Thomas D. Segel
The "Keep It Simple Stupid" Formula to Healthcare Reform
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 practitioner.

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 judgments.

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 provided annually.

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 enhanced care.

 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.