Ideas on how to fix the American Health Care system

At the moment, all talk is about 'Obamacare' and how President Obama's much-touted plans to reform the American health care system are either 'great' or 'gruesome.'

I don't care much for his proposed spending plans, but I'll tell you this for free - the sniping, bitching and whining from Conservatives about this issue is both counter-productive and, frankly, rather pathetic. They're spending so much time trying to scuttle Obama's proposals that they've totally failed to come up with any viable alternatives themselves.

Even the Republican's own 'great brown hope,' the Louisiana Governor Bobby Jindal, was lack-luster in his much-touted 'bipartisan solution' to the health care crisis. In a column in the Wall Street Journal, he boasted about having all the answers -but wasted his column inches attacking Obama's proposals rather than outlining his own.

The fact is, the right-wing is universally useless because they simply refuse to acknowledge the failures of the current system. When Democrats like Obama make proposals to improve, they're normally shot out the water by the GOP simply because they're not perfect.

Perfect? Perhaps not - but they're still more streamlined, cheaper, efficient or just plain better than the current system. However, because they don't match up to some hypothetical Conservative fairy-tale of what health care should be (even though it isn't), they're not willing to back any change.

But my ire isn't limited to the Republicans. Democrats are equally useless in tackling the crisis. Most of them have their heads in the clouds - with no idea about how much heath care really costs or how it could be realistically delivered.

A perfect example of how out-of-touch Democrats can be found within the pages of Democratic Party chairman Howard Dean's new book: Howard Dean’s Prescription for Real Healthcare Reform: How We Can Achieve Affordable Medical Care for Every American and Make Our Jobs Safer.

He touts a universal, government-funded medical care system like Medicare, or the British National Health Service, seemingly unaware that neither of them work. Medicare is bankrupt and the British NHS is a crumbling, ineffective dinosaur.

No, the solution to America's health care woes lies with neither the right or the left. Politics aside, we have to tackle not only the problems inherent in the current health care system - but also embrace its strengths.

Because if you can afford it, and have access to it, American health care is still very, very good.

You might remember my wife raising money for brainstrust.org.uk a couple of years ago. That charity helped send a young woman with a brain tumor to America for treatment, because the British NHS simply couldn't tackle her deeply-embedded malignant tumor. The British health care system had given her a death sentence - but the American system gave her a new lease on life.

As far as I'm concerned, witnessing that forever won me over to the strength of the privately-funded health care system. It saved a life that socialised medicine had already written off - and for that reason alone, I'm utterly convinced that the future of medical care - including much needed, groundbreaking advancements in treatment, pharmaceuticals, care and surgery - is best left in the hands of private industry.

But saying that, let's address two real issues that have broken America's current system. These are the problems I've experience and I'm simply astonished that nobody's discussing them in all the hours of debate about 'Obamacare.'

The medical billing system is disgraceful. I challenge you to find a more inaccurate, poorly managed, bureaucratic and ineffective system than what passes for 'medical billing' in America.

The system is so convoluted and complicated, it's a wonder it operates at all. Considering that the health care system is supposedly 'private' and patients are actually 'customers,' it's disgraceful how the billing system treats them.

Where else in the 'free market' would anybody put up with a business that bills you in dribs and drabs, months after the due date - and regularly (at least 1 out of 3 occasions that I've experienced) f**ks up your invoice?

Personally, I think the whole co-pay system is ridiculously over-complicated and adds reams of expensive bureaucracy to an otherwise fairly straightforward system. It alone adds up to over 5% of current health-care costs - and still can't get the job done even then.

I think the government needs to regulate medical billing so the following is guaranteed:

1. Medical bills will reach the consumer no more than 30 days after treatment. If they do not, the consumer is not required to pay.
2. All bills should be consolidated - one hospital visit equals one invoice. Currently, a single hospital visit can lead to a dozen or more separate invoices from various 'providers' all located in the same hospital!
3. Health care providers should be fined - heavily - for incorrect invoices. This is simply unacceptable in the 21st century.
4. If a medical care invoice is incorrect and undercharges, the health care provider should not be allowed to send a later invoice to 'make up the difference.'

Sounds severe? Think about it - these restrictions would mean that medical billing finally finds itself required to deliver the same standards as regular businesses.

If you had somebody come to spray your backyard for bugs, you'd never put up with receiving six invoices, four months after they'd visited, all requiring payment for a single service you've received. Why should the medical industry be any different?

Medical billing isn't just a customer service issue - it's obvious failings mean it's an expensive liability to both insurers and suppliers. Medical billing issues result in bills not getting paid - which leads to an increase in insurance premiums and care itself. That's why this is a crucial area that needs to be addressed immediately!

But, secondly:

Covered procedures must be finalized in advance. My European friends are always astonished when I explain this to them - but in the American system, you're health care provider can pick and choose which treatments they'll cover as part of your insurance after the fact.

This leads to situations like this - in which a young woman undergoes a double mastectomy, described as a 'medical necessity' by her doctor (because she has a 99% change of developing breast cancer later in life) and then discovered that her insurance company refused to cover the cost.

Considering that medical expenses can run into the hundreds of thousands - and 60% of all bankruptcies are as a direct result of medical expenses individuals can't pay - I am simply astonished that nobody has ever thought to question the practice of agreeing to cover procedures after they've been performed.

Just like with medical billing, it's a situation that you just don't see in the 'real' free market. It basically means that the consumer has no idea exactly how much their treatment is really going to cost them before they agree to it. It's like going into a family restaurant and ordering off a menu with no prices!

My solution? Make it law that all medical insurers have to decide, within three days of a doctor or clinic recommending a treatment, whether or not it's covered by their insurance - in advance.

And if those insurers say 'no', they have to provide a quantified medical reason why they disagree with the patient's referring doctor. After all, like in the case of the woman with the double mastectomy, receiving one expensive medical treatment upfront will probably prevent years of even more costly treatment in the future.

As far as I'm concerned, until these two issues get addressed, America's health care system could be the cheapest or most expensive in the world - it will still be irreparably broken.

Some Thoughts about Universal Health Care

When it comes to the ongoing debate about American health care, I'm definitely in the privatised, American camp. I've seen the British version of 'universal health care' and it's not pretty.

So far, Tina and my experiences with the American health care system have been much more positive than what we experienced in England - even if they cost more.

Our experiences

Tina's expecting a baby - so that means plenty of visits to Robert Woods Johnson Hospital for scans, checkups and advice. After the contributions of my job's health insurance package, we've been left with about $1,000 to pay out of our own pockets.

In England, the NHS would not have charged us any money. However, the treatment we've received in America has been in a beautiful, clean, well-appointed new hospital with very modern equipment. We weren't left waiting for very long and the doctors and nurses have held our hand through the entire process.

At the Royal Hampshire Infirmary, in Winchester, we had a couple of terrible experiences, being expected to wait about four hours for treatment in a dirty hospital, with old equipment and a doctor who once gave Tina a potentially life-threatening misdiagnosis (delivered in a rude and offhand manner.)

Even worse, two new mothers from Winchester recently died from the same form of streptococcal infection they'd coincidentally picked up while in the maternity ward of the Royal Hampshire Infirmary.

Clearly, private health insurance offers us (Tina and myself) a much higher standard of health care that we could receive back home

The Downside of Private Health Care

That being said, Tina and I are in the enviable situation of having a good health care package and living close to an excellent hospital.

The reason health care is such an important issue in the upcoming presidential election is because almost 50 million Americans - close to 20% of the entire US population - have no health care coverage at all.

This is because private health care is rocketing in price - and many companies, like Wal-Mart, don't offer an adequate health care package even to full time employees.

Now, even if you're a stuffy old Tory, like me, you can't help but admit that this is wrong. Adequate health care is a basic human right. That shouldn't be a political issue for either the Democrats or Republicans. It's only the best means to accomplish this goal which should be up for discussion. In theory...

In theory.

Because currently, the debate's taken a rather surreal twist and more and more conservative Republicans are railing against any notion of 'universal health care' as proposed by Barack Obama, Senator Clinton or even their own candidate, John McCain.

In fact, in his daily radio show, conservative pundit Mark Levin often claims that Obama and Clinton are pitching a 'socialised' medical system along the same lines as Britain's National Health Service - and he enjoys using the dismal state of the NHS as an example of why it would never work.

But the problem with the conservative argument (as is increasingly common with any conservative argument is that it's utter rubbish.

American 'socialism.'

Pundits love to label the likes of Hillary Clinton as a 'socialist' or 'Marxist' when they have no real concept of the term. For a Brit - at least one who's lived long enough to remember the socialist Labor party (before Tony Blair came along) - the idea of calling Obama or Clinton a socialist is completely laughable.

Neither Democratic candidate wants to introduce a nationalised health service along the lines of the NHS. Instead, the 'universal health care' they're suggesting would simply mean that everybody in America (hence 'universal') would have access to affordable medical care (hence 'health care.')

For those in poverty, that could be some kind of system like Medicare or Medicaid. For low income families, it could be some form of subsidized or Federal health insurance.

Additionally, Obama, Clinton and McCain want the consumer cost of private medical insurance to be reduced by opening up competition - meaning consumers wouldn't be limited to the health insurance package their employer offers - and could seek more competitive quotes out-of-state.

Also, big companies like Wal-Mart would be forced to do what they should have done from the very beginning - offer their full-time employees adequate health care.

Whatever happens, the intended result of universal health care would be a system in which everybody in America has access to medical treatment. And apparently the conservative Republicans loath this idea!

Why?

The major argument conservatives have against any form of universal health care is that it would be tax-payer funded. They're worried that their hard-earned income would be taxed in order to pay for the health care of low income families (read: other people. Conservatives don't like giving money for the benefit of other people.)

There is a simple and indisputable reason why this argument is idiotic. America already has a system of 'universal health care' that's funded by the tax-payer (and subsidized by the health insurance consumer.)

Federal law forbids hospitals from turning away patients. If a visitor to a hospital doesn't have health insurance - or the means to pay their bills - it's the government or hospital that eventually has to pay up for that patient's treatment.

Which means the tax payer already pays $15 billion a year towards the health care of people without insurance. What's worse, hospitals and doctors cover the expense of 'writing off' uninsured patients by charging paying customers more - which in turn dramatically hikes up health insurance premiums.

So whether it's through tax-dollars or an increase in health insurance premiums, at the end of the day, the bad-tempered conservatives are already paying for other people's health care.

It seems stubborn and idiotic for them not to open their minds to a more efficient (i.e. cheaper) way of doing what they're already doing now.

The Simple Maths

Health insurance premiums have skyrocketed over the last few years - and one of the major reasons is because hospitals and doctors have needed to recoup their losses from treating uninsured patients.

Since about 20% of Americans have no health insurance - plus the millions of illegal immigrants and undocumented workers - the current situation works something like this:

Four people go to the hospital and have treatment that costs $300.

One of those four people has no health insurance. So to cover their costs, the hospital is forced to split that loss amongst the other three paying customers.

$300 ÷ 3 = $100 each added to their bill.

That bill ends up being $400 instead of $300. Basically, they're paying 25% more.

And it's a spiralling problem. As health insurance premiums increase, more and more people can't afford insurance, which means doctors and hospitals have to increase their costs to cover them.

That, in turn, increases insurance premiums again, which again means that more people 'drop out' of health insurance programs...

And do you see where I'm going with this?

Something needs to be done.

This situation needs to be addressed - and conservatives can't stick their head in the sand and pretend otherwise.

Currently, all three of the presidential candidates have interesting and promising solutions to the health care crisis.

Senator John McCain

John McCain's solution is within Republican party lines.

While he rejects any form of government funded or subsidized universal health care, he wants to offer a $5,000 tax rebate for families with private medical insurance (helping considerably towards the cost.)

In addition, he wants to reduce health insurance premiums by opening up competition between states. Currently, health insurance providers can operate in one state alone - meaning there are a limited number of suppliers in each state.

McCain's idea is to allow consumers to select insurance from companies based all across the United States, forcing suppliers to offer more affordable premiums.

In addition, Senator McCain wants to allow consumers to opt-out of their company's health-insurance package and take their employer's contribution elsewhere - again forcing health insurance companies to offer more competitive rates, rather than 'signing up' big businesses and forcing a big, fat premium out of every employee.

"In health care," John McCain explains, "I believe in enhancing the freedom of individuals to receive necessary and desired care."

Basically: We help those with the means to help themselves.

Senator Hillary Rodham Clinton

Even though her opponents (like talk show host Mark Levin) accuse Hillary of being a socialist, the universal health care package she champions is very different from the National Health Service in England.

In fact, she spent [wasted - Editorial Bear] millions of dollars while her husband was in the White House investigating - and ultimately ruling out - a single-payer health care system like we have in Britain or Canada.

Clinton advocates government subsidies for low-income families, meaning that they will be able to afford health insurance.

She also wants to set up a federal health care system, which Americans can 'buy into' instead of their employer's health insurance package. This will force private health insurance companies to make their premiums more competitive and offer health care coverage to people with pre-existing conditions - people who would normally be refused private health insurance.

Because of the subsidies and the setting up of a federal health care system, Hillary Clinton's solution to America's health care crisis is the most expensive. However, with costs of $110 billion per year (in contrast, the war in Iraq costs $144 billion per year) this can be paid for by eliminating the controversial 'Bush tax cuts.')

However, it's the thought of killing this tax break which makes Hillary's plan so unpopular with the conservatives.

Clinton's election promise: "One of the goals that I will be presenting is health insurance for every child and universal health care for every American."

Senator Barack Obama

Obama similarly believes in real 'universal health care' and on the face of it, many of his ideas are similar to Hillary Clinton's.

Most importantly, the idea that every American should have access to affordable health insurance even if they have a pre-existing condition.

"I am absolutely determined that by the end of the first term of the next president, we should have universal health care in this country."

Critics of Obama have pointed out his lack of specific details when it comes to a proposed universal health care package - but it will still be rooted within the existing system of private health insurance providers (with some government intervention.)

Obama's plan will ultimately hope to reduce health care costs for all Americans, while providing low-income families or those with pre-existing conditions access to the medical care they are currently excluded from.

It's been a long time coming...

Whichever candidate ends up the White House, I'm confident that they will introduce improvements to the existing health care system and allow more people to have access to better care at a cheaper price.

One thing to note is that none of the candidates - not even Hillary Clinton - plans to eliminate the concept of private health insurance. They just want to regulate and streamline it.

Hopefully this means that the advantages of private medical insurance - driving the development of cutting-edge new technology and pharmaceuticals - will remain, while the disadvantages (the high insurance premiums and difficulty getting medical coverage for pre-existing conditions) will be addressed.

Having experienced both socialised and privatised heath care, I am convinced that the private system offers the consumer a better service. However, just like in any privatised industry, the demand to make money often threatens to overwhelm the mandate to provide a service.

I just hope that whichever presidential candidate makes it to the White House, they ensure that the patient always comes before the shareholder.