It's been nearly two weeks since I blogged on this site. The health care debate rages on in Congress. I would like to first speak on the idea of requiring people to purchase health insurance. It is very different than the auto insurance requirement. Here is why:
1. I do not really have to purchase auto insurance! Really? Yes, the law requires that you have auto insurance...if you have a car. You do not have to purchase a car or obtain a driver's license. If you operate a car, you agree to carry auto insurance, but you do not have to operate a car...therefore auto insurance is optional.
2. Auto insurance is about YOUR liability. It is to protect YOU against the financial losses when YOU make a mistake. SOME medical issues are preventable, but not all of them. Some are hereditary, some are environmental or involve other factors beyond your control. Why should YOU be responsible for something YOU can not control?
Now for the 8th point. In review, here are the other 7:
1. Catastrophic-only insurance. Government as a last-resort safety-net. Pay out of pocket for simple and common doctor visits and meds. He who has the gold makes the rules. When you run a business that relies on third parties to pay your services, you should not be surprised when those third parties attempt to control the process. The more the money comes directly from the patient, the more control the patient will have over the process.
2. Diffuse the risk. Bring low-risk populations that are not currently covered into insurance plans. These populations include immigrants, college students and younger workers. Reward those who take steps to lower their personal risk by joining gyms, loosing weight, etc. Lower risk means lower costs. It would also lower risks to focus on preventative measures.
3. Tort reform to end unneeded CYA-type tests. End medical testing that doctors order simply because they are afraid of being sued. Sure, there is negligence and the duty to care or at least do no harm, but testing simply because one is fearful of a lawsuit is a different thing entirely. It increases demand for medical services which drives costs.
4. Realistic end-of-life care that focuses on extending a quality of life instead of simply delaying death. This would include proper grief counseling for those who loved ones are near the end. It is hard to let someone go, but there comes a time to do so.
5. Train more providers of all types. Introduce more competition into the system by ending the shortage of doctors, nurses, physician assistants and pharmacists. I'm certain that everyone knows someone who would have been a great doctor if he could only get into medical school.
6. End the use of the Emergency Room when an unplanned medical problem arises. Have more insta-care type facilities including co-located facilities that people can use for such situation. If someone shows up in the ER who can wait, have them wait or pay through the nose. This will leave the ER people available for real life or death problems.
7. Alternative payment methods. Patients who can not pay for their medical bills should work them off through community service in lieu of forcing them into bankruptcy. No one gets a free ride. End the practice of just writing-off unpaid bills. End the expectation of a free ride. Use arbitration instead of threatening bill collection.
8. Aggressively prosecute medical fraud. Recovering from criminal losses adds to everyone's costs in one way or another.
Sunday, September 27, 2009
Tuesday, September 15, 2009
Remember When?
Before the "Great Society" programs of the Johnson Administration, the United States truly had the best health care system in the world. What are some of the differences between then and now?
1. In 1965, doctors got 67% of their revenues directly from the patient. Why is this an important? Have you ever heard of the "Golden Rule?" Not the biblical one, but the one from Disney'sAladdin , "he who has the gold makes the rules." Doctors could be more responsive to the needs of the patient because the patient was the source of most of their money. So the patients were in control. Insurance companies were involved when there was a catastrophic need. When the patients are in control of the process, the free market can work.
Solution:
I repeat what I have said before. If I go to my doctor and leave with only advice, there is no reason why I should have to file a claim with my insurance company. I don't file a claim with my auto insurance when I change the oil in my car. I don't make a claim with my home insurance when I paint the house. Insurance should be for catastrophic trouble only! Fewer claims mean lower prices and more accessibility. Don't cover routine doctor visits, or prescriptions. Don't cover eyeglasses or contacts. Focus on prevention, but offer premium discounts instead of reimbursements.
2. The population was younger. Why is this important? Even if you sew your wild oats night after night, problems rarely happen. If you don't crash your car or bike, nothing will happen. When you are under 45, you are invincible. Lower risk means lower prices for insurance and greater accessibility. Also, like homeowners and auto insurance, discounts should be given to people that take steps to lower their personal risk.
Solution:
There is little we can do about the population pyramid other than have more babies and bring more immigrants into the system. Let's get busy. If you have fewer than 3 kids and you are still in child bearing years, have another. Just kidding, of course. But our failure to realize that all the money we spend on children will come back to us is one of the biggest failures in modern society. We need younger workers to cover the older ones and the retirees. We should aggressively recruit the "invincible" crowd into insurance plans to reduce the risk.
3. There were fewer lawyers. Malpractice insurance does not directly add a lot of money to your medical bill. But your doctor orders a ton of unneeded CYA tests just in case he is sued. There is the belief that doctors have deep pockets and they become easy targets for law suits.
Solution:
We need medical tort reform. Doctors and other providers need to be held accountable for mistakes that they make, just like the rest of us. But limit the amount of money that can be collected. Also, if a doctor has to renew his license every year, than a lawyer should as well.
4. End of life issues did not exist. Something that we must understand: There is a difference between extending life and delaying death. In 1965 we had little power to do either. It is difficult and painful and emotional to realize that this line has been crossed, especially if it is your mother, father, brother, sister or child; but expecting other people to pony up when that line has been crossed is just as immoral as letting someone die before the line is crossed. The difference between 1965 and today is that we had little choice but to let people die. Many procedures we take for granted now were new back then.
This is likely the most controversial thing I have ever blogged on this site. But there is a "most miraculous ever" threshold. Once it has been crossed, say goodbye and let people go. There have been some high profile cases in the news in this area, and there is always someone waiting for the next miracle. If you have the means to keep your loved one alive forever and not be a burden to taxpayers or society, go ahead. But don't expect insurance companies and taxpayers or even your church to pay the bill. Costs for this type of care are expensive and escalate exponentially.
Solution:
Be sure that you have a will and a medical end of life directive on file. Ensure that family knows where those documents arrive. One of the big problems in prominent end-of-life cases is that family was unaware of the actual desires of the patient.
5. Doctor to patient ratios were realistic. Do you know when the last new medical school was accredited in the United States? Here is a trivia question: where is the newest medical school in the US? (Hint--They are one of the lesser known Universities in the Miami area.) They open just this fall and are the first new medical school in this country in many years. There are only 131 medical schools in the United States to server all 400,000,000 of us. We are not training enough doctors. Soon, baby boomer doctors will begin to retire and we will not be able to replace them. We also do not have enough nurses or enough pharmacists, or just about anyone. Who does not know someone who would have made a brilliant doctor that could not get into medical school?
Solution:
We need more medical schools and everything that they provide. We also need a lot more nurse practitioners and physician assistants. They can lower the overhead and free a doctor from many of the routine problems that take a doctor's time.
Trivia question answer: http://medicine.fiu.edu/index.php
6. Emergency Rooms. When people had a non life-threatening emergency, where did they go? It was not the ER. It was their local doctor. When my dad was 9--1952--he was knocked silly on the playground and the doctor came to his house! (He tells the story much better than I could.) And not only that, Grandpa did not go bankrupt because of it either.
Solution:
We have got to stop using the emergency room for every little problem. If you don't have to call 911, don't visit the ER!
7. Paying for service. Back to that story about my dad. My Grandparents were not Rockefellers. I know that my Grandad would exchange services with many people in the community. He was an exterminator. All of his medical bills were paid and the town doctor never had mice at the office or grasshoppers in his orchard. This is often how small business people got what they needed back in the day.
Solution:
If you can't pay your medical bills, there should be a way to work them off. The doctor provides you a service you can not pay for, you work a Saturday morning at the food bank. The doctor gets a tax write off. It's a win/win. No one, no matter what their circumstances are, is entitled to free medical services. If you can't pay, then you can serve. Even organizations like St Jude and Primary Children's Hospital should find some way for patients (or their parents) to pay forward the services they have received.
Think of these seven solutions, does any of this involve the Federal Government? Again, here are the 7 points of the plan:
1. Catastrophic-only insurance. Government as a last-resort safety-net. Providers should get the majority of their revenues directly from the patient.
2. Diffuse the risk. Bring low-risk populations that are not currently covered into insurance plans. These populations include immigrants, college students and younger workers. Reward those who take steps to lower their personal risk by joining gyms, loosing weight, etc.
3. Tort reform to end unneeded CYA testing.
4. Realistic end-of-life care that focuses on extending a quality of life instead of simply delaying death.
5. Train more providers. Introduce more competition into the system.
6. End the use of the Emergency Room when an unplanned medical problem arises.
7. Patients who can not pay for their medical bills should work them off through community service in lieu of forcing them into bankruptcy. No one gets a free ride. End the practice of just writing-off unpaid bills. End the expectation of a free ride.
1. In 1965, doctors got 67% of their revenues directly from the patient. Why is this an important? Have you ever heard of the "Golden Rule?" Not the biblical one, but the one from Disney's
Solution:
I repeat what I have said before. If I go to my doctor and leave with only advice, there is no reason why I should have to file a claim with my insurance company. I don't file a claim with my auto insurance when I change the oil in my car. I don't make a claim with my home insurance when I paint the house. Insurance should be for catastrophic trouble only! Fewer claims mean lower prices and more accessibility. Don't cover routine doctor visits, or prescriptions. Don't cover eyeglasses or contacts. Focus on prevention, but offer premium discounts instead of reimbursements.
2. The population was younger. Why is this important? Even if you sew your wild oats night after night, problems rarely happen. If you don't crash your car or bike, nothing will happen. When you are under 45, you are invincible. Lower risk means lower prices for insurance and greater accessibility. Also, like homeowners and auto insurance, discounts should be given to people that take steps to lower their personal risk.
Solution:
There is little we can do about the population pyramid other than have more babies and bring more immigrants into the system. Let's get busy. If you have fewer than 3 kids and you are still in child bearing years, have another. Just kidding, of course. But our failure to realize that all the money we spend on children will come back to us is one of the biggest failures in modern society. We need younger workers to cover the older ones and the retirees. We should aggressively recruit the "invincible" crowd into insurance plans to reduce the risk.
3. There were fewer lawyers. Malpractice insurance does not directly add a lot of money to your medical bill. But your doctor orders a ton of unneeded CYA tests just in case he is sued. There is the belief that doctors have deep pockets and they become easy targets for law suits.
Solution:
We need medical tort reform. Doctors and other providers need to be held accountable for mistakes that they make, just like the rest of us. But limit the amount of money that can be collected. Also, if a doctor has to renew his license every year, than a lawyer should as well.
4. End of life issues did not exist. Something that we must understand: There is a difference between extending life and delaying death. In 1965 we had little power to do either. It is difficult and painful and emotional to realize that this line has been crossed, especially if it is your mother, father, brother, sister or child; but expecting other people to pony up when that line has been crossed is just as immoral as letting someone die before the line is crossed. The difference between 1965 and today is that we had little choice but to let people die. Many procedures we take for granted now were new back then.
This is likely the most controversial thing I have ever blogged on this site. But there is a "most miraculous ever" threshold. Once it has been crossed, say goodbye and let people go. There have been some high profile cases in the news in this area, and there is always someone waiting for the next miracle. If you have the means to keep your loved one alive forever and not be a burden to taxpayers or society, go ahead. But don't expect insurance companies and taxpayers or even your church to pay the bill. Costs for this type of care are expensive and escalate exponentially.
Solution:
Be sure that you have a will and a medical end of life directive on file. Ensure that family knows where those documents arrive. One of the big problems in prominent end-of-life cases is that family was unaware of the actual desires of the patient.
5. Doctor to patient ratios were realistic. Do you know when the last new medical school was accredited in the United States? Here is a trivia question: where is the newest medical school in the US? (Hint--They are one of the lesser known Universities in the Miami area.) They open just this fall and are the first new medical school in this country in many years. There are only 131 medical schools in the United States to server all 400,000,000 of us. We are not training enough doctors. Soon, baby boomer doctors will begin to retire and we will not be able to replace them. We also do not have enough nurses or enough pharmacists, or just about anyone. Who does not know someone who would have made a brilliant doctor that could not get into medical school?
Solution:
We need more medical schools and everything that they provide. We also need a lot more nurse practitioners and physician assistants. They can lower the overhead and free a doctor from many of the routine problems that take a doctor's time.
Trivia question answer: http://medicine.fiu.edu/index.php
6. Emergency Rooms. When people had a non life-threatening emergency, where did they go? It was not the ER. It was their local doctor. When my dad was 9--1952--he was knocked silly on the playground and the doctor came to his house! (He tells the story much better than I could.) And not only that, Grandpa did not go bankrupt because of it either.
Solution:
We have got to stop using the emergency room for every little problem. If you don't have to call 911, don't visit the ER!
7. Paying for service. Back to that story about my dad. My Grandparents were not Rockefellers. I know that my Grandad would exchange services with many people in the community. He was an exterminator. All of his medical bills were paid and the town doctor never had mice at the office or grasshoppers in his orchard. This is often how small business people got what they needed back in the day.
Solution:
If you can't pay your medical bills, there should be a way to work them off. The doctor provides you a service you can not pay for, you work a Saturday morning at the food bank. The doctor gets a tax write off. It's a win/win. No one, no matter what their circumstances are, is entitled to free medical services. If you can't pay, then you can serve. Even organizations like St Jude and Primary Children's Hospital should find some way for patients (or their parents) to pay forward the services they have received.
Think of these seven solutions, does any of this involve the Federal Government? Again, here are the 7 points of the plan:
1. Catastrophic-only insurance. Government as a last-resort safety-net. Providers should get the majority of their revenues directly from the patient.
2. Diffuse the risk. Bring low-risk populations that are not currently covered into insurance plans. These populations include immigrants, college students and younger workers. Reward those who take steps to lower their personal risk by joining gyms, loosing weight, etc.
3. Tort reform to end unneeded CYA testing.
4. Realistic end-of-life care that focuses on extending a quality of life instead of simply delaying death.
5. Train more providers. Introduce more competition into the system.
6. End the use of the Emergency Room when an unplanned medical problem arises.
7. Patients who can not pay for their medical bills should work them off through community service in lieu of forcing them into bankruptcy. No one gets a free ride. End the practice of just writing-off unpaid bills. End the expectation of a free ride.
Friday, September 11, 2009
Davis bond proposal...not bold enough
Davis County is asking voters to approve a new bond initiative this coming election. The bond is for new schools. It is meant to raise money for four elementary schools (1 rebuilt) 1 junior high school in west Kaysville and for a 10-classroom addition to Woods Cross High School.
At first blush, it might seem a little bold, but looking at growth projections in the county it is not bold enough. It will lead to more portable classrooms and year-round schools. These new schools will not be enough. What is needed is six elementary schools, 2 junior high schools and one new high school. The other 3 elementary schools, the other junior high and the high school will be needed to be bonded in another two years. But it would be better to bond these projects now while the materials are at a lower cost and labor is willing. We may not have this luxury in another two years. Also, adding 250 new students to Woods Cross High School will mess up an already ugly boundary problem in the south end of the county. Are you going to bus kids in the Porter-Walton area of Centerville all the way to Bountiful High School and have the buses drive right by Viewmont High School on the way?
For more information on the Davis County School bond issue, please visit this link:
http://www.davis.k12.ut.us/district/2009_bond/
1,000 new students in the county every year. We need at least 6 new elementary schools, 3 new junior highs...Kaysville, North Salt Lake, and South Weber or East Layton. And at least one new high school in Farmington. This location will fix the boundary problem in the south end of the county and relieve the overcrowding at Davis High.
At first blush, it might seem a little bold, but looking at growth projections in the county it is not bold enough. It will lead to more portable classrooms and year-round schools. These new schools will not be enough. What is needed is six elementary schools, 2 junior high schools and one new high school. The other 3 elementary schools, the other junior high and the high school will be needed to be bonded in another two years. But it would be better to bond these projects now while the materials are at a lower cost and labor is willing. We may not have this luxury in another two years. Also, adding 250 new students to Woods Cross High School will mess up an already ugly boundary problem in the south end of the county. Are you going to bus kids in the Porter-Walton area of Centerville all the way to Bountiful High School and have the buses drive right by Viewmont High School on the way?
For more information on the Davis County School bond issue, please visit this link:
http://www.davis.k12.ut.us/district/2009_bond/
1,000 new students in the county every year. We need at least 6 new elementary schools, 3 new junior highs...Kaysville, North Salt Lake, and South Weber or East Layton. And at least one new high school in Farmington. This location will fix the boundary problem in the south end of the county and relieve the overcrowding at Davis High.
Thursday, September 10, 2009
Is This You?
In the health care debate, most of the complaints are about price. I want to know if anyone has a complaint that NOT related to price. This can include:
-Doctor Mistakes
-Waiting too long in the waiting room
-Inability to get an appointment
-"Bedside" manner
-Inability to make a complaint
Any problems at all other than price.
Post a comment to this blog.
Pass this on to your friends.
-Ben
-Doctor Mistakes
-Waiting too long in the waiting room
-Inability to get an appointment
-"Bedside" manner
-Inability to make a complaint
Any problems at all other than price.
Post a comment to this blog.
Pass this on to your friends.
-Ben
Wednesday, September 2, 2009
Obama can come to my school
Yes, I am a republican. But Obama can come to my school and speak to my kids any time he pleases. I would be pleased to hear him motivate the kids to do their homework, to be active in politics, to be physically fit. It would be an experience that they would never forget. I would even be pleased if he would address the kids about his struggles with tobacco.
What bothers me is when any politician, no matter the office, uses children to push their policies, whether I agree with them or not.
So, on behalf of all Clearfield High School parents, I hereby invite President Obama to come to our school and speak with our kids in an assembly. Please come and inspire and motivate our children and give them an experience that they will never forget. The children are the future of our country, and our chief should lead them to that future.
Speaking of which, the "I pledge allegience to our debt" commercial that has been running give me pause for thought. And remember, the debt is owned by both parties.
What bothers me is when any politician, no matter the office, uses children to push their policies, whether I agree with them or not.
So, on behalf of all Clearfield High School parents, I hereby invite President Obama to come to our school and speak with our kids in an assembly. Please come and inspire and motivate our children and give them an experience that they will never forget. The children are the future of our country, and our chief should lead them to that future.
Speaking of which, the "I pledge allegience to our debt" commercial that has been running give me pause for thought. And remember, the debt is owned by both parties.
Tuesday, September 1, 2009
Give Up Put Downs
I finally saw one, and I knew that it was coming. A bumper sticker that said, "Don't Blame Me, I Voted for the American."
I am not happy about this kind of rhetoric. Why? The original bumper sticker "Don't Blame Me, I Voted for Bush" were aimed at those who voted for H. Ross Perot in 1992. John McCain did not loose the last election because a third party candidate stole votes away from him. Second, it flames hatred in Politics. Here is the chain of hatred, as I see it.
Hatred against Lyndon Johnson for the Vietnam war gave us Richard Nixon.
Anger against Gerald Ford for his pardoning of Nixon gave us Jimmy Carter.
Anger against Carter for a weekend military and a poor economy gave us Ronald Reagan.
Anger against George H Bush for tax increases caused GOP defections for Perot that gave us Clinton.
Anger against Clinton gave us W.
Hatred for W gave us Obama.
We will not get a good president through anger and hatred. Focus that anger against your representatives in the House and against your senators. Here in Utah, focus your anger and Hatch, Bennett, Matheson and Bishop. Hold their feet to the fire. Make them understand that they represent you in Congress. Make your voice heard.
Then let's work to get a positive candidate for President in 2012. But remember, we have another election before then.
I am not happy about this kind of rhetoric. Why? The original bumper sticker "Don't Blame Me, I Voted for Bush" were aimed at those who voted for H. Ross Perot in 1992. John McCain did not loose the last election because a third party candidate stole votes away from him. Second, it flames hatred in Politics. Here is the chain of hatred, as I see it.
Hatred against Lyndon Johnson for the Vietnam war gave us Richard Nixon.
Anger against Gerald Ford for his pardoning of Nixon gave us Jimmy Carter.
Anger against Carter for a weekend military and a poor economy gave us Ronald Reagan.
Anger against George H Bush for tax increases caused GOP defections for Perot that gave us Clinton.
Anger against Clinton gave us W.
Hatred for W gave us Obama.
We will not get a good president through anger and hatred. Focus that anger against your representatives in the House and against your senators. Here in Utah, focus your anger and Hatch, Bennett, Matheson and Bishop. Hold their feet to the fire. Make them understand that they represent you in Congress. Make your voice heard.
Then let's work to get a positive candidate for President in 2012. But remember, we have another election before then.
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