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As Long as We Remember...

June 22, 2009

And Hippocrates Wept

Steven R. Berryman

The final form of changes to our current healthcare system, as is being pressed by our President Barack Obama, is still under wraps. A rational discussion of the ramifications for all concerned – including you – is an essential exercise now.


By not disclosing details, we are left to ponder with less specificity; but the real benefit to our single-minded administration is that there can only be less scrutiny. Perhaps after passage we will all – legislators included – get to actually read the legislation to see just what we have wrought.


If you are feeling the déjà vu now, it certainly comes from the recent experience with rushing programs through – avoiding debate – on a “sky-is-falling” basis.


This is a-la-TARP rescue plan finagled exactly in the same manner, with funds not accounted for, projections absent, zero transparency, accountability nil, pork larding, and results-a-wanting.


And how’d we do on that big multi-billion dollar spend on General Motors?


The Hippocratic Oath, administered to all doctors upon graduation, applies very well as analogy to the current healthcare system experimentation, and begs the most important questions: First, do no harm!


Surgeon Obama, speaking before the American Medical Association recently only got a rise from the crowd when he began to refer to the trial lawyers’ malpractice cost…and disappointingly backed off of a vital reform.


With the economic fix as job one, job two, and also job three, why would we choose now as the time to incur debt to the tune of over (another) trillion dollars plus plus?


Please, oh Lord, somebody explain to me how we are going to increase the number of people receiving medical benefits, while reducing the price tag at the same time!


And we are not talking about modifications where needed. All of the advanced press calls out a full body transplant in terms of the magnitude. Insurers, HMOs, doctors, medical schools, lawyers, and patients will have their customs, practices, and expectations forever changed.


And not for the better!


You will have a mandate from Uncle Sam to buy health insurance from the government itself if you do not buy into a company plan. And your company plan will be taxed up to the point of the loss of competitiveness in marginal cases.


Where we came from, in the olden days, was a system where your doctor viewed his job as a service in a humanitarian way, and got respect for it, especially upon the house calls. He was the man with the black bag that made your fever go away.


Already, many potential doctors considering medical schools, residency, and borrowing several hundred thousand dollars to finance career training, are choosing engineering, business, and law careers instead.


Our best and brightest, no longer willing to suffer for such an uncertain future, are abandoning medicine. Someday your surgery may be performed by somebody with a lesser skill-set.


So, what’s the driving force in all of this?


For one, healthcare became a business as opposed to a profession. Doctors invested in MRI collectives. HMOs became corporations very much for profit. Pharmaceutical conglomerates force their wares upon the public, in some cases, almost inventing the condition that was supposed to be cured by pill!


As more profit was skimmed off at more levels of the healthcare transaction with the customer – called a patient – everything became more expensive. A booster shot for a 100 bucks. Check your sore throat for 75 bucks.


For a while, many companies offered employee subsidized health insurance without many deductions. This was even cost effective for a time as compared with offering higher income. The added benefit had been company loyalty with a good health plan.


Will we challenge “portability” with an Obamacare solution?


Then with expense driving up, deductions, exclusions and contributions changed accordingly. Companies dropped healthcare. Insurance rates tripled.


But how does this translate into an emergency for our current healthcare system?


The very profit-lifeblood itself is getting sucked out of our system at several levels, and in several ways.


Of major note:


For both employer-assisted health plans and private health insurance companies, those paying into the plan who use little if any of the services, the healthy middle classers aged 20 to 37, are opting out of coverage.


Think of it this way: Of the entire universe of subscribers paying into any health plan, those at the entry level get about what they pay into the plan back in benefits and generate no profit at all. This is mostly a loss-leader group as viewed financially.


Those middle-aged and above also get out about what they invest on average to about 52, and our oldest group, with end-of-life palliative care outspend their premiums by the most, and is by far the budget buster.


So, by comparison, all of the profit in health insurance comes from those paying into the system, yet not having to take advantage of the plan benefits. They just don’t use it, being at a healthy age.


Problem: This 20-to-37-year-old demographic group is opting out of paying premiums in greater and greater numbers, as they are willing to work within the risk pool, and pay out of pocket instead of suffering premiums that essentially keep the entire remainder of the plans above water.


In fact, catastrophic illness and end-of-life care are involved in some aspect of almost 62 percent of all personal bankruptcies.




Emergency rooms have mandated free medical service obligations. The poor, the medically bankrupt, the entitlement world, and the illegal-immigrants all take it for nothing. You pay for them, as does your insurance company, as this is passed along as higher fees.


On an actuarial basis, the group above in our social strata also enjoys the distinction of needing more health services than other portions of our society. They just cost insurers far more than they pay into the system, if anything. That’s just a fact.


A $50 ankle sprain is now a $100 ankle sprain.


Where will the money come from to cover insurance costs of our poor and entitlement class? It will come disproportionately from our middle class, in a double cross of campaign promises.


It’s really a de facto tax increase.


New plans as proposed, although vague, will inevitably reduce income for doctors, increase treatment and procedure costs, increase wait times, and cause rationing of healthcare via a financial basis planned by a physicians’ board charged with maintaining profit.


This will shorten some lives.


Quite the political payback to the currently challenged – but not yet bankrupt – healthcare system that disproportionately funded the Barack Obama presidential campaign of 2008.


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