Everyone has heard the screaming on the Hill about Medicare. Should we change the system and if we do how should it be done? Paul Ryan made a risky and probably foolish move when he suggested phasing Medicare into privatized fee for service insurance. Everybody with a pulse is aware of the absurd salaries and bonuses paid to executives of insurance companies for successfully avoiding paying for care. So, obiviously, if we privatize Medicare we are throwing these guys a huge multitrillion dollar bone.
I suspect that unless Mr. Ryan has a special kick back set up he was suggesting this because he recognizes a truth we all wish to ignore. Private industry is not afraid to make decisions that government leaders lack the back bone to achieve. For example, it is well known that the final six months of life tally up about one half of the entire money spent on a lifetime of health care. No one in government leadership is willing to discuss this issue. I suspect that if Medicare was privatized the insurance industry would figure out a way to deal with this. The profit potential of reducing these costs is just too staggering.
On the other hand, if Medicare is privatized there probably wouldn't be any sympathy for the dying patients who desire care. By the way, I find it very curious that a Republican leader came up with a strategy of dealing with our elderly that would most likely result in a real death panel. For those of you who think that I am reaching a bit far I can tell you that only private insurance has subjected me to panels to evaluate whether a surgical procedure I would like to perform is appropriate. Medicare and Medicaid do no such thing. Instead they try to discourage procedures they don't like by reducing payments until the reimbursement is too unpalatable to consider performing.
I suspect if we privatize Medicare the incentive to make a profit will be so strong that patient care will be delayed as long as possible. Once the insurance companies have squeezed every last drop of profit they will abandon the model and beg the government to take over. By then we will have delayed so much care that just like failing to perform routine home maintenance we will be stuck with enormous expenses. So I do suspect certain disaster if we follow that route.
Despite this, I would like to thank Mr. Ryan for his willingness to at least discuss the Medicare disaster that is looming. I suspect that if we just raised the age when full benefits kick in and phase in an increase in copays and deductibles we can delay the disaster.
An even better idea is to reform the fee for service system. We need to put more responsibility with the consumer. I mentioned in a previous blog that physician compensation has not kept up with inflation. I also understand that Medicare cannot afford to pay physicians appropriately. But, the free market can. Currently, no matter what I bill a patient I am restricted to how much money I can be paid. Because of this, each year physicians are face with either leaving the Medicare program or in order to maintain income they need to perform a larger volume of services at ever decreasing payments. The upside is consumers get more services performed the downside is that for every dollar the physician generates in an additional procedure there may be associated expenses for facility fees, lab testing, etc. And, there will always be some doctors who bend the rules of indications for procedures and do things only to generate revenue. Those dogs make the rest of us look bad. Most of us just shorten our visit times and work longer hours to keep the revenue from sinking.
Perhaps we should allow doctors to charge what they feel the market can bear. Medicare doesn't have to increase rates they just need to allow the physician to pass those costs on to the consumer. They should require us to publish what our fees are so the consumer can compare. The free market will result in people reducing their usage of services if the cost is too high. They may travel to areas where cost of care is lower. Expensive hospitals would have to prove to the consumer that they are better. We could do away with the crazy red tape that Medicare uses to show quality of care. The consumer themselves would want to know who is the best for the money.
All this without a highly paid executive trying to transfer your money into his pocket. What do you think?
No comments:
Post a Comment