Faber Healthcare Solutions

With the costs of health care on the rise, and the number of uninsured Americans larger than ever, both major presidential candidates have plans in place to reform the system. Unfortunately, both their plans are seriously flawed, and, as I have said before, until we as a society are willing to reconsider what our expectations are from a comprehensive health coverage plan, we will never be happy.

The candidates’ plans are presented in no particular order. Full disclosure: I am registered as non-partisan, belonging to no political party.

Senator Obama’s plan, in his own words, “begins by covering every American.” However, despite this assertion, details listed further down his web page, make it clear that he is offering availability to everyone, but not necessarily coverage.

In addition, Mr. Obama writes that everyone will have access to the same plan as federal employees and that they would have “affordable premiums.” One has to wonder who can afford such premiums. Reviewing the 2008 premiums for these plans, which vary by state and within states, the plans are hardly cheap. Lower cost individual plan premiums run $3,939/year, and family plans are $9,060/year. More expensive plans run $6,522/year for premiums, and families pay $15,081/year. Hard to call that affordable.

Of course, we forget that when employers pay for plans, that money is really coming out of the employee’s pocket, because it is the total compensation package that the employer pays for, and truth be told, if health coverage were not offered, that additional money would be available in the form of salary. But most people don’t think that way.

Senator McCain, on the other hand, clearly offers a plan with universal access, not universal coverage, saying “access to health care for every American.” His program relies on private enterprise to provide coverage to all Americans instead of implementing a government controlled plan. This, however, is simply not realistic. Health plans, despite what they want the world to think, are in the business of making money, and have no interest in covering the sickest (read: most expensive) patients. The Senator writes about his GAP program – Guaranteed Access Plans – but details are conspicuously absent.

To make matters worse, Senator McCain’s program offers tax rebates to employees who opt out of employer-offered health plans, with the intention that those people would use the rebate money to purchase their own health plan. Alas, he appear to have ignored the rule of unintended consequences: as young, healthy people, who can purchase cheap health coverage, opt out of employer-offered plans, and the sicker people remain with the ‘more affordable’ plan, the employer plans will become more expensive with each iteration as the plans find their members costing more each year, and ultimately the gap between those who do and do not need comprehensive care will grow wider yet. (The irony of gap v. GAP is not missed.)

Lastly, it is worth bearing in mind that foreign governmental plans that provide comprehensive coverage for all citizens (i) have special, usually high, taxes that pay for those plans, and (ii) have many coverage limitations that would shock most Americans. It is hard to imagine a universally accepted national health program in this land of opportunity that would have coverage limitations such as no dialysis over the age of 65, or no pacemakers over the age of 70. On the other hand, if such limitations, which are not unheard of overseas, would be absent in a national American program, the costs of our national health care would certainly exceed today’s 16% of GDP by a large margin, and that money would have to come from somewhere.

Our Federal government has expended an enormous (if unnecessarily complicated and hopelessly difficult) effort attempting to ensure the privacy of our medical records.

And yet …

On the front of every Medicare card (and a few holdout health plans), prominently displayed, is the patient’s Social Security Number. How reassuring.

Since the government is not taking steps to protect these patients, providers can. Patients can be taught a simple step to protect their identity; not carrying their actual Medicare card, but rather a photocopy with some of the digits blacked-out (although, naturally, they will need to provide those numbers at the first service). This can help protect them from pickpockets looking to steal their identities.

It would be a lovely trust-building step for your office to undertake in providing this service to patients. The copy will cost you pennies, but the trust built with patients is priceless.

Health costs rose around 10% in the past year for smaller businesses, and coupled with increasing costs for transportation, energy and supplies, they have been cutting back on health coverage for employees.

A survey conducted by the NJ Business & Industry Association found:

- While 4 years ago 92% of the smallest companies provided coverage, today only 77% do.

- 76% of the companies who dropped health coverage said that they did so because of costs.

- 52% of the companies who do provide coverage require employees to pay part of the premiums.

Premiums are expected to rise about 10% this year again. If it were because health costs went up, and health plans made only a modest profit, this would be a difficult but understandable reality. But as the AMA reports, the health plans are making a big buck at our expense (and force physicians to spend money fighting claims unnecessarily), and would rather lose members than lose profits.

What will next year hold?

The New England Journal of Medicine published a study this week about the efficacy of home defibrillators, just one day after the American Heart Association released new CPR guidelines.

The Associated Press published an article today, titled “Home Defibrillators Save Lives in Study.” Sounds promising … until you read the first sentence. “Having a defibrillator at home can help a heart attack survivor live through a second crisis, but so can CPR and at a much lower cost.” Which CPR are they referring to, the new method or the old one? And while both CPR and defibrillators work, is one better than the other? Let’s waffle. As Dr. Bardy, the study’s lead author said, ”There’s no downside’.’

Yesterday the New York Times published a column about the same NEJM study, titled “Few Lives Saved by Home Heart-Starting Devices.” Seems to have an opposing interpretation of the same study. Nope. It also concludes that the device and CPR save lives at the same rate: “But the study, of more than 7,000 heart patients, concluded that patients in homes equipped with the gear died at the same rate as those without it.” At least this column comments that the devices cost about $1500 apiece, considerably more expensive than, say, the hands the CPR-performer was born with, and considering the results were identical that makes owning a home defibrillator an inefficient use of resources. The article quotes Dr. David Callans, a professor at UPenn, who commented on having a policy of home defibrillation devices, saying “It’s a great example of what is wrong with American health care.”

The New York Times carried both articles on the same web page. Hmmm.