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Solving Healthcare Through Verbosity

Imposing bureaucratic control on the expectation no one will understand you.

(Page 3 of 3)

Conservatives see doctors, patients, insurance policy agents and so forth as individuals who have their own knowledge base and motivation and whose self-interest must be unleashed and played against each other in order to create a competitive market system. Liberal "policymakers," on the other hand, see the same people as chess pieces to be moved around the board in order to achieve the desired outcome.

It's not at all surprising, then, to find that the one interaction that troubles the Brookings authors is "fee-for-service," the old-fashioned method where your doctor provides a service and you pay for it. Fee-for-service works for plumbers, for carpenters, cockroach exterminators, hair salon operators -- almost any service you can name -- but not for doctors and patients because… well, because the government wants to get involved and doesn't like the outcome. And so the Brookings authors offer instead "Pilot Accountable Care Organizations (ACOs)" and "Pilot Enhanced Episode-based Payment' Systems" in which:

Payment rates for certain types of episodes of care would be set through competitive bidding with risk-adjustment, with public reporting of provider outcomes and quality bonuses. On the beneficiary side, tiered co-payments should be implemented, to encourage use of providers that deliver more efficient bundles of services. Other promising reforms that might be piloted include new pay-for-performance models or care-coordination bonuses…

In other words, the players aren't adult enough to work things out for themselves. They have to have it worked out for them. Who will "implement" these "tiered co-payments" or determine the level of "care-coordination bonuses"? Why, your friendly neighborhood bureaucrat, of course.

I see very little room for compromise in all this. One side wants to free people up from government regulation and let patients, doctors, and the insurance industry work things out for themselves -- with some simple subsidization for people who cannot afford to pay for their own medical care. The other side wants to set up a complex, arcane system that only the people who run it will ever understand -- but where this elite will be free to determine the outcomes.

Which one would you choose?

Page:   1 23

About the Author

William Tucker is the author of Terrestrial Energy: How Nuclear Power Will Lead the Green Revolution and End America's Energy Odyssey.

Letter to the Editor View all comments (50) | Leave a comment

Pecos Pete| 9.9.09 @ 6:41AM

Mr. Tucker: Well written, easily understood for those familiar with ERISA. I particularly liked your concluding paragraphs. The law of unintended consequences always applies.

Pingback| 9.9.09 @ 7:10AM

Twitter Trackbacks for The American Spectator : Solving Healthcare Through Verbosity links to this page. Here’s an excerpt:

…e_Spectator philipaklein Philip Klein amspec American Spectator 109 Show more Shortened Links Linking to the spectator.org page http://bit.ly/1atcxB info   2 tweets Tweet The American Spectator : Solving Healthcare Through Verbosity spectator.org/archives/2009/09/09/solving-healthcare-through-ver – view page – cached I've finally figured out what it is about liberals. They speak a different…

Robert Rosencrans| 9.9.09 @ 7:10AM

There is another element in the health care system that can not be fixed. Health care resources are not infinite and are set up to administer to the current system. Drop 43 million freeloaders (Of which 20 million are illegal aliens) into the system and those with true health care needs will enter a virtual reality death camp.

There is a clause in one of the health care bills which requires statistical reviews of who is getting health care based on gender and race. It is only a question of time before race or gender determines who gets health care in an opportune time frame.

In essence, this is why the public option is needed. You can't create a collectivist society whose goal is to discriminate against someone, without a government takeover.

On that basis the act could also be named the Planned Obsolescence of White Male Act, or the Preservation of Blacks and White Females Act.

This is typical of all collectivists actions by liberals and statists. They are the ones who embrace racism and endorse it in every action. The public option would be the medical equivalent of the Dred Scott Decision, only it's negatives in terms of non-citizen status would be aimed at white males.
http://www.onenewsnow.com/Poli.....?id=640904
The Washington Times reported this week that four members of the U.S. Commission on Civil Rights want President Obama and Congress to rewrite some "little-noticed" provisions of the healthcare bill that factor in race when awarding billions of dollars in contracts, scholarships, and grants. In its letter outlining the request, the Commission quotes a Harvard medical researcher who said the notion that bridging the health status gap by expanding the number of minority physicians and providing culture-related training is "grounded in hope more than science."

Concurring with that stance is Roger Clegg, president and general counsel of the Center for Equal Opportunity. He says it is ridiculous -- and unconstitutional -- for medical schools and hospitals to weigh skin color or ethnic background when admitting students or hiring doctors.

Roger Clegg"Of all the professions where people are least likely to care about the person's skin color and are most likely to want simply the best-qualified person working on them, it would have to be healthcare -- it would have to be doctors and nurses," says Clegg.

Deborah D| 9.9.09 @ 7:39AM

Thanks for a truly enlightening article, Mr. Tucker. As Thomas Sowell said in an article yesterday, "Obama tried to rush Congress into passing a massive government takeover of the nation’s health care before the August recess — for a program that would not take effect until 2013...why postpone for years the date when the legislation would go into effect — specifically, until the year after the next presidential election?"

The Democratic Party is simply power hungry. They don't give a rat's patootie about who gets health care. They don't care what it will cost. They only wish to control every one of us through the new massive bureaucracies this program will create.

Why wait until 2013? Why not let us see how it all works out before the next election if they love it so much. To me, that Sowell statement tells you all you need to know about our president and his party.

Boston guy| 9.9.09 @ 8:10AM

Very good article, thanks. In a sentence from the last paragraph,

"None of this is supposed to be comprehensive to ordinary individuals."

I think "comprehensive" should be "comprhensible".

Curly Smith| 9.9.09 @ 8:54AM

I think the conclusion is a bit different. I also see little room for compromise because it's a fight between people who want the government to get out of the way and those in government who will never admit that their legislation is the basis of the problem. Instead of admitting that all of the prior health care "reforms" have led us to where we are the political class is working feverishly to add additional layers of incomprehensible and conflicting regulations that will ultimately make insurance so expensive that only the super-rich, and elected member of Congress, can afford it. Which, of course, is the intent as that path leads to Nationalized Health Care.

It's the perfect fight for any politician with "stones". You have the little guy subsidizing the Fortune 500, you have unions and group insurance plans raking in Federal Subsidies - also funded by the little guy. It's Mom & Pop versus the Special Interests and Mom & Pop can't get any interest. You have both major parties and the entire MSM cheerleading for Big Business and Special Interests. And, sadly, not a politician with "stones" in sight. Oh sure, we'll get a Republican "Compromise" that will drive up costs to Mom & Pop, McCain will get accolades as a Centrist and the additional subsidies that the little guys will pay to Big Business and the Special Interests will drive people to the "Public Option", which, again, is the intent. Let me say in advance "Thanks, John".

2Anglico| 9.9.09 @ 9:04AM

The whole "employer based" system is the result of government action in WWII, wage and price controls. And you are right, they want government control of everything but they cannot say their real intentions. Americans are not yet completely dumbed down. Thus, the mumbo-jumbo.

Gill O’Teen ✝✡| 9.9.09 @ 10:13AM

Curly Smith, in the verbosity spirit of this article and Boston guy’s remark, I think you should have not written “... the political class is working feverishly to add additional layers of incomprehensible and conflicting regulations ...”, but ‘... the political class is working feverishly to add additional layers of incomprehensive and conflicting regulations ..’ All kidding aside, just let me buy health care like I buy car insurance. I don’t file an auto insurance claim to replace a light bulb, I shouldn’t file a medical claim to get a bandaid on my boo-boo. My car insurer offers a menu of deductibles. If I want no deductible, fine, I pay for it. If I want a $1,000 deductible, fine, I pay for it. It’s my choice. I just make sure there’s enough cash in the stash just in case. The Boss and I can buy car insurance from plenty of competitors. We can buy life insurance from plenty of competitors. We can buy property insurance from plenty of competitors. We are limited to three companies from which to buy our medical insurance. Gum’mint should simply apply the KISS principle. Unfortunately, when it hears the word ‘kiss’, it forms a conga line to apply lips to the golden calf’s buff butt. We need to tell the obumabots in Gum’mint to kiss off.
Gill O’Teen ✝✡
gill.Oteen07041776@gmail.com
Don’t Tread on Me!!

Pete| 9.9.09 @ 10:30AM

RR,

Brilliant stuff.

Planned Obsolescence of White Male Act, or the Preservation of Blacks and White Females Act.

Christina Grinkmeyer| 9.9.09 @ 10:52AM

read your article this morning "Solving Healthcare Through Verbosity" and I wanted to say thank you. Thank you for making it easier to understand. I worked for large fortune 500 company for many years and had wonderful health insurance. Now self employed, struggle with the idea that I pay so much more for less coverage. I understood that competition across state lines would help bring down costs but I was unaware of all the other pieces of the puzzle. More people should read this....more people should access to this....and more people should try to understand how health insurance bureaucracy works.

Thanks again!!!


Christina Grinkmeyer

Birmingham, AL

Richard Johnston| 9.9.09 @ 11:39AM

I believe Mr. Tucker, in an otherwise comprehensive discussion, has omitted perhaps the most troubling effect of ERISA, and this is one which applies to all ERISA coverage, whether insured or self-funded. It affects not only health insurance coverage but also life and disability insurance – in sum any type of coverage which is employment-based.

ERISA renders any employment-based insurance coverage virtually unenforceable in court should it ever come to that. In the case of both self-funded and insured coverage, state laws regarding breach of contract, insurance bad faith, and remedies are gutted by ERISA and replaced with a scheme which very significantly stacks the deck in favor of the insurance companies and similar entities. It also limits the remedies which may be recovered – if, against the odds, the claimant is able to prevail – to a level which is utterly meaningless to the insurer. This is a major, major problem, as of course it directly impacts the behavior of insurers and plan administrators, who know full well that the coverage they issue is essentially unenforceable and that they may breach their contracts with no meaningful consequence. For one example, see this discussion at my blog about ERISA:

http://problemiserisa.blogspot.....young.html

and those interested may wish to peruse some of the rest of the blog as well.

One of the essential underpinnings of a free market is the rule of law. ERISA undermines the rule of law, and in this sense too it must be amended if any sort of real reform is to be achieved.

Curtis Rasmussen| 9.9.09 @ 12:09PM

Nah, Pete,

It's about class warfare now. If more than 50% of the populace votes for people that will put them on the dole, then the rest of us are doomed.

The hard working will be made obsolete as the fruits of their laber are forcibly taken to support all kinds of slackers. Voting out the politicians that are screwing us will become nearly impossible because the 'doles' fear the loss of their precious socialist benefits.

William Tucker| 9.9.09 @ 12:33PM

Richard Johnson makes a good point that I didn't have time to mention in the article. The other side of the coin of ERISA coverage is that ERISA plans can kick people out if they became sick and change coverate at whim because it protects the OTHER pool members. In other words, if one members gets cancer and is about to pile up huge medical bills, the plan can drop them from coverage on the grounds that bankrupting the plan would "come between the other pensioners and their benefits." All the horror stories Hillary Clinton told about insurance companies treating people arbitrarily were about ERISA plans. Yet she never made that distinction. Regular insurance companies can't cut people off arbitrarily - state and contract laws prohibit it. In fact state insurance regulators all hate ERISA because they have no authority over them, yet when ERISA plans do things ordinary insurance companies aren't allowed to do, the regulators always get the blame. Gill O'Teen is right. If health insurance were sold the same as life insurance, car insurance and homeowners' insurance, there wouldn't be any "healthcare" problem.

Oldefarte| 9.9.09 @ 1:07PM

The main problem is that the typical liberal, and the bleeding-heart moderates/conservatives want to [mainly due to their religious beliefs] provide another government welfare benefit to the indigent, the poor and the downtrodden.
The only probelm with this is that THE TAXPAYER HAS TO PAY FOR IT WITH INCREASED TAXIATION. The solution is to force our government to implement extreme birth control measures, but then you begin to hear the cry of RACISM, GENTRIFICATION, DIENFRNACHISEMENT,etc. The indigent/poor/minorities are simply having too many children, that they cannot financially support/pay for, and it ends up the responsibility of government and therfore taxpayers. Additionally, Obama/Democrats have not [and probably will not] allow for TORT REFORM, which ends up costing insurance consumers/taxpayers millions; since 'pain-and-suffering legal judgements against insurance companies are the rolled over/charged to present/future buyers of insurance as higher prices for health insurance. The current helathcare discussions need to include this, in addition to the pricing mechanisms detailed in this article!!!!!!!!!!!!!

Michael L. Hauschild| 9.9.09 @ 1:43PM

Wow, he does "know a little about health care." I have learned more about the debate by reading this article than anything cumulative to date.

tj| 9.9.09 @ 1:55PM

Read the last line if it had Said Only White Men....hmmmmmmm bru haha??

http://www.explorehealthcareer.....e.221.aspx

Richard Johnston| 9.9.09 @ 2:12PM

Oldefarte said:

"which ends up costing insurance consumers/taxpayers millions; since 'pain-and-suffering legal judgements against insurance companies are the rolled over/charged to present/future buyers of insurance as higher prices for health insurance. "

IMO, ERISA, as discussed above, in fact presents precisely the opposite problem: the liability exposure of insurance companies and similar entities is far too low to create any incentive for them to behave themselves, so valid claims get denied and people get dropped once they get sick, as Mr. Tucker notes in his comment just above. I understand the theory about tort reform when it comes to medical malpractice and health expenses (although there are some difficulties with that theory too) but the experience with ERISA insurers demonstrates what happens when you go too far in that direction, and provide insurers with immunity from liability for anything up to and including outright fraud. Again I will cite my own blog for further information although there are plenty of resources online which can be reached with a simple Google query:

http://problemiserisa.blogspot.com

gay republicans for jesus| 9.9.09 @ 5:06PM

I found this youtube clip of how we are being treated by Obama and I think we all like it:

http://www.youtube.com/watch?v.....re=related

Pingback| 9.9.09 @ 6:48PM

Tonight’s TV Coverage of Obama (Yawn) Health Care: Robert Gibbs Snarky about FOX Air links to this page. Here’s an excerpt:

…Pontifications: Obama Implies Illegals Will Be Covered by His Health Care Plan GayPatriot: Why President Should Ditch Obamacare, Focus on Economy William Tucker, The American Spectator: Solving Healthcare Through Verbosity FOX News: ABC, NBC Won’t Air Ad Critical of Obama’s Health Care Plan Examiner.com: Anti-ObamaCare ad that ABC and NBC refused to Air Big X, Big Hollywood: Debunking the Great…

Pingback| 9.9.09 @ 6:49PM

Pelosi & Reid: Quick, Pass ObamaCare While We Still Have the Votes and No One Has Co links to this page. Here’s an excerpt:

…RELY Free Republic: Sentenced to death on the NHS Liberty’s Army: Forecasting Death in the UK: Fasttrack to Death with the NHS Pathway Policy William Tucker, The American Spectator: Solving Healthcare Through Verbosity Frugal Café Blog Zone: UK Health Care Scandal Breaking: Neglectful, Cruel Treatment of 1 Million Patients Reported and France’s Broken Health Care System: Copying America’s…

Pingback| 9.9.09 @ 6:51PM

Dragnet’s Sgt. Friday to Obama: “Don’t Try to Build a New Country, Make the Old One links to this page. Here’s an excerpt:

…Socialized Medicine Horror: Giving Birth in UK Hospitals Hazardous to New Mothers - Shortage of Beds, Thousands Give Birth in Bathrooms, Corridors William Tucker, The American Spectator: Solving Healthcare Through Verbosity JustOneMinute: So Many White People VotingFemale Friends Speak!: Gallup Poll: the nation is swinging right The Weekly Standard: People Power Michelle Malkin: Why parents don’t trust the…

Osamas Pajamas| 9.10.09 @ 12:04AM

OBAMASCARE

Barak Hushpuppy OhBummer, "The Mistake of '08," is employing SCARE TACTICS to get his single-payer / universal / public-option / government-run socialized medicine / healthcare-hijacking fastened on the backs of the American people. More Americans will die if we don't do it HIS way, he says ---- and we'll all be guilty of murder by turning OhBummer down.

Here he pontificates to the great masses of ignorant unwashed Americans, as he is inclined to regard them ---- who evidently don't trust this sneaky, sticky-fingered, smoothing-lying low-down skunk. Nope. Shake hands with OhBummer. Now count your fingers.

"I will not waste time with those who have made the calculation that it's better politics to kill this plan than to improve it." MY ANSWER: Your plan is a hefty hunk of steamin' junk, there is no salvation for rot as ripe as this is.

"Well, the time for bickering is over," he said. "The time for games has passed. Now is the season for action." MY ANSWER: I feel exactly the same way, OhBummer, so knock off the scare tactics and propaganda, and the threats to the tea party and town hall protesters ---- and shut that lying hole in your face.

"I am not the first president to take up this cause, but I am determined to be the last," he added. MY ANSWER: I am determined that you will be the last SOB to try to impose this crxp on the American people, too. You're just a heathcare hijacker and a predatory humanitarian ---- while pretending to be Santa Claus, wanting only to confer your "gift" on the American people ---- this is like getting a gift from Typhoid Mary.

Now, it is a mistake to suppose that OhBummer and the OhBummer Wrecking Crew mean to "reform" American healthcare. This is not reform, it is an out-and-out hijacking.
It is worth noting while the Marxist socialists seek to nationalize the entire system ---- such that all healthcare employees become government employees ---- Hitler's Nazis ["national socialists"] adopted another version of the same poisonous statism ---- "interventionism." Under this system of total government control and dictatorship, the Nazis argued that they were merely "regulating" industry and that it continued to be "private enterprise under a system of private property."

But here's what the Nazis would never have tolerated publishing. A freeman owns himself, while a slave is owned by others. The first article of "private property" is "the self" --- and all other property earned or obtained by gift belongs to the individual. Private property consists of the freedom of use and disposal thereof --- and because the Nazis and their philosophical partners-in-crime, e.g.: OhBummer, Nazi Pelosi, Dingy Harry Reid, Gaseous Al Gore, Mt Potato Head Biden, Hillary HotRod, and Sick Willie Clinton wish to "regulate" their betters, they effectively cancel private property ---- including the ownership of oneself.

Now, lads 'n' lasses! Go out there and kick over some bloody coffee tables, would ya?! And if OhBummer's thugs from the unions and Move On and Code Pink try to stop you, "get in their faces!"

Yi Ha ***
Minister of Information
Peoples' Capitalist Republic of Whizbangistan
*** Pronounced "YEEEEEEEEEEEE HAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA!!!"

Patriot| 9.10.09 @ 1:59AM

Gay Repub, is that you in the video running around without your pants on being chased by an amorous donkey? Shame on you.

Real American| 9.10.09 @ 2:21AM

Liberal Democrats truly believe that the biggest problem with health care is that the government doesn't control it....and you.

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It is worth noting while the Marxist socialists seek to nationalize the entire system ---- such that all healthcare employees become government employees
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Pingback| 9.10.09 @ 7:53AM

Barack Obama now has a new list of Enemies: the Progressives who put him in office « links to this page. Here’s an excerpt:

…Pontifications: Obama Implies Illegals Will Be Covered by His Health Care Plan GayPatriot: Why President Should Ditch Obamacare, Focus on Economy William Tucker, The American Spectator: Solving Healthcare Through Verbosity FOX News: ABC, NBC Won’t Air Ad Critical of Obama’s Health Care Plan Examiner.com: Anti-ObamaCare ad that ABC and NBC refused to Air Big X, Big Hollywood: Debunking the Great Debunker:…

Pingback| 9.10.09 @ 10:39AM

What’s Hidden in the ObamaCare Bill? Rush Limbaugh Reviews Carefully All the New, Mi links to this page. Here’s an excerpt:

…Pontifications: Obama Implies Illegals Will Be Covered by His Health Care Plan GayPatriot: Why President Should Ditch Obamacare, Focus on Economy William Tucker, The American Spectator: Solving Healthcare Through Verbosity FOX News: ABC, NBC Won’t Air Ad Critical of Obama’s Health Care Plan Examiner.com: Anti-ObamaCare ad that ABC and NBC refused to Air Behind Blue Lines: Does the Government…

Pingback| 9.10.09 @ 12:46PM

When Yelling “You Lie” Is So Much Worse Than Booing (video) « Frugal Café Blog Zone links to this page. Here’s an excerpt:

…Pontifications: Obama Implies Illegals Will Be Covered by His Health Care Plan GayPatriot: Why President Should Ditch Obamacare, Focus on Economy William Tucker, The American Spectator: Solving Healthcare Through Verbosity FOX News: ABC, NBC Won’t Air Ad Critical of Obama’s Health Care Plan League of American Voters: Watch the New TV Ad Exposing The Obama Health Care Takeover RedState: The U.S.…

Curtis| 9.10.09 @ 9:53PM

One simple OT question I have to make:

What effect will all this talk of revamping patient data via hospital IT have on patient confidentiality (One of the most important and trusted parst of the medical professions hypocratic oath)?

I mean, you're putting peoples' personal healthcare history on to computers, and hooking those databases into the net so that its accessible to any hospital that person pops into.

Have the democrats even vaguelly pondered securing this system? Do you really want your employer or soon to be exspouse googling your sexual history? Do you really want your health insurance company to know that you smoked as a teen? Do you want the county prosecutor to know you smoked weed as a teen? Do you want advertisers to know that you've asked your doctor about fertility treatments? Do you want your childs' school teacher to know you were abused as a child?

I don't trust IT when it comes to sensitive data. I don't want my history on a mainframe, accessible by bureaucrats, bigots and bosses who have access. I don't want bored hackers selling my sexual history to advertisers and pillpushers.

Bruce Fancher| 9.12.09 @ 2:22PM

Thanks. This is the clearest and most concise explanation of what's wrong with the current system that I've come across yet. I wish everyone in the media would read it, understand it and believe it. My only complaint is one that applies to just about every conservative writer, radio host, etc. Could we please stop calling the other side "liberals" and start calling them something more accurate, like "statists?"

Pingback| 9.16.09 @ 11:32AM

ObamaCare in the Toilet: Rising Number of Americans Don’t Want ObamaCare… Snowe Back links to this page. Here’s an excerpt:

…Le·gal In·sur·rec·tion: Shocking Lack of Respect Liberty’s Army: Forecasting Death in the UK: Fasttrack to Death with the NHS Pathway Policy William Tucker, The American Spectator: Solving Healthcare Through Verbosity The American Pundit: Good News: Senate ObamaCare Punishes Families for Not Buying Gov’t Approved Health Care Doug Bandow, American Spectator: Health Care Nationalization Still Behind No…

Pingback| 9.16.09 @ 2:32PM

Steele Slams Jimmy Carter about Democrats’ ‘Pathetic Distraction’: “This Isn’t about links to this page. Here’s an excerpt:

…Le·gal In·sur·rec·tion: Shocking Lack of Respect Liberty’s Army: Forecasting Death in the UK: Fasttrack to Death with the NHS Pathway Policy William Tucker, The American Spectator: Solving Healthcare Through Verbosity The American Pundit: Good News: Senate ObamaCare Punishes Families for Not Buying Gov’t Approved Health Care NewsBusters: French Health Care Expert: France’s System Broken, Should…

Pingback| 9.21.09 @ 10:09AM

Beating a Dead Horse… House Minority Leader Boehner Says He Believes ObamaCare Is De links to this page. Here’s an excerpt:

…Le·gal In·sur·rec·tion: Shocking Lack of Respect Liberty’s Army: Forecasting Death in the UK: Fasttrack to Death with the NHS Pathway Policy William Tucker, The American Spectator: Solving Healthcare Through Verbosity The American Pundit: Good News: Senate ObamaCare Punishes Families for Not Buying Gov’t Approved Health Care Doug Bandow, American Spectator: Health Care Nationalization Still Behind No…

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