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Do Our Pets Get Better Health Care?
By Stephen J. Butler |
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My friend Torsten, an Orthopedic Surgeon, reported that he took his Great Dane to the emergency vet clinic when the dog had ingested a foreign object into its lungs. The vet wanted $400 to use a machine
that would aspirate the lungs and stop that rattling sound. Torsten was incredulous. "Four hundred dollars," he said? "Medicare only pays $135 to use that same machine on humans." With that, he turned to "Nick," lying on the gurney, and whacked the dog's chest with his fist. Out popped the obstruction, and off into the night went two beneficiaries of a low-tech approach to health care.
If only the rest of us could be so fortunate. The situation is especially disturbing for older Americans for whom the efficient delivery of health care is of paramount importance. The core of the problem seems to be bad legislation created over the years by lawmakers bending to pressure from the variety of special interest groups. The only way to correct the tilt away from what is in the best interest of consumers is massive public pressure to appoint a health czar with a vision and the power to rise above the influence of pressure groups.
To review a little history, we can say that the health industry got what it initially deserved. We had a system operating up until the mid-eighties that was essentially a cost-plus system. Doctors and hospitals could charge whatever they needed to operate profitably, and there was no natural market force creating competition that would control pricing. Costs were passed on to insurance companies who just kept raising insurance premiums that were paid by employers. Employees consuming the services had no incentive to make choices between one provider or another because they were always one step removed from having to pay the bill. For several years, health insurance premiums were increasing by twenty and thirty percent per year.
My friend Russell Carpenter, a health industry consultant and lawyer at the time, effectively drafted legislation for the state of California that created what is now the Health Maintenance Organization (HMO) industry. In a desperate effort to try anything that might stop this upward spiral, we opened the door to the to the negotiation of fees and contractual relationships between insurance carriers, hospitals and doctors. HMO's, as part of this legislation, were special. They could determine what was appropriate care, and among other benefits, they couldn't be sued. Russ said to me, at the time, that he was stunned by the magnitude of what those words in his draft could come to mean in terms of the billions of dollars at stake.
For the next decade, health insurance costs stabilized while the free market economy struggled to make a fortune at playing General Hospital. One after another, companies rounded up capital, collected premiums, and then went broke (but not until one president had awarded himself a $150 million bonus.) Throughout, these companies operated at a loss and provided services until they ran out of money. The pricing offered by these "ankle-biters" of the industry forced their more responsible competitors to maintain prices at the lowest common denominator. That common denominator applied to services as well as pricing. The industry was offering life-and-death decisions that were provided, some would argue, by nothing more than tele-marketers who told the doctors and hospitals under contract what the latter could provide to patients.
One positive component of this new world order was that employees now had freedom of choice which introduced free market economics at the level of the user. They could elect to save money by going with an HMO or spend more money and have complete freedom of choice. Removing the former "disconnect" between patient and payer has been the single greatest benefit of all we have had to endure.
Anecdotal evidence of decay in our health care delivery system is not hard to find. We are running out of surgeons and obstetricians because the economics no longer work for those careers. Patients in hospitals need family members present most of the time to make sure they are getting the attention they need when overworked hospital staffs are overwhelmed. HMO's that go bankrupt often leave doctors unable to collect for the services they have provided. And get this. Under some circumstances, those doctors are obligated by law to continue providing services to the patients covered by the failed HMO, but the law also bars the docs from collecting any money from their patients. Their only recourse is to the bankrupt HMO or Independent Physicians' Association.
In the face of this challenge to upgrade our health care services, we have allowed other conditions to persist that really underscore how drastically the system needs change. For example, an illegal immigrant recently delivered, for the third time, a child at a hospital in Concord, California. The birth was paid for by tax-payers, of course, and this woman who was a diabetic warned the hospital staff that if they failed to take the appropriate precautions she would sue them. Her three children, of course, are now American citizens. Immigration authorities will point out that one immigrant starts a tree of relatives that adds up to 135 additional people allowed into the country over time. In another example, renal dialysis is available to foreigners who come to this country at an average cost of over $1 million through a special government program that amounts to yet another collective lapse of sanity. European countries, by comparison, have more enlightened policies with regard to medicine in that they offer emergency treatment to foreigners and then send them home without making them automatic citizens.
All this points to a crushing need for reform and reform sits squarely in the lap of lawmakers who need our letters and encouragement. Medical decision-making should return to the doctors, and we should pay them more money. We need to be able to sue HMO's, but not for gross amounts that add to inflated costs. The tort system needs to be changed so that attorneys' fees, when warranted, are limited. Finally, we need to live with the fact that health care is more expensive today than it was ten years ago, and we should budget and plan accordingly. With good political leadership on this issue, the day may come again where a stay in the hospital will be like a trip to a resort hotel...a hotel, however, where the chef has just quit.
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