Private Health Care Alternative To Socialized Medicine

-By Dan Scott

If anyone has gone through their yearly renewal of health insurance plans either through their company sponsored plan or private insurance plan, the immediate shock was how much monthly insurance premiums actually are. For just a run of the mill plan for a medium sized company over 50 employees, monthly health insurance fees run approximately $400. Depending on the employer, they may pay half to all of that amount. If you want coverage for your spouse and child add another $500 a month usually at the employee cost. Even deductibles can be high in the $1,500/$3,000 (per individual/family). Then come the co-pays the employee pays for doctor and specialist visits which do not apply toward the deductible.

Medical care is not a cheap proposition when one requires it. However, the issue becomes who is responsible for the bill when it comes due. Medical care like any service in the market place is an individual responsibility for the consumer, not a government issued right at the taxpayer’s expense. This is where Socialists and Capitalists depart company since Socialists define health care as a basic human necessity that must be underwritten by society. To a Capitalist, medical care like eating, housing and clothing is a personal responsibility governed by individual choice, not subject to government meddling. The only common ground is providing for a legal means to recover damages when that care is done poorly or negligently resulting in injury or death.

Our first question regarding health care in America should be, is there a problem and what is it? That answer depends upon who you ask because it is seen in completely different terms based upon the point of view. To a Socialist, the problem is access to medical care and then how much the individual, the insurance company and government each pay. To a Capitalist, the problem is cost versus service rendered, access is created by competition to lower the cost. In any Socialistic plan, the government would dictate what was covered even if you didn’t want that coverage which means you are forced to pay for services you would object to or never use. The Massachusetts Mandatory Health Care, aka RomneyCare, plan forced premium payers to subsidize abortion (an elective procedure) for a $50 co-pay. At the other extreme, a government sponsored plan would also dictate (eliminates individual choice) what would not be covered or when at all. Such an example would be Medicare not paying for a bone marrow transplant until after you are forced to endure Leukemia when it could have been avoided via preventive health care. Death, suffering and costs rise needlessly under a bureaucratically controlled plan. Ask the people of England and Canada how socialized medicine is working for them, it isn’t and many of their citizens come here for treatment because they can’t get timely treatment there. All of these mandated schemes would be run by government bureaucrats following some PC agenda. The Capitalist solution was private health insurance to protect the consumer against catastrophic financial loss, however, that method has been seriously compromised by meddling, cost shifting and the incompetence all of government origin.

Since private health insurance is a tax deduction, John McCain attempted to re-allocate some of that tax preference via a tax credit to economically challenged people. That approach was simply unrealistic in what he proposed didn’t accurately take into account the real costs involved. In doing so, most middle class families would have ended up paying income taxes on their basic health insurance costs. In essence a family when considering the full cost of a company sponsored insurance premium, the employee cost of $5,000 plus an additional $6,000 for the extra family coverage equaling $11,000 a year would subject them income taxes on anything over $5000 on their top tier rate. Talk about rubbing salt into the wound!

From a Capitalist perspective, the problem is the cost of service for the individual who has need of the service. As previously mentioned private health insurance was formerly the answer to this problem as it protected the insured against catastrophic financial loss. The idea of health insurance paying 100% of everything was an unrealistic expectation foisted by Socialists. An Appendectomy can cost approximately $20,000, who has that kind of money laying around? Typically, the person with health insurance may see a total bill of at most capped by their deductible in any one year. Those without health insurance are saddled with the entire bill. Now here is where the problem actually exists. The charge the health insurance company pays is NOT the amount presented on the bill, it’s usually two-thirds to half of that amount. Medicare and Medicaid pay even less. What we have in this country is a three tier pricing system that discriminates against those who don’t have health insurance or some government plan. It is any wonder then many who are presented with a hospital bill can’t pay it or go into bankruptcy?

Now let’s add to the fact of a pricing system that is not uniform, the final straw that breaks it’s back, a significant number of people who don’t pay their medical bills due to government mandates. Emergency services are available to all whether they can pay or not, whether they are here illegally or not, whether they committed a crime or not. A significant portion of any medical bill is the recovery of other people’s medical bills that were written off by the medical care provider. This isn’t any different principle than retail stores adding 5% or more to an item for sale due to shoplifting. So when an individual has an emergency medical situation, has lifesaving surgery but is not insured, then is presented with a $100,000 bill does he a.) pay the bill in full, b.) pay part of the bill, c.) pay none of the bill. What would you do? Now let’s magnify that problem with 13 million illegals working low wage jobs. Do you really think any of them are paying their hospital bills? Now what is the hospital’s response? a.) pretend the bill doesn’t exist, b.) not pay the staff for their services, c.) not pay the suppliers or d.) recover the cost incrementally via a percentage applied to everyone else’s bill. The answer is d.) stick it to everyone because someone has to pay.

Massachusetts instituted via law that everyone must buy health insurance as a means to sidestep the issue of non payment. The success of this plan has been to say the least not gone swimmingly. The State now has been forced to raise taxes on premium payers and businesses to cover all the people who can’t afford to be literally in compliance with the law. The reason for this is the State of Massachusetts mandates a minimum level of coverage, in other words, you can’t just buy a catastrophic coverage plan, you must purchase a plan to subsidize all the PC pork like abortion. In addition, due to the Don’t Ask Don’t Tell policy on illegal immigrants, they are naturally included in the group getting health care for free at the premium payers and taxpayer’s expense.

What has been the insurance companies and government’s response to rising health care costs when hospitals and other medical providers present an inflated bill when attempting to recoup money they couldn’t collect from others? They demand a discount on services rendered by negotiating a fee schedule. The insurance company does this by saying either you negotiate with us or we won’t send any of our insured to use and pay for your services.

On top of this, the insurance companies require all kinds of supporting documentation (paperwork) to prove that the service was rendered. What’s the medical care provider response to that, they take the deal because a paying customer is better than none. The government does this by use of the Law, Medicare and Medicaid says you will accept our fee structure which is 25% less than what you negotiated with the insurance companies, you have no choice otherwise you are put out of business. Of course lots of paperwork is also involved with government sponsored coverage claims. Now State run insurance schemes are even worse than the federal ones, Medi-Cal being so stingy with their reimbursements, many doctors and hospitals refuse to participate in the plan at all and will only do so under penalty of Law. As you can see, a vicious cycle of padding medical bills and demanding deeper discounts develops, thus screwing over the uninsured who have no one, not even the government to represent them at the table.

Then we have those who believe suing a doctor or hospital is like playing the lottery. The winnings can amount to millions of dollars and most of those who do so are poorer people. A good example of this abuse is in obstetrics, OBGYN doctors pay the highest malpractice insurance so much so many doctors are refusing to even go into the field creating a shortage. Giving birth has always been a high risk procedure, modern medicine has drastically cut down on the rates of mothers dying in childbirth, however, guaranteeing a perfect child delivered perfectly is a tall order even with today’s medical technology and they have no control over the quality of prenatal care given by the mother if she chooses to drink alcohol, take drugs or engage in risky behavior while pregnant. We can thank tort lawyers and juries with no clue as to the consequences of their actions upon the whole medical system. I find self righteousness of people like John Edwards distasteful especially when it is wrapped in dollar bills. Many doctors and hospitals are now forcing an arbitration only consent prior to performing any medical service. No consent, no service.

This in a nutshell is what is happening in the medical care industry. So what is the solution if any? First we must accept that the current situation of government mandated health care without regard to cost is untenable. There is no such thing as free health care, even under Socialized Medicine, you pay for it in HIGH taxes, ask the people of England and other Socialized countries what kind of income taxes they are paying. For those who think Socialized Medicine is cheaper per person than private health insurance, you are wrong, period. The doctors and nurses still have to be paid, the hospital and supplies still have to be reimbursed, the drugs still cost money. Attracting and keeping professionals will not change either, lest you need to be reminded that many government officials make 5 figure incomes. Under any government health care scheme, a budget (a cap) for the whole occurs of necessity. That budget is limited by the amount of money the government can tax, borrow or print money. Again, ask the English about this, don’t take my word for it. In order to stay within the budget, something must give, less service, less procedures, less, less, less, etc. Why are there long wait times in Socialized Medicine? Few professionals are willing pay hundreds of thousands of dollars to commit years and years of education to ply their trade only to get little compensation when in fact, for less education and money they could earn more doing something else. Why should the drug companies invest billions of dollars in research to bring a new drug to market only never to recoup their investment let alone make a profit commensurate to the risk of their investment not panning out? Like the doctors who decide medicine is no longer worth it, the drug companies can invest their money elsewhere and do better with little government interference. Don’t even think the government is going to expend that kind of money on research since it’s track record is one of incompetence and misallocation of resources following PC agendas. One look at the panacea surrounding Embryonic Stem Cell research should clue you in on this, government grants in the billions of dollars wasted on a dead end line of research before President Bush banned federal funding of them. Other stem cell avenues such as adult and cord blood stem cells have yielded numerous working therapies for years now without having spent billions.

The answer lies in the Capitalist model with limited government meddling.

• The cost shifting of the three tier pricing structure must end. Medicare, Medicaid, insurance companies and private payers must all pay the same rate per procedure.
• State Insurance Commissions must give reciprocity to insurance companies based in other states who have been approved by their respective State Insurance Commissions, this will expand the number of insurance companies that can offer cost effective health insurance.
• Force all State Insurance Commissions to allow for pooling or aggregating of health insurance policies such as for small businesses in the same occupational risk group and individuals within a geographic area. Larger companies always get less costly insurance due to pooling of employees, why not aggregate small businesses and individuals?
• Enforce the immigration laws of the US without qualification, end the Don’t Ask, Don’t Tell policy used by all levels of government to sidestep and condone the issue of illegal immigration. It is the responsibility of foreign governments to care for their citizens, not ours. The illegals must leave and stop being a burden on the taxpayer.
• Require periodic review of all medical procedures for prevention and treatment, favoring long term cost effective treatments that avoid more costly serious illness later.
• End government mandates regarding level of insurance coverage, elective procedures such as abortion are by definition not medically necessary, and insisting zero expense services which increase the cost of health care for everyone against their express wishes.
• End the government mandate of health care without reimbursement in non emergency cases. Most poor people go to the emergency room for common non emergency illnesses, needlessly clogging emergency rooms and draining resources from the hospitals. Just because you show up at an emergency room doesn’t mean it is an emergency. Those who qualify for Medicaid or Medicare should already have an ID card which should be accepted by all Urgent Care Centers. Those who don’t qualify should be able to afford the visit since the three tier system would no longer exist, thus lowering prices.
• Hospitals should open separate Urgent Care Centers in conjunction with Emergency rooms using basic triage techniques. In a transient society, the idea of every family or individual having a personal doctor may not be realistic.
• Biometric Data Base, just as the internet gives us access to information all over the world, those who access medical care must have patient information readily available for medical care providers to use at their discretion instead of wasting time reinventing patient’s medical histories in an ad hoc fashion and most times incompletely. All information regarding a patient is the property of the patient, not the doctor, the hospital or the insurance company. All patient information should be digitized in a format that is readily accessible by the patient and their medical providers. Whether the patient chooses to carry that information on a flash drive or store it on line, should be their choice. Many medical practices are moving away from paper records, old records should be scanned and saved in pdf format instead of archived in boxes or thrown out. There will be cost incurred for the transition to digital and a nominal fee for reimbursement should be established for old patient records. There is no reason why using current technology that servers of medical providers can’t be on their own secure medical intranet sharing information much like the military does.

Finally, everyone needs to be reminded of a general observation regarding Socialized Medicine in practice versus Private Health Care. In Socialized Medicine, the object is to provide medical care to everyone equally, in practice this is a win/lose proposition where winning is defined as giving the illusion of total and equal access at the expense of timely access and adequate resources. In Private Health Care, the object is to provide medical care at the most cost effective means that gives a reasonable rate of return for the time and money invested. This is a win/win proposition where patients are given timely access, using state of the art technology, training and facilities and where innovation is handsomely rewarded. The greater the innovation, the more cost effective the service becomes over time. Yes, some people will not get the equal access due to their economic circumstance, however, this is not the fault of the medical services industry, this is mostly the fault of incompetent government officials who insist everyone else pay for the failures of government policy such as illegal immigration. The responsibility for failure rests upon those who created the failure not those who have been forced to cope with the government’s failure.
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Dan Scott calls himself a “Member of the Global Capitalist Cabal preaching Capitalism and personal responsibility as the economic solution to world poverty.” He is also a member of the 14th Amendment Society — victimhood is a liberal code word for denying the civil rights of others. He is also a proud member of the Global Warming Denier Cabal, insisting that facts not agendas determine the truth.

Dan can be seen on the web at http://www.geocities.com/fightbigotry2002/ as well as http://www.geocities.com/dscott8186/saidwebpage.htm, And can be reached for comments at dscott8186@yahoo.com.

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