"One Cannot Measure What One Does Not Manage": Socialized Medicine, An Anathema (Part XIII-k)

Steve Forbes writes in "The Fight," that the Obama Administration's plan to deal with the uninsured is a surreptitious attempt to socialize American health care, thereby taking over 17% of the economy—a "Medicare-for-everyone system" that is competitive with private carriers. He adds, "But this won't be competition; it will be a de facto government takeover."

Before reviewing some of Forbes' talking points, note 35% of health spending is covered by private health insurance while public programs (eg, Medicare and Medicaid) pay for 46%. (And I wouldn't want to be the collection agency for the rest.)

Source: "Health Care Costs - A Primer: Key Information on Health Care Costs and Their Impact," Kaiser Family Foundation, March 2009.

Talking Points:

1. Opponents of "candidate" Obama's plan will be tagged: "heartless for not wanting to do something about the uninsured."

2. Private carriers already "make too much money and spend too much on overhead and marketing... a nonprofit government insurer can make insurance affordable for those who currently don't get it through their employer or are out of a job."

3. A Medicare type scheme "would be a disaster. It would destroy innovation and lead to shortages and rationing. All the frustrations we experience with our current higgledy-piggledy system will pale beside the replacement's increasingly subpar care, ever lengthening lines for basic services and ever longer waits for 'elective' surgeries."

4. "Both Medicare and Medi-caid (sic.) are heavily subsidized by privately insured patients, to the tune of $90 billion a year" and they are "rife with fraud. Unlike private insurers, the government refuses to spend real resources on routing out the wrongdoing: overbilling, overtesting and charging for visits not made or tests not given."

5. The quality of medical services surely will decline; people will be "treated more like ill, undesirable cattle." Furthermore, because practitioners are not specifically paid to do certain things, they won't, for example, computerize or communicate beyond the billable visit.

6. "Instead of overtly running providers such as Aetna and UnitedHealthcare out of business, the federal government will take them over through

mandating what they can and cannot do, as well as 'reinsuring' private carriers for costs above certain levels. In other words, nongovernment insurance companies will become vassals and virtual subsidiaries of the Washington-run system."

Here is Forbes' meager healthcare reform proposition, point by point, followed by my comments (in italics) and then contributor Fredrick H.'s (in grey).

JK: You get what you pay for. FH: That comment simply replaces thought with a stupid motto! Did the people who bought Madoff funds get what they paid for? Or people who buy $600 "designer" jeans? Or people who buy into an HMO that spends 30% of its funds on enriching itself rather than paying for medical care? Is the most expensive wine always the best?

• Catastrophic health insurance.

JK: Makes sense.

FH: He suggests getting rid of State Insurance Regulation, but that is, typically, far more consumer-friendly than Federal rules. Sure, the conservatives want it, since it will allow big insurers to screw consumers the way big credit-card companies do!

• Allow the purchase of health insurance across state lines.

• Small businesses would buy insurance from a pool established by their affiliations such as trade associations, because "Free-market dynamics have worked in virtually every other part of the economy."

JK: Notwithstanding that health care is a right, not a privilege and that we rarely see that in the free market, we need universal coverage and that means non-discrimination (pre-existing conditions, gender—why do women pay more for coverage, anyway?), as well as all-embracing evaluation of the value of care, small business should have the same buying power as mega corporations. Moreover, insurance should not be tied into employment and it should be 'community,' rather than 'experience' rated.

Gilbert R. (an Academic Medical group's E.D.) chimed in: "I have only one nit to pick here: the difference between a government “obligation” and a personal 'right'; I don’t see a substantive difference, except in the delivery of these human rights or moral obligations."

FH: I deny that health care is a "right" of individuals. Rather it is an Obligation of a civilized state. And it has nothing to do with businesses, big or small. It is an obligation to INDIVIDUALS.

• Egalitarian tax deduction of health insurance premiums for companies, large and small and for the self-employed.

JK: And, what's there for those who pay out of pocket?

FH: No, Health Insurance is not Health Care, especially when there are greedy investors making the care decisions! Government shouldn't encourage consumers to give money to those insurance crooks! If there is going to be an expense to government for health care, it should go DIRECTLY to paying for health care - not to providing a cushy life style to Insurance parasites.

Gilbert R.: (sigh).

• Raise limits on contributions to Health Savings Accounts and on permissible deductibles.

JK: I think HSAs create disparities and disincentives for people getting care, early.

FH: Once again, HSAs etc. are attempts to put lipstick on a pig! There should be no insurance - no deductibles! You pay your taxes to get police, fire and military protection and a court system. There's no reason not to get medical care the same way.

The point is, once one gets a handle on what works, it can be promoted. The obverse is that by measuring and managing, waste and duplication can be assiduously avoided—throughout the entire system of health care.

FH: But "what works" for insurers is NOT what works for consumers! They "manage" in such a way as to increase their profit, not to increase the benefit to patients!

Forbes is simply a mouthpiece for the same bunch who've been screwing patients for years, and want to continue to do so in perpetuity.

"The Fight." Fact and Comment by Steve Forbes (Ed-in-Chief) Forbes.com [last accessed 5/1/09]

Fredrick H (MD, PhD, JD) also said Fri. 5/3/2009 11:35 AM:

This is about what I'd expect from a publisher (Forbes) catering to business, the reprise of 'Harry and Louise,' ignoring the monstrous flaws of the current system.