I ask, How are we paying for what we have now? We have an inefficient Medicaid system where care is episodic and not comprehensive. We have emergency rooms being utilized as primary care centers that offer no follow through and the resources in many cases are wasted.

In addition, we have general care that is either overused or underused. Add to that the misuse of care and the administrative duplication that occurs and we have a ton of money that is spent and wasted.

A study done by the Midwest Business Group on Health calculated tlhat upwards of half of the health care dollars spent were wasted. Add to that the cost to the economy by loss of productivity and you have an enormous amount of money that could easily fund a health care for all program.

I would like to hear from anyone why there isn’t enough money to do it right whaile we wast tons of money doing it wrong and we want to continue that spending?

One of the speakers at the health policy forum, Ron Goetzel would be able to confirm my assertions and probably be able to give you the exact sums that would be available to fund the new system.

Don’t tell me there is not enough money to do it right. The data as I have seen it sluggests otherwise.

Norman M. Charney
CEO
Health Care for the 21st Century

Irresponsible how? Penny wise and pound foolish? Too long term oriented? I don’t understand that comment and the comment about “paying for it is a problem.”

It seems some people think that health care dollars not spent by the government don’t count. So the 15K a year I pay for insurance is “off the books” as far as national health care expenditure is concerned. That’s why we look at spending per capita and as a percent of GDP. We do horribly in both these measures, and yet some worry that decreasing the amount we spend in the long term is “fiscally irresponsible” and we won’t be able to pay for it.

What are you saying?

it could be called Utilization, or Cost Control, or a host of other names. Let’s start with these two.

In the early seventies as a government planner, it seemed the answer was going to be a sort of HMO arrangement, and I was in on New Haven Health Care, modeled after Kaiser at that time.

HMOs were seen by large segments of the public as something people were being forced into, to save employers $ and reduce CHOICE. Imagine America being told you have to see a gatekeeper in order to get referred, and then you have to WAIT. This did not play well with Red or Blue.

Some learned to accept the trade-off as a way to get richer benefits as PPOs moved from an indemnity model to skimpier fare.

But HMO rates kept going up to where Kaiser is now offering PPO and HSA type plans!

And now we have a new SOLUTION: Medical Homes. At first I thought this was some sort of Long TErm Care. Reading more carefully it sounds to me like an HMO with Caring. Or something.

And it’s going to bring costs down HOW???

Let me move to utilization. As a broker who’s faced with helping small businesses, largely under 20 “lives” find affordable coverage, and avoid the pitfalls of great-sounding deals that come out Year 1 and by Year 2 offer 17-35% rate increases (talk about government oversight – are the DOI commissioners asleep when they look at the first submission, or what? Don’t they realize in the first place?! What happens here to allow approval of a plan in the first place, and then a rubber stamp for rate increases in Year 2?

And then there’s Utilization by the consumer. What the consumer/employee with decent health coverage doesn’t understand is that while they are going merrily along utilizing whatever they are offered (oh, I hurt my shoulder and my insurance will cover 15 sessions of physical therapy with no copay? Well, let’s have it then – and an MRI to be sure sure nothing’s torn, and chiropractic – is it covered? – why not?). Then the employee is downsized, or decides they’ve had it with cubicle life and wants to do contracting or gardening or something.

They call someone like me – if they are lucky and get referred by someone who knows the ropes – and they are astounded to find they’ll have to finish up COBRA and get on Guarantee Issue coverage for $800+ per mo till the shoulder issue goes away when they’ve had a year or more treatment free.

Both you and the client may be thinking this is mean-spirited and maybe Hillary will make it go away. But fellas and gals, get out your calculators. It’s not just the humongous overhead. Even if you take away the millions earned by some CEOs, you are left with the issue that Mary’s PT, Chiro, MRIs, GP and specialists visits cost a lot more than her company paid out in premium and when you multiply that by many employees…

So I’m bringing up a couple of issues relating to cost control, utilization, and the Uninsured Problem. Thank G-d my client has her car almost paid for, so she will have to spend that $ on health coverage now in order to afford the Guarantee Issue plan.

If employees knew about these issues, maybe utilization would go down.

But I also feel there’s another “remedy” being proposed by a few far-thinking docs who are not busily involved with buying and paying for more and more technology by referring all their patients (insurance insider view. not really accurate).

It’s called Slow Medicine. That’s the name at the moment, but it’s a mindset that is just now developing and evolving.

bett l. martinez, m.ed., broker/consultant/advocate
well-being@pacbell.net; 510-526-0312