Some Thoughts on Fixing Obamacare – Shoot Holes in this Please

I am going to take a stab at this. I am not a healthcare professional, but someone that has experience in US Government as a former intelligence officer, founder of multiple start-ups, brother of a sibling that has Multiple Sclerosis, and unfortunately, a family gene pool that is riddled with various illnesses. While each section can be expanded into volumes of books, this will be a short synopsis of what is needed. The following sections touch on healthcare, the role of the US Government, transparency of costs, high-risk pools, testing and the role military can play in helping to assist with these problems.

The Interest of Healthcare Companies

I have nothing against healthcare companies making a profit, but we need to be very clear that they’re a business. They are in business to make money. They are a business that deflects as many expenses as they can, as many businesses in any industry already do. The notion that healthcare companies are there to make you better, healthier by giving you extra care or give you every test needed is very far-fetched. The problem with the Affordable Care Act is that it removed the public option and required individuals to get insurance from the same companies that denied coverage to paying subscribers, underpaid for surgeries and would make you jump through hoops in order to get authorizations for treatment. Remember, these are the same companies where someone would pay for insurance for 15+ years and then be abruptly kicked off when they needed heart surgery, all previous years of payments would be refunded, and this would be because you didn’t check a box on some document fifteen years ago about having a vehicle accident in 1980. The requirement of getting insurance from the same companies that destroyed people’s lives, constantly denied treatment (especially towards end of life) and was out solely to make as much money with doing as little as possible in paying is the reason we should have had a public option.

Before we even start, there is a need to understand that healthcare companies are not responsible and don’t have an interest in how healthy the entire population is, whether they’re insured with that company or not. By default, only the US Government is there to take care of your health interests.

The Interest of the US Government

Let’s put the notion away that people don’t pay taxes, as some people argue incorrectly. We all pay taxes in some form. If I am working for a company, both the company and myself are paying taxes. If I own property, especially in Texas, roughly 3% of the value is taken for taxes every year. If I buy bubble gum or gasoline then I get hit with taxes. There are indirect taxes as well, which can account to toll roads, fees for various levels of government services and dozens of other examples. There is one certainty in the US, and that is you will be hit with some form of taxes. Whether it’s going to a local municipality or federal government, the money has disappeared from your wallet; taxes are taxes are taxes, no matter where they go.

The US takes an interest in your safety on a daily basis; you might not see this directly, but it’s there. Safety in the form of a heavily funded military that keeps the borders safe from potential enemies. Safety in the form of a growing highway system to keep you safe on the roads. Safety in the sky when you’re flying in and out of airports. Safety in the form of local and state police. The only lack of safety that is not offered is safety from disease, illness or accident.

It’s in the interest of the US Government to ensure that the people living within it’s borders, whether they’re citizens or not, are the most healthy they can be. The reason for this is that it gets back to taxes. A healthy person is able to work, able to provide, able to buy different goods, and within all those aspects, is paying some form of taxes. A sick person is limited on income, will pay less taxes and will end up in a financial hole if treatment is needed.

Just like the government takes an interest in collecting your taxes or keeping you safe from foreign armies invading, then it should also keep you safe from illness. It’s the upmost duty of the US Government, not because it’s just the right thing to do, but it makes economic sense to do so. A healthy person pays more taxes and a sick person pays less.

Transparency of Cost

The largest problem with healthcare, after access to good healthcare, is what you’re going to pay for it at the time. Healthcare is the only service/product where you don’t know the price. There is no other tangible product/service that you have NO clue what the cost will be, NO upfront information on the accuracy of potential costs, but you MUST get that service at the time of need. No one walks into a car dealership and says “I must have this car in the next two hours or I will physically die” and then will receive dozens of bills after amounting to tens of thousands of dollars. Transparency of prices is key to fixing healthcare, whether it’s the Affordable Care Act or any other replacement plan. If people don’t know the price of a procedure, treatment, doctor visit, testing in advance or life-needed procedure then there is no way the system can get fixed. Multiple studies, articles and in-depth conversations have outlined this specific point, but no one has resolved the issue.

The solution is simple, and in-fact, extremely simply. If the issue is no one knows what they will be paying for services, then offer the prices. There is not one emergency room or hospital I am aware that doesn’t request reimbursement or assistance from Local, State and Federal Governments. If an uninsured individual walks into the emergency room, the services are rendered and the hospital attempts to collect assistance from government for the service rendered. Here is the condensed process:

1- US Government creates a centralized website that will list every hospital, doctor and clinic.

2- As a condition for taking any type of local, state or federal funding healthcare providers will be required to upload all prices within their institution every year. This means that everything from a blood test to heart surgery is priced accordingly. There will be three classes for prices: no insurance, preferred insurance company plans and non-preferred insurance company plans.

The healthcare providers will have to abide by those prices and not bill one penny more. For instance, if a heart surgery is needed different codes will be provided in advance that are fully inclusive of the total costs. The heart operation will list codes that are commonly used in healthcare, but will be standardized amongst the entire United States. Previously, codes might be different depending on institution, even though the procedure would be the same. Within one operation you might get five codes including: 78635, 73641, 09937, 82633 and 09173. Each code will represent a cost that is commonly billed now, but comes at different times after a surgery. One is packaging the total costs for the surgeon, facility fees, anesthesiologist and additional fees in one package.

Ideally, the system will be simplified to the level of shopping for a new cellular plan. You can compare different hospitals offering the same service and in the same area for accurate pricing. One will enter their insurance plan and will automatically see prices in a city, state or even out of state. There could be a difference in pricing of 50% off a certain procedure or test, but if you previously couldn’t find out the pricing, now you have a centralized system to do so. The emergence of different medical choices can allow consumers to go to a neighboring city or even a different state if the costs of the facility are significantly less than what is offered in their area.

The goal is transparency. The goal is simplification. The goal is having the consumer choose and understand the pricing. The goal is for healthcare providers to issue proper pricing in advance. The goal is an open marketplace to know the prices, whether you have insurance or not. The goal is to make hospitals compete in lowering the prices with each other to attract consumers. The goal is competition, but that every consumer has a starting point to put all healthcare providers on the same level.

High-Risk Pools

Prior to the Affordable Care Act, my sister with Multiple Sclerosis was uninsurable. No company would touch her, and the ones that did, wanted over 10k a month for the premium. Let me repeat that, $10,000 a month for insurance and that doesn’t include additional medical costs. The Affordable Care Act, with all its faults, had a few benefits inclusive of covering pre-existing conditions.

I am assuming that many companies left the ACA because people that were actually in need of medical services started cashing in. I am aware of numerous individuals that held off surgeries in the years prior to ACA due to cost and no insurance getting the procedures they needed done after the start of ACA. Insurance companies have lost money due to this and this is inherently unfair for healthcare providers.

The solution to this issue can be achieved through a “High-Risk Pool” that is insured and backed by the US Government. The insurance would be similar to Medicare and Medicaid plans. The insurance would have just as much access as other for-profit insurance companies, so that a patient doesn’t have to drive hundreds of miles to be seen by a doctor. Certain ailments like MS, diabetes, heart disease would put you into this pool of insurance. The services for this insurance would not exceed a very bare amount of $50-100 a month, and would the majority of the subsidized cost will come from the government. Assistance for the unemployed and under-employed needing financial assistance will be available, so that we are addressing all levels of society.

If one is able to remove the high-risk pools, then inevitably, it will be cheaper for insurance companies to insure their current pool of more healthy individuals.

Testing, Testing, Testing

Had a blood test recently? Had an MRI scan or x-ray? Surprised by the costs and you had insurance? Surprised that a simple blood test cost you over $500? Surprised that an MRI ran you a few thousands of dollars? Surprised that developed countries can do this for a fraction of the price, sometimes for a few dollars?

People put off care because of testing. People will put off going to the doctor, even when they are ill, because of costs. People will avoid life-needed diagnosis because they don’t have the funds to pay for it.

The price of testing is absurd and has become a second cash cow for medical institutions. While the “transparency of costs” section addresses this to an extent, it needs to be addressed further. There is no reasoning of why the same MRI machine made by Siemens or General Electric will be priced 1x for images at a rural hospital and 20x inside a metropolitan area. There is no reasoning of why the same imaging machine made by the same company is priced .2x in Thailand, but is charged 1x in the United States.

The fluctuation of costs for the same machinery imaging is absurd, depending on what location the imaging is done. This is a role where government can step in with caps of prices for imaging and testing. A cholesterol test should cost, for instance $50 across the board, and not fluctuate from $50-$500 even with insurance. An x-ray should be mimicked in the same manner and so on with different types of testing.

We discussed earlier that there is a need to make the process of buying and shopping for insurance much more simplified to mimic shopping for a cellular plan. An additional add-on or package, could be unlimited testing for a family for “X dollars” a year. The service might be an additional $20 a month, but will give you the opportunity to get testing and imaging done with no additional costs. By using the combination of capping the cost and pre-paying for a pool of care, costs can be reduced. This is a simple business proposition, would I rather sell 5 tests at $1000 each or 5000 tests at $5? Costs will be reduced because there is a greater pool of buyers bringing down the prices with more purchases.

More testing will lead to quicker care. You will be able to find the cancer quicker and get it treated. You will find the issue of that pain before it becomes irreversible and untreatable. You will add years to your life from simple testing, if caught in time.

Military and Veteran Affairs Hospitals

There are additional ideas that can be expanded included providing access to military and VA hospitals for the general public. From my experiences of working with US Military in an intelligence capacity, there is a divide from the military and general public. While there is a great deal of funding that still goes to the military, the general public doesn’t see the benefit directly. Of course, there is a direct benefit of safety of the country from military service, but this goes over the head of the general population.

There are military doctors everywhere; in many bases, camps, training regions and in all VA hospitals. Access to these institutions for the uninsured can help relieve some of the need for the uninsured to go to emergency rooms that drive up overall cost. Doctors in the military will be able to get additional training and the infrastructure is already available to handle additional patients. While VA hospitals are improving in access to care, there is an ability to treat additional patients.

There will be pushback of people stating that since some didn’t serve they shouldn’t have access to care in those military medical institutions. The absolute truth is that the majority of the US Federal budget goes to defense, but the benefit is unseen by most. If utilization of some of those aspects and resources that are unused can be put for a domestic benefit, then it would be beneficial for all. Remember, that taxes are paid to fund defense. Hospitals are built in other countries using defense dollars. Why not use some of the under-utilized to improve the situation of those in need in our own neighborhoods.

Hopefully, the above is a short guideline of things to address now. One can expand on each section and fill volumes with other ideas. What we need are stronger leaders that actually have an interest in the overall population, and not just the ones that fund them. I would welcome your comments.

Sam Haytham

Linked.com/samhaytham

Austin, Texas

 

Comment by Sam Haytham (@sam62389518)