Posts Tagged ‘infant mortality’

A Healthcare Rant from Me…

November 14, 2013

Aren’t you all tired of this healthcare wrangling  in Congress? Tired of the website disaster? Tired of the monthly insurance bills? Tired of the letters from your insurance companies that are saying “you don’t have to do anything.” and then describing all the things you should do or consider doing? It just goes on and on…

I have opinions. Anyone who knows me thinks I have an opinion on just about anything (and I do)! Disagree with me if you like, but here is what I think:

Change is difficult for the average person. You get used to a process, you budget for the expenses, you have relationships, and then, “Wham!” Things change, and you have to figure it all out. Bummer. Most people don’t like changes to important things in their lives, and most changes come with a wrinkle or two. People don’t like change. Maybe we all just need to “get over it, and get with the program”.

Healthcare is important, and healthcare is expensive. It should be less expensive. Healthcare is complicated. As one gets older, the decisions seem to become even more important and more complicated. This needs to get easier as you get older and not harder. Are you helping a parent make healthcare decisions? It is daunting, even for me!

Obama-care establishes a minimum insurance “quality” and coverage benchmark. I say”Good!” I know that some people are so encumbered by health insurance expenses that they buy poor quality insurance because that is all they can afford. This is a problem, but I think that the healthcare credits fix much of this affordability problem. We need to get rid of the garbage policies in this industry.

The website didn’t work very well out of the gate. I say “Bad…” It should have worked. It should have. When I am disappointed by the quality of a service I am paying for, I refuse to pay the bill. I am a taxpayer, for crying out loud, and I would like Congress to stop payment on that check to the website contractor. The good news here is that it will eventually work like it should.

The law is the law. All this wrangling by the Republicans in Congress should have taken place years ago. Now that Obamacare is law, Congress can fix what is broken in the law, change what proves not to work, streamline what doesn’t work well enough, and improve this horrible law over time. I read this law as it went through its many iterations. It started out as a sensible, noble effort to make the poor and middle class healthier and make healthcare more affordable, and the draft law got worse and worse as the politics unfolded and edits and amendments piled up. In the end, it was a really messy law. There is a lot of room for improvement. Congress – get to work on this!

I am struck by the fact that we in the US spend about twice as much per capita for healthcare than any other industrialized country in the world. But we do not live longer – we are kind of in the middle of the pack for that statistic. Infant mortality is shockingly high in the US. Our doctors are skilled, and our hospitals are modern and well equipped. There are obviously big and bad problems with the “system” – with the processes that healthcare providers are following. AMA – let’s fix that!

When I am not satisfied with my healthcare, I don’t have any real recourse except to seek a new provider, and if I am ticked off enough, I guess I can sue. If I am dissatisfied, I don’t have the latitude to refuse payment (or they will sue Me). I, as the consumer, don’t have any significant power in this market. That issue is still unaddressed. I want a consumer “Bill of Rights” for healthcare.

When things are broken, and they are, my friend, a good manager sets objectives and delegates tasks. Here is what I would do:

  • Describe the scope of the problem and justify the incentive to repair what is broken. US healthcare costs twice as much as it should, and care outcomes are just average compared to the rest of the world. A healthy population is simply more productive and happier.
  • Heed the 80-20 rule. Don’t “upset the applecart” for the 80%… If that is what needs to be done, then move a little more incrementally with a Phase1 and a Phase 2 and so on to limit impact to the 20%.
  • Set a burden level for the healthcare  industry in the economy – 10% of GDP would be in line with the rest of the industrialized world. “Right-size” this sector of the economy.
  • Set coverage targets: a 1-sigma, 2-sigma, 3-sigma approach. 68% should be covered by insurance from the private marketplace without any government assistance; 95% should be covered with the benefit of credits if necessary for the additional 27% of the population; provide indigent care (medicaid) for 4.3% of the population so that 99.7% of the population receive healthcare.
  • Set performance goals: Infant Mortality down to less than 2% after five years of improvement programs – down from more than 6% today, for example.
  • Set a participation transition timeframe that is realistic. Six months is really a short period of time for people to change something so fundamental. Make it a year. I see that President Obama has essentially just done this. Give every business and every individual the entire year of 2014 to make the necessary changes.
  • Pay for performance improvement. Audit the hell out of poor performers – poor hospitals, bad nursing homes, incompetent doctors, etc. Challenge poor performers with incentives to improve – or go out of business.
  • Address the “tall pole” expenses. The last two-months of life problem is a “tall pole”. This is the most costly category of healthcare to provide. It has ethical considerations, quality of life considerations, and total scope of care considerations. This is complicated, but it is a crucial component of care to address.
  • Focus more on prevention. Focus more on lifestyle. Make chronic illness management more effective and efficient.

My bottom line here is that a healthy population is a more productive population and a happier population – you aren’t working when you are ill in the doctor’s office, and you aren’t happy to be there, and you don’t want to be still paying that bill when you return to the doctors office the next time you need healthcare…

I believe that the Government has a vested interest to enable a productive economy to the greatest extent possible in part by putting a comprehensive healthcare system in place – healthy people are more productive. I believe that every person in the country has a natural desire to be as happy in their lives as they possibly can be day to day, and everyone should have a desire for the most effective healthcare possible when they are ill or injured. A comprehensive National system gives everyone the same vested interest and an organization that is accountable to you and me for system performance if “done right”… And it hasn’t been done right.

There is a lot to fix.