by Douglas Laipple, M.D.
American Reporter Correspondent
November 10, 2007
REFORMING A DEFORMED HEALTH CARE SYSTEM
CARTERSVILLE, Ga. -- We doctors are frequently asked, particular during election campaigns, what we think needs to be done in the way of health-care reform. Although I wish the question would be asked of doctors a lot more and politicians, lawyers and insurance company executives a lot less, I doubt that will happen.
Frankly, I am way too busy downstream pulling out bodies to go upstream to see where they're coming from. My medical practice at the grassroots level helps me to see the problems with our medical system from the elephant's feet, but I can't begin to describe the whole elephant.
Others will have to do the upstream work, but please don't let it be the lawyers. Lawyers? Lawyers!? We don't need no steenking lawyers! By the time they analyze and re-analyze the problem, we won't be able to afford their bill, and it will be too late to help, anyway. Let's just add them to the bodies going downstream.
But do those of us who can and do work hard enough to pay for our health care have a moral obligation to also pay for the health care of those who can't or don't work hard enough? Admittedly, that still leaves many who can afford insurance but are refused coverage, due to weight or age, for instance, uncovered.
My premise is that we should help those who can't earn a living due to disability or honest unemployment (this includes Medicare recipients), but we don't owe a thing to those lazy, dishonest individuals who can but don't work. If attorneys need something to do, let them figure out how to separate the wheat from the chaff, because I guarantee you it is not being done now, and it is costing us kazillions of dollars.
Assuming you agree with that premise, the next question is, "Do all of us need to put a bunch of money into a pot each month and then let our health care be paid for out of the pot, or should we just pay for it as it comes up?"
To my way of thinking, although I believe I am in a minority, the fair thing to do is to have each of us (once the money has been taken out to pay for the unemployed and the disabled) pay for our own health care. That would save an enormous amount of money, which is currently going into the far-too-deep pockets of the insurance industry. That would leave the issue of catastrophic illness claims - running into the hundreds of thousands, quite often, unsolved. But it would be a way to start bringing down the cost of doctor visits and basic care.
Significantly, it would also reward those who practice a healthy lifestyle, because we would be paying for only our relatively less-expensive care. And it would encourage others to exercise, eat properly, stop smoking, and stop having babies they can't afford, all of which healthy people are currently subsidizing in the system we have now.
If anyone, rich or poor, healthy or unhealthy, opts to get health insurance for himself or herself, that is their privilege now. Insurance companies can decline the risky clients, though, and they tend to result in the highest claims. Another solution is required for them.
Assuming I am right about being in the minority, the next question becomes, "Who is going to manage the pot into which all of this money is going?"
Many of us doubt the government's ability to do so in a cost-effective manner. However, I would like to point out that the obscene profits currently being made by insurance companies, with their CEOs and other executives living in luxurious estates and retiring with multi-million-dollar pensions, are hardly indicative of the kind of frugal management we might be able to force from our government through the ballot box. An entity that pays hundreds of millions of Social Security recipients and veterans, and taxes all of us without fail, can probably be trusted to manage health care programs better than, say, Kaiser or Wellcare.
Another thing that I think needs to be done is to get employers out of the health-care business. They probably never needed to be there in the first place, but that is a moot point now. Tying health insurance to employment has caused more problems than it has solved. Today, few small businesses can afford it.
I would also certainly like to see whoever is going to manage the health-care system eliminate the high costs created by micromanagement. Hiring high-school graduates to question every move a doctor makes and every prescription a doctor writes is a tragic waste of money. Managed-care companies think that they are saving money but, in the long run, they are causing much more expense due to an increase in the number of doctor visits, hospitalizations and administrative costs they generate.
I also object strongly to the collusion of the insurance industry and the government in limiting payment to doctors for their services. Now I doubt that anybody is surprised that as an M.D., I would make that statement. But what may surprise you is my next statement.
It's not that I object to them, in essence, capping my salary at $200,000 per year (although I kind of wish overhead, malpractice insurance and taxes didn't reduce my take-home pay to $45,000). It's that I object to them not capping the salaries of insurance company executives, professional athletes, attorneys and lawmakers, all of whom have no more (and generally much less) education than I have and few of whom work harder.
In my humble opinion, no one deserves to be paid more than $1 million per year for any job, and Congress should be ashamed of themselves for voting pay raises and better benefits for themselves while capping doctors' pay and letting millions of Americans suffer the inequities of our health-care system.
Douglas Laipple, M.D., is a psychiatrist in private practice in Cartersville, Ga. He's been in the field for more than 30 years. Dr. Laipple can be contacted at email@example.com.