Outline of Speech in Buffalo, MO 7/18/09

Every United States citizen can have basic benefit coverage without increased governmental control and with lower per capita costs.

We want you to win arguments about healthcare reform. So, we are going to do this like a seminar. There is going to be a short lecture (at least everyone including me hopes it will be short but I can be long-winded), a roundtable discussion (educators call that the Socratic method of teaching) and handouts! If all else fails when you are arguing about healthcare reform, do what everyone else does and tell them you heard it from an expert. Tell them you heard this guy say it is possible for everyone in the country to have the same basic coverage Medicare provides and to do it without doctors and hospitals being run by the government and to do it without increased taxes or spending. When they say, “Who was this guy? I have never heard of him. He must not be one of the experts. Why should we believe him?” Tell them this:

• That he is a hospital CEO, an attorney and a teacher [I may not be an expert but I have spent my life in situations where, unlike most experts, what I say has real impact on people’s lives.]
• That he was raised in southwestern Missouri but educated in New England [I may not be an expert but I have my foot in both camps where experts are supposed to come from—the heartland, full of real people with common sense knowledge, and academia, full of eggheads with impressive vocabularies and statistics. Depending on who you are arguing with, either tell them that the guy lives in Webb City, Missouri or that he graduated summa cum laude, Phi Beta Kappa from an Ivy League college.]
• That the hospital he runs was listed in US News & World Reports as the least expensive in the entire nation [I may not be an expert but I’d say that means I know a little something about the cost of healthcare.]
• That, for the last ten years, three-fourths of the patients at his hospital were either Medicare, Medicaid or uninsured [I must not be an expert because the experts will tell you that it is impossible to run a health system on what the government pays—and we have done it without tax support, grants or donations. We are a private, for-profit, physician-owned hospital.]
• That, for the last ten years, his hospital has never sued a patient to collect a medical bill or forced a patient to fill out a complicated form disclosing all kinds of private financial information in order to qualify for so-called charity care [I must not be an expert because I believe most people are willing to pay their fair share of the cost of healthcare and I do not believe people without insurance should be expected to pay more than what the government pays.]

We want you to graduate from this seminar and start winning arguments about healthcare reform. We will suffer more harm from half-way measures and shortcuts than from doing nothing. We have been ready for a fair, rational healthcare system in this country for at least a hundred years. We cannot wait any longer. The time for a complete overhaul of the system is now.

You all have heard the numbers. There are almost 50 million of us without real healthcare coverage. Here is a debate tip for you. When you hear the experts say that 50 million uninsured is not a real number for a bunch of reasons—like, for example, because it includes a lot of people who could afford to pay for healthcare but don’t—just stare at them like they are from Mars and say: “Look, genius, I don’t care why they are not paying. If they aren’t paying, they are making me pay more.”

Half the individual bankruptcies filed in this country include big medical bills. As a private practice attorney I can tell you that people do not feel bad about filing bankruptcy when their situation was created at least in part by medical bills. People feel like it is not their fault if they can’t afford to pay huge medical bills and I believe they are right. The healthcare payment system is so screwed up it does not make sense to anybody. Those healthcare related bankruptcies have costs unrelated to healthcare. When people file bankruptcy because of medical bills, they discharge all their other debts. Why not? Talk about trickle down economics. There are a lot of credit card companies and other businesses that lost money because their customers could not afford healthcare.

The cost of healthcare in this country is higher than any where else in the world. It is bad for business. Here is another debate tip for you. When the experts tell you that healthcare reform will hurt business, look at them like they are from Pluto and say: “Look, genius, the cost of healthcare is hurting American business right now, making us less competitive in the global economy, and it is going to get a lot worse if we do nothing.” I am a businessman, too. I run a business with almost 800 employees. A few years ago, we realized we could not afford the rising cost of paying health insurance premiums to cover our employees. Fortunately, we had an option most businesses do not have. Since we are a healthcare system, we decided to create a self-funded plan and we encouraged our employees to shop at home by waiving the deductible and co-pay if they used our system. If we had not been able to do so and we were like most other businesses, we would have been forced to drop health insurance benefits for our employees. Businessmen can handle almost anything if they know what to expect—if they can plan, forecast, budget. Healthcare costs have risen so dramatically and erratically it has been impossible for businesses to cope. We need to impose rationality on the system. We need universal healthcare as much for the health of American business as we do for individual Americans.

When the experts tell you that they are against universal healthcare because it would be another infringement upon individual liberty by the big, bad federal government, stare at them like they have been spending a lot of time on Jupiter recently and say: “Look, genius, we already have universal healthcare; it just doesn’t work very well.” If a patient has an emergency medical condition and seeks treatment in a hospital, the patient will be treated regardless of ability to pay—everyone is covered by this policy benefit. We should stop debating whether to create a universal healthcare system and focus instead on how to pay for it fairly and efficiently. If everyone paid their share of the cost of providing healthcare to all, the cost to each of us would drop significantly.

We need a healthcare system based not on an individual entitlement to care but on the mutual obligation of all parties.

We have laws requiring connections to highly regulated utility services in order to ensure public health, safety and welfare. We have laws requiring automobile owners to maintain liability insurance coverage and to provide proof of it on demand in order to protect the public from reckless, irresponsible drivers. We have laws forcing employers to cover employees with workers compensation insurance in order to protect workers from irresponsible employers and to provide benefits for those injured on the job. There is no similar mandate extending the essential service of affordable healthcare to all people striving to live well in this country.

Here is another debate tip for you. Ask those experts against universal healthcare if they live in a house connected to a public sewer or have their garbage hauled to a public landfill. If they say yes, tell them you just moved in next door to them and you assume it will be okay with them if you let your sewage drain out on the open ground next to their house and dump your garbage in the back yard. Most Americans understand and agree it makes sense that everyone living in a town or city should use the public sewer system and have their trash hauled to a regulated landfill. To ensure public health, safety and welfare, we pass laws regulating public services. Since everyone has to do it, we pass laws requiring everyone to share costs by using the same public service. By the way, if they say they live out in the country and they use a private septic tank and burn their trash, tell them they obviously live in an area where there are not that many people concentrated in big numbers, but that 50 million is a big number and that is how many people in this country are potentially causing harm to the public health, safety and welfare by being connected to the healthcare service and not paying their fair share of the costs.

Recommended reforms:

• universal coverage for basic benefits—essentially the same as Medicare coverage with prescription drug benefits
• emphasis on primary care—the reason our hospital is the least expensive in the nation is a result of an emphasis on primary care
• single payer platform—it will save billions in costs and level the playing field; our hospital is a good example
• claims processing by private intermediaries—we resolve two issues by letting private insurance companies fill this role: 1) we give for-profit companies an opportunity to save the system money by creating efficiencies in processing (quieting those who say government is always bad and private business is always good) and we throw a much-needed bone to the powerful insurance lobby by giving them something they can do to make profits without raping the system
• four-year transition period—most of my fellow hospital CEOs will cry havoc and let loose the dogs of war: they will say that my proposed reforms would shut them down, that it is impossible to run a health system on Medicare rates of payment. I say it can be done and they will do it but we will have to give them a little time to adjust. Insurance companies will also need time to adjust to the loss of enormous profits many of them are making; otherwise, they will be lining up for a federal bailout.
• governance by a national board—do not let the experts sidetrack the debate by claiming that this kind of governance means the feds will be telling your doctor how to practice medicine. I propose a national health board for tweaking big picture issues only like preventing excessive profit making by hospitals, doctors or insurance companies. The problem here is that many of our allies who support universal healthcare are caught up in this idea that we need to reform healthcare by enforcing certain clinical practices from the top down. It is well intentioned but misguided—and it won’t work. [Let the experts win that point. It is a good debate tactic. Tell them, “You are right. It won’t work. It is irrelevant to our reform proposal. Move on.”]
• comprehensive malpractice reform—doctors waste resources because they practice defensively worried about frivolous lawsuits but we also need to protect patients from bad doctors. I propose a system similar to work comp.
• any willing provider—let competition drive quality up and costs down.

The reformed healthcare system would be financed through:

• existing Medicare and Medicaid programs—it would be similar to the Swiss system touted by Bill O’Reilly, of all people; it is not “free for all” or paid exclusively by the government: everyone will pay their fair share but by making everyone pay and by including everyone in the risk pool, per capita costs would be kept as low as possible. Those who legitimately cannot afford to pay would get the equivalent of premium assistance through state and federal governmental programs based on a sliding scale relative to income.
• mandatory premiums paid by employers, employees and the self-employed—as a businessman I can tell you I would not object to providing health insurance for my employees as long as: a) my employees were paying their share; b) my competitors had the same costs; and c) there would be governance to prevent healthcare providers and insurance companies from profiteering.
• unemployment benefits—the money to pay premiums for those who are unemployed would come from the unemployment taxes paid by employers and employees
• a tax assessed on those who fail to pay—if a self-employed person fails to pay the mandated premium, the cost would be assessed on the federal income tax return

There would be a universal 30% co-pay paid directly or covered through secondary insurances. This “healthy” co-pay will be keep patient-directed utilization down. It will be covered through secondary insurance or self-funded. The secondary insurance companies could also offer expanded or additional benefits not covered under the basic plan. If the national governing board failed to keep premium costs down and prevent excess profits by the insurances, it could authorize the “public option” everyone is talking about.

Conclusion:

We have to ask ourselves. What do we believe? Do we believe that life, liberty and the pursuit of happiness are fundamental human rights? If so, then the creation of a healthcare delivery system designed to ensure that people have an opportunity to lead healthy, happy lives is not charity. It is an obligation imposed on each one of us simply by living in our society. Independence and self-reliance are fundamental values in our American culture. When we are free and happy and healthy, we tend to forget that we are all in it together, that our actions and choices affect everyone else and that we all depend on each other—unless we happen to live in the wrong part of New Orleans when the hurricane hits. We need a healthcare system based not on an individual entitlement to care but on the mutual obligation of everyone. We can have basic benefit coverage without increased governmental control and with lower per capita costs.

Lowest Out-Of-Pocket Medicare Co-Pays per Patient in the Nation!

According to the US News & World Report on July 9, 2009, our hospital in Springfield, MO just topped the list of the 10 hospitals in the nation with the lowest out-of-pocket Medicare co-pays per patient for hospital and physician services.

Response to the OCH White Paper

We distributed the OCH White Paper a couple of weeks ago. The responses we have received thus far can be summarized as follows:

• Single payer universal healthcare is government-run and won’t work.
• Single payer universal healthcare will bankrupt the country.
• Your white paper is long and complicated.
• Your white paper is a compilation of reform ideas that have already been analyzed and rejected.

I suspect that the first two responses were mostly from people who did not actually read the white paper, and the last two responses were from people who did. My answer to the first two would be no and no. My answer to the last two would be yes and yes. I hope to get into a point and counter-point debate at a later time if there is sufficient interest, but, for now, I have been asked if I could provide a short statement focused on the one most essential message I hoped to convey in the white paper. It is this:

We need a healthcare system based not on an individual entitlement to care but on the mutual obligation of all parties.

The one question I am most often asked is: “How are we going to pay for it?” The answer is not by a huge subsidy from the federal government. Healthcare is an obligation we all share and we must all pay for it. While we must all be obligated to pay, the reformed payer system can use existing financial channels. The Federal Health Board would establish the “universal premium” we all owe each year. Since the risk pool includes everyone in the country—young, old, healthy, sick—the cost per life would be the lowest possible amount. That “premium” would be assessed to the Medicare and Medicaid programs, collected from all employers and employees, paid by the self-employed and covered as an unemployment benefit.

The payer system—built on the existing Medicare database—would be engineered to ensure effective and efficient delivery of services while preventing profiteering by individual or corporate providers. There is no reason why such a system could not also be designed to create an incentive for research and development, while rewarding wellness programs and innovation in technology.

The 30% “universal co-pay” applicable to all services initiated by the patient would not only reduce the basic premium, it would also create a disincentive for excessive utilization by patients. While the premium cost would be based on the average cost of providing care to all patients, the cost of the co-pay would be based on individual utilization and other risk factors. The Federal Health Board would regulate premiums for this secondary insurance and/or provide a public option, but it would do so with a mandate that individuals would suffer financial consequences for their lifestyle decisions.