UNIVERSAL HEALTH CARE IN THE U.S.

As I write this, the health care bill has finally passed the Senate with the required 60 votes. The bill is so long (over a thousand pages) with so many amendments (over 300 pages) that it is hard to know what is in the bill. But it seems something like 30 million more people will be included in health care nsurance, that you can not be refused insurance because of prior health conditions, and that nearly everyone will be required to have health insurance.

But there are some things that are not in the bill that ought to be:

(1) Tort Reform: Neither political party seems to want tort reform. For six years that Republicans had control of the Presidency, the Senate and the House and did nothing about tort reform. It is felt that Democrats are in the pocket of the trial lawyers so it is no surprised Democrats don't want to address tort reform. Further, it is said that the total amount of savings would be "only" about 4%. Assuming this is true, we are still talking about at least hundreds of millions of dollars. There are other reports that say the litigation and malpractice insurance total only about 1.5% of the medical costs (http://prescriptions.blogs.nytimes.com/2009/08/31/would-tort-reform-lower-health-care-costs/), figures that seem absurdly low. I doubt, however, that any sort of accurate figure can be obtained on defensive medicine costs. But physicians malpractice insurance costs are out of sight. A physician who specializes in premature babies said his insurance is $150,000/yr. For example, if a doctor.s appointment is $100, the first 4 to 6 patients (depending on the number of days he works in a year) the doctor sees in a day go to pay his malpractice insurance. And then more patients have to be seen to pay the rent, hire a nurse, a part-time bookkeeper, and a receptionist plus other work expenses. I have read that a neurosurgeon's insurance is $250,000. Such expenses must be made up before these physicians start earning any wages.

(2) Emergency Room: A lot of people don't seem to be concerned that the primary health care for many people is the emergency room. Yet, the emergency room is the most expensive kind of health care (http://www.consumerhealthratings.com/index.php?action=showSubCats&cat_id=274) averaging $560/visit and for people aged 45-64 it was $832/visit in 2003. Blue Cross/Blue Shield of Texas gives the following figures: " What should you know before going to the E.R.? The national average E.R. visit costs $383, while the national average doctor’s office visit is approximately $60" (http://www.bcbstx.com/employer/hccc/topic6.htm). Certainly any universal health plan should aim to reserve the emergency room for emergencies. But once again, we are told that emergency room costs are only a few percent of the total costs. Tell that to people who wait 6-7 hrs in the emergency room for some sort of treatment. And much emergency room treatment is not paid for by the patient but is passed on to those who can pay.

(3) Control of medical insurance costs has received much note as a significant percentage of insurance costs actually go to insurance companies seeking ways so that various types of coverage are not covered. The proposal to do this in the health care bill was to be a public option, but this provision has been removed. It is not clear whether the remaining provisions will have any effect. An agreement with the insurance companies has been that if everyone is to be covered by health insurance, then they would be willing to do away with "preexisting conditions" as a reason to eliminate insurance coverage. Apparently this provision is in the current bill.

(4) Rationing. Of course there is rationing of health care now, based on money. Plus certain types of treatment are not covered by Medicare - anything judged to be cosmetic surgery for example and, of course, dental expenses are not covered. And other tests are restricted - PSA tests for men and mammograms for women are limited to one per year. The word rationing conjures up bad vibrations, but they will be increasingly necessary. How many expensive organ transplants will a person be allowed to have in a lifetime, for example?

We do not yet know what compromises will be made to the current health bills in committee before a final bill can be voted on in congress and presented to the President. At best, it would appear that what is eventually signed into law will be a beginning and not a total solution.