About That "Quality Of Life" Business

The conversation about health care is ceaseless and pretty much one-sided.  We hear, over and over, how individuals can't afford coverage.  How businesses can't afford to cover their employees.  How the state -- and the feds -- must do something.  Well, they have been doing something.  Quite a lot, actually.  And they have come up with a great way to save money.  They  don't pay  providers for the full cost of their services.  They do this because ... well, because they are the government and they can get away with it.  Meanwhile, the providers have been covering the shortfall -- some of it, anyway -- by passing the bill to private insurers.  In the trade, this is known as the "cost-shift."  And it is one reason private health insurance is so expensive.  The government has created the problem it now proposes to fix.

These problems on the demand side of the equation are undeniable but they shouldn't entirely obscure the difficulties  over on the supply side where the "cost shift" has meant providers have had to cut services.  There aren't enough doctors in either Bennington or Rutland.  And if you were a recent graduate of medical school, looking for a place to practice, would you come to Vermont if you knew the hospital with which you would be affiliated was running a $3 million deficit and cutting staff?  Quality of life certainly counts for something but isn't the availability of good medical care one of the elements in that equation?  When you talk about the wonderful "quality of life" in this place or that, don't you sort of assume that there are doctors around to treat you when you are sick and fully staffed hospitals where they can operate on you if necessary? 

Affordable health care isn't worth much is there isn't any.

Comments

[GreggB]

VPR had a bit on the problems VT is having recruiting Dr.s last year, the funny part was after an hour of blabber in the last 30 seconds they suggested- the lack of good jobs for spouses and quality of schools might also be a factor. Ya think.

[Mister Guy]

The real cost shift in health care is between the individuals that don't have any insurance (but yet still need health care services that they can't pay for) and those that do. I would argue that it's very difficult for anyone to estimate the "full cost" of the health care services that people get right now. The billing practices of both health care providers and insurors are riculously & needlessly complicated. I haven't heard anyone argue that Vermonters aren't getting good health care in general.

[David Usher]

The cost shift occurs when expenses must be covered by revenue. Since revenue from the federal government via Medicare/Medicaid is not covering costs, private insurance premiums must make up most of the difference.

If hospitals run deficits they must shrink costs. Moving to a 21st century electronic health care records (medical) and administration (billing and communications) system would go a long way to reducing costs for all the players. My guess is we might squeeze out 20% of costs ( reduction in staffing) once we got over the hump of startup/conversion costs.

No politician wants to touch the third rail of health care, i.e., reduce costs or limit access, So, in Vermont and many states, the solution is to pour in state tax dollars to fill the gap between costs and revenue and falsely believe that a single payer system will wring out the excess administrative costs.

One of these days, a crisis will force us to significantly restrain (maybe even cut) spending on both health care and education and the resulting gnashing of teeth may require us to start our own school of dentistry.

[Mister Guy]

"Since revenue from the federal government via Medicare/Medicaid is not covering costs"

"No politician wants to touch the third rail of health care"

I think these are fundamental fallacies. These plans do not re-emburse at a hugely high level though. There are more and more politicans talking about reducing health care costs.

"Moving to a 21st century electronic health care records (medical) and administration (billing and communications) system would go a long way to reducing costs for all the players."

We are in agreement here, but there are obviously privacy concerns that will need to be addressed. If there was only one primary source for health care service payments, that would obviously reduce a huge amount of waste in administration costs.

[James Ehlers]

There is one primary source for Medicare and Medicaid payments, and that has not driven down costs, but raised them. Please explain your contention, Mister Guy.

Thank you.

Sincerely,
James Ehlers

[Mister Guy]

How about one primary source for all health care service payments, period? That's what a single payer system is all about. You guys will never go for that option because it goes against the Holy Grail of the free market.

[SPS]

Couple thoughts:
I remain unconvinced by either side regarding the single payer debate. I see what the free-market crowd is saying, but I've also single payer health care in Europe and it worked damn well and was legions better than what we received in the US for the same procedure (we had one kid in the US and the second in Finland). On the other hand, I don't think a single payer system will reduce costs on its own because the lack of incentives.

Second, I am stunned at the lack of innovation in the technology space in health care. My doctor certainly makes a very nice six figure salary, but he still hand writes prescriptions, which I then have to carry to the pharmacy. He also hand writes out all the notes from my visits. Such practices are quaint, but woefully inefficient.

I am not a health care expert, so I don't understand this. Why isn't there more innovation in health care tech? Can't a company go to doctor's offices and say we will take over all your admin and record-keeping in return for saving the doctors time and money. Take a percentage of the savings. Hell, just automating prescriptions and notes ought to be very lucrative. It seems like a no-brainer way to make a mint, but maybe I am missing a piece of the puzzle.

[James Ehlers]

Dear Mister Guy,
The issue is not who is paying, but who is not paying. This fact is the sticking point in any type of market system.

How much "free" health care do your propose for each citizen in your system? And what is the citizen's obligation to the system?

Sincerely,
James Ehlers

[David Usher]

"There are more and more politicans talking about reducing health care costs."

Politicians may be talking about reducing costs (by spending tax dollars) for the consumer or small businesses who buy insurance, but I hear few words about reducing the direct costs of providing care, except by reducing overheads.

I believe we should first take the steps to reduce overhead costs by eliminating inefficiencies via smart application of information technologies, not by overhauling the structure of the entire system. I fail to understand why this type of re-engineering is so painfully slow. Well, I guess I do. The workforce will shrink.

To their credit, Fletcher Allen Health Care has finally announced a significant step to insert IT for efficiency and quality improvements.

[Mister Guy]

"The issue is not who is paying, but who is not paying."

We are in agreement here, but I think that the post far above tries to say something different.

As I'm sure you know, a single payer system is not "free"...it is paid for with relatively small accros-the-board taxes. Everybody pays and therefore everybody gets the same amount of access to the system. Pay your taxes...the same obligation we all have now.