mardi, juin 06, 2006

The Future of Healthcare?

That might not be the most accurate title, and this may turn into a "coffee tawk" type of post, but you're welcome to use my place to kick back and talk about it, or tell me I'm wrong or full of it or whatever.

I've thought about this post for a long time, and the bouncing around in my skull was exacerbated by the announcement that St. Mike's would close.

Most people are aware that Milwaukee has exorbitant health care costs. There are a lot of reasons, mostly price fixing and the existence of Medicaid (doctors and hospitals cannot charge below a set amount dictated by the government, it's illegal). But one of the largest reasons is the uninsured. We hear plenty of squawking about the poor and uninsured not having access to health care, which is true for the most part, but the poor benefit the most from our current setup.

Why? Because those of us who pay insurance premiums and actually pay our copays are subsidizing the health care of the poor. St. Mike's had to close because they did not have enough paying customers to offset the cost of the gunshots, stabbings, other violent crime injuries, children whose parents do not monitor their health, and last but not least, my favorite, drug abuse and overdose. No rational paying customer is going to use that hospital because they aren't going to get in to see a doctor. And they don't want to deal with that atmosphere when they are in an emergency situation. Would you? If you were on the northeast side of town would you go to St. Mike's, or would you go out of your way to go somewhere else?

I'd take my chances and go elsewhere.

Now, St. Joe's will take the major brunt of the patient care load that formerly went to St. Mike's. They can do this for now because St. Joe's offers a wider variety of services for which they can demand a premium rate and offset the cost.

But there is going to be a larger problem with this.

SE Wisconsin is one of the first areas in the nation to experiment with a business healthcare coalition. For those of you who may not be familiar with the concept, a BHC is a group of businesses who partner with an insurance company or group to create a pool of providers, services, and facilities that will agree to a set cost for treatment or a condition. The aim is to reduce cost for both the patient (by still agreeing to pay 80-100% of the service IF the patient goes to the set group) and for the insurance company. Businesses choose these plans for many reasons including the fact that they don't have to absorb up to 60% of the premium cost per insured. The insured pays more of the premium and gets more coverage. If the insured stays within the group.

It sounds like an HMO and it's pretty close, but with better administration, and focus on quality resolution of health issues at a lower cost for all parties. When I look at this what I see is providers trying to maintain a steady stream of business at a lower negotiated price. The clientele is going to go elsewhere if the providers can't compete. And the clientele doesn't have much of a choice unless they want to pay a premium of 70+ for a single person per pay period.

Here is the problem... Hospitals like St. Joe's won't be able to mark up unchecked forever. No insurance companies will have them within their preferred network and therefore the clientele has to go elsewhere. Like a healthier community.

I'm sure you can see where this is going. The government will be forced to subsidize the hospitals to keep them open, or it'll be a socialized medicine model. Either way, you and I will have to pay for it. We may not pay for it out of our healthcare premiums and provider copays, but we WILL pay for it out of other tax revenues. We won't have a choice after a while, this is a fact.

Part of me says this: Drug abusers or overdose patients must go to a separate clinic to be treated. Not a regular hospital where the cost would be higher. People who are injured as a result of engaging in illegal activity - violent criminals who are injured in gang fighting or shooting or other crimes must go to these same clinics. Not hospitals. Hospitalization is too expensive, and it's not fair to pay for criminals to be treated if they've inflicted it upon themselves. Heartless, yes, but perhaps it'll do two things: motivate, and self select. If you're a criminal screwing around and you get stuck in a high security clinic, in pain, bleeding, and waiting because some crack or heroin addict is making all holy hell noise, it might motivate the motivateable to at least try to turn their lives around.

Because right now we just reward them. A dry, clean bed with plenty of attention and drugs to numb the pain? Sounds like a good deal to someone who hasn't taken responsibility for their lives, doesn't it?

And yes this approach raises all kinds of sensitivity questions and issues around entitlement. You know, entitlement - the E word - which caused all of these problems in the first place.

Would those clinics be horrible. Yes. Who, in their right minds would staff them? I have no idea. But if the security was tight enough and no bullshit/our rules or you'll be on the curb was the condition of treatment, it might be tolerable.

And it might be a good thing. It might not.

But where we are headed is in neither direction.


Blogger Scott D. Feldstein said...

The problem with our health care system is simply that it's market-driven, not that people are being frugal consumers of health care.

My suggestion is that we adopt a single-payer system that covers everyone for the same type of services one now gets from your typical HMO. Take the money for it right the hell out of our paychecks like Medicare.

It'll be like getting a raise! Because these types of systems cost about half what our current system costs. Right now your employer pays about 4k of the insurance premium and you pay about 1k (plus co-pays). Under the new system, the employer pays nothing and you pay about 2.5k. Here's the catch: the employer has given you a 4k raise, so at the end of the day you're UP 2.5k a year.

Plus everyone is covered. Plus you never have to worry about losing it.

Also - the idea of relegating certain people to substandard medical care in the hopes that they "change their lives" is something I'd never agree to in a zillion years.

4:22 PM, juin 09, 2006  
Anonymous Anonyme said...

Scott - What employer do you work for that provides family benefits for 5k/year? MPS currently pays 17k/year for family. My previous employer covered a family (with less beneies that MPS) for about 12k/year.

4:42 PM, juin 11, 2006  
Blogger Scott D. Feldstein said...

Single health insurance - such as I'm shopping for right now - may run me and my employer a combined $5700 a year. You're right. Family coverage is another matter. I would guess that to be about $15,000 per year.

I only used the figures above because in the United States we pay about $5k per year per person for health care. In other industrialized countries (Australia, Austria, Belgium, Canada, Cuba, Denmark, Finland, France, Germany, Japan, The Netherlands, New Zealand, Norway, Portugal, South Africa, Spain, Sweden, Taiwan, The United Kingdom, Costa Rica, etc.) they pay about half of that. And our nearest runner-up isn't even close. I think it's Sweden or the Netherlands with 3.5k or something. Not sure anymore.

5:05 PM, juin 11, 2006  

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