European Stars and Stripes (Newspaper) - June 13, 1991, Darmstadt, Hesse Thursday june 13. 1991. The stars and stripes a Page 13 commentary William f. Buckley a Complex problem a Learned Friend who was a precocious anti socialist at the age of approximately 13, and is himself an academic and a scientist ruminates that opposition to socialized Medicine is really something of a lost cause. In what ways when you come Down to it a he asks a could it be worse than what we now have not an uninteresting question. The medical problem is As entangled As any Ever confronted precisely because it docs not yield easily to free Market strictures. A this is so for reasons not easily dealt with Foremost among them that we attach an importance to human life after birth a before that you Are free to kill properly incommensurate to the Cost of. Maintaining that life. A a. ,. A it is literally the Case that hundreds of thousands perhaps millions become impoverished by the expenditure of Money to keep someone alive through months sometimes years of invalid ism. The sentiment of the Community is pretty Well consolidated on the Point that nobody should be permitted. To die simply because he or she cannot afford a doctor Here then Are the rough specifications of the problem. A a a a a a Quot. ,. V. 1. Too Many people Are going unnecessarily to the doctor.,.7"v a Quot v a v 2. Not enough people have medical insurance. 3. Doctors Are Over prescribing. Now some free Market measures that would prove useful leap instantly to mind. In order to guard against the abuse of medical care by hypochondriac the free Market is there with the classic remedy increase the size of the deductible. If the first visit to the doctor every year were to Cost the patient 100 percent the second 90 percent and so on it will take 11 visits before the insurer or the government has to pay the entire Cost of treatment. A a a a a a such a Reform a which of course is easily expert mooted with raising or lowering the deductible As experience counsels a is overdue. The British health sys Tern which costs less As a percentage of Gross National product than our own was hugely helped by Thea Hatcher governments introduction of charges for prescriptions. V at the other end much can be done by shielding the doctor from preposterous , an obstetrician in Florida needs to pay $130,000 per year for malpractice. A a. A a a a. A a. A .���., a a a. And the Cost of insurance is Only a relatively Small fraction of the Cost of unnecessary medical measures taken by doctors who wish to have a documented record that they exhausted every medical Means of prob ing the patients a a a a a a. During this season Congress is dallying with a limit to punitive damages in certain civil rights cases there is no reason not to extend congressional supervision of. Legal damages to include those payable in . We Are talking about an estimated $25 billion in Anthony Lewis reduced costs. A a. A a j ,. But consider now the Tough questions the first of these is the doctor millionaire. ,. Obviously there cannot be a ceiling placed on a doctors attentions. But just As obviously the doctor who regularly makes a million or More doing heart bypasses should he subjected to the the Market. It is always a Little unsavoury to talk about Competition when dealing with professionals but if a third party is paying for a heart operation the patient needs to be directed to a. Doctor who will perform for a lesser charge. A a a. A. A. In the classic Model if a profession regularly compensates at a very High relative rate then More people will practice that profession causing the Price of the professional service to come Down. A a a Here pressure needs to be exerted by insurance companies and also by the government. This is happening and indeed in the Case of medicare happening to the Point of imposing penalties on Many doctors who Are asked to perform at compensation fixed years ago and unrealistically indexed. But at the top Levels Competition is insufficient. And of course there is the problem of clerical overhead a More than $109 billion per year according to a study published in the new England journal of Medicine. That is More than enough to care for the More than 30 million who Are uninsured. A Why is the free Market incompetent to Cope-with-1 his. Problem Why is the american can do imagination failing to come up with a Hurbai crat eating device that makes life possible without enslavement to the form what would he the wording of an i Maine ipalion True tarnation to save americans from bondage to the questionnaire is government intervention at this Point the Only Way to go 1 More in due course.,1 a a Juni Vorsila i syrup into a. . Must have Universal health insurance medical insurance forms and Bills have become a torment for Middle class americans. We have trouble understanding their complexities and we do not know Why the computers keep spewing them out at us. When we Telephone for help we usually end up More frustrated. \ a Ca a Quot a a 1 he paperwork is just one symptom of the extraordinary complications of the american system of health insurance the most complicated on Earth. Another Winch can be even More burdensome is the penalty we pay Lor mobility. Every time an american moves or changes jobs its Likely that a different health insurance Carrier will to involved. The new policy May very Well not cover a pie existing conditions v pregnancy for example. In addition some people get no medical benefits where they work and have to find expensive individual poli cies. Ail of that is from the patients viewpoint. From that a die doctors the situation is no happier. In 1987, the average american doctor spent a Little More than 134 hours filling out insurance forms. That Wax 4.4 percent 6f his or her total professional time. And doctors have hired More and More clerical staff to Deal with the forms. A i Hose figures come from an article last month in the. Nav England journal of Medicine. It was by or. Steffie Wolhandler and or. David , of the Harvard medical school what they reported was Quot numbing. A administering health care in the United states Cost from $96.8 billion to $120.4 billion in 1987. The higher figure was nearly a Quarter of total spending on health a care. A a a a a a a. A a a a a a. A a a and the Burden of administration is growing. Between 1970 and 1987, the number of health administrators in this country Rose by nearly 400.percent. At the present rate of growth the study found administration will consume a third of All our health spending by the year 2003 and half by 2020. The recent government efforts to contain costs have Only made matters worse they a have required an army of bureaucrats a drs. Wool handler and Himmelstein write. 11 each piece of medical terrain is meticulously inspected except that beneath the inspectors Quot a. The Cost of health paperwork and bureaucracy is especially striking compared with other countries. The new England. Journal article makes detailed compari. Sons w Ith Canada. A a a. Canada devoted at most 11.1 percent of its health spending to administration in 1987, compared with As. A a much As 24.1 in the . Administration Cost at most $156 for each Canadian compared with s497 per capita in this country. Canadian administrative costs Are fall ing while ours zoom upward. ,. If health care had been managed As efficiently Here As in Canada in 1987, the United states could have saved As much As $83 billion. By now the saving would a be on the order of $100 billion a car. A a. The reason for the staggering .-Canadian difference is no secret. Canada has a genuine National health system covering everyone. We crazy quilt of medicare for the elderly medicaid for some of the poor and 1,500 private health insurers. Fragmentation is what makes . Medical insurance complicated and expensive. Every patient must be Inch a dually billed individually processed for insurance. Policies vary in deductibles in excluded conditions in requirements for co payments. For further coverage some people buy secondary insurance another layer of bureaucracy. As an example of a the scale of waste among private carriers a the new England journal article cites Blue Cross Blue shield of Massachusetts. To cover 2.7 million subscribers it employs 6,682 workers More than in the health services for All of Canada covering More than 25 million people. The article concludes that a Universal comprehensive coverage under a single publicly administered insure Nee p Rygr a m a is the e key to a had m i n is r a t Ive Sim of i f i c a. in Short the Cost and irritating complexity of health insurance in this country for patients and doctors Point to the same Reform As the systems inadequate coverage. Some 34 million americans have no health coverage at All. They and we who Are covered need a Universal a a. / Mew Drw Tinics. A
