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April 09, 2008


If one supposes that federally managed health care is some evil to be banished based on the assumption that anything run by the goverment is bad, then your statement would be correct. Which is what you seem to imply. Since you are making this assumption without any supporting facts or apparent knowledge of the medical world I'll see if I can shed some light on this from the limited amount of knowledge I have about this subject.

Being from a small town, where you actually get the chance to do something useful on occasion, Her Honor the Mayor asked me 8 years ago to serve on the board of our city owned hospital. What a deal! Free coffee and cookies with every meeting. She didn't tell me this was a second job, but I do it willingly because it is interesting. And needed to be done. So all my observations come from eight years of dealing with the administrative side of health care.

Back to the point in your article about government run health care. It is my observation that its not nearly as important who is paying for health care, as it is which rules do they play by. There are three primary payers in health care today, Medicare, for profit insurance companies, and supposed non profits like Blue Cross Blue Shield. These three groups pay virtually all health care costs in this country that are not charity or uncompensated care by local hospitals or clinics. There are private payers such as copays and some self insured too, but since these will probably be with us forever I'll leave that for another discussion.

Once you get inside the medical care world, especially on the business end of things, one thing becomes very clear.

For profit insurance companies and supposed non profits are universally hated by health care providers. Which gets back to my original point, what rules do they play by? This is a horrible problem for health care providers, because the lack of a uniform set of rules has created a mess that is virtually unimaginable to the outside observer. There really is no consumer choice once the copays are met because the health plan, again playing by its own rules, determines what it will pay for. The health plans have to meet mandates set by state and federal regulations, but beyond that its all in the contract they issue to the consumer. Ever read one of those contracts? Have any idea what they might pay for? Nobody else does either. Plus they can change the contracts pretty much at will. Again playing by their own rules.

On to the much maligned Medicare program. There are issues with Medicare to be sure, but the rules it plays by are set by Congress and are fairly stable. There are few surprises for medical providers with Medicare because virtually all diagnoses are identified by whats know as a DRG. Any provider will already know what Medicare pays for the more common diagnoses, and finding out what they will pay for all the rest is a cinch. I challenge anyone in or out of health care to do the same with for profit payers.

As for taking a position on for profit versus goverment run health care it really doesn't matter to me, as long as the rules are clear and not subject to change on a whim.

I will take a position on excess by for profits though. Google UnitedHealth (one word) and see what the former chairman William McGuire did. This is not good for health care providers anywhere and gives more ammo to single payer advocates than you can possibly imagine. William McGuires greed may just be the thing that causes America to move to a single payer system.

But again folks, its all about the rules we play by, and some people make their own rules.

Excellent post, Lowell. The kind I am fortunate to get in this blog.

I have given some thought to the medical problems here in the US. Most every sector of our economy has been outsourced to xyz countries, except healthcare. I suppose if you live on the Mexican border you get your dentistry done south of the border, the same with some medicines. There are some companies that have so called health tourism packages. If you need certain procedures done, they have a list of Doctors throughout the world they recommend. As far as I can remember you can fly your family with you get the procedure done, have a vacation and still have money left over. One day we will have to really shop America first or we will become like any other 3rd world country. We are importing our country to death. When will other countries stop taking dollars? We do not have a level playing field in our economies. I do not want to have the same buying power as the average chinaman.

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