Letter to Congressman Matheson on Health Care Coverage
Utah Citizens’ Counsel
Dedicated to improving public policy
Contact – David Carrier, phone – (801) 608-4898, email – carrier.dave@gmail.com
www.utahcitizenscounsel.org
March 15, 2010
Jim Matheson
U.S. House of Representative
240 East Morris Avenue #235
South Salt Lake, UT 84115Dear Congressman Matheson,
Medical science is now able to provide more medical care, life saving, healing, and corrective care, than all but the wealthy can afford at one time or the indigent ever.
Fred Friendly, ten to fifteen years ago, produced a prescient TV series on the topic with the title, “How Can We Manage Our (medical) Miracles”. We have yet to find the courage to do so.
We can afford our miracles only if they are paid for over a lifetime and paid by a collective of everyone. That means cradle to grave insurance coverage, paid for by parents at first, then the individual adult. It also means that everyone must pay into the fund, which in sum is everyone’s “insurance policy”.
How such premiums are paid is open to a variety of schemes, with subsidy for those unable to pay all or part of the premium. Payment into a fund over a lifetime will allow all to benefit from the “miracles” that our medical/science system can provide.
Will the cost be too great? We already pay for the care of the uninsured
with a wasteful system that resorts to emergency care too late and too expensively and inadequately. We are not prepared as a society, nor should we be, to let the indigent or uninsured die unattended. We are generous in the specific case, but we seem to be uncaring in the aggregate.
Who now pays? All non-indigent taxpayers. As it stands, our insured and wealthy receive good care. There is no reason for them to lose such care. But when the total population is considered, the US ranks well below developed countries in any index of “healthiness”, be it maternal, adult, or elderly care. Yet we spend a great deal more per capita, two to three times more, as a percent of GNP, on our total health care costs. Such an expense imposes an unacceptable burden on our global competitiveness when the cost of health care is another expense of production of a car, an airplane, or anything else we need to sell abroad to balance the cost of imports. The cost of steel in a car is less than the cost of the health care of the American workers who produce the car.
At bedrock, there are other conditions which are unacceptable in a nation as rich as ours:
Insurance unavailable and/or hugely expensive for those who do not have coverage on the job. Job paralysis occurs when a person dare not leave one job for another if coverage is not guaranteed.
Denial of coverage for pre-existing disease.
Cancellation of coverage when limits are reached.
Cancellation by insurance company sleuths who receive bonuses when they can find an unrelated paper oversight on the part of the enrollee, often decades earlier, to provide an opportunity to cancel coverage when an expensive care bill comes to the insurance company. Such practices have been confirmed in open testimony from former insurance employees who could no longer live with their conscience.
In sum, bankruptcy and even homelessness are a not an uncommon outcome of an uninsured severe health problem. Still, how can we pay for our “miracles” without draining society of the other important expenditures, such as social security, education, defense……?
There are large savings ready to be developed that have to do with our current pattern of care delivery. Medicare expenses vary between adjacent counties without reason except for un-managed waste. Procedures and studies are too often ordered without good evidence of value, at the cost as well as risk to the patient. Correction of such waste
can be achieved without “government coercion” by the techniques that have been developed right here in Utah among other places, Dr. Brent James of IHC and UU is a leading example. Physicians can be asked to review their practice patterns in the light of proven “better practice”, and when so discovered, compliance is surprisingly effective.
Excesses in malpractice awards are often mentioned, and reform could provide some important savings without denying a victim appropriate compensation.
The “new science” of determining how to compensate health care organizations for “best care” rather than for the number of procedures performed is showing promise.
Finally, improvement in care and expense can be provided with a renewed focus on the “general physician” (internist or family doctor) who is in the position to practice preventive as well as treatment medicine and group care using providers (physician assistants, nurses practitioners as well as regular nurses), and others, each providing a variety of skill levels at a saving of physician time, improvement of physician access for acute matters, and monitoring of disease, acute and chronic, by such assistants at lower cost and with the advantage of closer patient attention.
Members
Robert Archuleta
Genevieve Atwood (emeritus)
Aileen Clyde
Gale Dick
Irene Fisher
David R. Irvine
Boyer Jarvis
Chase Peterson
Grethe Peterson
J. Bonner Richie
Dee Rowland
Karl N. Snow Jr.
Emma Lou Thayne
Raymond Uno
Olene Smith Walker
Utah Citizens’ Counsel
Dedicated to improving public policy
Contact – David Carrier, phone – (801) 608-4898, email – carrier.dave@gmail.com
www.utahcitizenscounsel.org