Fix Healthcare by Slowing the Gravy Train
by Steve Busalacchi

The U.S. healthcare system is stuck a financial quagmire, and everybody knows it. “I provide the service, he gets it, and you pay,” deadpanned anesthesiologist Saied Assef, MD, during the well-attended health forum I moderated September first in Green Bay. Doctor Assef rightly pointed out that any commodity traded this way would lead to spiraling cost increases. Well, our country pays almost 50 percent more per person on health care than the next most expensive nation, according to President Obama. And there are plenty of reasons for that.

Much of America’s financial healthcare ails are rooted in our insurance system, both for health and medical liability coverage. Let’s talk medical malpractice insurance first. Just as drivers of automobiles are required to have licenses, those trained to practice medicine must be licensed, as well. As part of licensure, physicians must buy insurance in case any of their patients sue them for malpractice. At the health forum, John Gallagher, MD, told us he and his employer have paid about $2 million in liability insurance premiums over his 30-year career as an obstetrician/gynecologist. And he’s never been sued!

Well, where is that money going? Here’s one answer. In 2006, a Dane County jury awarded $8.4 million to a 33-year-old patient who suffered from what the proceeding determined was malpractice. Four million, two hundred fifty thousand dollars of that award was for pain and suffering. Will those millions eliminate the pain?

Here’s something even more excruciating. The lawyers in these cases end up getting a disproportionate amount of such massive awards. As evidence, the winning trial attorney in the above-mentioned case lives in a mansion near Madison’s Lake Mendota. In 2009, it had an estimated fair market value of just under $5.4 million.

If that’s not high-octane enough for you, how about this one: In 2006, the Wall Street Journal reported that the then CEO of UnitedHealth earned $8 million per year in salary. But Dr. William McGuire’s unrealized stock options totaled a staggering $1.6 billion! That’s for one human being. Now, this is a company whose main business is to offer health plans to businesses, and seniors on Medicare. And it’s just one company among many in this industry.

Here’s one more example, especially for those who fear a government takeover of health care, because it demonstrates how an insurance industry coup already has taken place. Green Bay’s Doctor Nicky Plementosh told the health forum how a patient’s insurance company “cancelled an operation” by saying they wouldn’t pay for it after it had been previously approved. Why? Because the patient required another day of intravenous therapy, according to Dr. Plementosh, an OB/GYN. The doctor simply rescheduled for one day later because the underlying reason for the surgery hadn’t changed. “I needed to start the pre-certification process all over again,” she explained. That took six hours of costly staff time. When asked how unusual this situation was, she replied, “Very, very common.”

So the first step in reforming our healthcare system is to address the lunacy. No person, certainly not the leader of a health insurance company, needs to earn $1 billion. Doctors, not insurance companies, need to be the ones calling the shots on what treatment is necessary. Trial attorneys should not be siphoning millions of dollars out of the system when patients suffer a devastating loss. Injured patients deserve full compensation to cover their care, but not millions for intangible losses like pain and suffering. And, as consumers of healthcare, we need a system that gives us a financial incentive to make smart choices. We need to care about how much we are paying when we visit the doctor.

We get there by creating real competition among insurance companies, requiring all of them to offer a “standard health insurance plan,” which a government-appointed panel would develop. That way, consumers and businesses can make an apples-to-apples comparison of what is offered, and force companies to offer competitive products nationally.
We get there by dismantling our medical malpractice system and directly compensate losses by bypassing the trial lawyers.

We get there by doing what the President suggests, and require every citizen to buy health insurance. If we’re all in the pool, including the young and healthy, we can mitigate the damage for those who suffer expensive illnesses and hopefully, catch many more earlier on.

Yes, heath reform presents a myriad of mind-boggling issues, but many of them will become less onerous when we pick the low hanging fruit.

Stephen J. Busalacchi is a medical journalist and author of White Coat Wisdom: Extraordinary doctors talk about what they do, how they got there, and why medicine is so much more than a job. © 2008 See

Watch the health forum Steve moderated

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