Tackling Some Skyrocketing Health Care Costs

Article excerpt

Americans - including the unemployed, elderly and seriously ill - both penniless and without health care they need. Hospitals are in trouble. Workers are being told they have to pay part of the costs previously covered by employer-paid benefits or take cuts in benefits.

Many reasons exist for this squeeze, some difficult to do anything about. But there are parts of the problem that could be tackled if we were serious about stopping the spiral.

- We use highly licensed professionals for work that might be done at lower levels. In the military, if you have a cold, you don't always see the doctor first. A medic may see you and recommend an aspirin. Podiatrists complain that they must spend time (and Medicare) for clipping thickened toenails of elderly patients when this could be done by a paraprofessional. Doctors take blood samples which nurses are able to take. Some believe that our society is overcredentialed in general and may someday be known as the Great Paperwork Civilization of the late 20th Century just as we now look back at the Bronze or Stone Age.

- Procedures may be governed by fear of lawsuits or loss of insurance, not what is best for the patient or would cut unnecessary costs. Insurance companies can be barred from refusing to pay and plaintiffs from recovering just because some technical infraction occurred (for example, under the laws of one state, only a physician can give a previously prescribed penicillin injection).

- People fear to turn in bad practitioners who add to costs. There is only limited legal protection for health professionals who accuse others of infractions. If the accused party - who may in fact be guilty - can claim lack of good faith or some procedural infraction, he may beat the rap. The accused should be required to prove the charge is without merit.

- Not all drugs - even generics - are bought at the best price. Some drugs are paid for by various government and private plans at estimated costs to pharmacists which don't subtract big rebates often paid back to the pharmacist as a promotion or volume discount. …