Monday, July 4, 2011

Health Reform: On Biggering Government and Belittling Individuals

July 4, 2011 - This nation was founded on these notions:

• Each person contributes.

• It is not how big you are, but what you do that counts.

• The constitution protects individuals.

• Collective actions of individual voters over-rule government.

• Voices of individuals must be heard.


In a June 26, 2011, Houston Chronicle Op-Ed, “Government Favors Bigger Health Providers, “ Louis Goodman and Timothy Norbeck, president and executive director of the Physicians Foundation, remind us of the dangers of government bigness in health care .

Here is their article.

Who would deny that health care is big business? It is also the most personal of all human endeavors. Why then does the federal government appear to be in such a rush to depersonalize our medical care? Bending the cost curve seems to be the driving force behind the recent health care reform, especially in light of the fact that national health expenditures have doubled over the past decade from $1.3 trillion in 2000 to $2.6 trillion in 2010. And the Affordable Care Act rewards hospital systems at the expense of small and solo, personally oriented medical practices, under the mistaken theory that bigger systems are — or can be - more cost-effective.

Where were the voices of patients and practicing physicians, two of the most important constituencies in these discussions? The answer is, their voices didn't matter to the reformers. There was a time when physicians and their patients worked together to determine what was best for the patient. Such participation has been ceded to the federal government.

The question of size may well be the most important aspect of the congressional overhaul. More than 80 percent of personal medical care services are provided in the doctor's office, and less than 20 percent of services are provided in the hospital.

Why should health care delivery remain in the doctor's office? Because it is the most cost-effective setting to receive health services. Medicare says the average visit to the doctor's office costs $61, compared to an average visit to the hospital of $10,908.

Why then is Congress pushing as many services as possible to the hospital through consolidation, merger, acquisition and shared savings programs? If the hospital is the most expensive place to provide care and the physician's office is the most cost-effective place to receive care, why has Congress moved care away from the doctor's office and into a hospital waiting room?

The answer appears quite evident. Congress and the executive branch of government believe that a single-payer system is where health system reform will rapidly evolve from our current system.

Here is the evidence.

First, the government's share of our national health care bill, which was 44 percent in 2000, is projected to be 50 percent in 2010. Or more aptly stated, the government's share of national health care expenditures has doubled over the past decade from $596 billion in 2000 to $1.3 trillion in 2010.

Second, hospital systems are getting bigger, and in many markets, they exercise monopoly power. For example, the Texas Attorney General's office filed suit against a large Houston-based health care system alleging violation of state antitrust statutes by unreasonably restraining competition among acute care in-patient hospitals.

Third, physician practices are evolving from predominantly solo practice to four or five doctor groups in order to remain economically viable. Large hospital systems are rapidly gobbling up small hospitals, and large health insurers are purchasing small insurers, further eroding what little competitiveness remains in the market.

After a short period of predatory practices, monopolistic dominance will result in higher prices, less service and arbitrary control over patient waiting times. And sooner rather than later, only a few big hospital systems and health insurance companies will remain.

Voila! Then the federal government will proclaim that there is no competition in the health care marketplace and therefore the government must intervene and create a national health service. Economist Milton Friedman's comment about the inefficacy of government resonates today. If you put the federal government in charge of the Sahara Desert, he said, in five years there would be a shortage of sand. And so it will be with health care.

In order to move forward, physicians and patients must become part of the dialogue. Decisions cannot simply be made by large health systems and the federal government. A more constructive discussion is needed or patients, and we are all patients eventually, will incur long waiting lines, rationing of care and higher taxes.


I conclude with this verse, borrowed and modified from Doctor Suess’s tale, The Lorax, with apologies to the good doctor.

Government is government!

And government must grow!

It has to grow bigger,

so bigger it gets.

It biggers the size of medical groups.

It biggers the size of hospitals.

It biggers the size of health plans.

It biggers the size of the load states must carry.

It biggers the size of Medicare and Medicaid.

It biggers the size of the tax bill.

And it figures,

on biggering,

and biggering.

To grow even bigger,

It belittles voices of individual patients.

It belittles voices of independent solo physicians.

It belittles voices of small entrepreneurs.

It belittles voices of individual innovators.

It belittles the voice of the market.

And it figures,

on belittling,

and belittling,

until it grows as big,

as it can get.


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