In response to an editorial comment by ames E. Dalen, MD, MPH, “Only in America: Bankruptcy Due to Health Care Costs” in the American Journal of Medicine, August 2009. http://download.journals.elsevierhealth.com/pdfs/journals/0002-9343/PIIS0002934309005257.pdf, I wrote the following.
I have no doubt about that many bankruptcy cases filed in the US in 2007 was a result of health care expenses, and most of the petitioners for bankruptcy were the middle-class citizens who had health insurance. I totally agree that the current for-profit health care system is one of the reasons that skyrocket the health care cost.
I am a physician in semi-retirement who wrote a book, “The Health Care Mess” in 1994, and campaigned for health care reform against managed care in the early 1990’s. I have never believed managed care is the solution to controlling the skyrocketing health care. Managed care has been a key to making profit by the insurers at the expense of both the patient and the physician.
My wife and I had catastrophic health insurance and Health Savings Accounts (HSAs, which were expanded from Medical Savings Accounts or MSAs), until both of us were forced into the arms of Medicare. My office was unable to extend its coverage for us, because my office had only one employee beside me and its health plan was too small to qualify. Before becoming the Medicare beneficiaries, I paid about $650.00 in monthly premium for both my wife and myself, and had contributed and accumulated an amount in our Health Savings Accounts (HSAs) enough to cover the deductibles. I did not continue to contribute after that. We believe that we should save our health care expenses by keeping us in good health and adopting a healthy lifestyle especially the dietary habits. For the latter, I conducted experimentations on my body for lowering my blood pressure and improving my health by dieting (Please see my book, “Carbohydrates Can Kill.”)
When we were enrolled into Medicare, we tried unsuccessfully to find the coverage with Medicare-HSAs, because no one offered that type of coverage in Virginia. Or, we could help Medicare save money by paying less in premiums to our insurance carrier for catastrophic insurance policies, as long as Medicare put some of the saving from our premiums into the Medicare-owned HSAs. Too bad, Medicare has never been enthusiastic in saving money with HSAs.
Indeed, we have not heard of many cases of bankruptcy filed by the Medicare beneficiaries. However, every physician in private practice would testify the Medicare reimbursement had only paid him a fraction of his fees. Because of the low Medicare reimbursement rate, many physicians had to raise their fees in hope that the non-Medicare insurance carriers would reimburse them more. The inflated fees do not affect the Medicare reimbursement, however, does impact the other insurers who arbitrarily cut the reimbursement rates. In the case when the patient had a low insurance option and did not prepare himself for deductible with savings, he would be stuck and had to file bankruptcy. Accepting assignment by physicians from the insurers including Medicare is one of worst business practices that wreck the health care system, and should be prohibited for being paid one price for all. If everyone pays the physician for the fees, the fees will come down. Keeping in mind, the physician’s fees share only roughly 10% of the total health care cost.
Health care is a simple professional service only between two parties, the patient and the doctor. Health care would exist even without the existence of government and insurance companies. The cost between the two parties would have to be reasonable, affordable, and transparent. Beside the cost for the services, health care requires compassion that all physicians have been taught but does not exist in an ordinary business.
We all should know to save up for the raining day. An individual may not be able to save up enough funds in a short time for an emergency. However, with the joint-savings from his family members and friends, he would be able to meet the need in case of an emergency. The joint-savings is the prototype of insurance, which would help every one who is belonged to the pool. The pool eventually needs a by-law to ensure its optimal operations to benefit its members.
I have observed the changes of the US health care system since the time when I began my postgraduate education in 1971. I noticed the intrusion by business management into the health care system, because it insisted the health care system must be profitable like other businesses. The business management loaded with “expensive” CEO, CFO, and other “Os” began to run the health care system for-profit, even many hospitals and insurance companies were still under the skin of “nonprofit.” Particularly, most of the community hospitals were “stolen” into the control of corporations and forwent the hospitals’ original mission that they would serve the ills regardless of the patient’s financial ability. Before the turn of 1980’s, physicians had still been able to stand up for their patients. Under the new laws and regulations, physicians have been silenced.
It is a human nature that many of us would take advantage of free lunch. Under the current system, the patient would only need to show up at the physician’s office, an emergency room or hospital whenever he thought he wanted to have some sort of health care. He would not worry about the cost of the care that he would receive, because his insurance company would pay for. The patient lost the financial incentives in this peculiar third-party-payer system. If the system had allowed him to have a Cadillac, would he not want one?
When the patient does not have the financial incentives and if the insurance company such as Medicare is forced to pay for all the services, there will be one of the two outcomes or both: either raising the premium and/or rationing care. Managed care is rationing health care. If the patient does not want rationing care, the insurance company such as Medicare will have to file bankruptcy! If the individual has the financial incentives like those with HSAs, the demand of care will decrease with the individual’s sensible discretion. In addition, individual will be more interested in maintaining his health with healthy lifestyles especially dietary habits. The improvement in the individual’s health will also reduce the need of medications. (Please visit http://www.carbohydratescankill.com.)
With the understanding of the ill health care system, we must rectify the health care system by returning it to the original and simple patient-doctor relationship. (Please visit http://www.autonomouscare.info for detail.) First allow individuals and businesses (not by the government!) to organize the non-profit, regional self-insurance pool for the joint-saving pool. The pool will offer various catastrophic policies depending on the individual’s need. The pool can either run the pool by itself or shop from different insurance companies for a list of policies for the members to choose.
In pairing with the catastrophic policies, the current laws should allow each individual, including the Medicare and Medicaid beneficiaries (http://www.autonomouscare.info), to contribute into his Health Savings Account for himself or his family for covering the deductible until the catastrophic policy kicks in. With the financial incentive, the individual will be concerned about his health care cost and his need of care. No insurance company or government is involved in his decision-making. More importantly, when the individual directly pays for his health care, he will demand quality care. The doctor receives the payment from the patient who now is his only boss, and must satisfy the patient with quality care.
By the way, the laws should encourage communities to rebuild their own non-profit hospitals and health care facilities, if the “stolen” ones are not responsive to the need of the communities.
Under the autonomous care system, there will be no managed care or rationing care. The system will sensibly reduce the health care cost and improve the Americans’ health.
Robert Su, M.D.
