Dear Leader on Health Care

I'm sorry, but this is something I know something about. And, as usual, out the the mouth of Dear Leader comes baloney:

Our Dear Leader:

Secondly, the health care is an inefficient industry -- when you really think about what information technology has done to your business, providing better productivity increases, as well as interesting challenges, by the way. The same productivity increases haven't happened in health care. I mean, you've got a guy writing down prescriptions by hand, and/or files being written by hand, and doctors don't write so good anyway, which leads to medical error, and inefficiencies. (emphasis added)

No, Dear Leader, the "inefficiencies" don't reside on my doorstep. I've got me an EMR*! I also do scripts on a printer. The inefficiencies in the Health Care system are the result of greed. (*Electronic Medical Record)

If you really want to know where health care should go, read the excellent article by Paul Krugman and Robin Wells in the New York Review of Books.

The system is broken. In my opinion, it is broken because of the system. Sounds like a tautology. It is. But it is not MD's that are most to blame. We want a system that works. The insurance companies want one that satisfies their greed.

Here are two graphs that hopefully summarize the situation. The first is a pie graph of where the American Health Care dollar goes:

(Click graphic to enlarge)

First of all, 7% for administration is a misleading number. As Krugman and Wells point out, already almost 50% of our health care is financed through the government: Medicare, Medicaid, VA, etc. The administrative costs for traditional medicare are low. It was only when the Insurance Industry persuaded the Government to put Medicare recipients into HMO's (i.e. where the insurance Company does the administrating and profit taking) that things got out of hand:

Other disturbing evidence from privatization is the rise in bureaucracy. The latest HCFA data show that administrative costs for beneficiaries in HMOs have skyrocketed to 9.1% while traditional Medicare's administrative costs are 2%.

Another misleading slice of the above pie is the "other costs." Contained therein is the bete noir of the American Health Industry, the outrageous profits being reaped by Insurance Companies. Not doctors, Insurance Companies.

The largest company in Maryland is now United Health Care that bought up many smaller companies including MAMSI (which had been ripping us off for years). Here is a graph of UHC's recent revenues (before they bought MAMSI):

(Click graphic to enlarge)

They will say that "pardonez moi, but our earnings are only 11% of our revenues. Higher than other industries, but still not outlandish." This is horse poop. Encased in that "other expenses" are a variety of things. For instance, the CEO's salary ($32 MILLION!!!) is not included in "earnings." The reality is, as is shown in the graph, the total rake off for this company is close to 30% of revenues.

They do this by the fact that they are a partial monopoly. They do this by screwing doctors on their fees (current fee for a UHC office visit is only 75% of the Medicare fee; most physicians charge 120-150% of Medicare for routine services, it is that low.)

Dear Leader,

Once again you have gotten it all wrong. Health Savings accounts (as Krugman and Wells so elegantly explain) are the answer for no one but your rich buddies. I wish that you could live in the shoes of an average American for one day. What an eye opener that would be.