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Cliff Cloonan MD

In fact, there is an entire literature devoted to queue management. It is not simple and is a major problem in countries like Sweden, Canada, and Britain where government controls access. People in those countries die waiting for care. They are members of OECD and whether you think their queues are excessive probably depends on whether your wife, mother, or father dies in a queue after waiting 6 months for CABG.

If adjustment is simple and inexpensive, one wonders why agreement is even lacking about how to measure waiting times.

The money has to flow more directly to the providers of care, doctors, nurses, Physician assistants, LPN’s, physical therapists, pharmacists and hospitals. Too much going into the
third party payment system permitting cost shifting and the high costs of paying someone else to pay your bills. I believe that Arnold Kling’s generalization is correct. In a truly competitive system, about one half of medical costs would be paid in cash and one half with insurance benefit dollars, with all earned dollars dedicated to health care receiving exactly the same tax treatment.

Medical errors are more common when the provider is insulated from the payer by a third party who is paying the bill. This is because all providers are paid about the same fee for the same procedure. The only way to do better economically is to do it faster. More time reflecting or consulting on the proper diagnosis is not rewarded by the third party payer.

“…appallingly low percentage of doctors and hospitals have patient records in electronic form, thereby missing opportunities to use error-reducing software.” This is probably true. My take is it is because they are not required to compete with one another and duplicate insurance coverage does not permit efficient payment of claims submitted. My internist entered everything on the computer.

In order to have cost effective primary care, individuals who earn the money need to
control its spending for health care needs. More cash in the hands of those who earn it will provide an incentive for more physicians to not sign contracts and compete with one another on a cost effective cash basis.

Studies also have shown that only about 5% of patients with an HD plan ever reach their deductible in a given year. I have read that there also it not a significant difference between the health needs of the rich and poor. Thus if only 5% of the lower 20% reach their deductible, we are talking about 1% needing significant help. I would not like to see any proposal that compromises the rights of those who accept responsibility in order to dictate a solution. I believe private charity would be capable of addressing those truly in need.

Excessive queues are easily controlled by simple queue management and minor, inexpensive adjustments of capacity when required. The OECD has demonstrated that many nations spending far less than the United States on health care do not have excessive queues.

Your claim that we wish to shift costs from taxpayers to physicians is certainly a reach that lacks any credibility since we support equitable, progressive tax funding of our health care system.

We do propose greatly reducing unnecessary spending by reducing the administrative waste of our inefficient, fragmented system of financing care, and by realigning incentives to reinforce our primary care infrastructure, which would provide less costly but higher quality health care services. We would also negotiate lower pharmaceutical prices by refusing to pay for inappropriate and wasteful DTC marketing, and by limiting research funding to innovative approaches that promise benefit, rather than continuing to fund the perverse research that is designed merely to restart the patent clocks that perpetuate excessive prices.

Price competition might work for a single, non-urgent office visit, but price algorithms for complex, major acute and chronic disorders can never be determined in advance, yet this is where most health care spending occurs. Price shopping through CDHC can never impact more than a miniscule portion of total health care spending.

When patients have free choice of physicians and hospitals, as they would once again under a national health insurance program, they will be able to select their care based on quality as we improve our ability to identify appropriate parameters.

Access for low-income patients can be dramatically improved by eliminating the chronically-underfunded Medicaid program and by providing comprehensive coverage for everyone. Using a program of national health insurance to fully fund the community clinics and other safety-net institutions will give them the resources they need to ensure access to care for those living in currently under-served areas.

These comments are based on sound principles well supported by the health policy literature. NCPA still has the burden of demonstrating that unfunded or depleted HSAs along with HDHPs (with the fiction of 100 percent coverage after the deductible) would somehow provide affordable access to high-quality care. Talk about myths.

Don McCanne, M.D.
Senior Health Policy Fellow
Physicians for a National Health Program
http://www.pnhp.org