Health Care Reform Issues

League of Women Voters^®
of Greeley-Weld County, Inc.

Summary of remarks by Dr. Randy Marsh July 28, 2009

Current System

60-65% of Americans are in some kind of federally supported and run health care system: Medicare, Medicaid, Veteran's Administration, SCHIP, Federally elected officials' health care system.
Money for these programs comes from one source--taxes--and pays from one source.
Insurance is the most expensive things we buy in our lifetime.
Some states (Massachusetts, Oregon) have tried to create solutions but they haven't been able to control cost.
Uninsured are not the center; they are result of the critical problems
Three most critical problems in current system:

COST
LACK OF FAIRNESS
CURRENT SYSTEM IS UNDERFUNDED

SOLUTIONS

All are equal
All in one system

COST problem contains this subset of issues:

Insurance Companies
Practice Inefficiencies (Doctors and Hospitals)
Defensive Medicine
Drugs and Medical Devices
Manpower
Individual Responsibility
Rationing

1. Insurance Companies

Should be independent of government, publicly funded, privately run (Congress will resist this).
Simplest solution is to extend Medicare to all with a private, non-profit governing authority.
Alternative system: Government delegates insurance to non-profit private companies who compete for business.  More complicated.  Companies must give same policy to everyone.  Companies make money on other types of insurance (house, car, etc.)  Tax money goes toward premium based on a sliding scale, based on income.  Currently, 2/3 of income taxes are paid by the top 10% of population.

2. Practice Inefficiencies

Fee for service for doctors needs to be eliminated; currently, doctors paid for quantity of services not quality (If you do more, you make more)
Bundled payments needed (examples: Mayo, Cleveland, Kaiser)

3. Defensive Medicine (malpractice insurance problem)

Less than .6% of the cost of medical care
Hidden costs of malpractice insurance: unnecessary testing
Solutions:  Need to change tort law  If one is injured in health care system, cost is paid for from public fund  Make system safer  Re-educate doctors and assess performance

4. Drugs and Medical Devices

Create an oversight board that controls costs
Bundled payments

5. Lack of Manpower among primary care providers

Need to support education for primary care providers
Increase numbers of nurse practitioners

6. Personal Responsibility

Healthy nutrition, exercise, healthy practices
Provide premiums for not smoking, working out, etc.

These ideas are based on the Dutch health care system.

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