Thursday, October 11, 2007

Goverment vs. Market Reform - Two Reform Schools

There are two schools of thought out there on how best to reform American health care.

• The government school says patients are basically helpless, composed mostly of the old, the poor, the children, and the sick. Most people, say its teachers, are not very bright, depend on government, tend to be passive, and, through no fault of their own, remain uninformed about doctors and hospitals who may take advantage of them at every turn. Therefore, a paternalistic and a caring government is necessary to protect most of the people most of the time against health care providers who charge patients for services rendered, even those without government subsidies. . Government must guarantee the populace universal access to care whatever it costs the government and its taxpayers.

The free enterprise, or market school says patients are resilient, intelligent, and are made up of a mixed population of the healthy, wealthy, the youth-preserving, the health seeking, the poor, and the sick. For the most part, most of the time, most citizens are perfectly capable of fending for themselves, spending a certain amount of their own money, judging whether what doctors and hospitals offer is of true value, and if they are helpless or poor, having government subsidize their care with taxpayer dollars. The poor and the sick, after all, will always be with us and must be provided for the more fortunate among us.

The government school has multiple articulate spokespersons among the mainstream media, among most major TV networks and national newspapers, among talk show TV hosts on major Sunday shows, among prominent politicians, among members of the elite and the academy. There’s an excellent chance their persuasive views will prevail in the next election, at least until costs to taxpayers of their well-intentioned and munificent efforts are tallied and subjected to open-debate to their true costs.

The free enterprise school has few spokespersons among the media, who tend to see their views as protecting the rich, health care special interests such as the drug and health plan industries, and affluent hospitals and physicians. Those who speak for this school tend to be Republicans, conservative think tank types, owners of certain media outlets such as Fox News and the Wall Street Journal, radio talk show hosts, and advocates of capitalism, who claim innovation and self-reliance lies at the heart and abides in the soul of the robust American economy. Some of their spokespersons, such as John Stossel of ABC News and its 20/20 program, have the audacity to say, “ Private competition, not government control, works best.

October 10, 2007.

Medical Competition Works for Patients

Health-care costs overall have been rising faster than inflation, but not all medical costs are skyrocketing. In a few pockets of medicine, costs are down while quality is up.

Dr. Brian Bonanni has an unusual medical practice. His office is open Saturdays. He e-mails his patients and gives them his cell-phone number.

"I need to be available 24 hours a day," he says. "I want to be there when a patient has questions, and I want to be reachable."

I'll bet your doctor doesn't say that. Bonanni knows he has to please his patients, not some insurance company or the government, because he's paid by his patients. He's a laser eye surgeon. Insurance rarely covers what he does: reshaping eyes so people can see without glasses.

His patients shop around before coming to him. They ask a question that people relying on insurance don't ask: "How much will that cost?"

"I can't get away with not telling the patient how much exactly it's going to cost," Bonanni says. "No one would put up with it. And the difference of a hundred dollars sometimes makes their decision for them."

He has to compete for his patients' business. One result of that is lower prices. And while the procedure got cheaper, it also got better. Today's lasers are faster and more precise.

Prices have fallen and quality has risen in other medical fields where most people pay for care themselves, like cosmetic surgery. Consumer power works -- even in medicine.

When government and insurance companies are kept away from the transaction, good new things happen.

A doctor in Tennessee I talked to publishes his low prices, such as $40 for an office visit.

Most doctors would say you can't make money this way. But Dr. Robert Berry told me you can. "Last year, I made about the average of what a primary-care physician makes in this country," he said.

Berry doesn't accept insurance. That saves him money because he doesn't have to hire a staff to process insurance claims, and he never has to fight with companies to get paid.

His mostly uninsured patients save money, too. Unlike doctors trapped in the insurance maze, Berry works with his patients to find ways to save them money.
"It's coming out of their pockets. And they're afraid. They don't know how much it's going to cost. So I can tell them, 'OK, you have heartburn. Let's start out with generic Zantac, which costs around five dollars a month.'" When his patients ask about expensive prescription medicines they see advertised on television, he tells them, "They're great medicines, but why don't you try this one first and see if it works?"

Sometimes the $4 pills from Wal-Mart are just as good as the $100 ones.

Speaking of Wal-Mart, medical clinics are popping up in Wal-Mart stores and in other similar markets. The clinics offer people with simple problems like sore throats and ear infections relatively hassle-free care ... cheap. Almost everything costs $59 or less. And the clinics are typically open seven days a week.

Grace-Marie Turner, president of the Galen Institute, a health-policy research organization, explains how these clinics thrive: "They're figuring how to do something faster, better, cheaper! They're responding to consumer demand because they see that they might make some money on this."

When consumers pay for medicine themselves, saving insurance for the big things, and doctors deal directly with consumers, doctors begin to compete. They start posting prices and work to keep them low.

And consumers gain more control of their health care. Instead of governments and insurance companies deciding for patients, patients decide.

Competition gives consumers more choices. And choice gives them power. Remember that when you hear a politician promise to make health case accessible and affordable through the force of government.


Two schools of thought exist out there on how to reform American health care –the government reform school and the free-enterprise reform school. In this presidential election year, each school will be vying for a piece of your mind and your vote. Think about the consequences of the lessons they are teaching – in tax dollars, in guaranteed coverage, in access to affordable care, and in the health care freedoms and choices 85% if Americans now enjoy and take for granted. And while you’re at it, consider a seldom mentioned third school combining elements of both with a heavy dose of prevention and responsible life styles.

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