Big Dogs Weblog

What’s Right, and What’s Wrong

by Blake on Oct 1, 2009 at 08:58 Political

The Liberal Democrat wing of Congress keeps trying to put the square peg of a public option into the round hole that is health care, and cannot seem to grasp that it just won’t fit- I guess they are just not smart enough- perhaps they need healthcare to fix that stubborn moronic condition- if it turns out to be genetic, John Holdren will sterilize their families. Gladly- our own little Dr. Mengele is always glad to play God.

In the meantime, you might think that Congress would  actually look at what works, and what does not, in the world of Healthcare- but apparently, once the ideological concrete sets, no jackhammer of logic will work on it.

First, let’s look at what does not work- the Canadian public option.

When the pain in Christina Woodkey’s legs became so severe that she could no longer hike or cross-country ski, she went to her local health clinic. The Calgary, Canada, resident was told she’d need to see a hip specialist. Because the problem was not life-threatening, however, she’d have to wait about a year.

So wait she did.

In January, the hip doctor told her that a narrowing of the spine was compressing her nerves and causing the pain. She needed a back specialist. The appointment was set for Sept. 30. ‘When I was given that date, I asked when could I expect to have surgery,’ said Woodkey, 72. ‘They said it would be a year and a half after I had seen this doctor.’

So this month, she drove across the border into Montana and got the $50,000 surgery done in two days. ‘I don’t have insurance. We’re not allowed to have private health insurance in Canada,’ Woodkey said. ‘It’s not going to be easy to come up with the money. But I’m happy to say the pain is almost all gone.’

online.wsj.com

What has to hurt almost as much as the pain itself is the dismissive attitude of cost- cutting bureaucrats- people that liberals say, like the yeti or UFOs, do not exist.  Waiting for treatment just has to suck- perhaps Congress should try that.

Whereas U.S. healthcare is predominantly a private system paid for by private insurers, things in Canada tend toward the other end of the spectrum: A universal, government-funded health system is only beginning to flirt with private-sector medicine.

Hoping to capitalize on patients who might otherwise go to the U.S. for speedier care, a network of technically illegal private clinics and surgical centers has sprung up in British Columbia, echoing a trend in Quebec. In October, the courts will be asked to decide whether the budding system should be sanctioned. More than 70 private health providers in British Columbia now schedule simple surgeries and tests such as MRIs with waits as short as a week or two, compared with the months it takes for a public surgical suite to become available for nonessential operations.

online.wsj.com

Well there- the Canadian system sucks, that is plain- as the liberals are fond of saying, “The debate is settled.” but there must surely be something that does work, at least better than Canada, right? Anything is better than that.

And yes, there is something better-

Like every other country in Europe, Switzerland guarantees health care for all its citizens. But the system here does not remotely resemble the model of bureaucratic, socialized medicine often cited by opponents of universal coverage in the United States.

Swiss private insurers are required to offer coverage to all citizens, regardless of age or medical history. And those people, in turn, are obligated to buy health insurance.

That is why many academics who have studied the Swiss health care system have pointed to this Alpine nation of about 7.5 million as a model that delivers much of what Washington is aiming to accomplish — without the contentious option of a government-run health insurance plan.

In Congress, the Senate Finance Committee is dealing with legislation proposed by its chairman, Max Baucus, Democrat of Montana, which would require nearly all Americans to buy health insurance, but stops short of the government-run insurance option that is still strongly supported by liberal Democrats.

nytimes.com

Yes, folks, the Swiss system is better in many ways than the Canadian system, and has things to offer the US system that could be incorporated without destroying the whole system- after all this capitalistic system, while flawed, has led to medical breakthroughs that otherwise would not have happened without the system of profitability available here. Controlled greed can be a good thing- it drives innovation.

By many measures, the Swiss are healthier than Americans, and surveys indicate that Swiss people are generally happy with their system. Switzerland, moreover, provides high-quality care at costs well below what the United States spends per person. Swiss insurance companies offer the mandatory basic plan on a not-for-profit basis, although they are permitted to earn a profit on supplemental plans.

And yet, as a potential model for the United States, the Swiss health care system involves some important trade-offs that American consumers, insurers and health care providers might find hard to swallow.

The Swiss government does not “ration care” — that populist bogeyman in the American debate — but it does keep down overall spending by regulating drug prices and fees for lab tests and medical devices. It also requires patients to share some costs — at a higher level than in the United States — so they have an incentive to avoid unnecessary treatments. And some doctors grumble that cost controls are making it harder these days for a physician to make a franc.

The Swiss government also provides direct cash subsidies to people if health insurance equals more than 8 percent of personal income, and about 35 to 40 percent of households get some form of subsidy. In some cases, employers contribute part of the insurance premium, but, unlike in the United States, they do not receive a tax break for it. (All the health care proposals in Congress would provide a subsidy to moderate-income Americans.)

nytimes.com

Good AND bad- as are most things, it seems there are pluses and minuses to even the Swiss plan. This is why we should cherry- pick what does work, and then apply this to our plans, instead of crafting something out of whole cloth that doesn’t fit. But apparently that doesn’t work for the Egos on Capitol Hill. Many, if not most, are working for their own glory, and barely have the people in mind when they plan these things.

There are also parts of the Swiss plan that some groups might find objectionable, like the elderly.

Unlike the United States, where the Medicare program for the elderly costs taxpayers about $500 billion a year, Switzerland has no special break for older Swiss people beyond the general subsidy.

“Switzerland’s health care system is different from virtually every other country in the world,” said Regina Herzlinger, a Harvard Business School professor who has studied the Swiss approach extensively.

nytimes.com

Yeahhhhhhhh- not so much- many older people need the Medicare subsidy, even though the roots of that program are socialist, as is Social Security and, to a lesser extent, Medicaid. But since the programs have been institutionalized in our society, they would be hard to root out, so they would need to be incorporated, not cut without a viable alternative.

The Swiss approach is also popular with patients like Frieda Burgstaller, 72, who says she likes the freedom of choice and access that the private system provides. “If the doctor says it has to be done, it’s done,” said Mrs. Burgstaller. “You don’t wait. And it’s covered.”

While many patients seem content, the burdens fall more heavily on doctors, especially general practitioners and pediatricians.

Dr. Gerlinde Schurter, Mrs. Burgstaller’s physician, says she feels squeezed by government regulators and insurance companies that have fought to hold down costs — most recently with a 15 percent cut in lab fees that forced her five-member group to lay off its principal technician.

Dr. Schurter also fears a so-called blue letter, a warning from an insurance company that she is prescribing too many drugs or expensive procedures.

If doctors cannot justify their treatments, they can be forced to repay insurers for a portion of the medical services prescribed. And while prescriptions are covered, the government has insisted that consumers fork over a 20 percent co-payment if they want brand-name drugs, rather than 10 percent for generics.

Similarly, the government health office also lowered reimbursements across the board for medical devices in 2006.

nytimes.com

Punishing Doctors is not a good thing, especially if you, as the government, are refusing to address the problem of  frivolous lawsuits that drive up the cost of Malpractice insurance. Tort reform has to be a pivotal part of this formula. If the doctors are going to have to earn less, so should the lawyers. The lawyers are a driver of the unnecessary overhead in terms of costs to insurance companies, and doctors. 

If you cannot control costs in all three of these areas, there will be no improvement- it has to be all three, or it will not work. Still, there is a downside in terms of cost, relative to the Swiss system.

Still, along with lower costs and the freedom to choose doctors come bigger bills for individual patients. On average, out-of-pocket payments come to $1,350 annually. That is the highest among the 30 countries tracked by the O.E.C.D. and well above the $890 average for the United States, which comes in second.

Then there are the hefty prices of the insurance policies themselves, which can top 14,000 Swiss francs a year for a family of four in Zurich, or about $13,600. That is roughly comparable to the national average annual premium for a family policy under employer-sponsored group plans in the United States, but in high-cost American cities the figure can be much higher.

Direct comparisons are hard to make, however, because in the American system, employers and employees share the cost of premiums, which are also exempt from individual and corporate income taxes.

nytimes.com

Good and bad- there is no system that fits everyone, so why try? What we need to do is find what fits the greatest amount of people.  There are parts of the Swiss system that are worth consideration- there might be other things that also merit discussion, but what Congress is attempting to do right now is to make sausage without a recipe, not a good idea at all, and doomed to failure. Even if they manage to actually make the sausage, there is absolutely no guarantee that we, as a nation, will be able to stomach what they are cooking up.

We really need to have a recipe before we begin to make this sausage.

Because we are going to have to chew on this for a long time, it needs to taste at least tolerable.

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Tags: doctors, healthcare, patients, tort reform