Straight Platform Politics

Health Care Reform And Veterans – Part 2

Recent health care reform proposals have caused the public to evaluate the health care systems currently operated by the U.S. government, namely the Veterans Health Administration (VHA) and the Indian Health Service. Recent investigations have revealed serious problems within the VHA system.

Earlier this year, the VHA was dealing with the scandal that unsanitary equipment used in procedures infected about 53 patients with either HIV or hepatitis B or C. See Part 1 Then, in June, it was reported that 92 veterans were given wrong radiation doses in a common procedure to treat prostate cancer. These veterans were treated at the VHA facility in Philadelphia.

These problems have caused people to question whether or not the VHA is showing signs of an institutional breakdown. There apparently has been little genuine oversight provided by the VHA and investigations into grave problems produced little improvement. Sadly, the Philadelphia tragedy was allowed to continue for six years.

Funding, of course, is always a problem for anything that is run by the government. Many people cite lack of proper funding as the reason for the decrease in quality health care in the VHA. However, the same thing can be said of the Indian Health Service, Medicare, Medicaid, etc.

And we want the government to run our whole health care system because…….?

HIV mode of transmission, HIV testing, Indian Health Service, Philadelphia, U.S. government, VA, Veterans Health Administration, health care reform, health care system, hepatitis, wrong radiation doses

Health Care Reform And Veterans – Part 1

Recent health care reform proposals have caused the public to evaluate the health care systems currently operated by the U.S. government, namely the Veterans Health Administration (VHA) and the Indian Health Service. The quality of these government-run systems is not encouraging.

Some people continue to refer to past studies that found the VHA to be better than Medicare, managed-care systems, and the highest rated non-VHA hospitals. Phillip Longman, in his article “The Best Care Anywhere,” (Washington Monthly Jan/Feb 2005) observed: “Outside experts agree that the VHA has become an industry leader in its safety and quality measures.”

But that was then.

Earlier this year, more than 10,000 former VHA patients were notified that they could have been exposed to HIV or hepatitis B or C through unsafe endoscopic procedures. These procedures involved substandard, unclean practices; some of these procedures were done as long ago as 2003. Three different states were involved – Florida, Tennessee, and Georgia. Unfortunately, 53 patients have tested positive so far.

U.S. Rep. Harry Mitchell, chair of the House Veterans’ Affairs Subcommittee on Oversight and Investigations, had this to say in a June press release: “Most infuriating is the irony that these veterans were undergoing routine medical evaluations to prevent illness, but ultimately, they may be in more danger now than before the procedures. [T]here is no question that shoddy standards – systemic across the VA – put veterans at risk and dealt a blow to their trust in the VA.”

And a blow to our trust in the ability of government to provide descent health care to many more people than just veterans.  See Health Care Reform And The Bridge

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Health Care Reform And The Bridge

Mary Theroux had an interesting opinion piece in the San Francisco Examiner (11/9/09). “After last week’s Bay Bridge failure, Bay Area residents would do well to consider the obvious parallel. If the government can’t build a bridge that keeps us safe, can it really be trusted with the future of American health care?”

An upper deck section of the eastern span of the San Francisco-Oakland Bay Bridge had collapsed during the 1989 earthquake. This section was repaired in a month, but it was necessary to make the eastern span earthquake resistant. The refit and repairs were estimated to cost about $200M and take about 4 years.

But then, after lengthy discussion and analysis, a suggestion was made in 1999 that a new bridge span would be better than just retrofitting the old one. Keeping the new bridge design simple would not increase the cost too much; the life expectancy of the new span would be 2-3 times longer than the old one; and maintenance costs would decrease. Sounded good.

Unfortunately, some people thought the simple design was not distinctive or dramatic enough and a committee was appointed.

The bridge span is still not finished; the cost is up around six billion dollars; tolls have continued to increase; the cost has continued to increase; a major crack was found and repaired in September; and this repair recently failed and had to be re-repaired earlier this month.

Mary Theroux’s other question: “How much faith do you have that a politically appointed committee in Washington, D.C., can determine what’s best?”

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The Free Market And Health Care – Part 3

  “What Is the Free-Market Approach to Health Care Reform?” This is an article published on The CATO Institute on Health Care Reform. http://healthcare.cato.org/     The article lists seven reforms; we have reviewed the first four and will now look at the last three. See Part 2

Reform 5. “We also need to rethink medical licensing laws to encourage greater competition among providers.” Examining the history of enabling legislation in the health care system causes many people to conclude that much of the legislation was enacted to protect the profession and not the patient. See The Four-Party Health Care System series

Reform 6. “Congress should give Medicare enrollees a voucher, let them choose any health plan on the market, and let them keep the savings if they choose an economical plan. Medicare could even give larger vouchers to the poor and sick to ensure they could afford coverage.” This may encourage a healthier lifestyle in the elderly while improving competition among insurers.

Reform 7. “The expansion of ‘health status insurance’ would protect many of those with preexisting conditions.” (See the February 18, 2009 Policy Analysis by John H. Cochrane on the topic of health status insurance at http://cato.org/ )

There have been good health care reforms proposed by a number of people and organizations. Many of these reforms would not be costly. But, are Congress and the President listening?

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The Free Market And Health Care – Part 2

“What Is the Free-Market Approach to Health Care Reform?” is an article published by the Cato Institute. http://healthcare.cato.org/ The article lists seven reforms to our health care system that would improve health care access, quality, and cost.

Cato Institute’s mission states that the organization promotes policies based on limited government, free markets, individual liberty, and peace. The Cato philosophy supports “a uniquely American solution, one that builds on free markets, competition, and choice.”

We will continue our look at each proposed reform. See Part 1

Reform 3. “Changing from employer to individual insurance requires changing the tax treatment of health insurance.” Employer-provided insurance gives the employed a significant tax advantage over the self-employed. The health insurance of the former is not taxable income while that of the latter is. This is not fair and must be changed. The article recommends that “[w]orkers should receive a standard deduction, a tax credit, or, better still, large Health Savings Accounts (HSAs) for the purchase of health insurance, regardless of whether they receive it through their jobs or purchase it on their own.”

Reform 4. “We need to increase competition among both insurers and health providers. People should be allowed to purchase health insurance across state lines.”

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The Free Market And Health Care – Part 1

The CATO Institute on Health Care Reform published the article “What Is the Free-Market Approach to Health Care Reform?” The article agrees that our health care system is in need of reform: “It costs too much. Too many people lack health insurance. And quality can be uneven.”

“But a government takeover of the health care system, as proposed by the president and some in Congress, would be a step in the wrong direction. Instead, we should pursue a uniquely American solution, one that builds on free markets, competition, and choice.”

The proposed solution lists seven reforms. We will look at each.

Reform 1. “Let individuals control their health care dollars, and free them to choose from a wide variety of health care plans and providers.” This would entail dismantling the huge amount of government legislation (both state and federal) that has denied individuals access to certain insurance providers and vice versa.

Reform 2. “Move away from a health care system dominated by employer-provided health insurance.” As the article asserts, health insurance “should be personal and portable” and not controlled by governments or employers. Under our employer-based system, the true cost of health care is hidden from employees, employee choice of health care policies is limited, the self-employed are at a costly disadvantage, and if employees lose employment, they may become uninsured.  See The Four-Party Health Care System series

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The Four-Party Health Care System – Part 5

“The Modern Health Care Maze: Development and Effects of the Four-Party System” was published in the Summer 2009 issue of The Independent Review. Authors Charles Kroncke and Ronald F. White conclude in their article: “Ultimately, the only way to reform our health care system successfully is to destroy the infrastructure that sustains the four-party system….” See Part 4

Kroncke and White wisely ask what most people haven’t yet asked: “In hindsight, did it ever really make sense to set up a health care system whereby fourth-party corporate employers purchase health care insurance for their first-party employees from third-party corporations, which in turn pay second-party providers for health care products and services? Does any other industry insulate buyers from sellers in this way? Why does this arrangement make sense only for the health care industry? Why not for food, clothing, and shelter? Why not for homeowners, life, and auto insurance?”

“The current maze of health care policy wrought by years of accumulated enabling legislation has in effect disabled free-market mechanisms….Until we reduce government’s ability to surreptitiously distort the market forces that drive the health care industry, the juggernaut and other dysfunctional arrangements will continue to plague the system.”

Hopefully, more people will understand the importance of changing our health care system from an employer to a patient driven system which would treat individuals far more equally than what we have now. It’s imperative that we settle for nothing less.

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The Four-Party Health Care System – Part 3

The Summer 2009 issue of The Independent Review included the article “The Modern Health Care Maze: Development and Effects of the Four-Party System” by Charles Kroncke and Ronald F. White. In their article the authors maintain that “much of the daunting complexity of health care reform can be reduced if we focus more critically on the four-party payment system.”

“In 1942, the U.S. government rescued the health insurance industry by means of enabling legislation that spawned the fourth (sic)-party payment system.” The 1942 Stabilization Act permitted big corporations to provide fringe benefits to their employees without violating the governmental freeze on wages and salaries then in place.

The tax exemption to employees on employer contributions to health plans was codified in 1954. More and more enabling legislation made the four-party health care system sweeter and sweeter.  See Part 2

“For a while, employer-provided health insurance was enormously appealing to all major stakeholders. First-party patients employed by major corporations received nontaxable, low-cost (or no cost) health insurance. Second-party providers continued to earn super-competitive compensation for their products and services. Third-party private insurance companies (for-profit and nonprofit) sold more policies and therefore could cover provider costs by economies of scale. And fourth-party employers could increase their employees’ compensation without having to pay the full cost.”

“Since then, the four-party system has become an entrenched tradition based on an unsustainable win-win-win-win illusion.”

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The Four-Party Health Care System – Part 2

“The Modern Health Care Maze: Development and Effects of the Four-Party System” was published in the Summer 2009 issue of The Independent Review. The authors, Charles Kroncke and Ronald F. White, state: “Prevailing discourse on health care reform aims at the simultaneous realization of three extraordinarily idealistic goals: universal access to high-quality health care at a reasonable cost.”

But what does all that mean? What does universal access really mean? Access to what, exactly? Who determines what is and what is not high-quality care? Doesn’t that differ with different people? And what is a reasonable cost? That certainly differs from person to person.

One important observation in this article is that European national health care systems do not provide universal access to high-quality health care at a reasonable cost. Therefore, imitating these systems will not get us anywhere near achieving these idealistic goals even if we could define each one.

Another observation is that the “current state of the health care industry in the United States has been shaped by an accumulation of enabling legislation that began in the early twentieth century and continues unabated today.” See Part 1

This huge amount of legislation influences access, quality, and cost. Our health care system was developed “less by the invisible hand of the free market than by the visible hand of government.” Therefore, “before Americans abandon the free market, they ought at least to try it.”

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The Four-Party Health Care System – Part 1

An article in the Summer 2009 issue of The Independent Review examined our nation’s four-party health care system. Charles Kroncke and Ronald F. White are the authors of “The Modern Health Care Maze: Development and Effects of the Four-Party System”.

The article states, “Our national health care system is so dauntingly complex that reform efforts seem hopelessly adrift.” The authors feel that reform efforts should begin with looking at health care stakeholders. The obvious ones are: first-party patients, second-party health care providers, third-party payers (private insurance companies and public governmental programs), and fourth-party employers providing health care insurance for their employees (who will become first-party patients).

Other stakeholders involved in our nation’s health care system include: scientists and researchers, research labs, colleges and universities, lawyers, law firms, unions, and professional societies. And we cannot forget all of us who “invest in mutual funds that hold stock in the health care sector.”

The authors point out that the fact that the “health care industry accounts for at least 14% of the gross domestic product (GDP),” illustrates just how complex our health care system is. It goes way beyond the doctor-patient relationship.

“In the United States, politics—that is, each stakeholder group’s capacity to influence powerful legislators—drives health care reform.” Health care has so many stakeholders that true and lasting reform seems out of reach.

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