Transform health care from a public bureaucracy to a personal and private choice.
Tear Down The Walls: Assign the IRC and ERISA to the dustbin of history.
Return Responsibility to The Patient: Just as war is too important to be left to the generals, and just as the education of your children is too important to be left to the government, your health is way too important to be left to either your employer or the government.
January Newsletter: http://www.medicaltuesday.net/Dec3102.htm
April newsletter: http://www.medicaltuesday.net/Apr2903.html
July newsletter: http://www.medicaltuesday.net/July2903.html
Single-Payer Initiatives: http://www.healthcarecom.net/EditorialNov94.html
David Gibson, MD, Health Care Consultant:
Single Payer: http://www.healthplanusa.net/DGSinglePayer.htm
Why are the uninsured, uninsured? http://www.healthplanusa.net/DGUninsured.htm
What’s behind health care costs? http://www.healthplanusa.net/DGRisingHealthCareCosts.htm
Pharmacy costs: http://www.healthplanusa.net/DGPharmacyCosts.htm
* * * * *
Del Meyer, MD, CEO & Founder
"If you think health care is expensive now, wait
until you see what it costs when it's free."
I shall be telling this with a sigh,
Sometime ages and ages hence.
Two roads divided in the woods, and I took the one less traveled by.
And it has made all the difference.