Again, I must disclose that I have spent most of my professional life in the hospital industry, so accept or reject my comments with that understanding. Watching the debate regarding the payment, the delivery and cost of our health care, to me, is rather frustrating. It is frustrating because many if not most of the points used in that debate are generally accepted assumptions regarding those topics, not the reality of those topics. For example, most of the hospitals in this country are governmental or "not-for-profit", so there are no stockholder pockets to be filled with excessive profits. Even in the for profit sector, for which I was a part, the same mandates and regulations apply, the only difference is that they must pay taxes. In both sectors, profits are needed to provide the working capital to access new technologies and respond to the changes in delivery, such as the transfer of services from inpatient to ambulatory or outpatient. Funds are needed to comply with the ever increasing government mandates, for example, hospitals had to spend significant sums to accommodate the privacy requirements of the HIPAA as well as the standard billing requirements.
It is agreed that many specialty physicians make significant incomes, but I think the public perceives that the average primary care physician is making far more than actual. The last time I looked the primary care physician was not making multiple hundreds of dollars, their average income approximated $175,000 to $200,000. An income I don't see as excessive due to the responsibilities they assume in our litigious society, the cost of their training and the fact that they were in training when others were advancing their careers.
When some like to suggest that we replicate the systems of other countries, they do so as if they are comparing apples to apples, but they are not. Our population and geographical demographic are significantly different. The total population of many are the same as or less than our uninsured population. In every major USA city there are multiple facilities providing the extensive care for which only a handful are available in other countries. With a governmental single payer system financed exclusively by taxpayers, such duplication of services will become an issue. So the coverage of services not only will need even tighter controls but those allowed to deliver such services as well potentially reducing immediate availability.
It should be remembered that the payment for healthcare is being debated, not the cost of healthcare. There are numerous factors impacting the cost of care specific to our nation. For example, our education system, the better educated a population, the better use of available healthcare resources. Some like to use life expectancy statistics. If accidental deaths and deaths via violence are removed, the USA rises to the top of the list.
I'm quite sure that many do not understand that the payments from commercial payers are subsidizing the payment short falls of the current government programs. Medicare pays what the program perceives to be cost, not actual costs. The Medicaid program does not even pay those costs. Without the commercial subsidization, many hospitals, especially rural hospitals, could not remain financially viable. Without that subsidization, the burden will be placed on taxpayers, all taxpayers.
While I thought the ACA needed some major improvements, I liked the concept of it. Specifically, it sought a form of private sector, government partnership. In my opinion, the best means to finance healthcare in this nation is a workable private/public partnership. It represented a means by which not to place the burden totally on taxpayers. Additionally, I would suggest that the system used in Maryland be examined. In Maryland, hospital rates are controlled by a Commission, much akin to a public service commission. Governmental and commercial payers are subject to those approved rates.
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