Published on March 11th, 2013 | by Todd Smekens1
Medical Industry Requires Further Reforms
We’ve talked numerous times on Muncie Voice about a variety of systems requiring transformation as we face a new era in the United States. One industry barely altered over the past several decades is the medical industry.
Barack Obama pushed through comprehensive reforms, but by the time lobbying groups and politicians completed hacking through the Affordable Care Act (ACA), its final version only polished up rough edges of a “gamed system” where consumers pay more and get less.
If you listen to comments made by the uninformed masses, you’ll hear the culprit is Big Government wanting to expand healthcare insurance causing increased taxes to all citizens, but that is incorrect. Had ACA not been stripped down by Big Medicine’s lobbying groups, it could have devised a single insurance buyer – the US Government. This would have saved our country billions in taxpayer dollars. The problem is the ACA didn’t go far enough.
In its final version, the ACA modified rules regarding who would pay for services in hopes of driving down costs by increasing the number of insured persons and the number of insurance exchanges who could then negotiate lower costs for covered clients.
However, it doesn’t address why the costs of healthcare are so high.
Big Medicine has a unique advantage over most all other industries since it negotiates prices with different buyers before they enter the market, and those who are not represented by an insurance company, generally get stuck paying full price for goods and services.
As a buyer, you don’t get to shop around for different deals before buying either. When you’re involved in a car accident the ambulance picks you up and drives you to the nearest hospital. You don’t get to shop around on the internet for the best deals.
When you think about it, this puts both Big Medicine and your physician in a unique position – they choose the products you will purchase and send you the bill.
Will they make the right choice for you? Will it be the least expensive option, or the most expensive option? Does knowing whether or not you have insurance factor in to their decision making?
These are good questions, and now that many doctors are employees of Big Medicine, it complicates the decision making process.
In Time Magazine, writer Steve Brine explores Big Medicine in depth with his article titled, “Bitter Pill: Why Medical Bills Are Killing Us.” He explores the issues discussed above in great detail providing multiple patient case studies, and then offers up some recommendations to fix the system.
In fact, his article encompasses the entire magazine and is well documented. One of his conclusions is,
Over the past few decades, we’ve enriched the labs, drug companies, medical device makers, hospital administrators and purveyors of CT scans, MRIs, canes and wheelchairs. Meanwhile, we’ve squeezed the doctors who don’t own their own clinics, don’t work as drug or device consultants or don’t otherwise game a system that is so gameable. And of course, we’ve squeezed everyone outside the system who gets stuck with the bills. We’ve created a secure, prosperous island in an economy that is suffering under the weight of the riches those on the island extract. And we’ve allowed those on the island and their lobbyists and allies to control the debate, diverting us from what Gerard Anderson, a health care economist at the Johns Hopkins Bloomberg School of Public Health, says is the obvious and only issue: “All the prices are too damn high.
Brine discusses the role of medical billing advocates who assist people in reading and understanding their bills, and try to reduce them. Sometimes significantly. They belong to trade groups called the Alliance of Claim Assistant Professionals and Medical Billing Advocates of America. Each advocate seems to handle 40 to 70 cases a year for the uninsured and those disputing insurance claims.
Some of his more interesting recommendations are:
- Tighten antitrust laws related to hospitals to keep them from becoming so dominant to assist insurance companies in negotiating with them
- Tax hospitals at 75% of profit (savings of $80 Billion a year)
- Have a tax surcharge on all non-doctor hospital salaries that exceed $750,000
- Limit the amount of pay for administrative salaries
- Outlaw chargemaster prices (the prices hospitals charge for goods and services)
- Amend patent laws on wonder drugs
- Reduce the drugmakers’ prices to what they receive from other countries
- Tighten up prices that Medicare pays for CT and MRI tests
- Cap prices on in-house lab tests
- Provide safe harbor defenses for doctors cutting costs and reducing the price of malpractice insurance
- Tort reform must be addressed as well to hinder these out of site costs on an already stressed system
Overall, this an article that should be read by every patient, taxpayer, public servant, voter, citizen, employee and employer to better understand the medical system and why healthcare represents 20% of our national GDP.
The important truth, buried within the article, but long known by those seeking reform for decades is, “Hospitals are supposed to be government-sanctioned institutions accountable to the public.”
That’s right, a hospital is a “government sanctioned institution” which means it serves the will of the people via our government. A trip to the hospital for parents with a child who has a broken leg, shouldn’t mean financial catastrophe and bankruptcy. Recent studies show that 60% of all bankruptcies are due to medical bills.
A democracy that serves the will of the people should be informing the public of the problems needing transformed and then collaborate with public health officials on solving the problems. Most of them are well known, but some are not. Transparency should be at the center of the reformation process. Brine discovered that openness and transparency were not the concern of well paid hospital administrators and those who run interference for them.
Lobbyists serving Big Medicine, Big Pharma, and Big Medical Device Makers should not be dictating the terms to the public officials who serve us. Our public officials should be telling the medical industry how the people are best served.
If our democracy was working as intended, these issues would have been remedied years ago, but monied interests have prevailed and a corporate owned media has been slow to inform the public. Times are changing rapidly.
Photo above came from http://www.streamlininghealthcare.org/page/resources