HEALTHCARE POLITICS-This article follows up my last CityWatch column, which was a response to the Times Business Section article of Michael Hiltzik that made the ridiculous and repeated confusion of "happiness" with Thomas Jefferson's "pursuit of happiness" (as in "life, liberty and the pursuit of happiness" written into the Declaration of Independence).
In Michael Hiltzik's world], " happiness" is what Big Government tells you, because it and its supporters are just simply smarter than you...and when you figure that out you'll be happy. Obamacare is apparently supposed to be the ultimate source of happiness, and woe be unto that person that questions the happiness that we're all supposed to have right now.
And I do want to distinguish between true Liberals, who question EVERYTHING, including the lies and obfuscations of our current presidential administration (which go into all sorts of domestic and foreign policy issues), and the Statists (who define Governmental Control as the end-all-be-all of what they fight for, and rather cruelly dismiss the screams of those who are hurt as a result).
And I particularly care for my patients in their twenties, for my patients in their fifties and early sixties, and for minorities, who are NOT by any means "Happy" and who are being sold a nightmarish bill of goods by a presidential administration who promised to finally look out for them, yet is clearly no better and/or no more caring than their GOP counterparts.
Yet while I don't ever claim to have all the answers, I do have the perspective of living the experience of reducing the cost of health care, while others merely talk about it. As a dermatologist, I choose to work only in jobs that prevent me from having a conflict of interest, and I fight every day for my patients' and families' happiness and affordable health care...so unlike the Obama-apologists, I really watch and think outside the box.
And unlike the Obama-apologists, who appear to think that God is on their side and who want to merge Big Government into the new religion of our times, I honestly believe that individuals can figure out how to make health care cheaper...and so I will do my best to derive five ways that we can actually lower costs for health care, and some of it WILL involve governmental intervention.
...as in governmental oversight, not governmental control of what the private sector has usually done. The one thing I give Hiltzik credit for is the accurate points he makes in describing how health care insurers and Wall Street has really hurt the ability of the ordinary individual to get ahead--and count me in as a Teddy Roosevelt admirer because--unlike so much of the GOP and Democratic fringes, I really DO care about the little guy.
And the so-called "Affordable Care Act" is doing everything BUT empowering the little guy, and exacerbates everything wrong with our health care insurance process while driving costs up, and by also minimizing innovation in health care cost reduction...such as:
1) Medications are too damned expensive, and both generic medication producers and big-name pharmacies are too damned untruthful.
So long as generic alternatives of medications are allowed to keep their costs up to 85-90% of brand-name costs, and so long as big-name pharmacies are willing to lie and distort the truth to their patients no matter what their doctors write (and despite the cost-saving rebate cards that allows Big Pharma to eat hundreds of dollars of pharmacy and deductible costs for patients), we're all going to pay too much.
The overwhelming majority of my prescriptions are generic, and in many cases they can save money, but they really aren't yet for too many of the more expensive brand-name medications. Unlike the original brand-name manufacturers (who are quite often guilty of their own excesses), generic makers do too little to enhance pharmacologic innovation and should be making their products for pennies (and charging patients, accordingly).
If health care insurers really want to do something about drug costs, then setting up a non-profit manufacturer with government oversight to safely and inexpensively mass-produce decades-old medications would be a huge boon to the ordinary American...
...and while we're at it, allowing a system where Americans aren't subsidizing Europe and Canada, and enabling drug manufacturers to charge Americans thrice the amount that other developed nations pay, is a practice that must end.
2) "Concierge Medicine" must continue to move towards the middle class.
As reported by the Wall Street Journal, this practice already is occurring and, under the right circumstances, can be ACA-compliant. And it's not just for the uber-rich, anymore.
However, rather than accelerate the negative impacts and abusive denial trends of health insurance (which is what the ACA is on its way to becoming), this practice is one that goes back to the original intent of insurance, which is to pay a reasonable amount each month (such as $50-100 a month) and eliminate insurance billing when clinic visits are performed.
No hassles of insurance billing, and by not having a "magic sugar daddy insurance" pay for it all, the fee-for-service treatment is menu-style and with money always taken into consideration.
Want to avoid high doctors' fees? Then have everyone pay cash and I assure you that doctors will charge less. Ditto for drug costs. All without governmental control (but, clearly, with governmental oversight to protect the safety and quality of all health care venues).
But the need to move beyond this as a supplemental plan must continue, because right now cash-only, uninsured patients (who might INCREASE in number as a result of the ACA) have to pay more than insured patients for the same service when seeing a doctor because they aren't BY LAW allowed to be charged a decreased cost when they pay cash. The ability to pay cash-only for reduced costs must begin ASAP.
3) Create low-risk clinics that operate 24-7 whenever possible, and wherever possible, and keep emergency rooms limited to true emergencies.
This trend is already occurring, and it's often occurring in pharmacies and in venues run by nurses, pharmacists and other non-physicians, and it's been moving forward without any government fiat. Yet it's one that must continue, and it's one that must be shouldered in large part by the physicians who insist on "banker's hours" in treating their patients.
Oversight is absolutely critical, because too-often the nurses and pharmacists who like to play doctor refuse to recognize their own limitations (doctors need to recognize their own limitations, too!). So if such an endeavor is to work, then health plans must step up and offer up to 25-50% reimbursement/salary hikes for those physicians, nurses and pharmacists who offer nighttime/weekend clinics.
Practicing what I preach, I work at least two Saturdays a month, and while it impacts me and my family I cannot ignore the joy and relief these Saturday clinics offer my patients--who might go without care altogether if myself and others weren't available to them.
Such an endeavor might even REQUIRE physicians to serve in such evening/weekend clinics a set number of hours per year in order to retain their licensure--which would certainly be a form of "big government", but it would also rededicate physicians to serving the needs of their patients, instead of the other way around.
4) Expand Medicaid, and give the working poor, twenty-somethings and fifty-somethings the ability to have a safety net if they're not gainfully employed.
Thanks to the hostile business environment created by BOTH the Bush and Obama Administrations, there aren't sufficient full-time-employment-with-benefits scenarios for the hard-working and desperate American Worker. This must end...yet folks in their 20's, 50's, students and others will often just NOT be in a position to work 40 hours a week, and they need a safety net that doesn't tell them, "You're making too much for health coverage."
The ACA probably hurts this group more than anyone, and this is a huge segment of our modern American society. They may not get enough love from Obama apologists and GOP ideologues, but Michigan just came up with a compromise that increased Medicaid, created incentives for patients to reduce their health care costs and enabled that state to live within its means with respect to their state health care budget.
Lots of GOP legislators in that state balked at such a proposal, but Republican governor Snyder and enough Republicans and Democrats came up with a plan to create that compromise, and it's reminiscent in part of the Healthy Families program that California Republican governor Pete Wilson created with a bipartisan Sacramento legislature.
We need to provide a safety net that allows the working poor to also have a sliding scale for monthly payments based on their personal income, and which both requires welfare recipients to stay in school and/or look for work while also not demanding the working poor and lower middle class give up their part-time and/or low-wage jobs in order to get health care coverage.
Yes, this is Big Government of sorts, but when BOTH parties work together it's Big Government at its best. And if it's outsourced, such as the programs I work with in Orange County, it can save money and manage healthcare in amazingly effective ways.
5) Can we please redefine what our employers owe our 21st Century society with respect to taxes and wages?
This is so overdue in discussion that I'm embarrassed to even bring it up...but have you HEARD that jobs are being outsourced overseas? Have you HEARD that employers don't HAVE to stay here?
Now maybe we need to legislate much of this away, and I certainly have NO tolerance for tax scofflaws, but a crackdown on tax-cheaters is as necessary as is a "New Deal" of sorts for employers, both big and small.
And when one realizes how some of the worst cheating employers jumped on the ACA bandwagon as a way to free itself of health care responsibilities to ALL of its employees, one can perhaps understand the assertion that the ACA is exacerbating, not fixing, America's health insurance problems.
Simply put, we must force ourselves to remember that while some employers are cheap/cheats by nature, most don't want their corporate taxes to go to initiatives that make no sense to them...and we must remember that they really do NOT have to stay here, and employ here.
With that in mind, the need to LIMIT corporate/business taxes and obligations to transportation/infrastructure, defense/first-responder, health care and pensions is more critical than ever. Let them hire, and let income and sales taxes pay for the rest.
People need jobs, they need jobs with benefits, and they need jobs that are full-time and stable. Bringing back jobs--which neither this or the last Administration did too well--to America is the best way to provide health care coverage and keep Americans HAPPY and SECURE.
So to my fellow Americans who are either Obama-apologists or GOP ideologues (actually, both groups are obnoxious ideologues), perhaps it's time we actually fixed our health care costs and coverage problem. Perhaps it's time we got past an "Obamacare" and focused on an "America Cares" approach to ensuring the health, financial and quality of life needs for all Americans.
And for those who won't...perhaps the problem is that YOU don't care.
(Kenneth S. Alpern., M.D. is a Board-Certified Dermatologist/Dermatologic Surgeon who is a Westside Village Zone Director and Boardmember of the Mar Vista Community Council (MVCC), previously co-chaired its Planning and Outreach Committees, and currently is Co-Chair of its MVCC Transportation/Infrastructure Committee. He is co-chair of the CD11 Transportation Advisory Committee and chairs the nonprofit Transit Coalition, and can be reached at [email protected] This email address is being protected from spambots. You need JavaScript enabled to view it. . He also co-chairs the grassroots Friends of the Green Line at www.fogl.us . The views expressed in this article are solely those of Mr. Alpern.)
-cw
CityWatch
Vol 11 Issue 91
Pub: Nov 12, 2013