Universal Health Care

What we end up with when — or if — Congress finally passes some form of health insurance law will undoubtedly not be a universal health care single-payer program. It may or may not contain President Obama's idea of a separate government insurance plan that competes with the commercial insurance industry. However, it is highly doubtful that the health insurance lobby will let any such idea get very far before shooting it to pieces. Many of the property and casualty insurers we adjusters work for are also in the life and health insurance business, and the last thing they would want is a government competitor.

Maybe they're right, maybe not. At one time, there were a number of states that established workers' compensation programs and administered all of the claims themselves. All but a very few are now gone, replaced with insurance sold by insurance companies. Why was that? Probably politics. When Nevada had a State Compensation Fund, it used to look at what was happening with its next-door neighbor California and point out how much better its state fund system was than that of California's workers' compensation, which became very costly. Now California is dead broke and Nevada is treating with a doctor, although it, too, may soon be in a financial hospital. Neither employers nor their workers are any better off in both states.

But do we want what the critics call “socialized medicine,” a la Canada or the U.K. or other European countries? Their taxes are higher, but as Dr. Michael M. Rachlis, a physician in Toronto, Ontario, recently wrote in a syndicated column, “In the 1960s, the U.S. chose public coverage for only the elderly and the very poor, while Canada opted for a universal program for hospital and physician services. As a policy analyst, I know there are lessons to be learned from studying the effects of different approaches in similar jurisdictions. But, as a Canadian with lots of American friends and relatives, I am saddened that Americans seem incapable of learning them.”

Rachlis points out that while Canadians have health insurance for both medical care and hospitalization, 46 million people in the U.S. have no health insurance at all, their expenses passed on to tax payers and higher insurance costs. “A single-payer system would eliminate most coverage problems,” he says. “Single payer systems reduce duplicative administrative costs and can negotiate lower prices.” He adds, “Single-payer plans can deliver the goods because their funding goes to services, not overhead.”

What he means is that when all medical services are paid by the government — doctors, hospitals, rehabilitation, nursing services — employers do not need to maintain a large employee benefits department; physicians do not need to pay a bunch of clerks to file insurance claims with hundreds of insurers, each of which reimburses different amounts depending on the terms of their policies; employers don't need to carry three wallets, one to pay employee benefits (with large portions often coming from the employees' own paychecks), one to pay workers' compensation, and one to pay lawyers and third-party claim administrators to tell them out of which wallet to pay the claim.

Hospitals could eliminate the billing department, the credit department, and the bill collectors, and spend the money instead on offering better care and service. The clerks could become nurses, who are now in short commodity. The government could negotiate for supplies and pharmaceuticals at a wholesale rate.

The Unemployed

“Yikes! He's talking about a lot of unemployed people here. That might well include a lot of claim adjusters. This debate is getting downright close to home!”

What would happen to our tax bills under a universal medical system? They'd go up, of course. But would they go up as much as the cost of insurance (including all those other policies that include bodily injury or medical payments) would decrease? That is the expectation, but it is also an unknown. When close to 50 percent of our medical costs go for administration, we are wasting money. Change would put a lot of lawyers who make a living resolving coverage and liability disputes out of work. But then, in the handful of states that still have auto no-fault laws, lawyers still seem to be making a living.

But wait! I have an idea for the unemployed, too. It will be discussed next month, so hold on; the best, or worst, is yet to come!

The Best Care Possible

The truth is that we have been lied to and ripped off, both by the Congress and by the health insurance industry. We're told that we have the best medical care in the world. Yes, some of us do. With the Mayo Clinic, the Emory Clinic, the Cleveland Clinic, Boston's Women's Hospital, the Sloan-Kettering, Johns-Hopkins, Case Western Reserve, and so on, America does have some of the finest medical care in the world. But it is only for those who can afford it, who, when they arrive at the hospital are able to pull two or three medical insurance identification cards from their pockets and fill out the release forms.

Without those cards, forget it. You get shipped to County Memorial, and your chances of recovery, even of survival, are limited. Now we sure don't want that “socialized medicine” like they have in Canada or France or Great Britain, do we? Isn't it a matter of “Take a number; wait your turn. Everybody eventually gets the treatment they need”? As Americans, we want it right now. In the U.S. system, somebody is getting the short end of the medical stick.

The crux of the problem, suggests Christina Patterson in the London Independent, is that U.S. medical insurance plans are only for the rich and the middle classes. The poor must survive on Medicaid, and funding for that has just been cut quite deeply. Patterson suggests that, in America, winning is everything. As for the poor, well, they are “failed Americans who [have] let the side down,” she says. “Sure America's got talent, but it's also got some of the most unpleasant, uncompassionate, unerringly ruthless people on the face of this planet.”

That's what Europeans think of us. Is it true? Having seen the greed-feeder capers of Wall Street over the past 18 months, there is evidence that it is very true. We can't have Enrons and WorldComs and guys like Madoff coming to light weekly and say it isn't true. Oh sure, you my readers and I are not those kind of people. We're in a helping profession of adjusting claims. But hasn't that put us precisely in a better position to see the rip-offs? Do we not see the inflated medical bills and disability benefit checks that go to claimants who could be doing something useful besides sitting around their houses all day watching lawyers advertise on television if they only had the motivation?

More Indictments

Patterson is not the only Brit who thinks we are nuts for not having and wanting a universal medical plan. Alex Spillius in London's Daily Telegraph provides statistics to show that, in the U.S., we spend more than any other nation on health care, “but by almost every measure [Americans] are unhealthier.” Why, he asks, “does the richest country on earth have an immunization rate worse than Botswana's?” Why is our infant mortality rate down among those of third-world nations? Why are young Americans sick and dying from malnutrition like in some sub-Saharan land? Well, we answer, we don't want rationing of health care. We want what we want when we want it, which is right now.

But the reality is that the current system already rations health care. I have friends who fly to Thailand for their medical care. It's cheaper, and it apparently is far better than care in the U.S. After all, most of their physicians were trained at U.S. universities and did residencies at U.S. hospitals. But if you can't afford to fly off to Rochester, Minneapolis, Bangkok, or to some internationally known medical institute, then welcome to rationed care. Get in line. If it's a colonoscopy you want, then, well, anesthesia is going to cost you a couple of thousand bucks more.

Studies conducted by the Department of Veterans Affairs and RAND Health and sponsored by the Robert Wood Johnson Foundation found the care that Americans receive is far from the best. As reported in the New England Journal of Medicine, their study of almost 7,000 adults in 12 major metropolitan areas found that only 57 percent of women received top-quality health care. This dropped to 52 percent for men and those over age 65.

Perhaps surprisingly, African-American and Hispanic populations received top-quality care at a rate of 58 percent, while Caucasians received it only 54 percent of the time. Also, those with incomes of less than $15,000 received nearly as much quality care (53 percent) as those with incomes over $50,000 (57 percent). No group, regardless of race or income, received better than the 58 percent, including those 30 and under. So 42 percent of Americans do not receive quality care in the U.S., whether or not they have health insurance.

Could universal care really do worse? Apparently those in Canada and Europe do not think so. However, maybe they are not stockholders in a health insurance company, hospital corporation, or in the insurance claim business. Suggestions:

1. Medical Malpractice Claims

President George W. Bush was right on target when he pushed for computerized medical records. Good heavens, it's the 21st century and doctors and nurses are still scribbling their notes and instructions with illegible handwriting. Have they never heard of typewriters in hospitals? Or are those only reserved for typing up the inflated bills? Improved medical records would reduce medical malpractice claims.

Americans live in a tort-driven society, where — as we adjusters well know — there are thousands of plaintiff lawyers just itching to file a lawsuit. If the Obama medical insurance program is to have half a chance of succeeding, then it should include some sort of tort reform or no-fault aspect, by which physicians no longer have to perform every test in the book in order to protect themselves from a malpractice lawsuit.

Of course, if the surgeon shows up at the O.R. high on drugs and saws off the wrong leg, yes, a lawsuit may be the answer. Yet there has to be a better way. A panel of peers for review is not it. High medical malpractice insurance premiums is not it, either. But there has to be some efficient way to screen the many malpractice lawsuits to thin them out to those that result from gross negligence only, not ordinary negligence.

2. Birth-Rate Problem Costs

It is not just the poor who give birth prematurely. If you have read Marley and Me, a book about a West Palm Beach newspaper man and his obnoxious dog, you've experienced what millions of other parents and expectant parents have lived through and survived. The point here is not so much the cost of saving babies, which is admittedly very high. It's the way it gets paid for, which is by suing the obstetrician.

Often because of the lack of prenatal care, Americans have one of the world's highest rates of infant mortality and birth defects. Almost every such birth defect ends up as a malpractice claim against the obstetrician and hospital, as the costs of raising such an infant are horrendous and are not covered by insurance. Suing the doctor, guilty or not, is one way of paying for those costs. That is an inefficient and stupid way of financing a catastrophic loss, unless the doctor or hospital really did “screw up.” With all sorts of in vitro fertilization plans possible, there are far more multiple births that any time in history. Twins have always been common, but today, mothers are giving birth to five, six, even nine infants, and it is expensive. Many of those extra babies have birth defects.

3. Old Age and the Pro-Life Debate

One of the major costs in medical care is the amount spent on the last few months of life for those who, until 1950, would have died of old age at home in their own beds, not hooked up to life support in some hospital or nursing home at $5,000 a day. It may be hard for some to think about, but eventually we all will die. Some nations are debating the end-of-life issue in terms of assisted suicide for the terminally ill who are in constant agony anyway. “Tsk, tsk! No, no, no!” say the pro-lifers. “Keep those folks on life support until the money runs out and they croak naturally.” If those hooked up to life support to keep them in a vegetative state until their insurance or their relatives' money runs out had signed a “living will” allowing the doctor to pull the plug, billions of Medicare and insurance dollars could be saved. Presuming that universal care will not result from the current Congressional debate, how about a five- to 10-percent premium deduction for those willing to sign a living will and who agree to donate their body parts to others who could use them?

Next month, your brave Iconoclast will attempt to purvey further ideas on America's overall health and welfare systems, and suggest a really out-there solution to problems including unemployment, inner-urban blight, the growing number of drop-outs, and the illegal immigrant influx.