The great danger of the current distressed economic situation is not the downturn itself but rather the subsequent political reaction that has brought us to the verge of abandoning the very principles that have made our country the greatest national success story of the modern world. Our nation has been the global economic engine and the global shining light of freedom because of traditional American free market principles and traditional American personal freedoms. American innovation, ingenuity , and our free market system has spawned the lion’s share of the modern world’s innovations in health technology, pharmaceuticals, aerospace, computer technology, communications, etc. from which the entire planet has benefitted. Undeniably, our country faces serious problems including the ailing economy, unsustainable expense of healthcare, inadequate primary and secondary education, incoherent energy policy, environmental deterioration, etc. But our troubles are not a result of the failure of those economic principles and values but rather a result of corruption of those principles and values by self-interests, special interests, and misconceived government policies.
Proposed policies creating a more centrally controlled economy so government can provide broad social programs such as health care for all, higher education for all, housing for all, etc., are inherently economically flawed. Funding for these programs inevitably requires increased taxation for nearly all individuals and businesses but disproportionately the successful ones. Eventually however, the increasing tax burden discourages and suppresses innovation, risk taking, and personal and business success, resulting in fewer and fewer successful persons and businesses. The resultant suppressed economy generates less private revenue (wealth) and in turn, progressively lower tax revenues. As tax revenues decrease, unsustainable deficit spending to pay for the social programs further restricts the economy. Ultimately with a decreasing ability to pay for those social programs, the government "benefits" inevitably are provided (rationed) at a minimal level. At the same time, because the government has promised to provide expansive public social programs and by policy discouraged individual achievement, fewer and fewer people try to provide for themselves. The end result of this system is an increasingly dependent and dispirited citizenry and, at best, a tepid economy. This is not theory but has proven to be the case throughout Europe and every where else such policies have been implemented.
We have reached a defining crossroads in our nation’s history. We can sit back and watch our country and our children’s’ futures slide down the slippery slope to European style socialism, which can only result in economic insecurity and individual dependency and unhappiness; or we can enact policy that both utilizes the self-energizing and auto-correcting forces of traditional American free market principles and addresses the corrupting influences of self-interests and special interests by increasing transparency in the public and private sectors. Our current economic and social problem can only be successfully reversed by utilizing those traditional American free market principles and personal liberties that made our great land the global economic powerhouse and bastion of freedom.
Sunday, September 27, 2009
Sunday, September 20, 2009
Wrong Diagnosis = Wrong (ineffective) Treatment
In medical practice, successful treatment of a patient’s illness requires establishing a proper diagnosis. Without intelligent and logical evaluation of a sickness, ill-conceived and hastily implemented “therapy” would only exacerbate the illness and would be worse than no treatment. It would be utter folly to declare a patient critically ill and hurriedly implement treatment because “something must be done” without first properly understanding the cause of the illness. Yet, this is the very attitude and approach underlying the current proposals in Congress for health-care reform.
Health-care costs currently account for 18% of our GDP and that percentage is projected to nearly double in the next 20 years. Escalating health-care costs place ever increasing financial burdens on families and businesses, threatening the long-term viability of our economy, the long-term solvency of our state and Federal governments, and, in the end, our opportunity and our children’s opportunity to live the American Dream. As needed for treating medical illness, successful treatment of this national health-care “illness, first requires thoughtful analysis to determine and identify the underlying causes of this “illness”.
While multiple factors contribute to ever increasing health-care costs, our health-care insurance system, which effectively disconnects the consumer of health-care services from the immediate cost of that care, is the essential driver of those costs. Certainly, the insurance premium cost is felt directly by the consumer who may pay for part or the entire premium, and/or felt indirectly through reduced wage dollars that are instead paid as health-care insurance employee benefit. However, once that premium is paid, there is little incentive not to use health-care services as much as one desires. Health-care insurance in our country is unlike any other type of insurance. Imagine the cost of auto insurance, if having paid the insurance premium one could have as much automobile as they desired or the cost of home owner’s insurance, if having paid the premium, one could have as much home as they desired. Once inside the health-care insurance system, the demand for services becomes almost unlimited. As a result, the cost to get into this system, i.e. the insurance premium, continually increases. In turn, the premium becomes unaffordable for more and more Americans or places increasing financial stress on families and businesses that continue to purchase health-care insurance.
The same mechanism drives the continually increasing Medicare and Medicaid expenses and propels those programs further into insolvency. As with the private health-care insurance, once inside the government (taxpayer) health-care programs, there is little incentive or restraining forces to limit demand for care. Not recognizing or not addressing this essential underlying cause of the health-care expense “illness”, the current health-care “reform” proposals effectively would place more people into the same unsustainable insurance system, and would only make the “illness” worse.
To achieve meaningful health-care cost control, any reform must include shifting the primary payment responsibility of routine medical care expenses and a higher percentage of initial extraordinary health-care expenses to the consumer of those services. Third party health-care payers would then be responsible for extraordinary medical expense above this higher consumer payment threshold. Much like high deductable auto or property insurance, health-care premiums for such policies would be significantly lower than for low deductible policies. The individual consumer could then apply the premium savings to payment of routine health-care and/or to payment of their portion of extraordinary medical expenses. Such a system would decrease demand for health-care services and therefore expenditures for health-care services. Further, the system would incentivize the individual consumer to demand more accountability and transparency with regard to quality and cost of those services from the providers of health-care services e.g. physicians and hospitals. This accountability and transparency would also indirectly promote lower implant and medication costs.
Such reform in fact has been proposed in Congress but has not received any serious discussion or even consideration by the Democrat majority. The critical component of these proposals is expansion of Health Savings Account insurance. These policies include high deductibles, low premiums, and individual owned and controlled tax-favored health-care savings accounts. HSAs are not the entire solution to our health-care problems but would logically and effectively address a key cause of our health-care “illness”.
Two years ago facing yet another significant annual increase of our health-care premiums, Orthopaedic and Spine Specialists discarded traditional health-care insurance and implemented an HSA policy. OSS pays a significant portion of the premium and annually funds the health savings accounts with roughly 70% of the annual (high) deductable amount for our employees. Although the change did involve some effort to educate ourselves and our employees about the mechanics of the program, last year was the first that our premium did not increase and it appears the premium will remain stable again this year.
Indisputably, we need health-care reform but successful reform requires thoughtful and rational policy formulation, utilizing traditional American economic free market values; not hastily crafted, misconceived and intrusive government policies.
There is no problem so bad that it can’t be made worse by doing the wrong thing.
We must all fight to prevent the wrong kind of health-care reform and the dangerous expansion of government control and debt. Every individual can make a difference. Write your congressman and senators (contact info found at http://www.conservativeusa.org/mega-cong.htm); and join and contribute your time, energy, and money as you are able to grass root organizations such as the American’s for Prosperity http://americansforprosperity.org/national-site, American Liberty Alliance http://americanlibertyalliance.com/, and/or other free market based grass roots organizations.
Health-care costs currently account for 18% of our GDP and that percentage is projected to nearly double in the next 20 years. Escalating health-care costs place ever increasing financial burdens on families and businesses, threatening the long-term viability of our economy, the long-term solvency of our state and Federal governments, and, in the end, our opportunity and our children’s opportunity to live the American Dream. As needed for treating medical illness, successful treatment of this national health-care “illness, first requires thoughtful analysis to determine and identify the underlying causes of this “illness”.
While multiple factors contribute to ever increasing health-care costs, our health-care insurance system, which effectively disconnects the consumer of health-care services from the immediate cost of that care, is the essential driver of those costs. Certainly, the insurance premium cost is felt directly by the consumer who may pay for part or the entire premium, and/or felt indirectly through reduced wage dollars that are instead paid as health-care insurance employee benefit. However, once that premium is paid, there is little incentive not to use health-care services as much as one desires. Health-care insurance in our country is unlike any other type of insurance. Imagine the cost of auto insurance, if having paid the insurance premium one could have as much automobile as they desired or the cost of home owner’s insurance, if having paid the premium, one could have as much home as they desired. Once inside the health-care insurance system, the demand for services becomes almost unlimited. As a result, the cost to get into this system, i.e. the insurance premium, continually increases. In turn, the premium becomes unaffordable for more and more Americans or places increasing financial stress on families and businesses that continue to purchase health-care insurance.
The same mechanism drives the continually increasing Medicare and Medicaid expenses and propels those programs further into insolvency. As with the private health-care insurance, once inside the government (taxpayer) health-care programs, there is little incentive or restraining forces to limit demand for care. Not recognizing or not addressing this essential underlying cause of the health-care expense “illness”, the current health-care “reform” proposals effectively would place more people into the same unsustainable insurance system, and would only make the “illness” worse.
To achieve meaningful health-care cost control, any reform must include shifting the primary payment responsibility of routine medical care expenses and a higher percentage of initial extraordinary health-care expenses to the consumer of those services. Third party health-care payers would then be responsible for extraordinary medical expense above this higher consumer payment threshold. Much like high deductable auto or property insurance, health-care premiums for such policies would be significantly lower than for low deductible policies. The individual consumer could then apply the premium savings to payment of routine health-care and/or to payment of their portion of extraordinary medical expenses. Such a system would decrease demand for health-care services and therefore expenditures for health-care services. Further, the system would incentivize the individual consumer to demand more accountability and transparency with regard to quality and cost of those services from the providers of health-care services e.g. physicians and hospitals. This accountability and transparency would also indirectly promote lower implant and medication costs.
Such reform in fact has been proposed in Congress but has not received any serious discussion or even consideration by the Democrat majority. The critical component of these proposals is expansion of Health Savings Account insurance. These policies include high deductibles, low premiums, and individual owned and controlled tax-favored health-care savings accounts. HSAs are not the entire solution to our health-care problems but would logically and effectively address a key cause of our health-care “illness”.
Two years ago facing yet another significant annual increase of our health-care premiums, Orthopaedic and Spine Specialists discarded traditional health-care insurance and implemented an HSA policy. OSS pays a significant portion of the premium and annually funds the health savings accounts with roughly 70% of the annual (high) deductable amount for our employees. Although the change did involve some effort to educate ourselves and our employees about the mechanics of the program, last year was the first that our premium did not increase and it appears the premium will remain stable again this year.
Indisputably, we need health-care reform but successful reform requires thoughtful and rational policy formulation, utilizing traditional American economic free market values; not hastily crafted, misconceived and intrusive government policies.
There is no problem so bad that it can’t be made worse by doing the wrong thing.
We must all fight to prevent the wrong kind of health-care reform and the dangerous expansion of government control and debt. Every individual can make a difference. Write your congressman and senators (contact info found at http://www.conservativeusa.org/mega-cong.htm); and join and contribute your time, energy, and money as you are able to grass root organizations such as the American’s for Prosperity http://americansforprosperity.org/national-site, American Liberty Alliance http://americanlibertyalliance.com/, and/or other free market based grass roots organizations.
Monday, September 7, 2009
My Experience in Government Medicine
When I was in orthopaedic training, I joined the Army Reserve. The Army supplemented my limited resident income and I assumed a 6 year reserve obligation to serve in the Reserve. Upon completion of my 5 year residency at Penn State University Hershey Medical Center and a subsequent 6 month fellowship in spine surgery at the University of Rochester, the Army posted me to a local hospital reserve unit intending for me to drill with the unit 1 weekend a month. Knowing that the Army could better utilize my training and skills for which they helped pay, I sent such a letter inquiring where they might better use the services of a board eligible newly trained orthopaedic and spine surgeon. Subsequently, I was assigned to the Dunham Medical Clinic at the Army War College in Carlisle, PA.
Once a month, I would leave my private practice in York and run an orthopaedic clinic at Dunham primarily seeing military retirees. Very quickly, I became aware of significant differences between my 2 practices. At Carlisle, I was taken aback by my patient schedule, being assigned 3 patients an hour for 3 hours, then an hour for comp time, an hour for lunch and then 2 more hours of patient visits in the afternoon. I quickly revised my schedule so I could see 50% more patients and still evaluate and implement an appropriate diagnostic and treatment plan.
Further, in York, I provided care to individuals from the York community; while at Dunham, I was seeing patients from a 150 or more mile radius. When I inquired of my patients why they travelled so far, I learned that otherwise they would likely be traveling just as far to Walter Reed Army Hospital in Washington for orthopaedic consultation where there was a many week wait for a non-urgent consult. My patients in York typically were seen within a week or so.
Finally, ordering advanced diagnostics or planning surgery within the military system proved to be difficult and untimely. In York, if I saw a patient who needed an MRI, that MRI could be obtained within a day or two. If surgery, were recommended that could occur within a week or two. In the military system, obtaining an MRI involved a couple month wait and surgery a several month wait for non-emergent problems.
At the time, I had 2 distinct thoughts about the practice differences. First, I felt that there would never be nationalization of our health system because people would not tolerate such slow delivery of care (now I recognize that nationalization could take place against the will of the majority). Even more, it struck me to be manifestly unfair that military retirees, men and woman who had served their country should have second rate care. In practice, uninsured patients in York enjoy more responsive care than those military retirees.
Again, there is no doubt that our healthcare system, which draws people from all over the world because of its premier status, would benefit from reform to decrease expenses and improve access; however there is no problem so bad that it can’t be made worse by doing the wrong thing. More government involvement in healthcare is the wrong thing.
We must all fight to prevent the wrong kind of healthcare reform and the dangerous expansion of government control and debt. Every individual can make a difference. Write your congressman and senators (contact info found at http://www.conservativeusa.org/mega-cong.htm); and join and contribute your time, energy, and money as you are able to grass root organizations such as the American’s for Prosperity http://americansforprosperity.org/national-site, American Liberty Alliance http://americanlibertyalliance.com/, and/or other free market based grass roots organizations.
Once a month, I would leave my private practice in York and run an orthopaedic clinic at Dunham primarily seeing military retirees. Very quickly, I became aware of significant differences between my 2 practices. At Carlisle, I was taken aback by my patient schedule, being assigned 3 patients an hour for 3 hours, then an hour for comp time, an hour for lunch and then 2 more hours of patient visits in the afternoon. I quickly revised my schedule so I could see 50% more patients and still evaluate and implement an appropriate diagnostic and treatment plan.
Further, in York, I provided care to individuals from the York community; while at Dunham, I was seeing patients from a 150 or more mile radius. When I inquired of my patients why they travelled so far, I learned that otherwise they would likely be traveling just as far to Walter Reed Army Hospital in Washington for orthopaedic consultation where there was a many week wait for a non-urgent consult. My patients in York typically were seen within a week or so.
Finally, ordering advanced diagnostics or planning surgery within the military system proved to be difficult and untimely. In York, if I saw a patient who needed an MRI, that MRI could be obtained within a day or two. If surgery, were recommended that could occur within a week or two. In the military system, obtaining an MRI involved a couple month wait and surgery a several month wait for non-emergent problems.
At the time, I had 2 distinct thoughts about the practice differences. First, I felt that there would never be nationalization of our health system because people would not tolerate such slow delivery of care (now I recognize that nationalization could take place against the will of the majority). Even more, it struck me to be manifestly unfair that military retirees, men and woman who had served their country should have second rate care. In practice, uninsured patients in York enjoy more responsive care than those military retirees.
Again, there is no doubt that our healthcare system, which draws people from all over the world because of its premier status, would benefit from reform to decrease expenses and improve access; however there is no problem so bad that it can’t be made worse by doing the wrong thing. More government involvement in healthcare is the wrong thing.
We must all fight to prevent the wrong kind of healthcare reform and the dangerous expansion of government control and debt. Every individual can make a difference. Write your congressman and senators (contact info found at http://www.conservativeusa.org/mega-cong.htm); and join and contribute your time, energy, and money as you are able to grass root organizations such as the American’s for Prosperity http://americansforprosperity.org/national-site, American Liberty Alliance http://americanlibertyalliance.com/, and/or other free market based grass roots organizations.
Subscribe to:
Posts (Atom)
