Yard Fairies and a novel about Health Care

It has taken two guys, a sitting lawn mower, two blowers, a tarp and the bed of a pick up truck, working since 10AM. As of 4:30 Pm, they still were not done. This is probably the best money I have ever spent because it's now obvious to me that I could never have done this on my own. Money can't buy happiness, but I sure feel better knowing that my yard is not harboring snakes under all those leaves. Did I mention that I paid the guys at noon, and they continued to work hard all afternoon? That is integrity.

Here are my current thoughts on health care. I posted some of this on a friend's Facebook page.

Obama's "Organizing for America" is a great website. You can find it at www.barakobama.com. I might not be in agreement with the content, but I am amazed at the how the website forwards his plans. Obama does new media very well. You should check it out, even if it is to see what you are up against. Many people could learn from how he allocates resources to interact with people via new media, for example, blogs and interactive websites, Youtube, Facebook and Twitter. Apparently he is the first President to keep his Blackberry and maintain his own email communication. From what I have read, his blackberry is James Bond-esque in it's security apps and his email address is known only to a select few.

I agree that there is a need for health care reform, but this version is not the best alternative. Health care reform is a huge problem with complicated solutions. I agree with Obama that the Reps had 8 yrs to do something, but they didn't. My guess is that they knew it was a complicated issue in ways that are technical, financial, and emotional. While I have not researched this, it is possible that political donations, lobbyists, and the overwhelming representation of lawyers in Congress have prevented them from tackling this issue before now. The more I research, the more I find that there is still to learn.

I read last night, and need to do more research to verify this, but the federal govt decided at some point in the past that if a doctor accepted cash, or what is called now "fee for service", they had to pay higher taxes on that amount than if an insurer paid a claim to them. It is my opinion that there are huge ramifications if that is the accurate; however, this story will probably never see the light of day again. For better or worse, doctor's needs are low on the priority list of health care reform.

My theory is that there are small parts of the puzzle that we could fix now. Here are a few:

1) Keeping costs low to the provider will translate to lower prices for the consumer:

Tort reform is a huge part of improving costs and access to health care. Look at the success Texas has had since they enacted Tort Reform laws. When you have a neurosurgeon who pays over $100K a year in medical malpractice, the money has to come from somewhere. And that "somewhere" is the patients.

Take the example of a surgeon who operates on an indigent patient. This could be someone who is not already covered by Medicaid, or an illegal immigrants, or it might be someone who has fallen through the cracks, homeless people, for example. The hospital receives money from the gov't, but the surgeon does not. Again, the money for the doctor has to come from somewhere. A certain percentage of pro bono cases is one thing, a large majority of a surgeon's work obviously cannot be done without compensation. This problem isn't likely to be fixed by the current reform. If people fall through the cracks, then mandating insurance for them won't help.

Another idea is to consider requiring that insurance companies, including Medicaid/Medicare, should be required to pay claims within 2 weeks, or a month at the latest. When a doctor has to wait a year to be paid, the money to pay for their overhead-the staff, rent, and equipment-has to come from somewhere (Read the patients).

Did you know that doctors do not have the right to collective bargaining? I thought that meant they do not have the right to unionize, but what Neil told me is that a medical practice negotiates for each of it's physicians a reimbursement deal from an insurance company. The doctor is not allowed to know what the other doctors in his practice get from the insurance company, nor are they allowed to know what a different practice is getting from the same insurance company. When you only have one or two large insurance companies to deal with, you have no option but to accept their insurance. I have heard that if the doctor finds out the rates for other physicians and act on that knowledge, the insurance company can sue that doctor. There are websites that allow users to compare salaries, so that potential employees can better negotiate and make better career choices. That option is not available to doctors.

2) Competition in the insurance industry. Is competing against the federal govt a good idea? Will it force the insurance companies to change or just put them out of business.

I am not a fan of insurance companies, but I am also not out to look for scapegoats. There are people that feel that a public option would force the insurance companies to compete, but I am not sure that competing against the govt is the best idea.

In every other communist/socialist country, where there is actual govt ownership of the means of production, the private sector always does better in comparison. When people are given the freedom to innovate and take ownership of their product, whether it is something tangible like a refrigerator or intangible like media, they come up with something better. They create a business or a system more efficient than the govt owned enterprise does. If you would like to open a private business in China, there are times that the govt forces the entrepreneur to take over two state-owned enterprises. One of them would be a company that already does what this new company wants to do. The second company would be a failing company, most likely in a different sector of the economy so that the new business owners will have to fix both companies. This is the only way to get access to the licensing rights and govt distribution channels that are necessary for business success in China.

If our country turns to the public option, would it be possible for these new govt employees to come up with ideas that increase efficiency? What if that means getting rid of a GS job (govt service job)? One thing is for certain, it is impossible to fire a bureacrat or GS employee. Neil tells stories all the time of how poorly performing employees are promoted to get them out of someone's hair. Surely a private insurance company can compete with that kind of inefficiency, but should they?

Apparently, there is an issue with insurance companies merging. As the options have disappeared, the competition in the insurance market decreased. As a result, the insurance companies can charge whatever they want and cover whatever they want, because who else is the patient, the consumer, going to turn to? For example, maternity benefits are not automatically covered.

US News and World Report says:

"The near total collapse of competitive and dynamic health insurance markets has not helped patients," AMA President Dr. J. James Rohack said in a new release. "As demonstrated by proposed rate hikes in California and other states, health insurers have not shown greater efficiency and lower health care costs. Instead, patient premiums, deductibles and co-payments have soared without an increase in benefits in these increasingly consolidated markets."

Rohack added that a lack of competition in the health insurance industry "is clearly not in the best economic interest of patients," and the AMA wants the U.S. Department of Justice and state agencies "to more aggressively enforce antitrust laws that prohibit harmful mergers."

End of part I.