Friday, May 27, 2011

Reducing Cost in Health Care

The New York Times had an op-ed piece a few days ago addressing a small portion of what is wrong with health care in this nation, the amount of money that is spent by Medicare. The larger problem is the amount of money that is spent for health care, period. Democrats claim that “progress was made” with the “health care reform” act of 2009, but both that act and the op-ed “Squandering Medicare’s Money” do not deal with reducing health care cost at all, but rather with regulating the amount that payment agencies will be willing to pay for it.

You ever watch a fireman put out a fire? He doesn’t play the stream of water on the flames that are coming out the windows of the burning building. He takes the hose inside the building and directs the water onto where the combustion is actually taking place. Regulating health care payment is directing water onto the flames, and it does not solve the problem.

Whether the paying agency declines permission for a procedure beforehand or denies payment for it afterward doesn’t matter. Quality of care may not be affected, may even be improved, but resentment is created and the perception is that freedom is abridged. Further, the battle over obtaining permission for the procedure, or securing payment for it after the fact, overriding and reversing denials, actually adds to the cost of the system.

Putting out the fire means addressing the source of the combustion, and that is the enormous amount of profit which is generated by the health care industry; not health insurance, the health care industry.

The op-ed piece address reducing the number of colonoscopies, for instance, but often the doctors ordering those procedures are co-owners of the laboratories which perform the colonoscopies. Those ordering physicians have a financial interest in keeping those testing facilities busy and profitable, and they are going to find ways to justify those tests and demand that they be paid for.

It is the “for profit model” of health care delivery, and the way that business model has taken control of the practice of medicine in this country that needs to be addressed. Where neighboring medical facilities used to share testing facilities, they have allowed the reluctance for splitting profits to lead to increasing facilities. These increased facilities need to be kept busy, and profitable.

Even where major medical facilities are non-profits, their directing boards are interlinked with boards of the companies which sell equipment, which broker real estate and construct buildings. There may not be profit to be made in the medical facility itself, but there is enormous profit which can be, and is, spun off from it.

There is no evil in profit, per se, but when it controls an industry to the destruction of the society which it serves…

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