Monday, June 15, 2009

Obama dangles 'caps' to AMA -- part one in a discussion of why the Left and Right are Wrong on health care reform

Mr. Obama will speak today to the meeting of the American Medical Association in Chicago. He will tell the doctors that health care "reform" is a priority and can not be delayed.

What shape those reforms might take is still... largely under wraps. The President's supporters hope, and the doctors fear, that whatever program is put forward will make the government a player in the health insurance business. The unquestioned goal among many Obama supporters is to make government the only player.

Many doctors fear anything that will jeopardize their income and status, yes, but many also fear that an increased government role in health care will deprive them of the right to choose what they believe best for their patients. Government health care may mean the loss of professional judgment and freedom.

So Mr. Obama is expected to wave a carrot at the recalcitrant doctors today: He is expected to express an openness to liability limits on medical malpractice claims. Caps.

So many doctors want caps so badly that they would give up almost anything -- including their professional freedom -- to attain them.

It is apparent that the days of employer-provided health insurance are numbered. An employer-provided option may exist, on paper, in the bill that emerges from the low-profile meetings now ongoing among usually high-profile congresspeople, academics, and lobbyists. But, if such an option does make it into the language of the bill, it will be largely a chimera.

The biggest employers in this country don't want to provide health insurance (e.g. Walmart)... or can't afford to anymore: The decline of the American auto makers has been blamed on health costs as much as anything else. So Big Business has finally been converted to the cause of government-provided health insurance; the Left has always has been in favor of it. I've said it here before... the skids are greased.

There may be an alternative.

Now, I'm not a great fan of individual health policies: I've paid for far too many over the years. When my Long Suffering Spouse began teaching full time in the Chicago Catholic schools, I got a big raise: I no longer had to shell out what was, by then, nearly $18,000 a year in health insurance payments.

As an insurance lawyer, I've seen horrible examples of private health carriers screwing individuals for having the temerity to become ill during the policy term, even suing to rescind health coverage.

And, personally, as one who's had a brush with cancer, I greatly fear my own ability to procure individual insurance -- at any price -- in a tooth, fang and claw free market system.

But... I've also seen Medicare liens that included amounts for services provided that never were provided. Out and out fraud... in $10 increments... but multiplied over a whole flock of old people... a gold mine for the unscrupulous.

Older Daughter worked in a hospital based medical practice for a year, one of six people who did nothing more than code bills for insurance payments. Why the elaborate codes? Because Medicare is already driving the health insurance market, and does so more with each passing, Baby-Boomer-aging year. Old people may not make up a majority of the population... but they consume a disproportionate share of medical services.

And hospitals and doctors charge obscene prices, at least on paper, for the uninsured, driving up costs for everyone and everything because Blue Cross or Medicare will only pay a percentage....

Mr. Obama, is right, at least to this extent: Reform is badly needed and badly overdue. But government can not even take proper care of its soldiers, sailors and marines who have been injured in our recent adventures in Afghanistan and Iraq. Think of the recent scandal at Walter Reed... the jewel of the military medical system. There are far too many other examples for our purpose this morning.

But both the Left and the Right misunderstand the proper role of government in health care reform.

For the Left, single-payer is the only way to go -- no matter its flaws and inequities elsewhere in the world. And since government will be running the show, we can even cap malpractice claims... because, after all, our barefoot doctors laboring for the President would never make mistakes.

But those on the Right, with their slavish devotion to the Market, the Market, the Market, are no better. These people are the geniuses who gave us credit default swaps.

For the Left, the government must be a Player. For the Right, the government must be a Bystander.

Does no one think the government might best serve as a referee?

That's the role of government in an individual option that I want to talk about in a future post. Perhaps -- work permitting -- as soon as tomorrow.

(Do not fret overmuch, however: Froth and levity will not be suspended indefinitely.)


The Beach Bum said...

Curmudgeon -

One of my Doctors (a Surgeon) at the VA once told me that he was making more money working for the VA (on a salaried basis)than he had in private practice.

I said "What" ?

He said "Malpractice insurance"!

As for Medicare billings - a good friend's wife recently had an one hour shoulder surgery in a Dallas Hospital. She was an out patient; total time in the hospital was less than three hours.

The bill to Medicare was over $32,000 (this included ice billed at $600), his portion (of the costs) was covered by supplemental insurance.

He faxed copies of the bill to his Congressmen as well as the President and received courteous responses.

I don't believe in Socialized Medicine, but somehow we must curtail the cost of insurance from the private sector and the overcharging of insured patients at the cost of the uninsured.

Back in 1980 it cost me $180 per month to cover my wife and three children. I wonder what that would cost today?

The Beach Bum

Jeni said...

What, really, is the difference between the government potentially meddling in our treatment plans or some number-cruncher working for an insurance company denying whatever our doctor might prescribe? Frankly, I don't see any difference there except possibly the cost and who knows how that would pan out if the government were actually running the medical show.
But most definitely, something has to be done to allow for medical care for ALL, not just the select few who can actually afford treatment, whether that be from their own pockets or through an insurance plan.

Jean-Luc Picard said...

Giood points made there, Curmy.

The Curmudgeon said...

By way of update, President Obama did not offer caps to the doctors -- but his remarks about a need to reform malpractice litigation were apparently received with warm applause.