Wednesday, July 18, 2012

Getting Healthcare Right

In my previous post, I explained what the Affordable Care Act is and what it does. I like most of what it does, with three exceptions:

1. The electronic health records requirement scares me. I think this is a bad idea. Health records, like financial records, should not be placed online. There is no way to protect them adequately from hackers or accidental disclosure. This is a huge privacy issue and it should be stricken from the Act. Making it a requirement with no opt-out provision is the most irresponsible act I can recall the government committing in my lifetime.

2. The Act doesn't take effect quickly enough. Most of the important provisions do not go into effect until 2014 and some take until 2020 or beyond to start. All of the provisions should be immediate for two reasons: (1) People need help now and (2) People will not understand what the law does until it actually starts doing it.

3. The Act doesn't go far enough. Nice try, but this is a Band-Aid on a problem that requires major surgery. Our healthcare system is a disaster. It is not a world class healthcare system and compares poorly to every other advanced nation's system. The World Health Organization ranked the U.S. 37th in the world for healthcare, despite the fact that we spend the most per capita by a large margin.We need to start from scratch, not amend the existing system. Some support the Public Option, which would create a government-run health insurance agency to compete with existing private health insurance companies. It's called a Public Option because it gives the public the choice of either a government insurer or private insurer. I don't like this idea because it doesn't go to the root of the problem - insurance companies. The reason healthcare costs are so high, and the reason so many people fail to receive proper care, is because insurance companies act as middlemen, pocketing the lion's share of the money and making decisions about your health that you and your doctor should rightfully be making.

We need to take insurance companies completely out of the picture. To do this, we need to change our current healthcare system to a Single Payer system. Medicare is an example of a Single Payer system. Instead of paying a large premium to an insurance company, you pay a small premium to a government agency pool (like Medicare). (It's a smaller payment because the administrative costs run about 3% versus 70%.) The bills go to the agency, which pays them less your deductible and co-payment (20% under Medicare). This eliminates waste and makes medical services affordable for all. If you're under 65, you probably don't understand Medicare (which is not the same as Medicaid, a program for low income people). But ask your grandparents or other seniors what they think of Medicare and if they are willing to give it up. There's a reason why they don't want to give it up -- it works!

So, if I had my way, we'd amend The Social Security Act Amendments of 1965, which created Medicare, by removing two words: "over 65". No need for a 906-page Affordable Care Act. Just delete those two words from existing law and establish "Medicare For All". It's that simple. Yes, it will cost money, but it will also save trillions of dollars in the long term. If we can afford to spend billions of dollars to kill strangers in Iraq and Afghanistan, how about spending the money to save American lives right here?


  1. Thank you for sharing this article on EHR and getting healthcare right Keith.I have been doing research online on this subject because I have been hearing so much about it. That's how I came across your blog. I found your article very interesting and insightful. I can understand why you would be against posting someones medical records online. Thank you again for sharing!

    1. Hi Mike, welcome to the blog. I hope you'll stick around for future posts, read some older ones from the Blog Archive (upper left of the screen if you're reading this on, and maybe even buy some books, lol. If you have concerns about privacy and the Internet, you might want to check out my book Issues In Internet Law, 7th edition, as that it a major topic discussed there.

    2. By the way, since Mike was thoughtful enough to slip in a link to ChartLogic, a company that "provides Electronic Health Records (EHR) solutions to medical practices across the country," let me reiterate I believe electronic health records are a bad idea fraught with privacy concerns, and that there is no way to protect them adequately from hackers or accidental disclosure. I do not support the concept and readers should not infer that I endorse this company or any other that posters might mention or link to in their replies to my columns. I believe in free speech and I do not edit my readers' comments, but that does not mean I necessarily endorse their views or their products.

  2. "Give me Liberty, or Give me Death!" - Patrick Henry

    What a brilliant ruling by the United States Supreme Court on the affordable health care act (Obamacare). Stunningly brilliant in my humble opinion. I could not have ask for a better ruling on a potentially catastrophic healthcare act than We The People Of The United States received from our Supreme Court.

    If the court had upheld the constitutionality of the individual mandate under the commerce clause it would have meant the catastrophic loss of the most precious thing we own. Our individual liberty. Thank you! Thank you! Thank you! Supreme Court.

    There is no mandate to buy private for-profit health insurance. There is only a nominal tax on income eligible individuals who don’t have health insurance. This is a HUGE! difference. And I suspect that tax may be subject to constitutional challenge as it ripens.

    This is a critically important distinction. Because under the commerce clause individuals would have been compelled to support the most costly, dangerous, unethical, morally repugnant, and defective type of health insurance you can have. For-profit health insurance, and the for-profit proxies called private non-profits and co-ops.

    Equally impressive in the courts ruling was the majorities willingness to throw out the whole law if the court could not find a way to sever the individual mandate under the commerce clause from the rest of the act. Bravo! Supreme Court.

    Thanks to the Supreme Court we now have an opportunity to fix our healthcare crisis the right way. Without the obscene delusion that Washington can get away with forcing Americans to buy a costly, dangerous and highly defective private product (for-profit health insurance).

    During the passage of ACA/Obamacare some politicians said that the ACA was better than nothing. But the truth was that until the Supreme Court fixed it the ACA/Obamacare was worse than nothing at all. It would have meant the catastrophic loss of your precious liberty for the false promise and illusion of healthcare security under the deadly and costly for-profit healthcare system that dominates American healthcare.

    As everyone knows now. The fix for our healthcare crisis is a single payer system (Medicare for all) like the rest of the developed world has. Or a robust Public Option choice available to everyone on day one that can quickly lead to a single payer system.

    We still have a healthcare crisis in America. With hundreds of thousands dieing needlessly every year in America. And a for-profit medical industrial complex that threatens the security and health of the entire world. The ACA/Obamacare will not fix that.

    The for-profit medical industrial complex has already attacked the world with H1N1 killing thousands, and injuring millions. And more attacks are planned for profit, and to feed their greed.

    To all of you who have fought so hard to do the kind and right thing for your fellow human beings at a time of our greatest needs I applaud you. Be proud of your-self.

    God Bless You my fellow human beings. I'm proud to be one of you. You did good.

    See you on the battle field.


    jacksmith – WorkingClass :-)

    1. Hi Jack, good to hear from you. I think we agree on Single Payer. I'm less enthused about the Public Option, for reasons already expressed. I think you need to include the pharmaceutical industry and the insurance industry on your list of culprits. While the Act falls far, far short of what is needed, in the current political climate of impasse and obstructionism, it might have been the best legislation that could be passed. Unfortunately, America needs the best, not merely the best we can get at the time.

      I'll address the tax or penalty issue in my next post.