Tuesday, July 28, 2009

America Is Looking At the Wrong "Model" for Health Care

It is beginning to appear that President Obama's health care plan may end up as dead as President Clinton's a decade ago.

The reason? It is modeled on Canada and England and other nations where health care is handled like fire protection -- provided by the government to all and paid for by some.

The issue in most American's minds is not who is going to pay for it. Indeed, Obama's plan is for the rich to pay for health care and that suits the poor and middle class just fine.

The problem for most Americans is what they will get for their money (or someone else's money).

The real issue is "quality" of health care, which is a code word for "what I want, when I want it."

Indeed, the drug companies openly encourage Americans to self-prescribe by telling your doctor what you need, which is what you saw on TV last night, and if he won't give it to you, find one who will.

Many Americans are just not comfortable thinking that the very best might not be available to them when they need it, i.e., on our death beds it seems everyone wants another day or week or month no matter what the cost. "Hell, I'll be dead," they think to themselves. "Who cares who pays for it?" Right?

Right.

Therein lies the problem with the socialized medical systems around the world. You take what you get and you get it when it is available which may not be today. And, they're not going to spend a million dollars who you can live another six months with some form of dreaded cancer. Nope. You're gone.

It would, indeed, be ashame for most Americans if we couldn't have immediate gratification when it comes to getting the purple, green, or yellow pill, or surgery on Friday, especially when we're told it will make us feel better.

That's why Canada's medical system isn't going to sell in the U.S., no matter how popular Obama may be. It's good, but it is not the very best.

Which brings me to my point . . . we're looking at the wrong model.

We should be looking south, not north. We should be looking at Mexico's health care system, which doesn't even pretend to be egalitarian, but rather recognizes that the poor get one standard of care and the rich get another.

In Mexico, the poor and the middle class (the latter of which are also known as the "poor" by U.S. standards) can buy into the State plan. It is run by the government. The doctors are hired and paid by the government. They are government employees. The hospitals are owned and run by the government. And if you get sick or injured you can go to one of these doctors or hospitals free of charge, 24/7, no questions asked.

You may wait for care. You may not get state of the art care. But you will get State care which is (most of the time) good enough. What you're not going to get is the best doctors spending unlimited money to prolong your life. You're not going to get a private room. You may even have to wait in the hall for a room. What you're going to get in the State plan you're going to be thankful for because you got it cheap. Indeed, our maid and gardener are part of the State plan here and it cost us a grand total of $200 a year for each of them and about $150 a year for each of their spouses and children. We know if they get sick or hurt they will be treated.

Which bring us to us -- people like you and me. People who can and choose to afford more.

The fact is I wouldn't be caught dead (or probably would be caught dead) if I had to go to one of the State hospitals in Mexico. I saw a friend almost die in one of those places, called her Mother in Australia and asked her whether she wanted to see her daughter alive again and, if so, to get her transferred to the private system. She did and her daughter is alive and as mean as ever.

Kelly and I are part of this "private" health care system in Mexico. The premiums for the private insurance cost about 10 times the premiums for the State system and the care is about 100 times better. I recently had arthroscopic surgery at a beautiful, bright, modern hospital in Queretaro, Mexico. My room looked very much a Ritz Carlton suite, including a separate room for Kelly that adjoined mine. The doctor was a highly-trained gastroenterologist who specialized in, you got it, arthroscopic surgery of the abdominal area. I checked in at 8 a.m., was welcomed by the "concierge," taken to my room, IV'd, and had surgery promptly at 9 a.m. As I was wheeled into the high tech surgical suite, I counted no fewer than 4 doctors and a half a dozen other nurses and technicians. I was in recovery by 9 a.m. and back in my room by noon. The nursing care was nothing less than spectacular -- almost too attentive. I went home the following afternoon. Having "private" insurance, I thought, would really pay dividends.

I was wrong.

My deductible was $5,000 U.S. and it seems the tab -- tax, title, license, hospital, doctors, anesthesiologist, drugs, tests, everything totaled $2700. One has to wonder why the same surgery in the U.S. was quoted to me at $20,000 (which is another part of the problem that remains to be solved.)

But even though I didn't need the private insurance this time, I'm still happy to pay my premium -- one that is about 30% of what I'd be paying for the same coverage in the U.S.

The point? There are two medical systems Mexico. Everyone gets care but everyone doesn't get the same level of care. The same thing happens in the U.S. everyday but we want to deny it and it is our denial that costs money -- a lot of money. By pretending to have one system that cares for all at the same level, we pay for what amounts to an expensive facade. The fact is Steven Jobs got better care than either you or I would have gotten when he had his liver transplant. Why? Because he is worth a billion dollars and can pay for the best of the best of the best and did.

Harsh? Maybe. But it is true and it is consistent with American history -- those who pay more, get more.

So, here's the proposal:

Set up a State system in the U.S. Hire doctors, build hospitals (or buy a few) and put the entire staff on the State payroll and offer health care up cheap to anyone who wants it.

(Note: This is not what Obama has proposed. He wants to keep the facade of everyone getting everything when they want it. Everyone gets the Cadillac. That won't work. The State system I propose would provide good, not great, medical care. It would be on a budget like every government program and it would have to live within that budget. If it mean waiting for surgery, then that is what it would mean.)

The rest, those who could afford it and are willing to pay for it, could buy the "BMW health plan." Top quality. Top service. Nothing overlooked. First class.

The cost of the private plan would be high (very high) but worth it for those who wanted the best and are willing to pay for it. The two systems would live side by side but be totally separate.

Yes, I know. This proposal flies in the face of our egalitarian beliefs but unlike the current proposal it is consistent with our history, it will work, and most of all -- it will sell.

2 Comments:

Blogger John Gallagher said...

Jim, Your points make way too much sense (or is it dollars and cents). On many fronts, the system in the U.S. is broken, but one in which the government makes the hard choices for you is not the answer. One of the reasons that the same surgery is $20,000 is the U.S. falls into three categories: 1) Malpractice insurance - too many ambulance chasing lawyers 2) Greedy doctors and companies (not all, but unfortunately, a few ruin it), 3) Anyone gets treatment at ALL hospitals (thus, bad debt). Good post. John

1:42 PM  
Blogger Spencer said...

Jim:

Part of the problem in the US is unnecessary confirmatory tests to protect doctors from lawsuits. Like the orthopedic surgeon I know who gets MRIs for patients after surgery to have proof he did his job correctly, although he already knows this to be the case.

My suggestion is we take malpractice damage payments out of the courts. I suggest that malpractice premiums could go into a fund from which those who are found to have been the subject of medical malpractice can make a claim. Their damages would come from the fund after a jury finds liability. Percentages of recovery would be determined by how much money was in the fund, allocated between those found to be entitled to it by an administrative body. The injured may not get $30 million awarded by a jury in Houston, but they would get something fair.

This model could follow the way Arkansas handles tort claims against the state, when a highway worker negligently runs over a person. Since the state is tort immune, the injured person files a claim with the state claims commission.

Spencer Robinson

9:31 AM  

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