Creekside Chatter

So things that I’d like to see happen that I think would curb costs without degrading current or future quality of care would be:

1. Significant tort reform where arbitration is used to weed out frivolous lawsuits and a system where negative outcomes are compensated reasonably, while criminal misbehavior is handled criminally. HMOs should no longer hold their privileged immunity from malpractice relative to physicians.
2. Assigning the cost burden of unnecessary or likely futile services to patients or their families
   Eliminating television and direct to consumer pharmaceutical marketing (which all started only in the late 1990s) (drug company marketing is now about $57.5 billion annually, according to a PLOS study by Gagnon & Lexchin in 2008, which nearly equals the $58.8 billion spent in R&D by the drug industry. This would help reduce costs by allowing physicians breathing room to recommend older yet equally effective medications to their patients.
3. Breaking the oligopolies of health insurance coverage present in many states & regions. 94% of insurance markets are highly concentrated. If ever there was a reason for anti-trust intervention, this is it. Consumer choice is constrained by such circumstances and costs are dramatically increased to patients and physicians. The solution to this is not creating a government monopoly of health care, but using deregulation & anti-trust law to allow cross-state insurer competition, and nurturing novel health care coverage systems through unions, community groups, civic associations, patient co-operatives, and physician-run organizations. Government could do a great service by jumpstarting the infrastructure to create such a true free market but it should not take over such a market.
4. Encouraging charity care: Lawyers can treat pro bono work as a tax deduction; hospitals treat charitable services (which are often overcharged in the first place) as a tax write-off and get income tax exemption for being nonprofits. Physicians currently have no such benefit.
5. Cost Transparency: A friend of mine who is a student in a professional school recently had an appendectomy and got a surgeon’s bill of $~3000 and facility bills of $13000. Insurance paid most of it, but he still paid $5000 out-of-pocket. By contrast, Medicare payment for the surgeon is $561 and for inpatient facility care is about $3000. Patients are charged wildly different amounts, and quite often indigent patients get stuck with full charges while Medicare or large insurance company patients get charged much less due to contractual arrangements. This process is just insane. If the rich or foreigners want to pay for concierge care and first-class service, so be it. But for the system as a whole, doctors should be allowed to set their own fees (which we, alone among professions, cannot – Medicare sets rates which we are obligated to accept), waive standard fees for the poor (remarkably, underbilling is considered fraud), and charges should be transparent and consistent.
6. Encourage innovation: Increasing tax credits for R&D, establishing prizes for translating discovery for big problems, and extending patent protection for new molecular entities while limiting patent extension for me-too drugs maneuvers turning Prozac into Sarafem or Wellbutrin into Zyban, would promote advances in drug and device development and maintain America’s edge in science & technology.

A thoughtful article that makes very good sense.