To Make Health Care Reform Work: Lower Health Care Costs

Every serious attempt to reform the U.S. health care system dies with the same question, the only question that seems to matter any more..."How are you gonna pay for it?"

Therefore, any attempt to reform the health care system that hopes to have any chance at success, or to make it past any state legislature, must anticipate, and clearly address the question.

There are two exceedingly simple ways to lower the cost of health care in the United States:

1. SIMPLIFY

2. PREVENT THE PREVENTABLE

First and foremost, the United States health care system is trapped within and weighed down to the point of breaking by a horrible, complex mess of Byzantine rules and regulations that complicate care and GREATLY INCREASE COSTS.

The key to successfully reforming the U.S. health care system is to greatly SIMPLIFY these rules and regulations.

At the risk of boring my dear readers, but to give just a taste of the administrative nightmare that medical organizations must traverse, the following is a simplified version of what needs to be considered today, in America, when billing for a patient visit...in order to submit a bill for service, every time I see a patient I have to calculate a level of visit code, which is based upon:

• Whether the person is new to the practice or a previously established patient
• Is being seen for evaluation and management of a medical problem or for preventive care (or some combination of the two, in which case you need to calculate and submit two codes)
• Then one of 5 billing codes is selected based upon:
• The number of items discussed in the patient's "history of present illness"
  
• The number of systems discussed in a patient's "review of systems"
  
• Whether or not or how many items have been reviewed from a patient's past medical history, family history, or social history
• The number of body systems examined, and the number of items within each system in the physical examination
• Then the level of medical decision making must be estimated, which is based on the general risk of the case, which can be minimal, low, moderate, or high
• The complexity of the diagnosis or treatment options
• The complexity of the patient data (testing) that has been performed (which, I suppose are all quite subjective)
• But, you could bypass all of the above and bill based on time, if at least one half of total face-to-face time involved counseling or coordination of care
• Then we have to assign diagnostic (ICD-9) codes to each diagnosis, which can be extremely difficult, because the coding system is incredibly complex and sometimes uses names for diagnoses completely different from the terminology doctors are taught
• Then CPT codes for any testing or other services that we may have provided
• Then, all this information has to be arranged on a billing form, which is different for each insurance company, and is so complex that it is usually done by billing staff.
  
• To make matters much worse, the insurance companies have large staffs, and often deny claims or large portions of them, based on idiosyncratic, arbitrary decision-making schemes.
  

I hate to tell you, but that was a simplified version, and only describes one layer of the many that a physician's office needs to weed through in order to practice in the 21st century (the dark ages). Because of the complexity, most physicians no longer feel capable of having their own offices, and choose to work for larger organizations, and all health care organizations, regardless of their size, need to have multiple administrative staff to take care of billing and other non-clinical duties, to the point that now approximately 1/3 of every dollar spent on health care goes towards administrative costs.

The lesson, of course, is that we need to SIMPLIFY THE SYSTEM! It is impossibly complex, does not improve patient care (probably diminishes and limits it), does not provide accurate data (it's too complex to use accurately), and adds a huge amount to the cost of medical care. There need to be greatly simplified and nationally uniform billing and coding schemes and one simple uniform national billing form. The current system, as determined and applied by Medicare/Medicaid and the hundreds to thousands of health insurance companies needs to be thrown out and completely redone and greatly SIMPLIFIED and uniformly applied across the country. Without this change, health care and health care reform will be too expensive. This needs to be STEP ONE of fixing and reforming the health care system.

STEP TWO is to PREVENT THE PREVENTABLE. In other words, and I'll try to be brief, a large proportion of medical care today involves preventable problems, such as obesity, diabetes, heart disease, smoking related lung problems, and many preventable cancers. It is well known that as our population ages that the costs of caring for these often PREVENTABLE conditions are going to expand, and likely become unsupportably expensive. We must embark on a national campaign to BE HEALTHY, to exercise and eat better, and to limit smoking. This must be officially, governmentally, coordinated and supported in homes, schools, and places of work. Such a campaign is necessary and will have a HUGE impact on our national well-being and health care expenditures, without which health care, and health care reform, will be too expensive.

To summarize, the number one requirement of successful health care reform is to successfully answer the question, "how are you going to pay for it?" The way to pay for it is to SIMPLIFY the system, and to PREVENT PREVENTABLE medical conditions.

BE HEALTHY