The following summary from a colleague on LinkedIn concisely and emphatically resolves every major concern about having a health care system which includes a public option. Bravo and thank you David!!! ~Christine
By David Vernon, a Management Consulting Professional
1) Private insurers have almost a monopoly on employer plans, so there is now no competiton on price and service. Risk pools are regional, so inter-state private insurance will not change this. Federal jurisdiction does not extend to regulation of insurance policies written within States, but it does extend to plans receiving Federal funds. That is why we need a public option – so that Federally funded plans can offer features private insurers do not now offer, forcing all private insurers to compete on price and service (ignoring pre-existing conditions, eliminating “exclusions”, etc.)
2) 30% of current costs are accrued at municipal hospitals providing routine care for the uninsured in emergency rooms for ten times the cost of routine care in clinics and doctor’s offices. Providing Federal coverage for anyone, no questions asked, for routine care would allow these people to get care for one tenth what it costs now. A 90% reduction in 30% of costs saves 27% of current costs. That is the “indeterminate” savings from covering everybody, at Federal expense, at a cost of 1.4 trillion dollars over ten years. That is how expanding coverage could actually save money and lower overall costs.
3) 80% of lifetime expenses are accrued in the last six months of life for intensive care while dying. Absent clear instructions from the patient, medical ethics and current law require that no expense be spared to prolong life, at least unitl the $1 million lifetime insurance coverage is exhausted. Every patient who elects not to have intensive care while dying saves the system $500,000, $400,000 in insurance payments and $100,000 in copayments from the family of the patient. The cost of covering a living will conference is $100. Net savings is $499,900 per patient who makes a living will refusing intensive care while dying. Absent living wills, the 40 million Baby Boomers will incur $20 trillion in intensive care costs while dying over the next 25 years.
4) After end-of-life and routine care in ER, the next biggest cost item is 15% of current costs due to lack of proper medical information. These costs involve 98,000 excess deaths annually, duplicate diagnostic testing and imaging, and the care required to recover from mistakes in dosage and treatment. The existence of complete, accessible, lifetime electronic health records, such as now exist in the VA system, will eliminate this 15% of costs.
Bottom line = without a public option, it will not be reform. without mandatory living will coverage, it will not be reform. with electronic health records, the living will savings will not accrue because the doctor at the hospital will not know you have one, and it will not be reform. Costs can be nine times the CBO estimate and will still be half the $20 trillion that no reform will cost. Savings potential for living wills and guaranteed routine care for everyone are more than half of what we spend now.
5) Current costs of about $16 trillion annually amount to $8,000+ per capita. Results rank between 20th and 37th worldwide. The “best” results worldwide are achieved in France, which has a “public” option but not “national health.” Costs there are 30% lower than ours per capita, and private insurers continue to make profits, although not as huge as they do in the USA.
The only losers if the proposed reforms pass are the private insurers, who now reap most of the benefits of this system that lets 20,000 people a year die for lack of coverage and costs half again as much as the next most expensive national system in the world. ~~~