Cut out the middleman to make health care affordable?

[IronLionZion]

Here's an interesting article by Congressman Ron Paul (R-Texas) He's on the Republican ticket but he's actually a Libertarian. Remember that while free enterprise can be disastrous when abused by greedy corporations, it puts food on the table for ordinary people.

http://www.house.gov/paul/tst/tst2004/tst050304.htm
some excerpts:

"Last week the congressional Joint Economic committee on which I serve held a hearing featuring two courageous medical doctors. I had the pleasure of meeting with one of the witnesses, Dr. Robert Berry, who opened a low-cost health clinic in rural Tennessee. His clinic does not accept insurance, Medicare, or Medicaid, which allows Dr. Berry to treat patients without interference from third-party government bureaucrats or HMO administrators. In other words, Dr. Berry practices medicine as most doctors did 40 years ago, when patients paid cash for ordinary services and had inexpensive catastrophic insurance for serious injuries or illnesses. As a result, Dr. Berry and his patients decide for themselves what treatment is appropriate.

Freed from HMO and government bureaucracy, Dr. Berry can focus on medicine rather than billing. Operating on a cash basis lowers his overhead considerably, allowing him to charge much lower prices than other doctors. He often charges just $35 for routine maladies, which is not much more than one’s insurance co-pay in other offices. His affordable prices enable low-income patients to see him before minor problems become serious, and unlike most doctors, Dr. Berry sees patients the same day on a walk-in basis. Yet beyond his low prices and quick appointments, Dr. Berry provides patients with excellent medical care.

While many liberals talk endlessly about medical care for the poor, Dr. Berry actually helps uninsured people every day. His patients are largely low-income working people, who cannot afford health insurance but don’t necessarily qualify for state assistance. Some of his uninsured patients have been forced to visit hospital emergency rooms for non-emergency treatment because no doctor would see them. Others disliked the long waits and inferior treatment they endured at government clinics. For many of his patients, Dr. Berry’s clinic has been a godsend. "
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This looks like a reasonable solution that will help low-income people. Under the current system, HMO's make tons of profit, health care is ridiculously expensive, and many people can not afford insurance but don't qualify for government aid so they can't get health care at all. In addition to this, I would open up the pharmaceutical industry to competition from imports (after testing of course) and reduce the time for drug patents.

The current system is clearly not working and socialized health care in Canada and Western Europe has resulted in poor quality health care, long waits for operations (long as in months), and high taxes.

your thoughts?

[Bandit]

1. This guy should join our ranks ~ He is very liberal

:shrug:

[IronLionZion]

4. Libertarians are an interesting breed

They call themselves conservatives even though they disagree with the Republicans on everything except low taxes. They are flaming liberals on rights and freedoms. There are libertarian Democrats out there too like Charley Reese.

[Liberal Classic]

27. I believe Paul is a pediatrician

So he is not totally unfamiliar with the industry in question. Many private practices are going under due to the sheer overhead of malpractice insurance and costs associated with complying with industry regulation. In response, a number of doctors are doing just what the doctor is the article is doing, rejecting health maintenence organizations and insurance companies and working on a cash only basis.

As an aside, I consider myself a libertarian as well. Political labels can be tricky sometimes, but I always like to read Paul's house website. If you're talking about the Charley Reese who writes for the Orlando Sentinel, then yes I like reading his op-ed pieces as well.

[NMDemDist2]

2. this idea with tax free medical "savings plans"

and a large umbrella "catastrophic" insurance rider would be a boon to the working folks of America IMO

[papau]

6. I disagree - poor kids get nothing, working poor/middle do not have funds

for MSA accounts - and get nothing except no health care.

[NMDemDist2]

9. i was talking about having my idea instead of employer

offered HMO's

we would still need to deal with the working poor and children

[papau]

23. I agree that it has high end potential - but Medicare as National Heath is

in my opinion a better direction.

Tax free income concepts never really help any but the rich. The non-rich just do not have enough invested to have a non-tax on a piece of their investment earnings really be a quality of life question.

I'd like to see a dollar of investment income always taxed at the same rate as a dollar of wage income, both at 100 cents on the dollar.

Then add on whatever tax incentive's that are needed to promote good social behavior.

[Liberal Gramma]

3. My preference would be

that we should pay for routine services directly and have insurance for big items. In the case of those unable to pay, routine services should be covered by the government.
I can plan in my budget for check-ups, mammograms, and the like, but it's impossible to plan or prepare for serious illness. Maybe there should be a cap on how much an individual should pay in any given year for medical services, after which insurance takes over.

And I do agree that doctors should be able to concentrate their time on seeing patients, not filling out insurance forms

[IronLionZion]

5. serious illness should be covered by catastrophic insurance

which is relatively inexpensive.

This plan will be a huge benefit for people who make too much money for Medicaid but still can't afford health insurance. And there's nothing new about it. That's the way it used to be in this country.

HMO's are crap. Their goal is profit so they cut down on quality.

[Lars39]

10. Even with catastrophic insurance you are at financial risk.

I had 2 surgeries within the same year while being covered by catastrophic insurance. I owed $4000 for the first surgery, but the 2nd was paid 100%. If the two surgeries had occured in December and February, I would have owed $8000. A year down the road and I'm still paying off the 1st surgery.

[Nederland]

32. If I might ask

What were the surgeries? I've worked as a consultant (i.e without access to a company health care plan) in the past and maybe will again soon. I've thought about just getting catastrophic insurance and paying for the rest out of pocket. I'm curious as to what these plans cover and what they don't...

[Lars39]

36. Sure.

D&C with laparoscopy(and some other procedure I can't remember right now) for the 1st surgery. Full hysterectomy for the 2nd.

I've recently had a 3rd surgery for a spinal tumor. If we had kept the catastrophic insurance, I would have been out another fortune, 'cause the bills so far(for the 3rd surgery) are in excess of $20,000.

I'm on COBRA right now at $1000/month; my *reward* for my husband finding a job with good insurance, and then losing said job. :(

[Nederland]

38. Unbelievable

A spinal tumor isn't considered a 'catastrophic' medical condition? Fuckers.

Hope you get better.

[Lars39]

39. Thanks. I had different insurance for that surgery, though.

I had a bc/bs policy that paid 90/10. That was insurance so good that the card would pracically get drooled over. That's what I'm paying COBRA $1000/month.

[el_gato]

12. I agree, get rid of the HMO leeches

I bet this doctor spends alot less money on paperwork as well

[NMDemDist2]

19. where can I buy catastrophic insurance

i couldn't find it when i needed it two years ago, and with me breathing down the neck of 50 years old, I shudder to think what my premiums for a PPO will be next year

[sendero]

21. Same here...

... I once tried to find an insurance product that would let me have a huge deductible (say 10K) that would be for something big like cancer or a major accident only.

I talked to several agents. There was no such product available.

[Paranoid_Portlander]

30. I have 5K deductible.

Regence Blue Cross Blue Shield of Oregon. The cost for me is $227 per month or less if you are under 60. I think they do have a 10K plan. There may be Blue Cross Blue Shield available in other states.

[NMDemDist2]

7. yes, but when I became "self insured" I looked hi and low

for a company to sell me catastrophic insurance (heart attack, cancer coverage) and it wasn't available anywhere

We ended up with a PPO for the tune of $450 a month for 2 adults under 50 y.o.

I go to the doc maybe 4 times a year and hubby even less. I pay for my real medical costs out of pocket (chiropractor, massage, nutrition supplements etc) and my drugs come from Mexico or Canada

what a gyp

[Blue Wally]

13. Used to be

"And I do agree that doctors should be able to concentrate their time on seeing patients, not filling out insurance forms".

A doctor in solo practice had a lady at the desk and a "nurse" assistant. Now they have a small army of clerical workers.

[sam sarrha]

8. present system is Corporate Welfare... for the insurance companies..

the fox doctoring the chickens.:tinfoilhat:

[JanMichael]

11. Bull.

"socialized health care in Canada and Western Europe has resulted in poor quality health care"

For one "Europe" isn't ONE system, for another your line is simply not true.

[IronLionZion]

14. How do you define quality?

If you have to wait months or even years to get an operation then that is not good quality health care. The wait is so long because people abuse the socialized system with fraudulent claims to get out of work. That wouldn't happen if they had to pay out of their own pockets. Canadians often come to the US for operationa and then the US hospital bills the Canadian government.

The quality of an operation is moot if you die while waiting for it.

[JanMichael]

17. Stop making broad brushed statements.

It isn't terribly honest. What are you doing again? Is it called False Dilemma?

To quantify/judge an entire system/systems/nations on your opinion is ridiculous.

[SeattleDem]

33. from the WHO link posted above

Responsiveness: The nations with the most responsive health systems are the United States, Switzerland, Luxembourg, Denmark, Germany, Japan, Canada, Norway, Netherlands and Sweden....

I get so tired of these rumors about how horrible the Canadian system is. We ration care by income; they ration care by severity of disease. Which system seems more "fair" to the population at large?

[SeattleDem]

35. strange logic

"wait is so long because people abuse the socialized system with fraudulent claims to get out of work. That wouldn't happen if they had to pay out of their own pockets"

so, since the majority of American have health insurance and are thus usually paying just a relatively small copay, why isn't this same thing happening here? Many American are also shielded from the true costs of care, but I don't see a crisis of fraudlent claims making queues for surgery in the US. I'd love to know your source for this "information"

[ClassWarrior]

15. Two words: SINGLE PAYER

We keep the same medical system, but overhaul the payment system. Cut out some 60% of the cost spent on paperwork.

[fob]

16. He seems to equate the middleman = Gov't, I see middleman = Ins Co's

Cut out the insurance companies for sure. Healthcare should be a not-for-profit industry. Government run programs such as Medicaid/Medicare have a much lower percentage of management costs (2% range) versus Ins Company programs (10 - 20% or more range). The difference in the overhead alone allows for world class healthcare for all if you just cut out the middleman, aka the insurance company!

Are these typical talking point generalizations intended to stand in place of facts?

socialized health care in Canada and Western Europe has resulted in poor quality health care, long waits for operations (long as in months), and high taxes.

The problem with Dr. Berry's set-up is scale. What would happen if this were instituted nationwide? How many patients can one Doctor see and still be effective? Ron Paul talks about the good ole days when this system was the norm. He makes it seem as if no one went without preventative medical care, everyone had catastrophic insurance coverage for emergencies, then "the liberals" came along and fucked it all up. I believe he is looking for and interested in a real solution to our current healthcare crisis, but you have to have a realistic view of your own proposed solution or else your "solution" solves only perceived problems, not real ones.

[dr.strangelove]

18. Patient Power - A Bad Idea

This idea sounds a lot like the Cato Institute's proposal called "Patient Power." http://www.cato.org/pubs/briefs/bp019.html
It is a libertarian idea in which the market sets the price for medical services.

The central idea behind Patient Power is that middle men, called Third Party Administrators or Third Party Payers, get in the way and increase costs.

I do not believe this is true. The middle men are HMOs. HMOs get a very bad rap, mainly from the AMA and doctors. The reason, they cut into the profits of doctors and hospitals. HMOs are really just the most popular type of MCO (Managed Care Organization). MCOs were developed was because the market for medical services was left unchecked and grew to unaffordable levels. MCOs do what their name implies, manage care.

I was recently in the hospital for a minor procedure and I'll use my bill as an example. The hospital normally charges a flat rate of $1200 per day for hospital services, however my MCO has negotiated with this hospital, put it on its approved list, and I went there. The hospital charged my MCO $720 for the day. A savings of almost 50%. I am sure the hospital did this because they get an increase in volume by being on the approved list.

Patient power calls for me to call around to local hospitals and negotiate the best rate on my own. I can also join a group that bargains on my behalf. However, since I cannot (at least I hope not to) provide the same volume of business on a personal level that my MCO can provide, I can not negotiate the rate that my MCO can get. Therefore, my care was cheaper and the MCO did its job by controlling the costs.

Although you did not directly refer to Patient Power, I thought I would address my problem with this system of health care first. On to your example.

Dr. Berry sounds like a great man. I wish there were more physicians willing to take a tremendous pay cut to see to the needs of their patients. However, since medical school costs now average over $150,000 and since the first 2-8 years of a medical career are spent earning something near minimum wage while paying loans, most physicians could not afford to take that level of pay cut.

The costs for the average office visit exceed $35. I don't know if Dr. Kerry charges additional amounts for the medical testing such as blood work, EKGs, pap smears, mammograms and x-rays that are routine parts of annual adult visits. If he does not, he can not possibly be staying in the black. If he charges for these services, the rational that the costs are the same as co-payments is lost since these services are often required to be included in the MCO office co-payment.

I also disagree with the idea that catastrophic indemnity insurance is available for little cost. I was uncovered while I attended law school and bought a catastrophic plan which would pay for $25,000 in medical bills per year for a $1,000 premium with a $1,000 deductible. This means I had to pay $2,000 (1 in premium and 1 in cash before the insurance kicked in) annually before I got any benefit from the policy. $2,000 is $166 per month. The average MCO premium nationally is $270 for an individual plan. The difference is price was not affordable to me in law school, if you can afford the extra $100 per month, the increase in benefits is massive.

I agree that their is tremendous interference from MCOs in medical decision making that makes healthcare difficult and I believe Ted Kennedy will eventually pass his Patients Bill of Rights which will allow direct lawsuits against MCOs for bad medical decisions.

I also disagree with your contention that HMOs make huge profits. HMOs are considered one of the riskiest business ventures with a failure rate significantly higher then most businesses. In NYC, over 50 MCOs have gone out of business since 1995. They were unable to make money. The big players, US Healthcare, Oxford, HIP and Kaiser, stay in business, but hardly report huge profits. I have no problem paying them to get deals for me the same way I paid my buyer's agent to get a better deal for me on my house and the same way Alex Rodriguez pays Scott Boras to make him the most money. An HMO is an agent that gets care cheaper.

I think the solution for healthcare for low income individuals in to increase the tax rate on persons earning over $1 million per year, and use the surplus to increase state Medicaid funding, among other things. Kerry proposes an increase in Medicaid funding to undue to cuts Bush has made. I would also suggest more states try the Oregon Health Plan which has increased the total availability of care.

I also do not think opening up the pharmaceutical industry to competition from imports would aid in price control since the drugs you would import are also made by the same domestic companies, however foreign states have significant cost controls on those companies, so the same drugs cost less. Instead of targeting HMOs as huge profit makers, I think you should look at the books of pharmaceuticals.

I agree that the current system is clearly not working. I do not thing that socialized health care in Canada and Western Europe has resulted in poor quality health care. There are longer waits for scheduled operations, however emergency medicine is of a high quality. Taxes are higher, but that is the cost of socialized medicine.

Anyway, my thoughts are that medicine needs an overhaul, but Patient Power is not the solution.

[IronLionZion]

20. There are plenty of drug companies that you've never heard of

"I also do not think opening up the pharmaceutical industry to competition from imports would aid in price control since the drugs you would import are also made by the same domestic companies, however foreign states have significant cost controls on those companies, so the same drugs cost less. Instead of targeting HMOs as huge profit makers, I think you should look at the books of pharmaceuticals."

American drug companies are crooks for charging outrageous prices, but they certainly do not supply the world with drugs. There are tons of drug companies all over the world that compete with and undercut American companies all the time. They don't give a shit about our patent laws either. That's free enterprise. American drug companies make out like bandits from a lack of competition.

[sendero]

22. Any solution ...

... to the health care crisis that involves insurance companies is no solution at all. They are the problem, and can never be part of any real solution.

[denverbill]

24. If it sounds too good to be true, it probably is.

It really does sounds reasonable, but I'd like to find out more about this guy's practice.

#1, if the patient is deciding, how many patients opt out of getting an expensive diagnostic procedure because they can't afford it? Sure, 90% of the time, that MRI might be negative for cancer, but can is it really in the patient's best interests to make that decision based on cost?

#2, what happens when patient's can't afford something which is not catastrophic? My guess is, that in this Dr's case, he sends them to a govt clinic. However, the Libertarian philosophy opposes all charity and govt programs, so where does this guy send them then?

#3, since the concept is so simple and basic, why aren't there thousands of doctors doing it?

It really does sound great, and I can't say I'm a big fan of health insurance companies or HMO's. However, my bet is that a LOT of these folks are somehow going to end up falling through the cracks in his system. It sure SOUNDS like it would work great for me. But am I really better off deciding that it ain't worth the cost for me to get a cancer screening or blood test?

[IronLionZion]

25. Doctors make money off of HMO's and the like

And they have fixed salaries. Under the old system (free market) they would have made less money and salaries were not fixed.

The Libertarian philosphy strongly embraces private charities. They whine about taxes and want to privatize government programs.

I can't answer your first point, but if they can't afford treatment, then they are probably on Medicare or some other kind of assistance.

[denverbill]

28. Libertarian view on charity.

Here's what Ayn Rand said:
"My views on charity are very simple. I do not consider it a major virtue and, above all, I do not consider it a moral duty. There is nothing wrong in helping other people, if and when they are worthy of the help and you can afford to help them. I regard charity as a marginal issue. What I am fighting is the idea that charity is a moral duty and a primary virtue."

I guess what I should have said is that they don't support the underlying philosophy of giving as being a good thing, or a necessary thing. They want to get rid of government programs and replace them with private charities, but they feel no need to give to the charity. And since 'greed is good', if the entire country adopted libertarian beliefs, there would be virtually no charity to replace the social programs.

[Kanary]

26. So, just cut out ALL elderly and handicapped people on Medicaid?

Since we have marginal health care now, just cut us all out??

Is this what all you "compassionate" DEMS are for?

Is this what *you* are advocating, independent?

Kanary

[IronLionZion]

29. This plan is for people who don't qualify for assistance

and can't afford health insurance. So no, I don't want to cut anybody off of health care. I'm interested in making it more affordable and accessible.

[Kanary]

40. The example you gave is a dr who *DOESN'T* accept

medicaid or medicare.

So, how is that for people who don't "qualify"?

If all, or most, or many drs do this, and you think it's so fine, then there's a lot of us who will be dying.

Or, maybe that's the point?

Kanary

[mongo]

31. The biggest problem with health care is FAIR PRICING

I'm on Coumadin for the rest of my life. Back when I had health insurance, I had to pay nothing for the test, and the insurance company paid the lab $3.96 for the test.

Now I don't have health insurance and the test costs $39.00. WTF?

Same thing for emergency room bills, etc. They see someone without insurance and bill them at least 2-3X what they would get from insurance for the same services.

I think that if health care providers were forced to charge the minimum that they accept from an insurance company for a particular service, health care would become affordable to more people.

[depakid]

34. While this may make some sense for certain PCP's

it makes litle sense for specialists- or for patients who require more complicated diagnostics, for example, which I am quite certain that Dr. Berry cannot afford on his fee schedule alone.

A typical libertarian argument- deceptively simple and overly broad.

[Lydia Leftcoast]

37. Like a lot of libertarian ideas, it doesn't stand up to scrutiny

Take something of interest to every woman: mammograms.

At the time I was reaching the age recommended for a baseline mammogram, the local hospital announced a "sale," because public health officials were concerned that so few women were getting them. The sale price was $49 (this was in 1991).

I took advantage of it, and it turned out that I had a suspicious spot, so I needed a biopsy. Since I was covered by my employer's Blue Cross program, I had a 10% copay, and ended up paying $200 for the biopsy. (Which was negative :-) )

Now here's the thing. I know from having been unemployed at some times and poor at others that $49 is a HUGE amount if you're living on the edge. Furthermore, even those uninsured women who could afford the mammogram would have to pay $2000 for the biopsy if anything suspicious showed up--and even more if they actually had cancer.

If you have anything other than a few of the really common, easily treatable ailments, then the country doctor system doesn't work very well.

I'm old enough to remember the old-fashioned doctors who made house calls, but the resources at their disposal were primitive compared to what is available today. You might want to talk to some older people about access to medical care for the poor before World War II, as well.

BTW, it's really disturbing to see DUers repeating the right-wing talking points about long lines for medical care in countries with "socialized medicine" and "thousands of Canadians" coming south for medical care. Canadians consistently rate their medical care system highly, and if you think it's an imposition to wait two years for a hip replacement in Canada, try getting an appointment with your primary physician at an HMO any time before three months from now. Maybe if you think you have pneumonia, you can have somebody drive you to the one clinic in the system that's open on Sundays and a nurse practitioner can check you out.

My "primary physician" at my former HMO had so many patients and so little contact with each one of them that the FIRST TIME I went to see her she greeted me with, "Nice to see you again."

Oh, and I've written before about my brother the doctor who was fired from an HMO because he spent more than 15 minutes with each patient.

Yeah, it's a great country we have here. :eyes:

[Kanary]

41. Spot on about the "RW talking points"!

I'm so amazed at the lack of REAL information on this issue on DU....... the forum that prides itself on being in the forefront of research and education on all matters political. Yet, here is one HUGE issue that is so important to us all, and ............very little understanding the basic components, yet such strong opinions.

Truly amazing.

I think I'm coming to the conclusion that this is a topic that is toooo important to me to play games with, so I'll just have to absent myself from all this misinformation, and let them continue to support each other in their lack of knowledge.

Kanary