Monday, December 23, 2013

Christmas - The glue that binds

Christmas - The glue that binds us all.




Christmas is celebrated by almost every person in America. According to a Pew Research poll 96% of people in the U.S. celebrate Christmas. 81% of the non-Christians who celebrate are a diverse group of atheists, agnostics, and those of other religions. Although, Christians are decreasing as a percentage of Americans, the percentage who celebrate Christmas is still about the same.

Even if one doesn't attend church on a regular basis, over 60% say they will attend services. And of those who don't attend church at all, 16% say they will. 86% say they will gather with friends and family and exchange gifts for Christmas.

The first recorded date of Christmas was 336AD, during the rule of the Roman Emperor Constantine. December 25th is the winter solstice, the celebration of the Roman sun god Mithras. Wishing not to participate in the sun god celebration, Christians adopted that day for their own as the birth of Jesus (which many experts suggest was sometime in the spring). Orthadox and Coptic churches chose the use of the Julian calendar and celebrate Christmas in January. I personally like the play on words of the sun god verses the son of God. 

As you can see by the map, most countries around the world also celebrate Christmas.

No other holiday is as festive and cheerful as Christmas. It crosses political party lines and cultural divides. It is the one holiday that literally forces people to set aside their differences to come together. It is easy to focus on the negative aspects of the holidays, such as suicide or commercialization, but I believe people really want a chance to renew relationships and have a reason to be kind to others.

It really is the holiday of holidays, because it binds us like no other day of the year. I believe Jesus is the best reason for us to be merry, but I am also thankful that we in America and around the globe consider it important enough to observe this special day to celebrate and have a Merry Christmas.






Sunday, December 8, 2013

Ideal Healthcare - Part 2

Ideal Healthcare – Part 2
Practical implementation…think schooling.



In my last article, I offered the solution to healthcare as dependent upon three key elements to be successful:
1) Healthcare must be provided for all U.S. citizens.
2) Medical professionals must be able to work in a profitable environment.
3) Insurance companies should be excluded from healthcare

Unless the Affordable Care Act is dismantled, the law forces us to continue with government controlled healthcare. I would like to continue to outline how we can modify the ACA to have a successful healthcare system.
As expected, a more liberal view would doubt that my proposed system could work without government control overseeing abuse in healthcare institutions. While the conservative view believes that government should not be involved in healthcare operations due to inefficiencies. To achieve this, I believe it necessary to detail items 2 and 3 to resolve these concerns.

I have said before that we should not do what other countries have done, but learn from their mistakes. I will begin with two countries who I believe have the most promising of healthcare plans and expand upon them.

First, the Netherlands changed their government controlled “single-payer” (single-funded) system in 2006 to a privately run single-payer system by the insurance companies. The key point is that they realized a few things that occurred when government was completely in control. Health inequality between rich and poor, long waiting lines, and cost increases were a few of the reasons to let the private sector run the program. (See link below)
After 2006, the healthcare system did improve, but negatives also crept in. 80% of the insurance now operates through only a few companies. This is an example of an oligopoly and not true competition (something the state wanted to avoid)…the results were costs increases. Besides increases in health spending, there are also many instances of less competition and consumer choice.


Second, In 1995, Taiwan’s “single-payer” system was implemented and modeled after the U.S. Medicare concept. The working population pays premiums split with employers. Waiting lists are short and most preventative services are free. They use a smart card with their health info on it, which keeps fraud down and efficiency up. They have the lowest administration costs in the world...in a way. 
After closer scrutiny, Taiwan is spending more than taking in, and borrowing to finance the rest. The government is afraid to raise premiums because they fear a voter reprisal. Their solution is to ration care to keep spending in line with revenues. (see link below). Unfortunately, there is a low doctor-to-population ratio resulting in too many patients depending on too few doctors. Patients visit the doctor more frequently causing doctors to keep visits short to about 2 to 5 minutes per patient. There is no system to regulate systematic reporting of clinical performance, patient outcomes and adverse events. Taiwan is also slow at adopting technology except for drugs, and borrowing is needed to cover for these needed costs.

Both the Netherlands and Taiwan have good healthcare at a good price. Both countries initiated their programs after looking around the world and gleaning the good from others. As they examined other countries learn the good and bad, so too should we in the U.S.

I'm suggesting that a common negative with these two countries is the lack of incentives and the greater reliance on punitive measures to control healthcare. Doctors and medical institutions need efficiency at a reasonable cost if they are to remain profitable and successful. Competition can resolve this issue (see link below).
     In the Netherlands, with only a few insurance companies in the system, lack of competition restricts efficiency in operations and choice, ultimately leading to cost increases.
     In Taiwan, with insurance companies removed and smart cards in use, millions have been saved. Again however, there are no incentives for doctors; this reduces a reason for doctors to enter the workforce, ultimately resulting in a burden of a high patient ratio and reduction of effective health care (i.e. those visits of only 2-5 minutes). Additionally, with no competition between health institutions, advancement in new medical technology has been suffering.

I would like to veer off topic a moment to examine the U.S. school system...the reason will soon become clear. Our government requires every child to attend school. Not every child is required to attend a public school, but every parent must pay into the public school fund (taxes). My proposal for healthcare would mimic the U.S. education system - with one exception.
The exception is that the school system, albeit quite functional, could be much more efficient and successful…by implementing private sector techniques. Charter schools have been experimenting with better techniques in the last several years. The jury is out on the total effectiveness of charter schools in general, but some areas are proven (see link below). Examples would be to give teachers rewards for high performance, or maybe a bonus to school principles effective in high standards and efficient use of funds. The ideas are endless, but the basic concept is sound.

Healthcare can run in a similar fashion. 
Every person should pay their taxes for their healthcare, like we do for the school system. 
Every person should be able to go to the doctor, like we do for the school system. 
Every person should have a local healthcare administration center to monitor effectiveness of the program in the community, like we do with the local school board (creative incentives would best work closest to the source).

In the end, the United States school system has a ways to go to achieve excellence in education, but the private sector has already proven some techniques that can help make improvements. And so too can we implement the current school system as a model to redesign our healthcare system, then make additional improvements that have proven successful. 
I contend that if we exclude the insurance companies from the process and allow doctors and institutions to be profitable, our healthcare system could once again be truly rated the best in the world.



Netherland healthcare

Taiwans healthcare

Teacher performance incentives

Sample of competition gains

Sample private sector incentive plan

Sunday, December 1, 2013

Ideal Healthcare in the USA

Ideal Healthcare – Part 1
Can we handle the truth?



With all the current controversy about healthcare, it’s time to point out what could be the best possible solution to Health care in America. The Affordable Care Act (a.k.a. Obamacare) may hold an ideological solution to healthcare, but not a practical one. Regardless of party affiliation or current mental paradigm, we have moved too far across the divide to turn back to the old ways. The two dirty little truths are that we must face up to the fact that good healthcare comes with sacrifice and that money doesn’t grow on trees. It is vital we set aside our sacred cows, realize the common goal, then get to problem solving.

It’s well known that our society is a benevolent one. We send financial aid to every corner of the globe and most often we are the first physically available to assist. We also do the same for our own citizens, but unfortunately not to the extent we wish to. Our government is in a pickle, because it must act before current healthcare policies are too entrenched and bogged down by a cumbersome expensive new system.  

The ACA/Obamacare website has already been experiencing roll-out inefficiencies, and soon it will have to contend with huge cost overruns (see link below). This has the ire of a large majority of people, with the list getting longer everyday. Nevertheless, I would risk it to say that everyone in America truly wants to help out those less fortunate. The key question is how will it work, still be efficient, and stay within reasonable costs?

I believe there are three key elements to good cost effective healthcare.
1) Healthcare must be provided for all U.S. citizens.
2) Medical professionals must be able to work in a profitable environment.
3) Insurance companies should be excluded from healthcare.

1.  For many years the United States has led the way in areas such as economics and freedom. The U.S. has also led the way in medical innovation, but it hasn't trickled down to all its citizens to accomplish true healthcare leadership. Even though every man woman and child is provided emergency care, whether they could afford it or not, millions of dollars are wasted addressing the illness at the latest stages of the illness. Preventative healthcare could reduce emergencies and serious conditions before trauma and expensive medical costs spiral out of control. I have to admit that this is one promising goal of Obamacare.

2.  Doctors, hospitals, and pharmaceutical companies must be able to function with a profit. It is my contention that once healthcare becomes only a benevolent institution it will fail. The reason is that there are only a few medical professionals bred with internal philanthropic motivations but there are many more with monetary motivations (see link below). If the system becomes a non-profit system, incentives and motivation will vanish. Not only would the quality of care be lost, but quantity of caregivers as well (think of long lines). Doctors and other healthcare professionals provide a service that should be rewarded for their talent. Just like the rest of us in our jobs. Unfortunately, Obamacare will hinder this process.

3.  Insurance companies that facilitate the operation of healthcare should be obsolete. I believe we must ask ourselves why we need insurance companies in the mix. The easy answer would be that by grouping healthy people with sick people it will lessen the burden on all people. But the insurance companies are only middlemen who don’t really help with this process. Insurance companies make a profit speculating the risk of those who will be sick and pocket the profit off that speculation. Where is the direct health service?
          I assert that the real insurance providers should be the citizens of America. This means that we would still utilize the grouping mentality as stated before, but instead our group plan is all of us. In other words, we Americans are the one big group plan paid for by us in the form of taxation.
          After enacting the Affordable Care Act, we inadvertently backed into what is known as a “single payer” – or more accurately, a single-fund system. Since the government has been given authority by the Supreme Court to tax every citizen (that pays taxes) for healthcare, the IRS can now charge or penalize Americans through taxation. There is no longer a need to involve an insurance company to profit from that same process.
          An example of implementation would be as follows: The sick person sees the doctor for free, the doctor and his/her clinic attends to the needs of the sick, the doctor sends the invoice to a local branch of the HHS (health and human services), the HHS sends the invoices to the IRS, and the IRS makes a yearly adjustment in our taxes if required. That is where we ultimately pay the bill. In our progressive tax system, the rich pay the most and the poor pay little or nothing.
          Those concerned with overspending might say, “Hey, the doctors and hospitals will get away with sending in huge overblown bills, burdening the taxpayer with astronomical increases.” The solution to this is where I pointed out that the doctors would send the bill to the local HHS. It would be a branch that is run by the local community; it would oversee funds, critique and monitor any excessive income, and even provide rewards for those who stay healthy. This would be much like the committees that handle a local utility company profits…adjusting rates periodically due to extenuating circumstances related to the region. It’s not perfect but it’s the best check on overreach.


These are three key elements for good healthcare that would ultimately produce good service at a fair price, and it would provide care for the sick in a timely fashion (since more doctors would choose to enter the system knowing they can make a living). Billions of dollars (see link below) could be used for real health needs rather than absorbed by insurance companies; not to mention the freedom from the monetary headaches and hassles dealing with insurance.

A final bonus to this plan is that by default Medicaid and Medicare (and their associated inefficiencies) would no longer be necessary. All people, rich and poor, young and old, with any type of medical issue would bring it to their doctor to be appropriately dealt with. If someone wishes to pay for custom or unique medical situations, such as cosmetic surgery, these services would be available for clients to be paid out of their own pockets. In fact, if a doctor can survive without sending the bill to the government for reimbursement, he/she should have the freedom to operate as they choose.

If you want an efficient healthcare system at a good price, I believe this is the most effective one available. However, I did mention some sacrifice. At the turn of the 20th century, it was assumed that the horse and buggy suppliers would be sacrificed as the automobile grew in popularity. What’s not mentioned is that many of these companies didn’t die. Sure, buggy whips were out, but the 1890 style roller wheel bearings were easily adapted to automobile wheels. So too will the insurance industry find other opportunities to keep their business afloat.

If we choose not to fear change for the things we love we will always be successful. We do not have to do what other countries have done, but we should learn from their mistakes - then do what is best for the United States of America. This is the time to make a great sacrifice for an even greater healthcare system…one that will allow us to once again be known as the country with the best most affordable health care in the world.



Healthcare increases

Sample of Insurance company profits.


 High-quality medical graduates leave Canada for better-paying careers in the U.S http://www.cmaj.ca/content/161/8/1028.full