It likely goes without saying that the ongoing healthcare debate in Washington has become confusing to the extreme. Even the most educated of folks are struggling to sift through the rhetoric and blatant falsehoods in order to feel secure about discussing the details of the topic intelligently.

Perhaps that complexity is the reason why so many young folks are remaining on the sidelines when it comes to this matter. While we can understand the reasons for such a response, that development is extremely disappointing for two reasons.

Richard Becker, writing for the Kentucky Kernel, offers the following statistics from the National Conference of State Legislators: 13 million of the some 30 million Americans (one estimate of the uninsured) who don’t have health insurance are between the ages of 19 and 29. Becker also notes that four million of those 13 million are college students.

Second, the lack of interest is especially disappointing to see given the impact young people had on the most recent election. Last we checked, this age group was a critical component of bringing to fruition a campaign that featured the motto: “Change we can believe in.”

A Moral Issue

Because when it comes to change we can believe in, universal healthcare is one today’s young people can and should get behind. In fact, we unequivocally agree with Nicholas Kristof of the New York Times who offered the following assessment:

“The collapse of health reform would be a political and policy failure, but it would also be a profound moral failure. Periodically, there are political questions that are fundamentally moral, including slavery in the 19th century and civil rights battles in the 1950s and ’60s. In the same way, allowing tens of thousands of Americans to die each year because they are uninsured is not simply unwise and unfortunate. It is also wrong-a moral blot on a great nation.”

Add to that the view of Ethan Mermelstein:

“Health care reform is one of those rare issues in our country’s history where the essence of the discussion is between right and wrong. To use the ever-poignant words of Dr. Martin Luther King Jr. (which were aptly often heard from the president this past election season), the power of our collective voice on the issue of health care needs to be heard loudly and clearly because of the ‘fierce urgency of now’.”

While we agree with these two comments, we regretfully must note that in a recent Gallup Poll, just 34 percent of Americans between the ages of 18 and 34 indicated they wanted their representative to vote for health care reform. An equal number, 34 percent indicated they wanted their representative to oppose health care reform.

But the real disappointment, the major regret, was the status of the remainder. A full 31 percent of those ages 18-34 said they weren’t sure where they stood on the issue (that percentage is about 10 percentage points higher than any other age-group polled). 

Perhaps our youthful vigor gets in the way when it comes to the idea of sickness and medical care. Or maybe, it is the complexity of the issue. Whatever the case, young people are not standing with their presidential candidate on the one issue that he deems the most important issue for our country moving forward.

We believe that should change immediately.

Universal Care as a Fundamental Right

The first basic question is the moral one, the idea that every American should have access to basic health care as a fundamental right. To get an answer to that question, we need only look at the other developed nations that form our now, globally flat world.

Today, 32 developed nations have some form of universal health care. In regards to the creation of a public option, it must be noted that healthcare is not necessarily government run in all 32 countries, but care is available to all citizens.

As for yet another sense of how far behind the times America is when it comes this issue, universal healthcare has been available in places like Norway since 1912, Germany since 1941, and Canada since 1966. That’s correct: Canada has offered universal health care for more than 40 years already.

Clearly, America is in the minority of contemporary practice on this issue. Yet, stating one backs universal healthcare does carry some risk of criticism in certain corners. It means supporting the notion that even those people with eating habits that result in extreme obesity, or smoking and drinking habits that put their bodies at early risk of significant health problems, or sexual habits that have placed them at risk still deserve access to fundamental care.

In fact, Mark Perry at Carpe Diem reviews basic insurance practices in other arenas, home, auto, etc., and renders the point that refusal based on preexisting conditions is how all forms of insurance typically work. While his point is valid, we disagree with the one arena that involves healthcare. One only read John Hewko’s editorial, Health care is a crisis that sees no party, to get a real understanding as to how the notion of preexisting conditions is being abused by the industry.

We believe everyone should have access to healthcare from birth and because of the denial some have faced to this point, they must be let into the system. Moreover, to accomplish full access, healthcare must also be required of all citizens.

Will Insuring Everyone Mean Higher Costs?

The general assertion is that by bringing young folks into the insurance mix, a larger pool of subscribers will be created. Given that many of these young, uninsured individuals are extremely healthy, many insist that bringing this group into the insurance pool will further decrease the overall costs of everyone’s insurance.

Certainly, any savings gained by enhancing that pool could well be eaten up by another group, those currently uninsured who have been denied coverage for various reasons. In fact, insurance companies maximize their profits through two practices, rescission and purging.

“Rescission” is the practice of removing a sick policy holder for having omitted a minor illness or pre-existing condition at the time that person applied for coverage. In such cases, the insurance company may cancel the policy regardless of the length of time people may have paid into the system.

The practice known as “purging” involves the process of removing unprofitable accounts from the system. Generally, this process is accomplished by raising premiums to unrealistic rate levels, sums that the insured group or individuals cannot conceivably afford.

These processes are part of the insurance industry’s push to limit what is called “medical-loss.” The idea is simple: it doesn’t cost as much to insure healthy people.

With this in mind, it is now easy to see why the numbers being thrown about for costs of universal healthcare vary significantly.

Karl Denninger of “The Market Ticker” offers two simple suggestions for dealing with those currently outside the system and the current practice of insurers. Denninger focuses on the nature of American enterprise, the need for market competition, while insisting that all insurance plans must become open plans.

“If you sell insurance” to anyone in a given state,” Denninger writes, “you must accept all persons in that state on the same terms and at the same price. If an insurer has a ‘we accept anyone at the same price’ policy for a business, you must be able to buy into their plan for the same amount of money that the employer is charged on a per-person basis. That is, all plans must be ‘open enrollment’ for everyone within the state – period.”

This concrete step would finally eliminate one of the major flaws in our current system, the process of tying health insurance to one’s employment, and thus making it nearly impossible for the self-employed or unemployed to access reasonably-priced insurance.

Denninger adds the traditional insurance caveat that exists within the business sector when an employee does begin working for a particular company. That employee can “only elect out or into a policy or plan on an annual basis” and once in “you’re obligated to participate for a full calendar year.” Using this traditional step would certainly eliminate the process of someone seeking to purchase insurance only after they get ill.

Ultimately, the goal should be to bring everyone into the system and a good many people think it can be done. The bottom line is everyone should have access to healthcare insurance and to gain that access, we would even go so far as to agree with the suggestion that acquisition of insurance be required of all of us.

Insurance Companies Are Not Necessarily Making Enormous Profits

While even our president has espoused a disdain for the profits made by insurance companies, it must be noted that such profits are not excessive when it comes to the concept of private business. According to a number of internet sites, insurance company profits top out in the four percent range.

Here we turn again to Mark Perry at Carpe Diem who offers direct data, noting that “Health Care Plans” as an industry sector ranks #86 by profit margin at about 3.3%. That site notes that “four health insurance companies (Molina, Health Net, Coventry, and Universal American) have profit margins below 1% for the most recent quarter, and another four (Humana, Magellan, WellCare and Centene) have profit margins between 1 and 2 percent.”

One industry trade publication, America’s Health Insurance Plan, reported that annual health insurance premiums averaged $2,985 for individual coverage and $6,328 for family plans in 2009. Again, noting the work of Perry, using the “industry average profit margin of 3.3% means that insurance companies make less than $100 per policy in profits for individual coverage, and a little more than $200 in profits for each family policy.”

Such numbers pale in comparison to the rhetoric and hyperbole. Reducing policies by $200 would result in savings of about $17 per month. When one is paying $500 or even $1,000 per month in premiums, a $17 reduction does not resemble any form of being a game-changer.

Of course, one can get into the realm of executive pay, one of the largest costs associated with such companies and an item reducing overall profitability. Perhaps, that is one area where insurance companies could be addressed in the long term but given their current net profits, simply insisting they become non-profits will not greatly impact the current status.

Reform Is a Must

David Tuber, writing on North by Northwestern, insists that reform of the entire healthcare system just isn’t warranted. Tuber insists, ”President Obama, Senator Baucus and Speaker Pelosi would have you believe that lack of decent health care is a crisis, and a complete and total overhaul is necessary.

“But if you look at the numbers, you’ll see that an overhaul doesn’t make that much sense.  When 85 percent of your population is insured, that’s a very good thing. An 85 percent insurance rate says that the system, however flawed, works as a whole. Spending billions upon billions of dollars to rework it so that 15 percent of the population is covered seems, well, stupid.” 

We could not disagree more with his general point, that reform is simply not needed. First, we again believe it is a moral obligation that we provide access to basic health coverage for all citizens, not just the lucky 85 percent who currently have access. Most importantly, under today’s current structure, when the average worker receives a pink slip, they immediately lose access to healthcare unless they can come up with significant sums of money to cobra their current plans.

As for maintaining status quo, every indication is that Medicare is about to become bankrupt. In 2008, annual spending exceeded revenue brought in from taxes. Therefore, to fund Medicare, it was necessary to begin spending some of its reserve.

Medicare trustees indicate that reserve fund will be exhausted by 2017. Given current trends, others insist that the actual date of bankruptcy could be as early as 2015.

There are basically two ways forward: increasing revenues, i.e. increasing taxes, or cutting services. Status quo is not an option.

Add to the Medicare issue the most glaring one, that the roughly ten percent of the population who lost jobs during the current downturn often could not maintain their coverage during their unemployment period and we concur that reform is a must.

The idea being we can shore up the loose ends with a little bit of tweaking here and there is simply not realistic.

We Must Find Savings In the System

Currently, America spends more per capita on healthcare than any other country. Johns Hopkins researchers reported that in 2002, Americans spent $5,267 per capita on healthcare. At that time, the rate was 53 percent per capita more than the next highest country, Switzerland. It was also 140 percent above the median industrialized country per capita rate.

Other sources have a smaller differential but none contend that any country pays more per capita than the US.

Perhaps even more importantly, the lead author in the Hopkins study, Gerald Anderson had the following caveat:

“Paying more (for healthcare goods and services) is okay if our outcomes were better than other countries. But we are paying more for comparable outcomes.”

Clearly, we must find ways to make our healthcare costs more competitive. Of course, this is the spot where the divergence really sets in.

Some insist that limits on medical malpractice lawsuits would result in enormous savings. Those who want to see reform in tort law insist savings would come in two distinct formats.

First, there would a reduction in overall malpractice insurance costs if tort reform were implemented. Yet, while many insist that the savings in this area could be significant, tort reform would also free up doctors from practicing defensively. That would mean enormous potential savings because doctors would seemingly order up fewer unneeded tests.

Ricardo Alonso-Zaldivar, a writer for the associated press notes the impact of defensive medicine as follows: “Some doctors will order a $1,500 MRI for a patient with back pain instead of a simple, $250 X-ray, just to cover themselves against the unlikely chance they’ll be accused later of having missed a cancerous tumor.”

For those who wonder if the practice of defensive medicine is real, we turn to Lawrence J. McQuillan, from the Pacific Research Institute, who had this to offer:

“A recent survey of doctors published in the Journal of the American Medical Association found that 93 percent of physicians admit to practicing defensive medicine.”

More importantly, he adds:

“Defensive medicine wastes patients’ and doctors’ time and costs $191 billion annually, according to the best scholarly research. Such waste drives up the cost of medical care and the price of health insurance.”

But when it comes to health care savings, the really large numbers could well be found at the level of doctors and hospitals. Just this week, Thomson Reuters released a white paper study, “Where Can $700 Billion in Waste Be Cut Annually from the U.S. Healthcare System.” This report identified six factors that could help create anywhere from $600 to $850 billion a year in savings: administrative inefficiency, provider inefficiency, lack of care coordination, unwarranted use, preventable conditions, and fraud.

Brett Arends at the WSJ notes information from the 2007 Commonwealth Fund study of health costs in the world’s nine richest countries.

“We spend three times as much on doctors’ services as the average, twice as much on pharmaceuticals, and three times as much per day of in-patient acute hospital care,” writes Arends. He goes on to note the insights of Jonathan Skinner, an economics professor at Dartmouth College.

“…the system suffers from too many bad incentives and waste. Doctors get paid to perform needless MRIs. Hospitals blow a fortune on proton beam accelerators.

“Serious reform needs to examine costs at hospitals and clinics – and that reform may yield other investments with potential.”

The Elephant in the Room

But when it comes to healthcare, it must be noted that personal decisions do in fact matter. And if we are to insure everyone, those personal decisions also affect the rates of others.

By some estimates, fifty percent of the nation’s health care costs are attributable to lifestyle choices, such as smoking, alcohol abuse, improper diet, lack of exercise. In addition, by some other estimates, “roughly 75 percent of all health care spending is associated with a small number of patients with one or more chronic conditions.”

Therefore, there is reason to discuss the notion that meaningful reform must somehow help provide incentives to changing these risky behaviors. The idea is that meaningful reform will need to include both segments of the population, those with chronic conditions and those who simply need insurance for that rainy day issue.

But if personal decisions do matter, than so does personal experience. Here we turn back to Kristof who has created this modest proposal:

“If Congress fails to pass comprehensive health reform this year, its members should surrender health insurance in proportion with the American population that is uninsured.

“About 15 percent of Americans have no health insurance, according to the Census Bureau. Another 8 percent are underinsured, according to the Commonwealth Fund, a health policy research group. So I propose that if health reform fails this year, 15 percent of members of Congress, along with their families, randomly lose all health insurance and another 8 percent receive inadequate coverage.”

We Believe

We believe Kristof is dead-on with his suggestion, that there are cost-effective, viable models out there for us to consider and it is high-time our elected officials stopped the bickering and the rhetoric and worked towards the path of real reform.

More importantly, we also believe it is time for young people to step up to the plate on the most important moral issue of our time, universal healthcare. In fact, the idea that 31% of the 18-34 age group simply has no opinion on the matter just might be the most troubling statistic of all.

It has been interesting to watch the Obama administration attempt to tackle the notion of healthcare. Whereas both the exorbitant costs and the poor standard of care flew under the radar for years, both elements seem to be getting greater and greater scrutiny these days.

At the same time there has been a strong push back from the system to retain the status quo. But after a report like the recent one from the Archives of Internal Medicine, it is clear that our healthcare system is in vast need of a major overhaul.

Substandard Care

The issue of quality healthcare came under discussion again this week with the release of a new study published in the Archives of Internal Medicine. One startling result involved abnormal patient test results.

The study revealed that 7 percent of such results aren’t reported to patients. That means one of every fourteen patients that undergoes some form of medical tests, often extremely expensive in their own right, may have health issues yet they never are apprised of the potential problems.

Generally, anyone undergoing such tests likely assumes that if they do not hear from their doctor the results must have been routine. Clearly, this new report indicates otherwise.

According to the study, nearly one third of the practices reviewed did not report testing results to patients. This finding came despite the Agency for Healthcare Research and Quality insistence that doctors should inform patients of all test results, normal or abnormal.

Fortunately, the study did not appear to reveal any missed cancers. But there were instances of where women were not told of the need for a follow-up Pap smear or mammogram to review an abnormal finding.

The Real Issue and What to Do?

Many insist that the real issue here involves the payment practices of the American system. Here, doctors don’t get reimbursed for the time taken to review test results but do get paid for ordering tests.

Others insist that the issue simply involves doctors that are just too busy to keep up with the demands of the profession. Yet another group insists that the reason that doctors are too busy stems in great part from the system’s structures.

The bottom line is that any patient not receiving test results from their physician must take the basic step of calling to follow up themselves. To have a sense as to when to call, begin by asking when you can expect to hear from the doctor regarding the test results. When you get home, mark that date on your calendar, then if you have not heard call the office.

You should insist on such contact even if the office reports the use of electronic medical records. While systems are designed to safeguard test results, the study found that both practices using electronic records as well as those using paper record keeping missed reporting. In fact, the worst came from those practices using a mixture of the two forms of record keeping.

Lastly, if you cannot get your doctor or the office to return your call, vote with your feet and switch doctors. Experts suggest that if you do not hear within three days then it is a sign that the practice you are using is simply not well-managed.

Healthcare Reform

The more we hear the clearer it has become that we are in need of healthcare reform. What makes the issue so challenging is that even though our care system has been costly, once upon a time that care was considered the best in the world.

Not so today.

And while it is clear that we are in need of healthcare reform, it is imperative that as we wait for must we take the steps necessary to ensure our own health. In the case of the latest data, that means following up on test results whenever your physician fails to contact you.