Last night I posted a story on Senator Orrin Hatch stating that he would be just fine kicking the proverbial can down the road in regards to repeal of the individual mandate in the Affordable Care Act.  My thoughts on the mandate are quite known, that I would have no problem repealing it due to the fact that it forces individuals to buy a product or face punishment by the federal government.
Almost immediately comments were rolling in, both supportive of my position and several in opposition. Many who were in the opposition asked “What would you replace it with.” In the broad sense, the free market, but that doesn’t suffice to explain things as it is not specific. Unfortunately terms like “free market” have been convoluted to mean favoring the wealthy. It doesn’t help when the most visible people speaking in favor of what is alleged to be the free market are Republicans, who actually advocate for corporate cronyism.
So let’s talk health care for a moment. It is certainly one of the most impacting things in a person’s life. Most of us, at some point in our lives, will experience an event that will have us in a hospital, emergency room, or urgent care clinic. Whether it is an injury or illness, we will be impacted.
When the federal government passed the ACA, it used sweeping legislation to tear apart the entire system and put everyone in America in a bind. My dad once told me that you don’t tear down the house when you have a leak, you find the problem and fix it. I wish the men and women in Washington, D.C. had that sort of wisdom. Perhaps we wouldn’t be so careless in passing laws that tear down the house.
So what are the problems with health care as it once stood?
The most glaring item was of course the cost of health care. Prices for a hospitalization or a visit to the emergency room reach into the thousands and even tens of thousands of dollars. In most cases, this is where an individual would have a catastrophic insurance plan to help offset the costs that would be incurred if something ever happened to them. However, this isn’t enough to look at. Nearly everyone knows that insurance against sudden illness and injury is a necessity. However, what insurance has become in recent years has caused higher costs.
See, many people use insurance for every discomfort out there. Working in an Emergency Room from 2007-2009 showed me that there were a lot of people going for non emergencies. Symptoms that could have easily been handled at home, or waiting for an individual appointment with the doctor, were being seen in the ER. This frequent use of insurance drives up the price for insurance premiums. The higher cost to be seen, the more impacting it is for everyone. So this first portion becomes one of individual responsibility. If it isn’t broken, bleeding, causing pain to the point of tears, chest pain, head injury, a high fever that won’t go down, or breathing problems, the best option is to be seen by your family physician.
This next portion ties in with the first, and it is people uninsured going to the emergency room for non-urgent care. The problem started when Ronald Reagan signed EMTALA legislation in 1986. Originally, it was to ensure that a person couldn’t be denied emergent care at a hospital, however, because EMTALA requires that an examination be performed and steps be taken to rule out threats to life and limb, in order to cover themselves, doctors often times will do more tests than required; this will be addressed further down as an impact to health costs. Where we wind up is that nearly 55% of all emergency services are now uncompensated. Where does that 55% go? It goes to the person who can pay, though as this continues, the amount who will be able to continue to pay will dwindle more and more. While we can all agree that those who have their life at risk should be taken care of, after a walk in is triaged, if a medical professional determines that they don’t require emergency care, they should be sent home and not admitted to the ER.
This next portion deals with malpractice lawsuits that cost hospitals millions of dollars each year. While we certainly should have the ability to file suit for gross negligence and malfeasance, there are many instances of frivolous lawsuits filed annually. Approximately 40% of lawsuits filed against hospitals and doctors are considered frivolous according to studies conducted by Harvard. The findings of this study also discovered that of those filings, 15% of them either get a settlement out of court or are compensated after verdict. In the published results of this study conducted, the total price tag was $449 million. With just over 1,200 cases examined, that means the payouts for frivolous suits equated approximately $67 million to less than 200 people. That cost is passed on to other consumers. This is why we need to have a better process in determining frivolous lawsuits so that doctors are not having to perform unneeded tests just to cover themselves from risk of lawsuit.
The final thing I will speak about in this writing is the high cost for bring medication to market. This is one of the highest costs in medical care that a patient will receive. Often times medication will cost hundreds, if not thousands of dollars. Part of the reason these medications cost so much is because it costs anywhere from $160 million to $180 billion to bring a drug to market. Some of this is research that is needed regardless, however, a big portion, especially on new drugs, is the process they must go through in the FDA. While caution and safety should be in the mind of a company bringing drugs to market, the mandated process by the FDA could be improved drastically to decrease the costs associated. It would be my preference to have independent peer boards test medication for safety and quality, as opposed to the federal government, as private organization tend to be more efficient and less expensive, but until that happens, we at least need to decrease the burden for companies to save and improve lives.