A word on health care from front lines: Fix reimbursement
| Monday, Sep 14 2009 10:30 AM
Last Updated Monday, Sep 14 2009 10:32 AM
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I am not a health care expert, just a single soldier living in the trenches of that American battlefield known as the emergency room. I can't list endless statistics about one system vs. the other, only my perspectives on what I think needs to be done.
Everyone agrees that we need health care reform. But I do not think we need a complete overall of the entire system in order to cover Americans who aren't covered by medical insurance. About 85 percent of Americans are happy with their insurance. So let's fix the problems we have with the uninsured.
We can start by establishing a fair and reasonable rate of compensation for services rendered on a national scale. Currently that compensation varies from state to state and region to region. For instance, MediCaid in Arizona pays a different rate than that of Nevada or Utah. Since MediCaid is a federally funded program (with state contributions also a factor), the compensation rate should be determined by an independent committee. States should not be permitted to tinker with it, as California (which has one of the lowest compensation levels in the nation) has done. It is no wonder that MediCal patients flood the ERs in California, as they have no where else to go -- primary care doctors can't afford to see them.
Fair and reasonable rates should be determined for all procedures and services for all payers across the board. Medical insurance companies would know how much they are going to be paying out and physicians and hospitals would know what they are going to collect. It should be established by convention and agreed upon by everyone. Then physicians across the country are paid for the patients they see, the procedures they perform and the equipment and medication they use.
It's a sad commentary on our society that the No. 1 reason for bankruptcy in the U.S. is medical bills. Americans should not have to lose everything because they have become ill and need medical treatment. This speaks to the compassion of our society that such fears have a real basis in reality.
Consumers' biggest complaints with insurance companies are rising premiums, excluding coverage because of pre-existing medical conditions, and the increasing denial of medical coverage. One way to fix that, along with a nationwide fee schedule, is to declare medical insurance companies as "utilities" subject to public oversight. They can still make a profit and pay shareholder dividends, but an oversight agency would regulate how much they can raise their premiums, and companies must justify costs.
Cost containment is one of President Obama's priorities, but this approach still allows the private sector to run health care, rather than a huge government bureaucracy. Such an oversight agency could also investigate abuses. The state Department of Managed Health Care has been seriously flawed in that regard, and it is not the model we should use.
Congress might also limit medical insurance's administrative and marketing costs to 10 percent of premiums collected, and the rest must be used for patient care.
Limit administrative costs (and CEO salaries) or mandate that medical insurance companies be nonprofit. It seems a conflict to me to have an insurance company authorizing care and also trying to increase profits. Those two goals seem contradictory. Ethically, the two cannot co-exist.
I firmly believe that we can fix our health care issue with prudent legislation -- without creating a huge new bureaucracy and putting the U.S. further into debt. The key is cost containment along with affordability, portability and coverage for all.
Dr. Kevin Schmidt is president of Emergency Medical Services Group, which provides services to emergency departments.
