On Health Care

Somebody said something rather stupid today in the Dallas Morning News. For those of you who just flew in from the face of Venus, I’ll provide you the link.

Almost one of every four Texas residents – 24.8 percent – were uninsured in 2006 and 2007, based on an average of the rates for those two years. That’s up from 23.9 percent for 2004 and 2005.

…

But the numbers are misleading, said John Goodman, president of the National Center for Policy Analysis, a right-leaning Dallas-based think tank. Mr. Goodman, who helped craft Sen. John McCain’s health care policy, said anyone with access to an emergency room effectively has insurance, albeit the government acts as the payer of last resort. (Hospital emergency rooms by law cannot turn away a patient in need of immediate care.)

So most of the liberal blogs stopped there and had a roast of John Goodman. Fair enough. What Goodman said is ridiculous. He hasn’t been what we call in my business, “media trained.” In other words, don’t say anything you wouldn’t want to see in print. No doubt, he’s wishing someone had given him that little nugget before a reporter from the Dallas Morning News called him up yesterday.

But the blogs ranting on Goodman do a bit of an injustice in not reporting the rest of his (still foolish, but somewhat rational) quote. Here, I’ll help:

“So instead of producing worthless statistics that people fling around in vacuous editorials and pointless debates, the Census Bureau should produce meaningful numbers, identifying all of the sources of funds people will draw on if they need medical care,” he said.

To his point, to say this person is uninsured, or that person is insured, lacks nuance. It lacks context and most of all it doesn’t address the problem.

Allow me to provide some context. Let’s assume we can all agree health care in the country is a problem. Ok, what good does the Census Bureau’s stats do to fix that problem?

Zippidy Do Dah, Nada.

So here’s what the Goodmans of the world say. Rather than take a number and hold it out there as some measure of insurance versus uninsurance, instead let’s look at funding and find better ways to fund health care.

Instead what happens is people look at insurance numbers versus uninsured numbers, and equate it to care. But that isn’t accurate. Health insurance is not health care. Currently, our system relies on the insurance system, mostly due to inertia, but this is the very heart of the problem. All that is being funded is a middle man. This is a problem and it doesn’t address the real bugaboos in the system: One, how to make health care more affordable. Two, how to make sure there’s enough health care providers to cover 300 million people.

Allow me to provide some context for why health care is “expensive” in the US:

Employers are the primary provider of coverage. This prevents the creation of a national pool in which we can group all 300 million people into the US to defray the costs among the sick and the healthy. Rather, we are left to defray the costs across the gainfully employed, under 65.

In this plan, insurance companies then put a bunch of garbage into the plan which is far from necessary. Coverage for acupuncture, invitro fertilization, male erectile dysfunction are by no means preventive in nature yet they are included in many health care plans because they are lucrative.

Employees have little option to opt out of unnecessary coverage options listed above. What is needed is a national pool of insurance providers with options that allow people to purchase the amount of health insurance they need. But…

State regulations protect state health insurance providers rather than open a national market for health insurance. Yet, it’s not all the state’s fault…

Health insurance agencies, refuse payment to hospitals because hospitals often time inflate the cost of treatment. Hospitals inflate the cost of treatment because of the reasons listed below…

1. We place a huge emphasis on end of life care so people can die with “dignity.” This will sound cold-hearted, but, is this the best use of health care costs? Sorry, sometimes we have to make the tough decisions, but we are prevented from making these decisions because of…

The tort bar. The tort bar extracts huge sums of money from doctors by using props (read: sick kids) in a court room to illicit an emotional response from jurors. These awards having no bearing, whatsoever on a doctor’s incompetence. To pay for these grossly inflated awards, doctors take out hefty malpractice insurance, which they then pass on to the insurance companies, which refuse to pay for doctor services because they say the treatment costs too much.

Doctors, fearing malpractice lawsuits, run redundant tests, and often times unnecessary tests. This moves care beyond preventive for health, but preventitive for lawsuits.

So to Goodman’s whole point, let’s actually collect stats that are worth something. Let’s look at why people elect not to purchase insurance. Let’s look at how people pay for health care. Let’s look at where those funds come from and what’s the best means of transferring funds to pay for these services.