Guest Opinion: Forget the claptrap, here’s how to fix health care

Unexplained claptrap has been put forward by candidates Bush and Kerry alike. Some 45 million Americans are uninsured as I write. If it costs $1,000 to insure each of them we have just spent $45 billion. If $2,000, then $90 billion, and so forth. The expenses quickly become “telephone numbers” if we do not cut wherever we can.

You cannot spend money twice, even if you can print the stuff. There are “cost engines” driving the annual cost of health services in the United States, up by 12 to 15 percent per year, which makes no sense, and which must be addressed/ controlled before we talk about extending health care to the uninsured.

Huge savings potentials exist, but remain unaddressed, due to lobbying and other political machinations.

At least five cost engines must be “derailed,” and the savings put back into the overall budget before any budget numbers are “real” and any plan will succeed. They are:

• HMOs: Originally presented as efficiency plans which would cut the redundancies in health-care expenditures, and pass the savings back to payors, consumers and government alike. Instead, HMOs extracted from everyone and their executives pocketed the savings. There is no logical reason to continue this experiment. Billions of health-care dollars have been diverted from the overall budget and pocketed by a greedy few, to the detriment of us all. Cancel all contracts with these greedy devils, forthwith!

• Pharmaceuticals: The most expensive in the world, five to 50 times more expensive in the United States than anywhere else in the world. Demand “world pricing” for all pharmaceuticals forthwith! And offer the drug manufacturers longer patents in return, to lessen their lobbying.

• Medical education: U.S. medical schools place an average debt of about $200,000 on each medical student. No other industrial country allows this to happen. Load debt on an altruist, create a businessperson — to the detriment of us all. Let these students pay tuition and expenses back via service on reservations, in prisons and under-served areas. Out of this equation will come the primary care doctors we no longer create, who will treat us as their predecessors have — kindly, without the bottom line as their sole motivating factor. Too few primary care physicians equals expensive specialists as first-line care.

• Prevention: No attempt is made to make those who insist on following unhealthy lifestyles and practices pay progressively more money and/or dropping them from coverage. If we were to charge the smokers, the obese, more and more for every year they persist at these unhealthy practices, they will at least pay for the additional expenses that they cost the system at the end years of their shortened lives, lightening the burden on the rest of us, the sensible/healthy lifestyles.

• Hospital charges: According to a recent National Public Radio broadcast, hospital charges include perpetually escalating year-to-year mark-ups across the United States, which average 267 percent, for everything they sell or do — from aspirins to operating room charges. “Boutique hospitals” escalate charges even more. Most hospitals are “nonprofit,” meaning that the hospital CEO is embarked upon a continuous building/capital equipment spending spree in order to bury profits. Demand real-time bookkeeping and real-time charges via the Government Accountability Office, and these costly practices will cease.

Control of these “death spiral” cost engines will allow a realistic national health care budget, single- or multi-payer, to be constructed, budgeted in real time and implemented. Failure to control these costs is the death knell for any affordable national health care plan, Republican or Democratic.

Terry Bennett, M.D., is a Rochester primary care physician who has designed health-care projects in Third World countries by saving at all points possible and using the savings to buy essentials.