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Dr. Darrell White's Personal Blog

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Updating An Immodest Healthcare Proposal

I have been pretty generous in sharing my thoughts about some of the ills of our American Healthcare system, especially with regard to the barriers erected between physicians and patients. I find the various proposals now before our legislative bodies in Washington to be rather curious, even offensive. Since when does the United States of America adopt wholesale an economic solution from another country? Especially another country that is in some way otherwise riding the considerable coattails of the U.S. economy?

The “baby with the bathwater” approach in the halls of our Capitol and the editorial offices of our leading media outlets (WSJ excepted) is about as wrong-headed as you can get.  What we need is an AMERICAN solution to the challenges that we presently face with the economics of healthcare in the U.S., using our present system as the foundation.

Not surprisingly, I have some thoughts!

1) Malpractice tort reform. See my thoughts in “Tort Reform = Healthcare Reform”. Effective reform will dramatically reduce the scourge of defensive medicine with its attendant costs and risks to patients. Defensive medicine represents 15-25% of all medical costs in the U.S. That’s 15-25% of $2.5 Trillion. Do the math. While we’re at it, how is it good for the country to allow the tort bar to advertise for cases? Rake the muck in the hopes of unearthing errors or imagined?

2) Tax Reform #1: Remove the tax deduction for employer-offered health insurance. Provide a 100% TAX CREDIT to the lowest 60% of wage earners for the purchase of health insurance. Provide a progressive TAX DEDUCTION for the upper 40% of wage earners.

Tax Reform #2: Remove the tax deduction for advertising as a business expense for Hospitals. If we are concerned about unnecessary increased utilization of medical resources why are we allowing advertising by hospitals? For that matter, remove the tax-exempt status of any hospital or  provider that advertises. How is it appropriate to allow a hospital system to advertise to increase revenue, deduct that advertising as an expense, and still be not-for-profit? If it looks like a for-profit business, acts like a for-profit business, and sounds like a for-profit business, tax it like a for-profit business.

3) Insurance Reform #1: Reverse all of the for-profit conversions of previously not-for-profit health insurance companies. Who was the genius who thought THIS was a good idea? I don’t remember insurance premium increase that were quite so massive when all of the Blue Cross/Blue Shield plans were not-for-profit, do you? And while there were $Million execs in the non-profits I don’t recall any $10, $20, or $100 Million execs. Removing the need to answer to the stock market will create companies that will compete quite nicely with the for-profit companies without the horror of a government run system. Let the equivalent of NGO’s compete with the United Healthcares of the world.

Insurance Reform #2: Remove state-level coverage mandates and create a minimum federal set of mandates for comprehensive insurance policies. A REAL minimum. REAL medically necessary items. No Viagra or artificial  insemination coverage. Allow cross-state competition for the business. Real competition always drives prices lower.

Insurance Reform #3: Allow insurance companies (Medicare and Medicaid included) to discriminate IN FAVOR OF people who make healthy lifestyle choices (eg. no nicotine, no DUI, etc.). We are all so afraid of the stick that we refuse to allow any use of the Carrot.

4) Freedom of Speech/Restraint of Trade Reform #1: Abolish, once again, direct-to-consumer pharmaceutical advertising. There was a quantum leap in the utilization of all sorts of medications immediately following the 1997 rulings that allowed DTC pharmaceutical marketing. If it is so obvious that our ever-increasing levels of spending on medical care is a threat to the very existence of our fair Union, then DTC drug marketing is a version of yelling “FIRE” in a crowded theater.

Freedom of Speech/Restraint of Trade Reform #2: Begin a return to the professionalism of yesterday by prohibiting all forms of advertising by, or for, physicians. The AMA gets a lot of criticism, most of it well-deserved in my opinion, but the court and FTC rulings that prohibited the AMA from censoring physicians who advertised was a seminal event in the de-professionalism of doctoring and medicine. Doctors and other medical advertising was, is, and always will be wrong. While we’re at it, do the same thing for the rest of the lawyers and the practice of law.

5) Public Health. Finally, and most importantly, go to the true root of whatever “Crisis” we may have here in the United States, be it a “Healthcare Crisis” or a “Healthcare Finance Crisis” or what have you. We as a people are not healthy; certainly not as healthy as we ought to be. We are not healthy because of some wrong-headed previous Public Health decisions (simple-carbohydrate based diets, abolition of school phys-ed programs, tort-fearing closures of playgrounds, etc.). We are not healthy because our ability to treat the diseases that result  from poor lifestyle choices (cigarette smoking, alcohol abuse, preventable accidents, etc.) is SO GOOD that we are able to keep more and  more unhealthy people alive longer and longer, paying ever more to do so along the way.

This is where true leadership can make a difference. Remember JFK and the President’s Council on Fitness? I do. 8 pull-ups in the fifth grade for me. Polio, measles, smallpox and whooping cough were once the leading killers of children in the U.S. but are now historical footnotes due to Public Health initiatives. (A pox on all the cretins advocating against childhood immunization).

We lead the world in per capita alcohol related accidents and deaths, losing young lives by the thousands each year. We have ever more increasing numbers of truly obese citizens who go on to suffer the diseases caused by that obesity, and we pay ever more for their diabetes, hypertension, strokes and heart attacks. These lifestyle choices are root causes for our increased expenditures on Healthcare, much more so than all of the targets of Beltway demagoguery like insurance company expense ratios and pharmaceutical company profit margins. A solution to this issue, more than all of numbers 1 through 4 combined or any other proposal yet floated, is the true crux of the solution to any “Crisis” we may be facing. Everything else is only there to buy time. Time to get healthy.

Pick a number; choose an age. 40. 50. 60. Anyone under that age gets “Well-care” or “Get Healthy Care” starting right now. Over that age they can have “sick care” only if they wish, but under that age if you try to be healthy you get rewarded.

There are no votes to be had in making Americans healthier. Nothing but hard work on every side of the equation. Who will stand up and do the hard work? Who will lead?

Who will have the guts to not only say that the Emperor is naked,  but also drunk and fat and puffing away our economy.


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6 Responses to “Updating An Immodest Healthcare Proposal”

  1. March 29th, 2012 at 6:31 am

    Paul Zagaria says:

    Amen Darrell. Leadership (used in jest) in this country is agenda-driven, rather than being focused on working together for any type of real solution. “Leaders” are focused on one thing: protecting their lifestyle, at any cost. No guts to propose real solutions for the actual issues at hand. You offer common sense approaches. Unfortunately, common sense approaches in our society “need not apply”. Can’t see the forest thru the trees, or better yet, don’t want to see.

  2. March 29th, 2012 at 7:07 am

    Bailey says:

    Once again, Bingo, you are spot on. I have a friend in the healthcare insurance industry who supports a large number of organized labor clients. We had discussions regarding how to subsidize the people who are trying to be healthy. I will share your link with him. I am sure he will be interested in the other thoughts on health care and pharmaceutical advertising reform.

  3. March 29th, 2012 at 12:37 pm

    Apolloswabbie says:

    Not that it matters much what I think, but I fully support parts 1 and tax reform 1 of your platform. Funding people to buy their own insurance is THE way for people to be able to get care when needed, without devising some liberty crushing monstrosity that, at best, just averages down care to some minimum standard that may possibly be affordable when implemented with the characteristic waste and inefficiency of coercive government monopoly.
    However, whether or not it is good for the country to “allow” lawyers to advertise is not a question I would ask. I would ask what part of the constitution, and under which part of the idea of individual liberty being the entering argument, would permit such repression of the freedom of speech?
    I think Herzlinger does a nice job in “Who Killed Health Care?” of showing how so called “non-profit” hospitals abuse their privilege. I’m not a big fan of those so called “non-profits”, but the point of a non-profit is to provide a way for an “almost corporation” to function with a tax benefit compared to a real corporation which exists only when the entity is so desirable and effective that it can and does return a profit to the owner/owners. The inevitable result of this kind of law is that someone gets to make the rules for what is/what isn’t in the interest of “the public” (or are these decisions made in the interest of the political class?). How long until this power is abused, and the organizations so blessed start to deviate from their supposed public interest cause? 3, 2, 1, GO!
    For that matter, remove the tax-exempt status of any hospital or provider that advertises. How is it appropriate to allow a hospital system to advertise to increase revenue, deduct that advertising as an expense, and still be not-for-profit? If it looks like a for-profit business, acts like a for-profit business, and sounds like a for-profit business, tax it like a for-profit business.
    I like the sound of the above, but how long until that power node is just another corruption node? The folks making the rules do so for their own interests, even if sometimes by accident those rules benefit “the public.”
    Insurance reform #1 – no need to meddle here at all. Fix that perverse tax incentive, fix the absurd state by state regulation of insurance sales and the accompanying bizarre mandates for coverage, and let the market sort out who the right providers are. For my money, million dollar execs are not an issue whatsoever – million dollar execs in government manipulated and controlled markets are not only predictable, they are nearly insignificant. Government manipulated markets have no effective pricing system, insuring that massive waste is built right into the deal. All parts of it. Complaining about the visible parts – execs making more money than we do – is just lazy thinking in which we pretend that’s the only or even a significant amount of waste; in my humble as ever opinion.
    Insurance Reform #3: Allow insurance companies (Medicare and Medicaid included) to discriminate IN FAVOR OF people who make healthy lifestyle choices (eg. no nicotine, no DUI, etc.). We are all so afraid of the stick that we refuse to allow any use of the Carrot.
    Allow, disallow – Bingo, I might trust you to hold that much power, but I don’t trust anyone else, and frankly, I don’t think you want to job. Let folks decide what coverage to offer and let folks decide what policies to buy, leave the “allowing/disallowing” to things like “not allow fraud” and “not allow breach of contract” and “not allow people to pretend that because an insurance business is “regulated” it cannot fall apart.”
    #4 touches a hot button for me. Either doctors are not doing their jobs – they hold a coercive government monopoly on prescribing meds, so they better take that seriously – or the result about which you are complaining is a good thing, not a bad thing. If I have purple toes, and Big Pharma comes up with a cure and tells me about it, and I go to ask for the cure, and the doc prescribes it, that’s all good. If the doctor is doing his/her job badly, well how about we give him/her a ball peen hammer upside the head instead of wasting time worrying about advertising?
    Whether or not you or I are coerced into (wastefully) paying for someone else’s “Purple Toe Cure” is the real problem, not the fact that Big Pharma, which is now a functional subsidiary of US Govt health care law, is advertising drugs the FDA says people need, and that doctors are prescribing. I agree that this is an excellent symptom of a bizarre, non-market based process which creates massive waste which you and I pay for at gun point. I agree that sucks. I can’t get with the idea of violating freedom of speech as an antidote to a government caused and coercively backed problem. The threat to our fair union is the government’s ever increasing and by definition coercive intervention into a process it has no business manipulating. Every manipulation pits some of us against the rest of us to serve the needs of the political class. THAT IS WHAT IS WRONG.
    As for the AMA – I’d be first in line to get rid of that organization’s politically protected status. Good doctors do not need a coercive government monopoly and bad doctors should not have the protection of a government protected entity. Not expecting to get a ton of applause for that sentiment, sir. I trust you’d rather see my unvarnished opinion than a pretense of respect for a profession that could be much more respectable, but it sold out and will ride down with the government to which it hitched its wagon. The only functional elements of our “sickness survival system” that work and the ones like yours, which are still not totally controlled and manipulated by laws/insurance companies.
    Part 5 – we have a government led and directed “health care crisis”, based on people with good ideas who had them implemented via government – the only problem being that they were dead ass wrong. They wanted us to eat grains and cut out fat and that is killing us.
    I have to willfully stop myself from expressing my true sentiments about the deceased president you referenced, about whom the more I learn the closer I have to work to avoid hatred. But as for his program, we had the President’s Council on fitness stuff when I was in school, too, and the effect was too small to notice. I am skeptical that defaulting to a least case scenario (government directed anything and the pretense that it might one day make a difference for someone) will have any desirable effect. What might make a difference is if truth came out about the relationship between the food we are told to eat, and the resulting predicable reduction in activity level. Feeding kids food that makes them feel lazy and asking them to do pull-ups is working in the wrong direction.
    Who will have the guts to not only say that the Emperor is naked, but also drunk and fat and puffing away our economy.
    I have done my best my friend, because “the Emperor” is the continued use of the government’s coercive monopoly on force, guided by the fatal conceit, to a completely predictable result – the diminution of human well being, the reduction of humankind to a group of those wise mandarins who will decide the cost benefit for the peons, and then slap themselves on the back for their virtuous intent.
    Every coercive government intervention creates the negative unintended consequences needed to justify the next intervention – a law provable with even a casual consideration of the “health care crisis” we are discussing.
    I doubt a solution awaits. I fear only further political decision making, based on political calculus, with benefits for all the connected parties, and the expense of the rest of us. Once out of the box, the government is very rarely if ever stuffed back in. The chance that my rants will be of any effect is zero. There’s a virtual certainty that my children will suffer greater indignity at the hands of some charming politician and her/his cronies than I have.
    I believe the best human outcomes come from cooperation, not coercion. The only legitimate function of government is to protect you from coercion by me and vice versa. Ah, such a quaint notion. All of the political participants are essentially saying “My version of coercion is going to be better for you than his version of coercion.” Perhaps the Paul campaign can shift the debate at some point, if people decide they like liberty again.
    So what to do? Enjoy every day. Be grateful that, relative to most of the world, I enjoy less government coercion than most of the other 7 billion. Love the babies. Love my friends and write on their blogs. Look for ways to escape the crushing interventions of our government. Pretend like my efforts might possibly matter to someone someday and keep writing when able.

  4. March 29th, 2012 at 12:46 pm

    darrellwhite says:

    In the end, Paul, our differences lie not so much in core philosophy (because I’d be hard-pressed to disagree with almost all of what you say were I able to do so in a vacuum or a Heinleinian thought experiment), but in the necessity to acknowledge the cold reality on the ground that I/we must accept the present construct (govt. exists) and devise a workable real-world solution.

    Why don’t you put that whole thing on FB so that others can comment on that as well?


  5. March 29th, 2012 at 12:38 pm

    Apolloswabbie says:

    Well – so the idea of annotating your comments with italics did not survive the cut/paste from Word. That’s going to be a little bit confusing.

  6. March 30th, 2012 at 3:45 pm

    Apolloswabbie says:

    D, understood entirely. I’m just taking my thoughts and withdrawing from any semblance of the arena of what is a remote poltical possibility.

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