Reform Health Care - Let's Truly Get Patient Focused - Time for Action

When the Federal government took over 40% of the healthcare system with Medicare in 1965, the industry has bordered on crony capitalism. Costs have continued to rise. This combined with idea that employers should provide health care insurance had eroded the wealth of the middle class in this last decade; what would have been wage increases have instead gone to pay for enormous increases in health care prices (costs are really not known in health care in the US).  Most of the American public are unaware that they are paying for the entire bill; "The employees ultimately bear the full cost of of the health insurance plan they get form their employer," says Kate Baicker, a Harvard economist who served on President George W. Bush's Council of Economic Advisers from 2005 to 2007. "Even though they're only writing a check for a part of it, they're bearing the full cost."

Here are some immediate fixes:

1. Post prices (not the inflated Charge master) for services to be delivered at hospitals and clinics. Singapore does this on a regular basis. Being patient focused means more than giving a survey at the end of the service. Here is link that shows the prices for SingHealth on regular services: http://polyclinic.singhealth.com.sg/PatientCare/Fees/Pages/Home.aspx

The Ministry of Health also post prices for particular operations and procedures. Much of this can be read in the free Kindle book from Amazon entitled, Affordable Excellence by William A. Haseltine. From the book: “Services at the outpatient clinics had been free-of-charge— modeled after the practice of the British healthcare system. But the government quickly changed that. As Lee Kuan Yew recalled in his memoirs: The ideal of free medical services collided against the reality of human behaviour, certainly in Singapore. My first lesson came from government clinics and hospitals. When doctors prescribed free antibiotics, patients took their tablet or capsules for two days , did not feel better, and threw away the balance. They then consulted private doctors, paid for their antibiotics, completed the course, and recovered. Lee's government imposed a fee of 50 cents for each attendance at the clinics, doubled during public holidays. 11 This bold move reminded Singaporeans that healthcare is not free, and that the nation would not be building a welfare system such as Britain's. People would be expected to a large degree to pay their own way.”

2. Post the quality of the service delivered by institution; if 1 & 2 happen, then the consumer/patient can work the equation: Value = Quality/Price; without this transparency, there is NO MARKET.

3. Change the language; health care loves to throw around the word, "cost," as if this calamity that has absorbed income from the middle class for the last 10 years was foreordained. People who write about health care avoid the word "price" because their costs are not known. If the price of gas goes up, people are ready to riot, while health care "costs: go up, we shrug our shoulders. Nonsense! Let's try a real market!

In my junior high days at South Gate Jr. High, I was fortunate to have a homeroom teacher by the name of Mr. Leeds. Each morning he would greet us with the following statements: Good morning Gentleman (homeroom was all boys in a drafting class)! Remember two lessons:

1.    The government cannot give you anything unless they take it away from you first.

2.    The older you get, the worst you get.

After 3 years, I understood the first lesson. Since I have hit 60 years of age, the second lesson is coming home to roost.

References:

1.    Haseltine, William A. (2013-04-15). Affordable Excellence: The Singapore Health System (Kindle Locations 308-315). Brookings Institution Press with the National University of Singapore Press. Kindle Edition.

2.    You’re spending way more on your health benefits than you think by Sara Kliff (August 30, 2013): http://www.washingtonpost.com/blogs/wonkblog/wp/2013/08/30/youre-spending-way-more-on-your-health-benefits-than-you-think/