Well, I can say that I definitely made a mistake trying to break up my thoughts on health care into multiple posts, rather than one big one.  In Part 1, I laid out what I believe to be a Christian view on where provision of health care belongs, and on the role of government, as seen in Scripture.

In short, the basic principle is this – It is the job of Christians and the church to help bring healing to the world.  It is the job of the government to provide for the common defense, a system of justice and rules for civil order.  We have reached the current crossroads because both have failed in their mission to this point.

Now, the question at hand, though, because of current events, is what should the government do about health care.  Some have taken the previous article as an argument for the status quo, which it was not.  It was simply a statement of my belief that Christians should not be content with the government taking a role that should belong to them and to the church.  It was also a warning that such a move of government, outside of its Sciprutal boundaries, is a move toward entitlement and further enslavement of its people.

What this is and is not

Now, though, I would like to outline some ideas – things that the government can do that are within its boundaries – that would help fix the current system.  This is not to say that I do not think the church should be actively involved in helping to fix the problem by filling the current void.  I think that the creation of hospitals, clinics and other provision of care should be at the forefront of the church’s mind, not just the “spiritual” well-being of the people.  This compartmentalization (of the spiritual from the physical) is a disaster, aided and abetted by the fundamentalist tradition of the past 100 years.

Also, the reader has my advance apology for the dryness of this article, as many of the illustrations and outside applications I’d planned on using would make this truly a behemoth of an article (more so than it will already be).

Technology

My background is in engineering and information technology project management, and I am always amazed at the inefficiencies on the administrative side of the healthcare profession.  One of the basic set of inefficiencies in the healthcare arena is in the area of paperless and b2b information technology.

While technological advancement in healthcare, itself, has moved at a fast pace in America, some of the basic blocking and tackling of information technology has not been addressed, partially out of privacy concerns, but also because of a good deal of red tape in its way.  Putting standards in place for patient data and records, allowing them to be portable, allowing consumer-gated permissions for sharing across providers and insurers will significantly reduce the current administrative burden within the system.

The data standards should be encompassing enough to capture data required for insurers (which also significantly reduces duplicate documentation), and standards for paperless submission, retrieval and processing of claims.  They should also allow for direct transfer of patient information to secondary providers (labs, pharmacies, etc.) that would make it more easy for consumers to make cost-conscious decisions for these secondary services.

Finally, by having personal data in a standardized fashion, a government-run website could allow patients to temporarily import their records and compare them to public norms and trends, and provide them with high-level advice on preventative lifestyle behaviors customized to their own data.

One of the challenges is in the area of privacy – making data more fungible – is that it becomes more succeptible to privacy abuse.  Controls would need to be put in place for this, with consideration to the consequence of some information being accidentally (or purposely) revealed in breach of privacy.

Tort Reform

If America’s health care system is broken, its tort system is completely smashed.  In the healthcare system alone:

• PricewaterhouseCoopers calculates that medical liability concerns increase annual health care spending by $124 billion in 2006 dollars. The additional cost of liability-based health care costs adds 3.4 million Americans to the rolls of the uninsured. (“Jackpot Justice: The True Cost of America’s Tort System,” Pacific Research Institute, March 27, 2007)
• Ten percent of every dollar spent on health care is attributed to the costs of liability and defensive medicine. (“The Factors Fueling Rising Healthcare Costs 2006” PriceWaterhouseCoopers, January 2006)
• An estimated $50 billion per year is spent on unnecessary test procedures designed primarily to guard doctors and hospitals against malpractice claims. (Fear of Litigation Study, Conduced by Harris Interactive, Final Report, April 11, 2002)
• Nationwide, 45% percent of hospitals reported that the professional liability crisis has resulted in the loss of physicians and/or reduced coverage in emergency departments. (American Hospital Association, Professional Liability Insurance Survey 2003)
• Almost 80 percent of Americans concerned that frivolous lawsuits have made it harder for them and their families to get affordable health care coverage. (Sick of Lawsuits National Survey, Conducted by Public Opinion Strategies, August 16-18, 2005)
• Quality and access to health care is being threatened in many states. The American Medical Association has identified 20 states as presently facing a medical liability crisis. (”Mass. Named State in Medical Liability Crisis,” American Medical Association, June 14, 2004)
• Women in almost half of the states in the country are experiencing disruptions in obstetrical care. The American College of Obstetricians and Gynecologists’ has identified 23 states where medical liability problems threaten women’s access to physicians delivering their babies, a figure that is up from 16 states two years ago. (”ACOG’s Red Alert on OB-GYN Care Reaches 23 States,” American College of Obstetricians and Gynecologists, August 26, 2004)
• The impact of lawsuits on the health care system has encroached on critical doctor-patient decisions, such as deciding on course of treatment. More than 90% of high-risk medical specialists said that liability pressures were important in their decision to stop providing certain services. (American Medical Association Survey, PR Newswire, April 3, 2003)

Recently, Texas enacted malpractice reform, which has resulted in an influx of doctors, increased enrollment in medical schools, and lower health care costs in the state.  Good malpractice reform would include a number of provisions: caps on “pain-and-suffering”, board pre-determination of case merit (which would trigger ‘loser pays’ if the case was not deemed meriting), consequences for ‘merited’ repeat-offenders, and tougher standards of evidence to prove negligence.

While malpractice reform is an important component currently missing from healthcare plans on Capitol Hill, product liability reform is also needed for medical devices, instruments and pharmaceuticals.

For example, the increasing cost of vaccines has outstripped that of pharmaceuticals as more and more manufacturers are driven out of business by legal predators.  Vaccines are particularly vulnerable to abuse in the tort system, because the inherent side-effect profile is much more dangerous.  Because many vaccines are made with the viruses they protect against, a small percentage of patients taking the vaccine actually contract the disease.  This is not the fault of the manufacturer, but of the genetic makeup or environment of the patient.  But this does not matter in the current legal climate.

A nice side-benefit of such reform is that it would spill into other areas of product liability which currently create a ‘hidden tax’ for US consumers of almost all goods.

[As a side note, during a recent tetanus vaccine shortage, private clinics had to pay $95/dose.  At the time, Medicaid would only reimburse $65 for administering tetanus vaccine.  So, Medicaid patients were often sent to emergency rooms to get the vaccine, because private clinics - often willing to donate free service to the poor - were not just being forced to donate time, but to also pay for the care of the poor if they administered this vaccine in their offices.  And this is just one example.]

Fraud Prevention

One of the dirty secrets of Medicare is the amount of fraud and abuse that exists within the system.  One recent government audit found that 3-4% of government health care claims (worth 7.5% of funds) were fraudulent (some estimates show that this is low, and is more likely up to 10% of claims).  That’s $75-100 Billion.  Currently, Medicare spends 0.2% of its budget on combating fraud.

If we compare that to a private-sector industry with a similar number of claims, a similar amount of money, and a high threat for fraud- the Credit Card industry – we find that the credit industry has a fraud rate of 0.03% – more than 100 times lower than the Medicare/Medicaid fraud rate.

And we want to put more people into the government plan?  That’s crazy talk.

The government needs to spend more on fraud prevention, which in the end will result in significantly less overall spending due to fraud reduction.

Health Insurance Plans

Keeping in mind the underlying principle of reducing the individual’s dependency on the state (or other human entities), and increasing personal responsibility, there are a number of reforms that could cut costs, improve overall health, and allow more to be insured (if they wish to be).

The use of Health Savings Accounts should be encouraged, as they provide catastrophic coverage, but have high deductibles and a number of incentives that encourage their participants to make wise health decisions, for which they are rewarded.  Such plans limit the abuse found in low-deductible, comprehensive plans which encourage over-consumption and raise the overall cost of healthcare.  [Unfortunately, the current plans on Capitol hill basically outlaw HSA's and force the low-deductible, comprehensive plans on everyone - which will do nothing to stem the costs of healthcare, and will result in rationing and other problems.]

Additionally, health insurance should be available across state lines and portable when they change jobs.  Insurance companies should be incented to create policies that better fit high-risk pools and pre-existing conditions.

Those employed by small businesses, churches, and the self-employed should have the ability to join private co-ops that have many of the same tax advantages that large corporations gain from the economy of scale (which picks up a large number of the uninsured, who work for such small organizations).

Healthcare Provider Transparency

Healthcare Providers should be required to post the costs of their procedures, supplies, tests and other treatments – along with their health impact – on the internet.  This would allow their patients to be most cost-conscious – both when choosing a provider and when choosing the procedures & treatments they wish to use.  It also allows more transparency between competitors, which results in improvements to internal efficiency.

For chronic illness treatment (Diabetes, Cancer, Heart Disease, etc.), Healthcare providers should be encouraged to treat these as an overall “package”, rather than as discrete visits for treatment.  This results in more consistent treatment over a long term, while reducing costs.  Additionally, it can help insurers structure plans for those with pre-existing conditions by giving coverage for the pre-existing condition ‘packages’, but more HSA-like provisions for conditions that are not pre-existing.

Funding & The Poor

But what about the goal of improving care for the poor?

To begin with, by improving the efficiency of the existing providers and insurers, both money and time are freed up that can be spent caring for the disadvantaged.  Additionally, by removing the disincentives that drive medical professionals out of medicine (or from ever joining it in the first place), the availability of providers is increased – which also benefits the poor.

Additionally, the government can provide incentives for the existing insured to make wise choices by taxing employer plans that are not  consumer-cost conscious – which encourages HSA’s (or similar cost-conscious plans for those with high risk or preexisting conditions) and provides funding from those plans which are more cost-consuming (like low-deductible comprehensive coverage).

Aditionally, the government can provide tax credits to refund the costs of insurance to low-income consumers.  This keeps the government out of the insurance business, while rewarding those who would not be able to afford insurance otherwise.

What This Does Not Include

As I noted at the beginning, this does not include where I think the church should fit into the system.  However, I think that the following ideas (which can be expanded on later) would be practical examples of how the church could step into this system (which has much less allegiance to Caesar):

1) Church-run clinics for low-income citizens – primarily providing vaccinations, lifestyle planning and basic consultation

2) Parachurch insurance co-ops

3) Classes available to the public on how to make the best healthcare choices (keeping in mind the increased amount of data available to the public)

4) Money to help the poor meet short-term needs.  Since catastrophic coverage would be more widely available, the needs would be more primarily geared toward more managable disease states.

etc.

If all of these things could be accomplished in comprehensive “reform”, the overall number of uninsured (who wish to be insured) would be significantly decreased and health care costs curbed.  Is it likely there would still be problems to fix (some of which, one would hope, the church could step into the gap to repair), but they would not require increased government dependency.