As for physicians having to deal with 1,000 insurance companies, if physicians supported cash payment rather than some kludge of a government payments system, they could replace dealing with third party payers with dealing with Visa, MasterCard and Discover. Much easier according physicians who have shifted to cash practices.

One of the major problems is that no one can agree on the basic facts/numbers used to calculate all the cost projections that we all argue about. Each number is sourced from a famous “think tank” which therefore means it’s accurate. As an example in this alert (July 13th) you quote the that “good old” 47 uninsured number as does the Administration and every talk show host–yet you and many others have presented data that clearly shows this number is significantly overstated. If the data upon which we are designing the solution to our Health Care crisis is significantly flawed then it doesn’t take an expert to predict the outcome–whatever the solution it will be DOA. It would be great if you and at least a critical mass of respected experts would compile THE BOOK of basic data/facts– the Holy Grail of Health Care. Then we could have one source upon which all the ensuing arguments relative to the design and efficacy of proposed solutions could be based and quoted by the Administration and David Letterman.

As a letter to the editor in the Wall Street J. asked today, when 40 countries have greater life expectancy than USA, they must be doing something right.

Vested Interest on all sides. Who do you trust? Health Care Insurance Companies and private hospitals? Is Medicare more efficient than Private Insurance Companies? Medicare would win this honor– a secret that industry does not want to discuss. Is the public more satisfied with Medicare, a public insurance organization, or private insurance companies? Medicare seems to win again.

What is the most efficient organization in doing a job with less waste in administrative costs? Social Security.

When the opposition gets up to speak in Congress it is very interesting how they are not able to think for themselves. They use the same wording, same lines given to them from industry– called private health care industry.

Bottom line, can we continue to have no cost controls and spend 18, 20 or 25% of our GNP and get less per dollar spent than any country in the world every year? Now, the industry will be very happy to have 50 million new clients added to private insurance with bills paid by US Citizens or tax payers that they claim to be worried about so much. Similar results to the misguided Part D Drug Plan add on to Medicare. At least it did not cost as much as predicted. However it may have been the most poorly designed approach to expanding access that man on this planet could have designed. Who designed it? Pharmacy Industry?

Many of my physician friends now understand that private insurance world is not their friend. They all pay vast amounts of money to pay for staffs or others to bill over 1000 insurance companies. Why are so many physicians now in favor of a public system alternative or single payer model? Have they gone brain dead?

On the other hand, if that 247 pound diabetic has to foot the bills for much of his healthcare, he might very well pay attention to the reasons for his extensive healthcare expenses. Let him pay directly for his shortcomings, not through an institutionalized underwriting process. If we offer high deductible (catastrophic) insurance at an appropriate rate, there should be as miminal medical underwriting as possible, and an absence of prejudicial lifestyle engineering.

A quicker read than Atlas Shrugged, and an entertaining exploration of ways of organizing a society that differ radically from those proposed by the leftists that have been on the long march through U.S. institutions.

Frank, You must be on the left coast:) It’s quite different here in the Midwest. I do get to study this stuff every day and I can tell you that lifestyles are the root problem. I was just reviewing a medical history application for an individual who was born in 1953, is 5′4″ and weighs 247lbs. I didn’t even have to look at the rest of the form to know the person was a diabetic, had hypertension, heart disease, among other problems. Consider that 25% of the population is diabetic, and another 20% are pre-diabetic. 2/3 of U.S. adults are overweight or obese and 1/3 of U.S. adults are obese, and that is only getting worse. Heart disease is almost entirely preventable with diet, exercise, and medication. People with Type 2 diabetes and who are over 50 almost always are obese and carry many co-morbidities, such as heart disease, hypertension, organ failure, and cancer. Most cancers are at least impacted by diet/exercise. We would need to make a relatively small on the top 25% of at risk individuals to have a large impact on costs!

Beverly,

You are correct about the individual markets in some states. There is also the ability to offer incentives in a group health plan, tied to outcomes such as body mass, cholesterol, and blood sugar. The incentives cannot exceed 20% of the insured rate for employee only and 20% of employee/spouse rate if the spouse is included. This equates to roughly $70/month for employee and $140/month for employee/spouse. So it is permissable to require that an employee pay a reasonably large surcharge based on health outcomes.