Healthcare, the argument for and against

Continuing the health care debate, I ran across this column by Steven Findlay in USA Today. I chose this column to rebut because Findlay does a good job at summarizing the pro-reform crowd who are convinced that our medical system is deeply flawed and must be completely overhauled. I encourage you to read Findlay’s words, and then read my response to his talking points below. Findlay is just one example of many who clearly don’t understand the facts of this debate and are therefore either ignorant of the issue or are deliberately trying to deceive the public into supporting something that will ultimately be harmful. You can decide that for yourself. Here are some of Findlay’s main points:

Gov’t insurance wouldn’t have a competitive advantage over the private industry. “it wouldn't be that difficult to design a public option that abides by the same rules as private insurers and has no competitive advantage”. The argument is that a gov’t system would eventually squeeze out the private sector and before long we would all find ourselves insured by the government, thus putting our health in the hands of bureaucrats. What would start out as a “government option” would eventually become the only option. Findlay says this is a bogus argument, that no such scenario would happen and anyone who beats that drum is just fear-mongering. Bull.

How Findlay can say that a gov’t program would have no competitive advantage over the private sector is beyond me. A “public option” would have a huge competitive advantage in federal subsidies. The bottomless pockets of the US taxpayer would ensure that a public option could undercut the market and eventually drive away any competitors. Private companies don’t have access to this type of subsidy. So this fear is very real. A public option could most definitely become the only option, just as it is in Canada and England.

Quality and access won’t suffer. “Cookbook and rationed care? This fear stems from concerns that the government aims to dictate what doctors do and cut costs by limiting access to care. These notions are wrong. Rather, what Obama and both Democratic and Republican leaders want to do is aggressively measure the quality of care that doctors and hospitals deliver and change the way those providers get paid so quality of care — rather than quantity — is rewarded.” It’s simple math. Today’s doctors manage a group of patients while walking a fine line between quantity and quality. However, we get paid by volume, the more patients we see the more payment we get. That allows for good access since most doctors can comfortably see 3-4 patients an hour and still deliver quality care. But what if this were changed so that ONLY quality was rewarded? Well, suddenly doctors wouldn’t be as concerned about volume. Spending 30-45 minutes with a patient would lead to better payments, meanwhile access vanishes. A doctor that usually sees 3-4 patients an hour is now seeing one or two. In other words, appointments will be hard to come by. Quality and Quantity in medicine are inversely related. That is a hardened fact. Increase one at the other’s expense. Today, we walk that line rather well, but changing the rules puts access at risk. And when you consider that 45 million people will suddenly flood the primary care system in a public option and it’s easy to see just how difficult it will be to get in and see your doctor.

“The medical industry must be challenged to cuts costs;” Findlay says that medicine is too expensive and much of this comes from unnecessary tests and procedures. He wants a leaner, more efficient medical community, with doctors who only order tests that are necessary. I agree with this, but changing the current system of compensation isn’t the way to go about it. Findlay and those like him seem to think that we order unnecessary tests because it is financially beneficial to do so. That’s untrue. If I order a CT scan, I don’t see a dime of that money. However, ordering such a scan, even though the likelihood of finding an abnormality is slim, could potentially protect me from a lawsuit a few years down the road. This is called defensive medicine. I know that this patient doesn’t need a CT scan. But I also know that in a courtroom, a hired physician can armchair-quarterback in front of a jury and claim that I should have ordered that scan and potentially saved the patient some pain and suffering. It’s very, very easy to armchair-quarterback in medicine. So I order the scan, and this ultimately costs the system, which is wrong.

In order to stop things like this, then it’s the legal system that should be reformed. When doctors stop fearing the lawsuit, then they are more apt to avoid the unnecessary tests. Findlay makes absolutely no reference to the legal community in his article.

An earlier post of mine referred to some key points about improving health care in America. 2 of those things involve reforming the payers, so that we don’t have to hire people to fight with insurance and medicare in order to get our payments, and we don’t have to deal with declining reimbursement for our services. I also mentioned tort reform and more focus on preventive medicine. If these things aren’t addressed, then the system will not improve. Findlay didn’t hit a single one of these points. He simply has no idea, and neither does Washington.