Wednesday, July 29, 2009

Is it the health care system that is broken?

GS Don Morris,Ph.D.

What precisely is wrong with the USA healthcare system? I ask this question given the over stimulation by all media forms during the past several weeks. No doubt it is a complex issue and any attempt to ask some fundamental questions might be viewed as naïve. Setting this aside allow me to ask a few questions so the “experts” can provide the answers
First focus is upon the nature of the actual health care. Seems to me that the quality of the care is considered among the best in the world. OK then what about the availability of the care to Americans? Well, this depends upon with whom you speak-the numbers provided seem to vary depending upon one’s political party. Using US Census Department information I found the following most curious given the reports in our media today:

The number of uninsured children declined from 8.7 million (11.7 percent) in 2006 to 8.1 million (11.0 percent) in 2007.

I did not locate any more current data. This notion of insurance availability does shift given race, nativity, and geographic region in the USA and by states. Again, the Census data was interesting:

• Both the percentage and number of people without health insurance decreased in 2007. The percentage without health insurance was 15.3 percent in 2007, down from 15.8 percent in 2006, and the number of uninsured was 45.7 million, down from 47.0 million. 1

• The number of people with health insurance increased to 253.4 million in 2007 (up from 249.8 million in 2006). The number of people covered by private health insurance (202.0 million) in 2007 was not statistically different from 2006, while the number of people covered by government health insurance increased to 83.0 million, up from 80.3 million in 2006.

• The percentage of people covered by private health insurance was 67.5 percent, down from 67.9 percent in 2006. The percentage of people covered by employment-based health insurance decreased to 59.3 in 2007 from 59.7 percent in 2006. The number of people covered by employment-based health insurance, 177.4 million, was not statistically different from 2006.

• The percentage of people covered by government health insurance programs increased to 27.8 percent in 2007, from 27.0 percent in 2006. The percentage and number of people covered by Medicaid increased to 13.2 percent and 39.6 million in 2007, up from 12.9 percent and 38.3 million in 2006.

• In 2007, the percentage and number of children under 18 years old without health insurance were 11.0 percent and 8.1 million, lower than they were in 2006—11.7 percent and 8.7 million. Although the uninsured rate for children in poverty decreased to 17.6 percent in 2007, from 19.3 percent in 2006, children in poverty were more likely to be uninsured than all children.2

• The uninsured rate and number of uninsured for non-Hispanic Whites decreased in 2007 to 10.4 percent and 20.5 million (from 10.8 percent and 21.2 million in 2006). The uninsured rate for Blacks decreased to 19.5 percent in 2007 from 20.5 percent in 2006. The number of uninsured Blacks in 2007 was not statistically different from 2006, at 7.4 million.

• The percentage and the number of uninsured Hispanics were 32.1 percent and 14.8 million in 2007, lower than 34.1 percent and 15.3 million in 2006.

You are correct, so many numbers to digest-so what to make of these them? I suspect that since this census data the numbers might be different and those who want to dismiss this piece will gleefully point this out. What I do notice is the arguments against our current system began nearly 2 years ago-dire descriptions and predictions. We all remember the ads and the news stories. Thus the preceding numbers must have been the ones used-correct?

Appears that nearly 7 out of 10 Americans had health insurance that in turn enabled them to participate in our quality care system. I noticed also that in many segments of the population the trending toward more people having said insurance was occurring-not all but many populations. Also note that these data do not describe the numbers of Americans and non-American citizens able to tap into Medi-Care. I also know that it is State and Federal law that requires hospitals to provide emergency care to anyone who shows up in the emergency room, regardless of the patient's citizenship status or ability to pay. Regrettably I have been to my local Emergency Room on three different occasions in the past 2 years. My analysis: those without health insurance are served for even the simplest of ailments such as the common cold. Our ER’s have become “health clinics”.

It is incorrect and disingenuous for anyone to say peoples are unable to avail themselves of health treatments! You want to discuss location of those services-OK, for another piece. You want to discuss management of individual delivery systems-OK-for another piece. However, to use as the fundamental argument that Americans cannot and thus do not have access due to insurance availability or Federally required mandates is a misrepresentation of the facts, i.e., lie.

Given that those nearly 70% of Americans who still have health coverage indicated recently that they really do like their coverage what’s the pointing “fixing” a non-existent problem? The current approaches being developed do not represent the CHANGE most Americans voted for and any good leader listens to his people!

What to do? First, correctly identify the problems. Second, exhaust all of the possibilities to resolve the problem. Third, identify the support system(s) necessary to engage the solution(s). In other words, think outside the proverbial box, include individuals with expertise in said support systems (this means outside the beltway folks) all of which takes time. We arrived here after decades of neglect; to satisfy a political appetite by hastening bills through is similar to eating a huge meal in 5 minutes-the result is unbelievable heartburn and pain.

Let me examine one component of ”The System” that needs reconsideration-reduction of actual health costs. Aside from tort reform (we all know the reasons for this) provide incentives for doctors to perform more pro-bono work. For X amount of such service, their capital gains tax is reduced by 2%, 5%, up to 10% each year. A simple reporting system is easily developed modeled after other professions. This will increase the voluntary service delivery negating state and federal charge-back expenses incurred by hospitals and physicians alike. Put capitalism principles in play, humans are motivated to perform when they are used-this is a fact of life. Our society requires our population to work and to earn our way to success. Intuitively we know this to be true. Have you noticed what happens to a child’s and/or teenager’s motivation to perform if every thing is given and nothing is earned? Without a challenge these individuals emerge into an adult who is far less productive than counter parts who have earned their way in life. These individuals grow up to become the “entitled ones”. The path to positive self is through earned accomplishment. Rewarded challenge has produced the best health care services in the world, right here in America. Let’s get busy and do the correct thing-analyze and strategize beyond the beltway kind of thinking-our very future depends upon us doing the difficult things in life.

2 comments:

Ruben Misrahi said...

"There are lies, damn lies and statistics."
As a statistician, I recoil at the use and abuse of stats, because it ignores some of the most important ones:
Over 16% of the GDP goes to health care, which is 50% over what most industrialized countries spend. Why is that statistic absent from your analysis?
Higher premiums mean higher cost to any company that wants to compete in the world market. See where our car industry is.
Obama's plan is good? I don't know, but what we have is bad and getting worse by the day, however stats you pick.

GS Don Morris, Ph.D./Chana Givon said...

Ruben,
Thank you for taking time to respond. With all due respect I used US Census data-found online-these are stats they reported. I did not "with hold" stats as your comments imply. You missed the point of the argument. Your logic comparing us to "most industrialized countries" is misleading-you failed to mention that most offer some form of nationalized health care-and where are your statistics explaining the tax costs to their populations? Of course our private insurance companies have higher costs when compared to a subsidized system-please! Obama's plan is not good either from an economic or philosophical position. The "stats" support this economic contention, the narrative found within the bills supports the other-so we disagree.doc