Can We Drain the Swamp ?

Like Washington, D.C.  Healthcare seems to have become a swamp. Perhaps the situation is similar. As we have witnessed in politics when the swamp is drained it exposes the muck and rotten roots below the waterline.

As I was doing my background research on this topic I discovered my title was already coined by the American Association of Family Physicians (AAFP)

If health economics were exposed (transparent) and the public knew what transpires below the water level there would be an uprising.

The swamp already existed prior to ObamaCare

Trump Needs to Drain the “Healthcare” Swamp

Let's say at the outset that Trump cannot drain the swamp. What it will take are congressional hearings (public) and transparent first to identify what the swamp contains.

Congress allowed the swamp to be built and now every taxpayer or healthcare user needs to stand up and demand Congress to fix it. There is however a problem.  I have seen many . ' experts and physicians drawn upon by congress as advisors. Their recommendations are rarely accepted. These are authoritative sources from the private sector, think tanks and other repositories of credible knowledge.  Many have resigned after their ideas were left on the table and discarded.

Our federal government is huge and has great inertia.  It takes a lot to move it.  Most suggestions will affect a segment of health care and health care financing. When that occurs the lobbyists show up paid for by interested parties. 

In his Feb 28 address to the Joint Session of Congress, President Trump called the Affordable Care Act (ACA, or “ObamaCare”) an “imploding disaster.”

His references to soaring premiums, contracting choices, and market collapse are all spot on. And of course, everybody wants “reforms that expand choice, increase access, lower costs, and at the same time, provide better Healthcare.” Trump wants Americans to be able to choose “the plan they want, not the plan forced on them by the Government.”

But what must we do “first” and “second”? From a physician’s perspective, “first” is to make the diagnosis. “Second” is to remove the cause of the ailment if possible. And that means to drain the swamp.

Unfortunately, Trump’s “first” is to “ensure that Americans with pre-existing conditions have access to coverage” and “second” to “help Americans purchase their own coverage, through the use of tax credits….”

These “popular” ideas emanate from the swamp, percolating up through lobbyists, think tanks, and congressional “leadership.” Correctly translated, these mean to abolish true insurance—and the only reason for buying it when healthy—and to force healthy or higher-income people to pay more than their fair share. A “refundable tax credit” is a disguised subsidy, courtesy of present and future taxpayers.

And who are the swamp dwellers? They are the ones who siphon off a huge portion of $3 trillion “healthcare” dollars—perhaps 50 percent or more—before it goes to anything recognizable as a medical good or service received by an actual patient. They are part of the vast growth in the number of administrators compared with physicians. They include the “nonprofit” hospitals that charge up to ten times as much for a surgical procedure as the Surgery Center of Oklahoma does. They include brokers who “re-price” medical bills—getting a 30 percent “discount” from a bill that is overpriced by a factor of two or more and pocketing a cut of the “savings.” And they include the code writers, the regulation writers and auditors, the software and hardware vendors, and the data aggregators who are selling your medical record for profit.

Denizens of the swamp are self-identifying, as in a Jan 25 letter to President Trump and Vice President Pence offering to help implement “value-based” care. The more-than-120 signatories include the American Medical Association (whose main cash cow is the CPT procedure codes that doctors must purchase), numerous other medical trade associations (who help doctors learn how to comply with ever-changing rules), insurers, giant hospital systems, pharmaceutical companies, and self-certified “quality” agencies.

The “resources” they plan to save come from care denied to patients, and especially from the 19 percent of medical spending that goes to physicians’ practices. Instead of paying doctors more if they work more (“fee for service”) the system will pay for data collection and protocol compliance, and punish doctors if they order more tests or treatments for patients. And of course, all those involved in determining “value” get paid first.

The healthcare planners’ bane is the 10 percent of medical spending that goes directly from the person getting the service to the person providing it. None of this leaks into the swamp, and the value is determined by patients, who are presumably too ignorant to make complex judgments.

Swamp dwellers generate reams of studies about the resources that go to actual medical care—some of which would be exposed as being of limited value if patients had to pay out of pocket for them voluntarily. But such studies avoid mention of the enormous resources that go to “planning,” “certifying,” “evaluating,” “reviewing,” etc.—which vanish without a trace into the bureaucracy. Of course, these agencies like to conflate “care” with “coverage”: care is a loss, not a profit center. Even if ACA demands a “medical loss ratio” of 85 percent, that means at least 15 percent is diverted from actual care, and 15 percent of $3 trillion is a huge amount of money. If coverage is “comprehensive,” third-party managers have access to much more than they would if insurance covered only unpredictable catastrophes.

Everyone has an idea, what is yours. Please comment