August 19, 2017

Healthcare Reform – The Dirty Words No One Wants To Say That Guarantee Failure

I’ve been watching with interest the back and forth over healthcare reform. My good friend Bookworm has a great article on the subject you should read.

But having taken a look at this, it does seem to me that the Republicans, as usual, are trying to win by avoiding being cast in the media as mean nasty villains robbing people of something. And after all, if you can spend other people’s money and look good…

Although of course, they won’t look good no matter what they do to the Democrat’s trained seal media. You’d think they would have gotten a clue by now!

Far better to concentrate on real policy and do it right, no? And let the results be the judge.

Insurance is what I call a ‘projection’ industry, where fortune tellers known as actuaries crunch numbers and determine the rates on policies and on investments known as insurance contracts as far in advance as possible. Forced instantaneous hope n’ change like ObamaCare hits insurance companies with a sucker punch and costs them a lot of money – which of course, like any other business they pass on to their customers.

What’s going on in DC now is ridiculous. If the GOP puts together some kind of bogus ObamaCare lite entitlement and President Trump signs it, it will be the first campaign promise he’s broken. I’m pretty sure cooler heads will prevail and there will be significant changes made to what we have now.

This is exactly why I said in an earlier article, that the first thing that needed to be done by President Trump, together with Speaker Paul Ryan and Majority Leader Mitch McConnell was to have immediately announced the repeal of ObamaCare, especially the individual mandate penalty and named a date in the near future – say, November 10th, 2017 or whatever – when it will no longer be in effect.

Aside from assuring the American people they weren’t being screwed again, it would give congress a clearly established deadline to thrash out the new legislation and it would have allowed insurance companies some badly needed lead in time to plan for ObamaCare’s demise.

And a demise, it must be. ObamaCare is so flawed, so thrown together without common sense that trying to build something viable using its parts is a fool’s errand.It was garbage to begin with, a tax scam rather than anything to do with healthcare.

But what next? Where should we go with healthcare? Incredibly, there are two dirty words that nobody is mentioning. And there’s a really good reason why…

Those dirty words?

T O R T

REFORM!

Say it again, with feeling….

T O R T

R E F O R M !!

Keep this in mind.. when someone is chattering away in wonkspeak about healthcare, mandates, health savings accounts and the like, unless they’re mentioning those two dirty words they’re simply blowing smoke up your nether regions.

Ask any health professional about what their biggest fear is. I’ve asked quite a few, and the answer is almost always predatory lawsuits. Have you ever gotten one of those official looking letters -actually calling them advertisements is more appropriate – asking you to sign on to a large class action suit against an HMO or hospital? Sure you have. The result of this trolling is almost always a fortune for the lawyers in fees and a pittance for the rubes who signed up as part of the ‘class’ if they mange to win and get a judgement. Even if they lose, their target spends big dollars in legal fees, or rather their malpractice insurance company does. After which the insurance company jacks up their premiums.

Picture yourself as a young American doctor. You’re already carrying six figures in student loan debt. And on top of that, depending on whether you’re a GP or a specialist and depending on where you’re practicing the usual rates for malpractice insurance run from just under $30,000 per year to six figures in the pricier areas.

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Aside from the ever rising cost of malpractice insurance, this fear of predatory lawyers also pads the price of healthcare by causing repetitive paperwork and staff work and many unnecessary and repetitive activities, even on routine medical procedures.

No doctor or institution should be allowed to get away with malpractice, and the medical profession actually does a fairly decent job of weeding put bad actors. But unless the current barrage of lawsuits is brought under control and some reasonable guidelines established, the cost of medical care is going to continue to increase. There are simply far too many lawyers, and far too many unnecessary lawsuits targeting the medical profession and healthcare institutions.

So why is no one mentioning this? So simple! Ask yourself this…what did most of the members of congress do for a living before they became congressmen? What do many of them do for a living when they leave? Why, they’re lawyers of course. And even while they’re in congress, a number of them receive an income from law firms they have a partnership interest in. As lawyers, let’s just say that many of them are reluctant to cut off a steady stream of income for the profession if not for themselves. And as we all know, law firms also contribute a lot of money to legislators who see things their way. That’s why a lot of what Senator Rand Paul has to say on healthcare sounds so sensible. He’s a medical doctor,not a lawyer. We’ll come back to this point later, but keep it in mind.

Another ongoing problem I haven’t heard mentioned in this debate is illegal migrants. Their effect on the cost of healthcare is a lot more insidious. In California and some other states with large illegal migrant populations, many of them are on Medic-Aid, because no one checks too closely about insignificant details like citizenship.In fact, there are actual privacylaws in California that prohibit and cross checking, so the system is almost set up for fraud. Fake social security numbers or EIN’s are also used quite a bit.

Another common occurrence is the abuse of ER facilities. If an illegal migrant working as a day laborer hurts himself on a construction site, he’ll go to the nearest hospital emergency room for treatment. Since legally and humanely he needs to be treated, he is. And when it comes to payment, a quick discussion between the migrant and the hospital staff makes it very clear that this one is going to be a freebie. So the hospital eats it. King-Drew Medical Center in South Los Angeles was bankrupted by this type of patient, and I doubt they’re the only ones who were, or who at least suffered major losses financially.

Tort reform and dealing with our huge illegal migrant problem are essential to stopping the spiraling cost of healthcare and repairing the damage ObamaCare caused. So is actual competition across state lines. And actual freedom of choice, dammit!

Keep these simple concepts in the above paragraph in mind.

Apparently a number of Americans like the idea of keeping young adults of 26 and under on their healthcare policies if they’re still lucky enough to be able to have one. And they like the idea being able to get insurance with preconditions without paying for them. It’s become exactly what Rand Paul said it is, a new entitlement.

Believe it or not, there is one healthcare system I know about that is government mandated, but also embraces all the of the concepts I’ve mentioned for real reform. I mean, if we’re headed for ObamaCare Lite courtesy of Paul Ryan, why not?

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Israel never really planned government run mandatory healthcare, but they were more or less forced into it by circumstances. After 1948, they had a large segment of their population who were ‘graduates’ of the concentration camps as well as almost a million Jewish refugees who arrived there penniless after being ethnically cleansed from the Arab world. So a nationwide healthcare system was cobbled together. And it works quite well. Why?

  • Israel has a very small illegal migrant problem. And thanks to the border walls, it’s even smaller now. They don’t have tons of illegal migrants bankrupting the system.
  • The ideas of competition and freedom of choice are maintained. While the government oversees and finances part of the system,it doesn’t micromanage it itself or insist that everyone have cookie cutter insurance. There are four different carriers (essentially, HMOs), all of whom compete with each other for members and have different plusses,minuses and ‘specialties,’ by which I mean a reputation for excelling in particular kinds of care or having better rates for certain extras or different copays and levels of coverage. All Israeli citizens get the basic plan the government subsidizes.If you want extras in certain areas, you buy them from your insurance carrier, so you have the ability to shop. On the flip side, you’re not paying for something that’s of no use for you, like maternal care for an elderly couple past childbearing age. Preconditions aren’t an issue because everyone has to have insurance. The National Health Insurance Law guarantees all Israeli citizens access to one of the four carriers, and the right to transfer between the carriers once per year.
  • Tort reform is not a problem since not only does Israel lack the litigious climate lawyers have fostered here in America (at least, so far) but lawyers also aren’t coming out of the woodwork there as they are in America. And at present, lawyers don’t constitute any kind of majority in Israel’s Knesset. The ratio of doctors to lawyers in Israel is about the opposite of what it is here.And the level of care, even private care is so high quality and reasonably priced compared to the EU and America that medical tourism is common. Med school is also cheaper, and Israel offers special incentives for medical professionals who want to become olim (Jewish migrants to israel under the Law of the Return).

Does it work? In a survey of 48 countries in 2013, Israel’s healthcare system was ranked fourth in the world in terms of efficiency, and in 2014 it ranked seventh out of 51. In 2015, Israel was ranked sixth-healthiest country in the world by Bloomberg rankings and eighth in terms of life expectancy.

So it can be done. But major tort reform,getting rid of a substantial number of illegal migrants and fostering competition and freedom of choice for consumers is what it takes. That, and creating a lot more doctors, medical researchers and personnel as well as a lot less lawyers.

Far easier said then done, but doable.

Rob Miller writes for Joshuapundit. His articles have appeared in The Jerusalem Post, The Washington Examiner, American Thinker, The Los Angeles Times, The Atlanta Journal-Constitution, The San Francisco Chronicle, Real Clear Politics, The Times Of Israel, Breitbart.Com and other publications.

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