Time to Brexit the Health Care System?

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Can’t. Won’t work. We’re stuck with this. We have to fix it.

But “Brexit” was a great logo/hashtag/campaign meme, with echoes of “Britain, break it, exit” all in one. Falls right off the tongue, it does. And it described fairly exactly the mood behind it, one of breaking, getting out.

So in healthcare? Time to FFSexit — exit the fee for service business model. Nah, doesn’t trip off the tongue. And it has echoes of “sex” and even “sexist.” Next!

Time to ITexit — exit the non-interoprative, non-communicative garbled EHRs and other information systems we have ended up with. Nope, nope. Sounds too much like inviting Texas to re-think this whole annexation thing.

Time to Vexit — exit the volume-based business model. Hmmm, no. Sounds vexatious, vexed.

Time to exit the fragmented, opaque, partial, byzantine, and outright cruel healthcare financing system we have now —FragOpParByzOutCrexit! Sigh.

Wait. Wait. Here’s the core problem of this meme-pondering: We don’t want to “exit” healthcare in any way.

The Congressional Republicans hope to exit the defined benefit Medicare system and make it a defined contribution system, presumably so that sooner or later they can drown the contribution in the bathtub. Republican state legislatures have found as many ways as possible to exit Medicaid, or its expansion.

But we the people can’t exit the healthcare system because unlike political parties and ideologies, we actually have bodies, and those bodies need tending whether we like it or not.

The healthcare economy is hollow. You know the drill. It costs twice as much as it needs to for no good reason, overtreats to the tune of close to $1 trillion per year, at prices that have no real support in the cost basis or the market, still is a major cause of personal bankruptcies, and manages to cut vast numbers of people even people “covered” by high deductible plans, out of any treatment at all because it’s so expensive to use the system.

We don’t need to exit. We need to fix it. Fixit!


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10 replies »

  1. Clever and fun. Thanks Joe. Wouldn’t it be great if we could hold a simple referendum in the U.S. on “The Health Care Systems in America – Like it or not? Vote YES or NO.” I have no doubt “NO” would win.

  2. “Private” is not a precise synonym for “free.” That’s my only point. Sloppy use of words begets sloppy thinking, and vice versa. Implicit in the “free market” exhortation is the naive idea of wholly autonomous dyads of fully rational actors possessing the same information and economic power and having no need of 3rd party regulation.

    “There is no such thing as ‘society’.” – Margaret Thatcher.
    “_______________________” (pick your choice). – Ayn Rand

    See also “This Time is Different: 700 years of financial folly.”

  3. Whole Foods. Free Market. Sustainable too. ; )

    OF COURSE free does not quite denote free in the classic, all you can download without paying for it sense ..

    / j

  4. LOL. There’s no such thing as a “Free Market.” Private markets, yes, but human affairs get regulated one way or another. Moreover, in a truly “free” market, powerful incumbent interests would be “free” to collude and restrain trade in whatever ways suited them.

    BTW, people can spare me the “No True Scotsman” beg-off.

  5. Everybody keeps talking about our healthcare system here in America. Our healthcare system is the greatest in the universe. First, let us define healthcare system. To me, a physician, it means doctors, nurses, allied healthcare workers, researchers, clinics, hospitals, pharmacies, etc. I do not include payment methods, such as cash, credit, insurance policies, etc. in the definition of healthcare.

    The confusion in this country about healthcare is that the medical insurance carriers and government insurance carriers and policies and rules and regulations are what are portrayed as “the American Healthcare System”.

    Yes, Obamacare is pathetic as a method of payment for medical treatment and should be eliminated totally from our system of government. America was founded on the “free enterprise system” which has its basis in capitalism. Because of the free enterprise system and the ambitions of many Americans ever since the early 1700’s, this country was made great and prospered in every endeavor. We have had the greatest architects, engineers, scientists, builders, traders, designers, bankers, doctors, researchers that the world has ever known. We are great because we did not interfere with the ideas and enterprises of our great people…….until fairly recently. In the last 50-60 years we have seen greedy politicians attempting to revise our great American history and subvert our basis for the American culture and way. This has led to multiple laws and government programs that are anti-American and anti-capitalistic. Obama himself wishes to “change” America and has had great success in trying to make America into a third world country.

    Check your Constitution. Look at the Bill of Rights. You have been given the “opportunity” to do almost anything that you want. You do not have the right to free medical care. You do not have the right to be fed free food daily. You do not have the right to free shelter. Now, tell me where in the Constitution where these rights are!

    Do I believe that Americans should not receive medical care or starve or live out in the weather. No. I want everyone of my American citizens to be comfortable and have food and have medical care and have a roof over their heads. But……..you do not have a “right” to these things.

    Back to our healthcare system. I have worked in some of our greatest hospitals and university medical schools. We have the greatest medicine in the world. Our researchers are world renown. Did you know that most of the Nobel Prizes in Medicine are given to medical scientists in America. Did you know that if you traveled the world over and wanted to find the greatest cardiologist in Pakistan that you would discover that that cardiologist took his or her training in the United States of America? If you traveled to Buenos Aires and was looking for the very best nephrologist who uses the latest dialysis equipment that you would find that that doctor trained in our medical schools in the United States of America?

    But, our lawmakers have put handcuffs on doctors and a bunch of attorneys are trying to tell doctors how to practice medicine. There needs to be a stop to the destruction of healthcare in America. I propose giving medical insurance companies free reign to follow the free enterprise system with no intense government regulation. Instead of providers, or healthcare workers, start calling the world’s greatest doctors…….doctors!

    Thanks for your time!

  6. “However, my limited experience with cash pay for both dental care and routine vision care is that I’m expected to pay the full list price which always exceeds the rates paid by whatever insurers the provider has a contract with. I think that’s unfair and unreasonable.”

    My experience also Barry when I was cash pay uninsured. Attempts to bring up cash charges brought sideways looks and vague response. They’re just not set up mentally to comprehend.

    This is why I laugh at Republican’s push for “free market solutions” as the “cure” for high prices.

  7. In a perfect world, there would be a transparent cash price for all services, tests and procedures that is less than the commercial insurers’ contract rates. The reason that it should be less is that the cash paying patient costs less to serve than the insured patient does. The provider doesn’t have to file a claim or wait for his money. If I pay at the time of service, he gets his money immediately and with no hassle. While insurers may, in theory, provide access to more lives than I can as an individual patient, the insurer does not guarantee any specific level of patient volume or revenue.

    If Medicare and especially Medicaid rates don’t fully cover the cost of providing services, than the cash price can legitimately exceed those levels. However, my limited experience with cash pay for both dental care and routine vision care is that I’m expected to pay the full list price which always exceeds the rates paid by whatever insurers the provider has a contract with. I think that’s unfair and unreasonable.

  8. Well, some doctors are “drexiting” the system by going direct pay. Many I have seen are working out ways to enable people to see them for reduced prices, so they can at least get a basic eval by a doc. Problem is paying for meds, testing, radiology studies, etc., these prices are going out of sight. I don’t know the answer to bringing those costs down, but the ACA certainly hasn’t.