Trust Your Government, Your Doctor, or Yourself

The health reform bill is coming down to this. Trust your government, our doctor, or yourself.

The government is pushing a public plan to compete with private plans. Public plan premiums would be about 30% less than private plans, and it would run no financial risks, since it would have the federal treasury as a back-up. It would “compete” with private plans and make them “honest,” a favorite word of President Obama in his speech to the AMA.

The Message

The Obama message is: you can trust the government. As the saying goes, “I’m from the government. Trust me.” Your government will save money by cutting $380 billion out of the budgets of hospitals, doctors, health plans, drug companies, who are presumably “dishonest.”

Hospitals alone,. 5700 of them, many of them in your neighborhoods, would receive $200 billion less. And doctors? Well, under a public plan , they would be paid at Medicare rates, 20% less on average then they receive now.

That would make them “honest.” Don’t worry about them abandoning you or not accepting you. They have no other choice because private plans will be out of business. A public policy will make honesty the best policy.

Government Track Record

Yes, Sir, you can trust your government. After all, it created open-ended Medicare and Medicaid programs, now hurdling towards bankruptcy by 2017. Critics say bankruptcy is due to inefficiency, fraud, abuse, and inability to control costs – costs which are crushing budgets of state governments.

Oh, I know government in 1965 said Medicare and Medicaid would never cost more than $9 billion and costs now exceed $1 trillion. But you can trust the government to bring these costs down – by preventing disease, stopping the aging process, installing computers in every doctor’s office and every hospital, and coordinating care across the disease spectrum.

Spend Now, Save Later

Yes, I know government says it will need to expend vast amounts of money now – by investing in stimulus packages to lay the foundation – so they can save money later. The Senate Finance Committee projects costs of $1.2 trillion over the next ten years, but the Congressional Budget Office estimates the real costs at $1.6 trillion. Obama distracters say these figures are voodoo economics, a form of political doo-doo, but you and I know it’s Bush whacking to correct past mistakes.

Trusting Doctors

Or, I suppose you could trust your doctors. But the government, and its budget director, Peter Orzag, says you can’t trust them. Their practices vary greatly price. They can’t compare prices due to antitrust rules, but they are charging what the traffic will bear, even though Medicare, Medicaid, and private plans set their prices. They get around this by over-treating and by doing things that don’t need to be done. If you don’t believe that, read about the Dartmouth Institutes studies on practice variation, or the recent Doctor Gawande study on McAllen, Texas, or my blog interview with Dr. Jerry Reeves on Los Vegas.

Why, you have to pay doctors more in McAllen, Miami, Los Vegas, and most big cities than you do in the rural South. It’s a shame. The government ought to be able to federalize, standardize, and homogenize doctor payment everywhere. One unified health care nation with equal payment for all, that’s what we need, no matter what the costs of doing business, patient demands, the health of the local, or malpractice rates.

Trusting Yourself

You could trust yourself. If the government would give each citizen – whether employed by a large company, a small business, or self-misan$6300 a year.with more for families – perhaps you could decide how to spend it yourself. Of course, you would have to be well-informed, you might even have to seek out a doctor you could trust, based on word-of-mouth, advertised rates, and public outcome data.
Here’s how a Wall Street Journal editorial writer sees how that scenario might play out in the future.

Because consumers were not spending more of their “own”money on health care, doctors and hospitals found it necessary to public hand even advertise their prices. For the first time, Americans spend less and get more. Spending fell overnight 13%, which happened to be exactly w3hat6 economists had predicted if the price tags were restored to health care and consumers were allowed to see clearly what they were getting (or not getting) for their money.

As Donald Palmisano, MD, a spokesperson fot the Coalition to Protect Patient Rights and former president of the AMA for 2003-2004, noted in a June 15 Chicago Tribune piece,

A lot is at stake as the nation engages in the health care debate. Will we have a system that puts the patient in control with the doctor as trusted advisor, or a government system-run system that ultimately rations care and stifle innovation and self-determination?