Back to Basics

A real case of government healthcare…

One of my daughters became pregnant and found to everyone’s surprise she was going to have identical twins.  The news came with mixed emotions as well as difficult decisions.  This was not her first child and she, like many in the family, believes in natural childbirth without medication.  Only her first child was born in a hospital while all the others were born at home with a midwife.

She initially started seeing her midwife for prenatal visits, but when they discovered she was expecting twins the reality of government interference took hold.  The state of Arizona does not allow midwives to knowingly delivery twins, so they had to find a doctor.  They are on the state insurance, which poses it’s own challenges.  However, trying to find a doctor that not only would accept the state insurance but would also deliver twins and accept a patient at 10 weeks became almost an impossible task.  It took her a month to even obtain the booklet of doctors she requested from the state to start her search.  She went through the book and was more often turned down because the doctors no longer accepted the state insurance.  With the help of her midwife and fortunately a state employee willing to help, she was able to obtain the services of a high-risk OB team.

Through the ultrasounds they discovered the babies were identical twins, had separate bags of water but shared one placenta.  This put her in a higher risk category.  At one point during the pregnancy they determined she was experiencing twin-to-twin transfer and was then referred to a specialist.  Because of this the doctors wanted to see her 3 times a week and she underwent regular ultrasounds and non-stress tests.  During her third trimester an ultrasound indicated she actually had two placentas; that there was a division in the placenta that had not previously been noticed; the twins may not be identical.  At that time it was also revealed that she had not actual experienced twin-to-twin transfer, it was only borderline.  With only 4 weeks remaining until her due date the doctor told her she needed to find another doctor because she was now no longer considered high risk!

She took childbirth classes at the hospital she was to deliver at.  She is also a childbirth instructor so these classes were quite unnecessary from a childbirth aspect, but with this unusual pregnancy she wanted to be informed about the hospital, their procedures, as well as the special considerations in delivering twins.

During her regular doctor visits they discussed the expectations of delivery.  This resulted in a difference of opinion from the doctors and expectant parents.  The doctors believed in a medicated birth with a likely outcome of an induced labor as well as a cesarean delivery.  The parents believed in an unmedicated birth, as natural as possible, and only in an emergency to save the mother and/or babies did they want a cesarean.  They created their birth plan and the doctors made their modifications.  They were able to “negotiate” delaying an induction until 38 weeks.

She went in to labor naturally and the first baby came quickly.  They never made it to the hospital.  Labor never stopped and what seemed like a very short time later the second baby was delivered; he was a breech delivery.  Both babies were well and of good size, especially for twins (7 lbs. 14 oz. and 6 lbs. 9 oz.) with the mother and father cooperating during delivery; no one else was present.  This was a Sunday and at this point they did not want to go to the hospital because there was no need.  So they contacted one of their midwifes who came over to make sure mother and babies were okay – everyone was fine.  It also turns out the twins are identical, sharing only one placenta – the latest ultrasounds were wrong!

On Monday morning they contacted the OB doctors and told them the babies were delivered.  The parents asked if they should come in to be seen by the doctors and were told by the doctor’s office that they should come in 2 weeks.  The parents questioned this and the doctors decided they should make an appointment for that Thursday.  Everything seemed fine.

However, the parents received a call from the referring midwife indicating the doctor had issued a 911 call and told her to see the mother and babies immediately.  This second midwife came over Monday and checked everyone out – everyone was fine.

They kept their appointment on Thursday with the doctors, and again everyone was fine – or so they thought.  They expected to return to the doctor for her 6-week visit.

The democrats’ approach to reforming the health care system makes about as much sense as amputating an arm because someone broke a finger.  Instead of addressing the problems in smaller doses they are going to turn the entire system upside down.  I don’t know if they have been listening, but the United States has the best health care in the world.  Why would you want to destroy that?  They want to model it after systems like Canada, but have they listened to the complaints and problems Canada has?  People from Canada come to the United States for treatment because they can’t get it in their own country!  Canadians also have to carry secondary insurance because the government insurance isn’t good enough.  They also pay a HUGE percentage of their income (and not just the “rich”) to pay for these programs.  Is this really what we want?

Even in our own country the state of Massachusetts has their own version of universal health care.  Just recently they reported a cut in coverage to certain groups of people because they don’t have the money to keep the system running.  People who once had good coverage are complaining because they now have to wait to see a doctor or get treatment.  Sure, they may brag that they have the lowest uninsured population, but having the insurance and obtaining care are not the same thing.  The Massachusetts system has started failing in 3 years!

So I ask again – are the democrats listening?  Repackage, renaming or doing whatever creative means to disguise the same bill is still an attempt at passing the same bill.  We are getting tired of the democrats and president trying to sell the same used car with a different paint job.

Reform should start with the very basics and address the problems of the system.  Take it a step at a time, making changes to address the critical problems first, and then continue to monitor the system to see how much more is needed.  Treat the system like a patient – don’t do radical surgery when medication or a change of diet may solve the problem.

The uninsured is one of the current issue.  There are a good percentage of uninsured that have chosen to be uninsured.  They are people who are making a decent living and have made a personal choice not to obtain insurance.  Perhaps they are young and don’t feel the need for it.  They may be a family who does not have the children covered but the parents are.  Whatever the reason, it is their choice.  The government should not force them to purchase insurance.  However, if they have chosen not to obtain insurance then taxpayers should also not have to foot the bill for their medical issues.

The government has caused one of the problems in the system today by passing a law stating everyone has access to health care through the hospitals whether they can afford to pay for it or not.  This law allows anyone, including illegal immigrants, to visit their local hospital and obtain care for anything.  Many of these visits are for something that should be taken care of in a doctor’s office or clinic, but because they don’t have insurance they visit the hospital.  If insurance reform is made, then this law should be revised to only include life threatening illnesses or injuries only to citizens or legal immigrants.  Any minor health issues would be seen as long as the person could pay for the services, or should be referred to a clinic or doctor – which also would require payment.  So, if the person makes the choice not to purchase health insurance then they would have to deal with the financial consequences – not the taxpayers and not the hospital.

I am not talking about the citizens who simply cannot afford insurance.  Part of any reform should include government subsidies to help those people obtain insurance.  Many are now eligible for Medicaid or a state health care system, so they are not without coverage.  If they have not applied for that coverage you cannot blame the system; you have to hold the individual responsible at some point.  These services should continue, but should be limited to citizens or legal immigrants only.

The second group of uninsured are those with pre-existing conditions or chronic illnesses who cannot afford coverage or have had coverage cancelled or been declined coverage.  Congress has already passed a bill that allows states to set up high risk pools to provide insurance for these individuals.  The system has already been established, but many states have failed to create that system.  Some states have done a great job, others have struggled.  You have to start holding states responsible.  Take those states that have created the system that works and make it mandatory for all states to create a system that models the ones proven to work.

Another group of uninsured are those whose employer does not offer health insurance or the small business owner.  There are some policies offered to cover these individuals, but in my own search for a policy I found it difficult to find, more expensive with less coverage.  There is no reason creating new pooling systems to provide insurance policies to these people cannot be done.  The insurance companies need to be responsive to the need and demand for these policies and they need to be allowed the opportunity to create such pools.  The policies should be equivalent to those offered to large corporations at similar rates.  Further, anyone that pays for their own insurance policy should be given some sort of tax advantage, similar to what employees receive when they purchase insurance through their employer.

Insurance policies should also be customizable to individual needs.  Your basic insurance plan needs to be established to cover all the basic medical needs anyone may encounter.  The individual should then be able to determine and purchase additional options to customize their care.  If you are a single male or a female beyond childbearing age or have had a hysterectomy, then you would not need to “add” maternity coverage to your policy.  If you don’t smoke or drink alcohol then you wouldn’t need to add coverage to address those issues.  You may want to “add” chiropractic services to your plan, maybe naturopathic medicine, children’s well care checkups, hair replacement treatments, or any number of other options that would meet your needs and personal beliefs to address your health issues.  Other options would include what deductibles you want to set, co-pays for office visits or other services, and the percentage you want to be responsible for.  In this manner people would be paying only for the services they want and need instead of some inflated policy covering medical issues they will never use.  These policies should be made affordable and each individual would have control over their costs.  If they can only afford the basic coverage, then that would be their choice.  If they really want cosmetic surgery covered, then maybe that is an option they could add that they would also pay an additional premium fee for.  The choice should be up to the customer – not the insurance company or employer.

How much will the H.R. 3200 cost?  Historically, the cost estimates of every medical program implemented by government has cost more, often significantly more.  Massachusetts passed a universal-coverage plan in 2006, which required all residents to have health coverage and gave subsidies for lower-income uninsured families.  Sounds like the plan the government wants to pass for the country.  The plan was estimated at $472 million for 2008, yet the actual figures for that year were $628 million.  They made some assumptions that proved incorrect.  They assumed that as more people joined the system the premiums would go down across the board.  They further assumed that as more people became insured the number of people visiting the emergency room would drop dramatically.  They assumed this would save them money.  It backfired!  None of these things happened and the health care reform that was supposed to save money has cost more money than expected!

Similar budgetary problems have been seen in Federally run programs.

When Medicare, Part A was established in 1965, covering the hospital insurance portion of the program, the cost was estimated at $9 billion annually by 1990.  The actual spending in 1990 for Part A was $67 billion.

In 1967 the new Medicare program was estimated at $12 billion for 1990.  The actual Medicare spending for the program in 1990 was $110 billion.

A universal entitlement to kidney dialysis was enacted in 1972 at a cost of $100 million for 1974 and actual spending was $229 million for that year.

The DSH program established in 1987 which states use to provide relief to hospitals serving large numbers of Medicaid and uninsured patients was estimated at a cost of less than $1 billion in 1992.  The actual cost for that year was $17 billion.

When Medicare’s home care benefit was changed in 1988 the projected cost for 1993 was $4 billion.  The actual cost in 1993 was $10 billion.

In 1988 a catastrophic coverage benefit was added to Medicare to become effective in 1990.  The cost estimates for this program were initially $5.7 billion and then raised to $11.8 billion, and even the revised number they estimated might be too low.  The program was repealed before it could take effect, largely due to the cost estimates.

The State Children’s Insurance Program in 1997 appropriated $40 billion to states over 10 years, with estimates of $5 billion a year once it was implemented.  By 2006 all unspent reserves were nearly exhausted and Congress appropriated an additional $283 million in 2006 and $650 million in 2007.

Bill H.R. 3200 is estimated at a cost of $1 trillion over the first 10 years and $2.4 trillion over the first 10 years of full implementation.  With the track record of the government grossly underestimating the cost of medical programs, one can only guess what the actual cost will be.  The country already has serious financial problems with spending in the first 8 months of this administration greater than all presidents combined.  The country just cannot afford to invest that amount of money on a program that has been proven in one state not to obtain the desired results at a significant increase in cost.