The Health Care Debate Continues

As time moves on, the health care debate does too. And all we see is the passionate debate for or against it, with no real discussion of what's broke about the system and what specific aspects that need fixing. It seems that there are 2 schools of thought; Government run health care or increase insurance competition without the government entering the business. HR 3400 is the Republican solution to health care which simply put, has tax credit provisions for maintaining health insurance, and allows for small businesses to pool into groups to purchase insurance for their employees at large group rates, and more blah blah blah about fraud waste and abuse and so on.

Let me tell you something, when you have a middle man administrating the care whether it's the government, in the case of Medicare and Medicaid, or the private sector in the case of all other insurance, rates are predetermined/negotiated. Which means the insurance company or the government tells the provider how much they will pay them for a certain service or procedure regardless of cost. A set up like this encourages fraud waste and abuse on so many levels. Meaning a doctor sees a patient and takes the opportunity to run all sorts of tests and procedures, ordinarily unnecessary but particularly if it is of no harm to the patient in order to increase their reimbursement. All they have to do is justify it medically, and when you are an expert in the game you can justify anything. This is especially easy to do and difficult to prove on older patients or if the patient makes any comment that could be construed to justify ordering this or that, which is another billable item.

What I am trying to say is that as long as there is a intermediary that must employ doctors, nurses and administrative personnel to administer payment on behalf of the patient, fraud waste and abuse will continue. Do you not find it fraudulent that insurance companies can deny coverage on the basis of a preexisting condition? But they can. This is the issue I think Americans can agree on and where we ought to start. That doesn't mean these patients might not have to pay higher premiums or higher deductibles or co-insurance.

Let's be honest, the fact that we pay premiums just means that insurance is just a payment plan for our routine medical care that is expected to even out over time. How else is an insurance company going to make money? For example. My parents were without health insurance when they first got married, by choice. They could have paid for it, but money was tight and it was a risk they chose to take since they are both very healthy. About a year later, dad went to the ER for kidney stones. They paid the discount they were offered to pay in full at the time of service. (All facilities offer this probably doctors too, some just make you ask for it) Calculated out, it cost about what insurance premiums and a deductible would have cost them for the time period of being uninsured. Had they put that money in savings every month, they would have had that money at the time of service instead of having to put it on a credit card.

I will say it again, if doctors and patients ban together to cut out the middle man, whether the government or insurance companies and take back personal responsibility for our health care, (dare I say live healthy lives?) I bet the cost of care would drop dramatically because doctors wouldn't have to employ staff or pay agencies to bill and collect from insurance companies. They could just collect the full amount up front at the time of service and I bet it would be lower than the "negotiated rates" they get from insurance companies or Medicare because Doctors and facilities would truly have to compete for your business. See my previous post about this issue on July 12. But I know 90% or you or more will likely disagree with me on this issue just like 90% of America is going to disagree with me about privatizing social security.

My point of this post is rather than each side insisting on their solution and their solution only, both of which only treats the symptoms, how about we think outside the box and treat the problem. At the very least, let's focus on 1 part of the system that we can all likely agree on (preexisting denial, or perhaps something else) and start there if the majority don't really want to treat the problem. As it is it just seems like a political power grab taking freedom from you and me the consumers.

What's Texas Doing Right?

Is Texas doing something right that California and other states aren't?

I was sent an article from the national review but as I haven't figured out how to upload I file for you and the National Review requires you to pay to be a subscriber to their magazine, I went searching and found the article reprinted with permission on Rick Perry's website. I encourage you to read it.
http://governor.state.tx.us/news/press-release/13234/

It points out that while Texas is feeling the effects of the recession or the slow down of the economy, it's effects are minimal compared to the states that have been hit hardest. It points out that we still have manufacturing thriving while Detroit has been hit hard. It points out that there is a mass migration from California while their government workers are taking IOUs as they attempt to balance the budget. Texas went into this recession with a surplus to the budget which will help ease the pain of the recession.

Texas has no state income tax. We have sales tax. Texas essentially operates as an example of the way the fair tax is meant to, by taxing everyone that makes purchases here. Legal or illegal, resident or visiting. So these people using our programs, whether they should or shouldn't be, are still paying into our system some way shape or form even if they aren't paying their emergency room bills.

This article makes the much hated Rick Perry look like a genius. He's running for reelection in 2010 and if he wins will be the longest serving governor in Texas history. While he is despised, the much despised and loved (depending on who you talk to) Kay Bailey Hutchinson will be challenging him. I'm on the despising side since she voted for the first bailout before Bush left office. I wrote her and told her not to. She won't be getting my vote for governor. I'll likely vote for the libertarian running, though I've heard a 3rd republican has thrown her hat in the race that is supposedly endorsed by Ron Paul. I have yet to check her out. Maybe she will prove worthy of my vote. Rick Perry and Texas is your classic nanny state. They passed a steroid testing bill in 2007 for Texas high schools that cost several million dollars a year or so that has turned up few positive tests. Aren't there physical signs to steroid abuse that could be the trigger to test someone rather than random testing? Anyways there are many other nanny state bills that he hasn't vetoed that make him unpopular. The term country club republican applies to him and Kay Bailey.

That said while there are a economic positives, Texas has a high uninsured rate. Page 5 of this report shows the stats by poverty rate and by citizenship status. One thing that pops out to me is that 60% of non citizens are uninsured compared to 20.4% of natives and 32.9% of naturalized. You can see that 20% of natives is still a larger number than the other two groups. This is obviously a problem. But we have to start some where. I'm guessing there are laws that could be enforced for the 60% of non-citizens if they don't pay their bills when they go to the doctor or emergency room. They should be deported immediately. Maybe an expert out there knows if this is a currently enforceable law or not. If it's not, then this is one place to start.

What those stats don't address is the rates of delinquent health related bills by poverty group or citizenship status. Is one group offending more than another. It's one thing to be uninsured and not utilizing or paying cash for your health care, but it's quite another to be going to the ER once a week with no intention of ever paying your bill. What I do see is a lot of people choosing not to purchase health insurance 2.5 million people are making 200%+ of the poverty level and yet they are still uninsured. "More than 1.7 million uninsured Texans live in families with incomes above $50,000." I've stated before on here, from experience these people have cable or satellite and cell phones among other luxuries.

Some possible solutions to this problem:
-Debtors prison (work your debt off)
-Revoke visas or citizenship to non natives who allow a bill to become delinquent and deport them immediately
-See my previous post from July 12 for a move in the right direction
-Fair Tax - collects taxes from all offenders that spend any money - perhaps states could set up free clinics as a result and attract doctors by paying their medical school bills in exchange for lower salary and a 4 year commitment. That way people have a choice in free health care if they really want it. Or they can pay for it themselves.

Why can't we start with some of these ideas before allowing the government to take more and more of our hard earned money?

So is Texas an example for the rest of the country? Yes but it's not the only state. We just happen to be the 15th largest economy in the world (from the above referenced article from NR). So it stands out more than others. We have 6 of the 25 largest cities in this country, which is more than any other state has. Texas is growing while other states are shrinking. So while our unemployment rate may be increasing as a result of the recession, it's still one of the lowest in the country all while working with a migration from other states.