October 1, 2009
To the Editor
NY Times
Re: Swiss Medical System
The essential point which is not considered in this article is the “overhead” cost of medical health insurance. What is the percentage of “overhead” that the Swiss permit their insurance companies to charge? How does this compare to the “overhead” which American Insurers divert from the total expenditures for health care in the United States? Of that approximately 6% difference between the percentage of the GNP spent on health care in the U.S. and in Switzerland, how much of this difference is derived from insurance company “overhead”? One must wonder if the Swiss permit the CEOs of their insurance companies to pay themselves $100,000,000 per year, or to purchase $55,000,000 corporate jets and spend $400,000 for a week end jaunt to Aruba.
Further, granting insurance companies in the U.S. additional power to control the practice of medicine through “prior authorizations”, “reviews of service”, demands for the demonstration of “medical necessity”, “green letters”, etc., would simply be giving an A-47 to the coyotes already “guarding” the hen house. In the U.S. insurance companies could care less about patient well-being and effective/efficient health care. Proof of this is their refusal to pay for preventative and “life-style” prophylactic medical care. As Michael Moore made abundantly clear in “Sicko”, they care only about making money, and restricting health care is how they do it. There is absolutely no regulation and/or competition in the health care insurance industry. So the suggestion that what the U.S. needs is more powerful insurance companies is outrageous. Do your homework before you jump into the dialogue.
J.S. Hochman MD
Executive Director
The National Foundation for the Treatment of Pain
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Weighing in late on this one:
ReplyDeleteWhat is the actual contribution of healthcare to the Gross National Product?
Insurers assert it to be about 20%.
But consider my cousin in Cleveland. His anesthesiology practice requires him to put work in, on pre-op evaluation, pre-op planning with the surgeon, running the ventilator and monitoring vitals while the surgeon is busy poking around the patient's abdomen, then monitoring vitals while the patient is waking up in the recovery room. Suppose he puts in 5000 dollars worth of work on some surgery and needs to make 5000 dollars pay.
He first has to spend another 5000 bucks on his malpractice premium.
That brings the cost of him getting the work done, up to ten thousand dollars. But he has to spend another 10,000 bucks to pay a medical billing company to argue with insurance companies over the necessity of each billed item, to justify paying the billing company, the malpractice insurer, and himself. So far, we're up to $15,000 worth of added costs, to collect a lousy five grand. Then the health insurers tack on their admitted 30% overhead (which is probably underestimated significantly). Taking the insurers at their word, it cost $21,000 of unnecessary charges, to deliver $5000 worth of healthcare to patients (the real cost probably being higher than insurers admit).
So the question this raises is:
What was my cousin's contribution to the Gross National Product, by performing anaesthesia during surgery?
Was it $5,000?
Was it $26,000?
Or was it a loss of $16,000 FROM the gross national product, after all the parasitic and counterproductive machinations of insurance companies were paid for?
In the Enron and WorldCom bankruptcies of a decade ago, it only became apparent after these companies collapsed, that they were deceiving investors by making costs appear to be income, and the investors weren't sophisticated enough to figure the trick out.
If, along with the $100 million the health insurance lobby put into promoting Obamacare, the President took the hook of believing that health insurers add 20% to our Gross National Product, rather than subtract 15% FROM it, he's going to have some sleepless nights, and will probably have to toss some unreliable people off his advisory team.
When Dwight Eisenhower was President, he had the habit, on a day he was planning to sack somebody, of dressing in a brown suit. The second time Ike stepped out of the White House in a brown suit, people at the Executive Office Building started trying their best to look busy, so as not to attract the attention of a President in the mood to fire people.
I'm waiting to see what is Mr Obama's favorite item of clothing to wear, when it's time for somebody in his administration to get the heave-ho. Because anything this big, is bound to produce at least one firing.