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Tuesday, February 16, 2010

"Fly on the Wall" Healthcare conversation...

So I had a conversation with someone that initially said that they didn't believe that a Public Option would be helpful and that a Physician's association would be best suited to make decisions for the masses. That the reformed Healthcare system should be modeled after the Veteran's Administration healthcare system and that stringent regulation of existing healthcare without opening the the geographic boundaries of Healthcare competition/coverage is the answer. I couldn't disagree more with most of that, but it does seem like, as for how we both view the current Healthcare system and what a working healthcare insurance industry would look like, we're on the same page. It seems like we're interested in a similar or the same destination, but are interested in two different sets of directions to get there. She would not give me permission to re-post what she said, but here are my two statements on the issue just to give a bit of a fly on the wall perspective on where HealthCare Insurance reform needs to go:

It seems like we agree, in essence, on 90% of our opinion on the current state of US health insurance system. The one thing that I'm more than willing to accept that maybe you aren't is that there's no "For Profit" insurance provider that will A.) Allow Doctors to determine needs without extreme pressure to do what the insurance companies want {Look at what they did with the attempting to roll back mammogram testing through a completely valid Medical Association} and B.) There's no "For Profit" Health Insurance company that will even attempt to run their company like the VA there's a high enough profit margin in it for them. Additionally even if doctors were to run the system there will be an organizational structure, probably with a profit agenda, that will look and operate like a health insurance company, just called something else.

Understanding these things is what informs me that a Public Option is really the only efficient way forward to keep private insurers honest, pop their overinflated profit margin balloon and balance the cost of MediCare which insures the oldest people in need of the most and most expensive health care. My major problem is that abortions, lip augmentation, Botox injection, breast implants and other completely elective procedures should not be covered under a "Public Option" and those things have been included previous Acts. With a Public Option broad interstate rights for Insurers only helps, because they won't be able to charge 3X the rate of the Public option and they'll be forced to find new ways to differentiate themselves. That could mean medical transportation or, membership to more exclusive exercise clubs, or heavy discounts on expensive, but fresh organic produce. It's just a better outcome.

Like I said I think we are in agreement on a lot of things. I just don't know that a board of physicians, that are used to getting paid hundreds of thousands if not millions per year in some cases and enjoy "Rock Star" social status are the best group of people to put in charge of health care in the U.S. They have all kinds of reasons to make all kinds of decisions that aren't necessarily always in the best interest of patient care and we already see that happening now. Just as importantly again, organization of an AMA sponsored Healthcare system is going to look like insurance AND in all likelyhood would be outsourced to the same former private insurance companies that are leeching millions of people every year now. Hospitals that are run by Physician's associations locally in many areas where I live have already had management service reigns handed over to "For Profit" entities creating the same kinds of problems that existed before and worse so there's no reason for me to believe that that's not how a national medical association would handle ownership of national health care insurance.

I would prefer to roll the dice with smart people that get paid well, but still live in the real world receiving the same benefits for themselves and their families mediating some portion of the decision making. From my standpoint having a Public Option introduces all of the regulation that's necessary. For private insurers the only mandate they could have is to provide health care that people don't feel cheated by or whither away which is radically different from current mandate of "Take as much as you can."