A public-private partnership to solve health care
As ideologues on both sides of the political divide drone on over how the health care system in America should go forward, a shameful amount of attention is being paid to developing new models for handling the problems we face in providing access to care at a price people can afford.
Conservatives remain duty bound to support a free market, consumer driven approach consistent with the fundamental tenants of their ideology. Yet, the primary expression of the free market approach to our health care system- the private health insurance market- appears to be reaching its natural end and will soon no longer be a viable player.
Why? Because younger, healthier people, believing they have better ways to spend their money, continue to avoid expensive enrollment options while middle-aged, healthy participants are increasingly forced out of their insurance plans as a result of skyrocketing premiums costs. The result is a growing imbalance in the insurance pool that is already leading to losses in the individual policy category and will eventually turn the large profits to be found in the group insurance market into equally substantial losses. When that happens, and it will, our system will no longer operate on an insurance model because there will be no insurance available – at least not to middle class Americans.
On the other side of the fence, the progressives see a single-payer, government provided health care system as the answer to granting access to the largest number of Americans at the best possible price.
Opponents of single-payer are quick to remind us that massive government involvement in any system tends to be inefficient and delivers poorer results than what the private sector can deliver. By design, government does not function for profit and is, therefore, less careful in spending money and less motivated to deliver a high quality product.
The opponents to single payer have a point. The measure of success -and the currency for reward – to those who run the government, comes by way of the vote – and votes arrive when voters are made happy, whatever the cost. It’s not hard to see how this might not be the best way to run a health care system. Throw into the mix the looming crisis of a Medicare and Medicaid fund quickly running out of money and the problems that come with the government solution become increasingly clear.
While pitting these opposing ideologies against one another makes for good political theater, we know all to well that it also leads to government gridlock and watered down measures designed to achieve political benefits that may, at best, put a band-aid on the problem and, at worst, end up doing more harm than good.
But what choice will we have? If our only choices are private health insurance or a public single-payer government plan, the last option standing will be the victor. As health insurance will, at some point, disappear as an option for the majority of Americans, single payer will be our only remaining choice.
And that may be fine. But before we limit what is available, shouldn’t we, at the least, be asking the question, “Are there other ways this could go?”
No matter how hard the nation’s leaders try to tell us otherwise, health care is not about ideology. When insufficient health care is available, Republicans die from disease as easily as Democrats. When expensive treatment results in financial ruin , Libertarians will fill the bankruptcy courts in the same numbers as as Socialists.
Which is why continuing to allow the politicians to battle the issue on ideological grounds will do nothing to begin the process of finding real solutions to our health care difficulties.
Consider this – is there not some way the profit motivated private sector can join with the deep pockets and influence of government to solve one of our most pressing problems rather than continuing to battle one another?
It turns out that there already exist certain government programs designed to work hand-in-hand with the private sector to solve the problems presented in health care – and they work.
Take, for instance, the Federally Qualified Community Health Centers (FQCH) program.
These community operated health centers, typically rum by private or community operators, are funded by the federal government through an incredibly small annual budget of only $2 billion, yet provide primary care health services to approximately 18 million Americans through the 1200 FQCH centers spread throughout the nation. The centers provide primary health care services, dental services, mental health counseling and low-cost prescription drugs to those in need. Patients pay on a sliding scale. If you have private insurance, Medicare or Medicaid, the centers gladly accept your coverage. But if you don’t, the centers charge based on what the patient can afford to pay and nobody is ever turned away because they have no money.
The program, which was spearheaded by Sen. Edward Kennedy some forty years ago, is now under the ‘protection’ of Sen. Bernie Sanders (D-VT) in the Senate and Rep. James Clyburn (D-SC) in the House.
According to Sanders –
This is not gonna solve all the problems of the world. But expanding access to high quality primary health care, and low-cost prescription drugs, and mental health counseling, and dental care–which is a big issue–this is a very significant step forward. If you walk into a health clinic and you have no insurance at all they will treat you on a sliding scale basis. So, that’s affordable healthcare.
Via The Nation
Sanders further argues –
By increasing funding to less than 0.5 percent of overall U.S. spending on medical care, we could provide primary health care to every American who needs it. In other words, for a total of $8.3 billion by the year 2015, we could have 4,800 health centers caring for 60 million more Americans in every currently-designated medically underserved area of the country.
Via Huffington Post
And here’s the kicker – in the case of Medicaid alone, total costs for patients are almost $1,000 less per person per year than for Medicaid patients treated in other settings.
By anyone’s standards, this is a program that works – which is why President Bush helped to expand the program dramatically during his Administration despite the fact that it is sponsored by the only avowed socialist in the United States Senate.
What if we were to bring the private sector even deeper into the program?
For example, what if non-profit hospitals who meet certain levels of financial stability (these are the institutions that pay no taxes whatsoever and often have enormously large bank accounts as a result) were obligated, as a condition of maintaining their tax-free status, to set up an FQHC at or near their emergency room operations? The cost of setting up these centers could be shared by the federal & state governments along with the non-profits that own the hospitals.
By redirecting those who show up at the emergency room in need of primary care – rather than emergency treatment – to a primary care center on or near the hospital grounds, we can reduce not only the traffic jam that grips virtually every emergency room in America but the high costs of treatment that comes with it. In its place, those who have arrived at the ER because they know it is the one place they can go when they have no money or insurance to pay for medical care, can be treated in an environment that provides quality medical care at the lowest prices available. These costs savings reverberate through the entire health care payment system and can make a real difference.
This is but one example where combining the assets of the federal and state governments with private for-profit or non-profit businesses can help to put a dent into our pressing health care problems. One can only begin to imagine how many other solutions are out there if we can get past the ideology and politics and get on with the job of actually solving our problem.
We can argue ideology all we want but I promise you it will not produce the best possible results in American health care.
We can do better. But we can only do better when we force politicians to stop taking the easy way out in the quest for votes and start getting creative in the quest for solutions.
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It is nice for these clinics that federal rules allow them to accept patients on a sliding scale based on their ability to pay.
The rest of us who participate in Medicare are required to charge all of our patients the same. To some extent, Medicare sets the fee. Private insurers follow suit. Medicare then tells the providers and facilities what they will get paid. Providers and facilities in different parts of the country get different payment from Medicare based on a political schedule that has nothing to do with costs or quality. No free market forces working here. Failing to charge equally is called “Medicare fraud”, even if you charge someone MORE than you charge a medicare patient.
Medicare only pays a percentage of the “allowable charge”. Private insurance companies also pay a percentage of the allowable charge. At least providers and facilities get to negotiate the percentage with private insurers. (Free market forces at work). The cash paying patient gets stuck with the whole inflated bill. The providers and facilities have to pursue the cash paying patient to get his cash in order to not appear to be giving him a deal that Medicare does not get. Again, to avoid appearing to give someone a better “deal” than Medicare gets. Eventually, we write off the unpaid bills as a loss.
Imagine if the government told Ford motor company “We are going to buy 10,000 vehicles for 80% of your cost to build them, and you will be legally obligated to sell them to us for that amount.” The cost of a vehicle would immediately go up for the rest of us.
So, another version of your suggestion is to allow cash patients to pay on a sliding fee scale wherever they get their care. The problem with this is that people who are insured make up the difference in what the cash paying patient pays and what the care costs in the form of higher premiums. The insured also pay a hidden Medicare tax in the form of higher premiums to make up for inadequate Medicare payments.
In your example, the rest of us make up for the cost of the care for this group of patients by paying federal taxes. Call the clinics whatever you want. The care is being paid for by the tax paying public. Why not just put up an honest cost analysis for paying for everyone’s health care and see if the tax payers want to pay it? The answer is no, by the way.
I do applaud these clinics for their efficiency. More of this is needed.
These clinics create a 2 tier health care system that most people say is unfair. Nice plush comfortable suburban clinics for insured patients and cramped shoestring budget inner-city clinics for the uninsured or underinsured. Where will the providers come from to staff these new extra clinics?
Americans need to prioritize providing themselves with adequate health insurance. It needs to be more important than owning that big house, and two new cars. More important than taking an exotic vacation or buying a pack of cigarettes each day. Rent your home, ride the bus and buy health insurance.
Everyone should have CATASTROPHIC health insurance. It is cheap because the risk is low. The major expenses that society bears come from underinsured patients who have major health care events. Give everyone comprehensive coverage, and they will all want their benign moles cut off for “free”. It is not free.
Oh yes, I can’t wait for comprehensive healthcare so that I can run out and get my mole excised! What a bullshit comment! Typical from someone who works within the current system. As a matter of fact, a system that allows more of us to go to the doctor more frequently would save money in the long term by catching malignancies and health risks at an earlier stage. Sheesh! What a maroon.
In response to another comment. See in context »Scott:
I truly wish this comment was untrue. Unfortunately, I see this weekly in my practice. People with Medicaid who have absolutely no clue, nor do they care, what their care costs.
Since Rick has frequently relayed his appreciation for personal experiences, I will share a story with you. I cared for a patient who was having a plastic surgery procedure. She bragged about figuring out exactly what to say to get it covered as medically necessary by Meidcaid, how she lied about her health (infection status) to be allowed to have a private hospital room, and how she would claim to be in pain in order to stay in the hospital and keep the IV pain medicine coming through the weekend after a surgery that is usually done on an outpatient basis. Oh yeah, this was her 14th time doing this. She told us and her surgeon that she would file discrimination complaints against us with the State Medical Board if we did not give her what she wanted. And she bragged about how it would not cost her a dime.
Another patient of mine was on “disability” her care all paid for by the taxpayer. She could not work because of her bad back. Five minutes later she was explaining to me how she boards and rides horses for cash.
If you disconnect the cost of care from reality, people will abuse it. The economic principle is called the “Tragedy of the Commons”. The classic example is of a public pasture that gets grazed down to nothing by everyone’s sheep. Then it is left as a bare and useless dirt field. Unfortunately, in our everybody wants something for nothing, this is a reality.
“a system that allows more of us to go to the doctor more frequently would save money in the long term”
With the exception of a few proven preventive care methods and screening tests this is largely untrue.
Going to the doctor does not make one healthy!!!!!!
In response to another comment. See in context »I am past the delusion that the federal government will provide a rational, one size fits all, healthcare. Obama’s beligerent opposition to any plan that provides true competition, in spite of his campaign rhetoric, is now the biggest obstacle to true reform. I believe that what you are promoting would find the most fertile ground at the state level.
“The program… is now under the ‘protection’ of Sen. Bernie Sanders (D-VT)…”
CORRECTION: While he caucuses with the Democrats, Sanders is an independent.
Check out “Healthy SF” — a program that attempts to use public dollars more wisely by using existing public health resources.
After decades of neglect and underfunding, public health care resources still exist and are the only health care resource that can be made affordable for the 50% of the population that can’t afford the profit, waste, fraud and abuse of the private health care delivery system.
“Build it and they’ll come.”
One more entity in the game (FQCH) means one more set of rules for providers to follow. Read this for enlightenment:
http://distractible.org/2010/02/23/chaos-theory/#comments
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