Thomas D. Segel
The "Keep It Simple Stupid" Formula to Healthcare
August 26, 2009
There are many who accuse me of being on a tirade when in comes to
writing about healthcare reform or healthcare insurance reform or
whatever the politicos are calling it today. Having spent the last ten
years of my active working career as a senior healthcare administrator
and the past six years as a consultant for the Texas Department of State
Health Services, I have stored up a little information on the subject.
Thus I feel qualified to opine.
First of all, 1,117 pages of Washington Speak is not a healthcare bill,
but a collection of words designed to mislead or deceive. Any logical,
fair-minded legislator wanting to enlighten and encourage support would
have developed a much shorter bill. It would also have been written in
language easily understood by the majority of the population.
Next, the bill would have been well researched utilizing the experts
from the medical profession. There is no lawyer, politician,
governmental staffer, or lobbyist who knows more about how to
effectively deliver and control medicine and treatment, than the
At the top of the list in addressing cost savings or control would be
tort reform. This is not even mentioned by the Obama Administration or
Congress. That is understandable because no American locale has more
lawyers per square inch than the congressional chambers of Washington,
DC. It is also well documented that the trial lawyers of the United
States are extremely generous contributors to the Democrat Party.
One example often cited about how out-of-control malpractice law has
become is the former Democrat candidate for President, the former
Senator and the current defendant in a paternity case, John Edwards.
During a 12-year period, Edwards won $175 million in malpractice
Malpractice litigation has created skyrocketing medical costs for the
past three decades. One doctor that I visited has been the defendant in
10 malpractice cases. His liability insurance costs went through the
roof...and he was never convicted of a single charge.
It was so bad in Texas that medical practitioners fled the state in
droves. This deplorable situation remained a serious problem until 2003
when the Texas State Legislature passed a sweeping set of medical
liability reforms. It also offered the citizens a constitutional
amendment to validate a non-economic damage cap in the state
constitution. Caps on non-economic damages were limited to $250,000 per
occurrence. Since the passing of that legislation more than 7,000
doctors have returned to the Lone Star State and costs have stabilized.
If such reforms were adopted nationwide, former New York Mayor Rudy
Giuliani estimates medical costs would drop a minimum of 10%.
I often write about the Rio Grande Valley of Texas, which because of its
proximity to the Mexico border is one of the most economically depressed
areas in the country. There are literally thousands of uninsured people
making their homes in the delta region of the state. They also crowd our
emergency rooms to the tune of millions of unpaid dollars in care being
But, again, the state has recognized the problem and is attempting to
reduce the heavy burden our hospitals have been carrying. Rio Grande
State Center (RGSC) in Harlingen has an outpatient clinic that has been
serving the indigent population and the working poor of a four county
region for the past decade. Nobody is ever denied services. Currently
RGSC is in the process of having a new $10 million outpatient facility
built which will be open this winter and will provide modernized and
RGSC serves the public to the tune of 50,000 outpatient visits a year.
All are accepted and are charged fees based upon their ability to pay.
Services are sometimes covered by insurance, but most often are pro
bono. If the state outpatient clinic system were to become the
operational model for healthcare reform across the United States,
everyone in need could be served.
The third way to reduce costs and improve services would be to get third
party payers (insurance companies) out of the billing process. If
patients paid their medical expenses out of their own funds and then
sought reimbursement from their insurers, they would make sure every
dollar expended purchased a dollar’s worth of value.
would be my KISS formula:
1. Reduce the size of the bill, have it researched by medical experts
and simplify the language.
2. Require meaningful national tort reform.
3. Establish statewide outpatient clinics for the poor and underserved.
4. Have all payments made by patients to their doctors, and
reimbursement sought after payment is made.
This may sound way too simple, but then, most solutions are never that