Everyone is talking about throwing trillions of dollars at healthcare.  Look, as a trauma surgeon, I am happy to make more money.  You can throw as much money in me as you would like.  What many people are talking about, many progressives, is universal healthcare.  This means you eliminate insurance costs from the equation.  This frees up $700 billion.  Somebody go get a calculator.  We spend just over $7,000 per person in the United States.  We have 46 million Americans who are currently not covered by any insurance.  We can use this $700 billion and cover all 46 million Americans.  No extra cost.

Joe Scarborough is trying to split the argument into two pieces.  First he wants to talk about taking care of the 46 million Americans because, as he says it, “it is a moral issue.”  Secondly, he has no idea how we get a control exploding costs.  Well, Jack Welch threw out some words without actually throwing out a coherent argument of how to control costs.  Here's how we control costs:

— create a Healthcare Board.  Yes, I know, more government bureaucracy.  This is critically important.  This Healthcare Board will be in charge of health care in the United States.  They will be able to direct NIH monies.  Monies will be directed to finding “the best of care” strategies for the most common diseases (congestive heart failure, diabetes and hypertension to name a few).
— Congress needs to give this Healthcare Board the power to negotiate with pharmaceutical companies.  Negotiating drug prices will push healthcare costs down.
— this Healthcare Board must be given the authority by Congress not to approve certain drugs which come up for FDA approval.  Currently, the FDA is charged with figuring out whether a drug is safe or not.  The FDA does not evaluate if the drug does the same thing that three other drugs already do.  There are something like 50 different drugs available to treat hypertension.  There are seven or eight different beta-blockers (these drugs act directly on the heart to slow the strength of the hearts contraction.  Therefore, lowering blood pressure.)  We are wasting resources developing the same drugs over and over and over again.  The Healthcare Board can reject drugs that aren't BETTER than current drugs that are on the market.

— the Healthcare Board must evaluate all medical products.  There are literally thousands of medical products.  This market includes everything from titanium orthopedic rods which stabilize fractures, to examination tables, to mammogram machines to those scooters.  Scooters are an excellent example of an explosion of a product.  15 years ago, there were no scooters.  Sales in wheelchairs and scooters top $3.2 billion in 2005.  These costs need to be controlled.  Along the same lines, does every hospital need a 64 slice CT scanner which has the ability through sophisticated software to show physicians a three-dimensional image of the heart and spin that image in space? Does every hospital need magnetic resonance imaging?  Currently market forces are pushing hospitals to buy more and more technology.  This is driving up costs.  It is unclear whether it is driving up quality (I'm pretty sure that it is not).  The Healthcare Board through scientific evaluation can curb these expenses.

— the one thing that Jack Welsh said, almost under his breath, was that we need to talk about end-of-life issues.  We need to go back and examine the Terri Schiavo case.  We, as a country, need to decide when we are doing something to the patient as opposed to for the patient.  Although the numbers aren't crystal clear, it is commonly believed in the medical community than 50-70% of some patient's overall medical expenditures are spent during the last six months of life.  Therefore, if it is possible to identify these patients, prospectively, should we work on increasing the patient's quality of life and not their quantity of life?  This needs to be studied and thoroughly debated.
— physicians, for the most part, need to be paid differently.  Primary care physicians (general practitioners, family practitioners, geriatricians, internal medicine physicians, general pediatricians and some OB/GYN's) should be paid to keep a population of people healthy.  Therefore, there is no incentive to see a patient every week unless the patient needs to be seen every week.  Physicians that adhere to “best practices” should be given bonuses.  Best practices should drive down costs while improving quality of life for patients.

— hospitals should be paid along the same lines.  Hospitals should be paid to take care of a group of patients.  Hospitals will be penalized for pressuring doctors to discharge patients early.  On the other hand, hospitals should be given bonuses for adhering to the “best practices.”

— the role of nursing homes and home health has not been discussed.  Using a fleet of nurse practitioners and physician assistants, we might be able to keep a lot of patients out of nursing homes (which is costly) and keep them at home if we are able to get these physician extenders to visit these patients frequently at home.  We need to figure out how to make home health and nursing homes more efficient and more cost-effective.

Finally, there are some odds and ends in this discussion that I should clean up.  Medicare and Medicaid patients will be rolled into this new universal healthcare.  Universal healthcare will offer the same benefits that Medicare offers currently.  Payroll taxes will be taking out of workers checks in order to pay for this system just as Medicare is currently taken out of our checks.  Business should save billions of dollars by not having to deal with health care and health care costs.  States should save money by not having to shell out money and personnel to deal with state health benefits.  State taxes should fall!! Insurance companies will not go away.  Instead they will probably offer supplemental healthcare insurance.

Do not buy the malarkey that we have to spend trillions of more dollars on health care.  This is a lie.  We currently spend 16% of our GDP on health care.  That is plenty.  We need to use the money that we have — we just need to use a better.



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