Oct 3 2009

Comments – Senate Committee’s Ideas on Medical Expenses

Dear Ron,

There is merit to many of the Senate Committee’s ideas.  Max’s worked very hard to find common ground to say the least. He has the patience of Job and very good people skills. I hope some worked out deal is passed to address the most difficult issues, not just a “cram down” which I see as unlikely now.

If I were asked to advise him, I’d say incrementalize, simplify, refocus on Prevention, thus cutting our  remedial costs.

The left wants single pay.  The right status quo or not to be disturbed, or no increase in annual debt (it is debt since we run on annual deficit on going).  The middle is scared.  The doctors are not sure.  Some want better pay Medicare extended, taking insurance companies out.  Pharmaceutical companies and hospitals want to make money.   Senators and Congressmen fear losing an election over this.  Max has challenges from every side and passionate ones.

But the United State does need to prevent health problems far more than just treat them. It’s moral, but it’s also pragmatic. You and I pay for remedial for others now. Ways to lower overall costs now $2.6 trillion out of $13 trillion GDP through  prevention would be 1,000- 10,000 mobile offices in shopping centers with nutritionists, nurse practitioners, internists, blood testers and safe scanners, think technology. I would build them and make them inviting to people who will not go to doctors often because they are frightened and afraid of price.  I just met a young smart man in the hospital who lost both legs to sugar diabetes that probably cost the system $500,000- $1 million, who put off seeing a doctor unnecessary, a shame. We pay for him.

If Max could show the $2.6 trillion now spent on healthcare including insurance admin and profit could be reduced through prevention to say $2.4 trillion including 47 million people (now paid for in emergency rooms etc), he gets the conservatives.  You and I pay for their remedies now.  If they, you and I paid for prevention of their issues, it could financially balance.

I suggest the visit there to be $250-$500 paid by the consumer to be credited against mandatory new insurance premium that I do agree with.   Everyone should have skin in his game. No free lunch. If $0 million of 47 million plus 5 million of 12 million illegals pay $2,000 each for insurance that’s $90 billion a year.

I agree with the provision an insurance company can’t drop you if you get sick or fired. I also agree people with preexisting issues should have subsidy above normal premium they should pay.

In general, I believe insurance should  not be for each doctor visit so I would like a large annual  family  deductible per family. We buy cars, get haircuts, even pay for dentists out of pocket; maybe politically improbable, but economically sensible.  If insurance or Kaiser type annual check ups are mandatory, people will more likely get check ups.  Deductibles will bring down insurance premiums.  So will check ups.

As for remedies, I would also explore exporting some operations to insured, accredited hospitals in India, Thailand, Brazil etc. whose prices are often 1/10 ours.  My friend in Brazil had three first class stomach operations this year, total $7,000.  MY wife’s hospitalization four days to have the baby was $35,000. (Politically improbable, economically sensible).

Finally, we can’t pretend illegals don’t exist.  We do treat their problems.  We can’t stop that.

As for sources of finance, an excise tax paid by insurance companies on guilt policy profits makes sense, as does tax on soft drinks etc.

Three other things we should address, is clear simplified billing, encourage ten to fifty providers in each state including some that provide the economically sensible plans above, and removing punitives for all but the most egregiously negligent offenses.


Oct 3 2009

Remembering Bill Safire


Pleasing column on Bill Safire after his passing. I agree with you, he was a mensch.  He metaphorically and in fact had rumpled dignity in his demeanor and in his columns.  His were opinions worth reading.  I remember him and Scotty Reston middle and Tom Wicker on left, sort of a golden age of New York Times for me.


Peter Dwares

Cc:  Roger Aronoff