Improving Healthcare

It seems to me…

Modern medicine is a negation of health.  It isn’t organized to serve human health, but only itself, as an institution.  It makes more people sick than it heals.”  ~ Ivan Illich.

The U.S. spends more on healthcare, about 20 percent of our GDP, than the ten next most expensive nations (Japan, Germany, France, China, the U.K., Italy, Canada, Brazil, Spain, and Australia) combined and we have the worst overall results.

Where in the Hippocratic Oath does it state that even mid-level managers of major healthcare facilities are entitled to compensation in excess of $1 million/year?  Over $5.36 was spent by pharmaceutical, healthcare product industries, and organizations representing doctors, hospitals, nursing homes, health services, and HMOs on government lobbying since 1998 – over three times what was spent during the same time period by the entire military-industrial complex.  In most towns and cities throughout the U.S., the local hospital generates more revenue than any other employer including the city in which it is located.

Conservatives oppose government involvement in healthcare in the mistaken belief that increased competition would result in improved care and lower costs.  While this might sound good in theory, this has repeatedly been shown to not work in practice.  When a medical emergency strikes, we have to pay whatever the cost.  All of us are buyers of a product about which we have little knowledge and no ability to negotiate.  Patients rarely object to medical procedure costs since they either do not learn its cost until they receive the bill or it is covered by their medical insurance.  Many employer-provided insurance plans provide limited coverage on the maximum daily charges covered or do not cover a medication or required treatment.

For most of us, especially for those in small towns or cities, an employer provides a limited selection of insurance options, there is only a limited number of medical practitioners in our area, and while not a government-granted monopoly, there normally isn’t any option as to which hospital or care facility to choose.  Local competition in the medical field is largely a myth.

Several studies have shown that lowering the age for Medicare eligibility and allowing Medicare to competitively price and assess drug efficacy would result in significant healthcare cost reductions[i].

While some unnecessary procedures and treatment are prescribed by doctors and hospitals to increase profits or recover equipment costs, most appear to be associated with legal defense against medical malpractice litigation.  Malpractice reform should allow for the use of the so-called “safe-harbor” defense rather than a limitation or awards to victims.  The safe-harbor defense would permit the defensive argument that provided care was considered acceptable practice by the medical profession.

Many medical providers attempt to justify excessive charges for treatment or medication as a method of cost recovery for charitable or nonpayment but it is only those without adequate insurance coverage that receive bills with the highest payment rates.  Other patients covered by Medicare or other insurance programs are charged considerably less than those without medical coverage.  Seen from a cost perspective, results currently seem secondary relative to patient visits or total time spent with a patient though some private care organizations now are trying to avoid “over doctoring” by paying physicians salaries and outcome-based incentives.

The Patient Protection and Affordable Care Act (Obamacare) enables Medicare to impose penalties for unacceptable problem rates such as infections or injuries while in a hospital or readmission within a month following discharge.  Congress, for some reason, prohibits Medicare from negotiating the cost of prescription drugs, to make purchasing decisions based on comparative effectiveness, or to use competitive bidding for durable medical equipment even though it has been estimated that this could reduce Medicare overall costs by as much as 40 percent[ii].

While I do not consider “The Patient Protection and Affordable Care Act” passed by Congress in 2010 to be an adequate solution to our healthcare problems, it does represented a small improvement in current healthcare provisions.

There are many aspects of the affordable healthcare Act I did not agree with but also believe it should have been debated on its merits rather than ideology.  The basic problem with so-called “Obamacare” was that it was a weak bill that showed a distinct lack of courage and an over willingness to compromise with those who potentially were expected to oppose its passage – which, in retrospect should have been expected regardless of the measure’s merits.  Republicans lost an opportunity to get a good bill solely due to political dogmatism.

That’s what I think, what about you?

[i] Brill, Steven.  Bitter Pill, Time, 4 March 2013, pp16-55.

[ii] Ibid.


About lewbornmann

Lewis J. Bornmann has his doctorate in Computer Science. He became a volunteer for the American Red Cross following his retirement from teaching Computer Science, Mathematics, and Information Systems, at Mesa State College in Grand Junction, CO. He previously was on the staff at the University of Wisconsin-Madison campus, Stanford University, and several other universities. Dr. Bornmann has provided emergency assistance in areas devastated by hurricanes, floods, and wildfires. He has responded to emergencies on local Disaster Action Teams (DAT), assisted with Services to Armed Forces (SAF), and taught Disaster Services classes and Health & Safety classes. He and his wife, Barb, are certified operators of the American Red Cross Emergency Communications Response Vehicle (ECRV), a self-contained unit capable of providing satellite-based communications and technology-related assistance at disaster sites. He served on the governing board of a large international professional organization (ACM), was chair of a committee overseeing several hundred worldwide volunteer chapters, helped organize large international conferences, served on numerous technical committees, and presented technical papers at numerous symposiums and conferences. He has numerous Who’s Who citations for his technical and professional contributions and many years of management experience with major corporations including General Electric, Boeing, and as an independent contractor. He was a principal contributor on numerous large technology-related development projects, including having written the Systems Concepts for NASA’s largest supercomputing system at the Ames Research Center in Silicon Valley. With over 40 years of experience in scientific and commercial computer systems management and development, he worked on a wide variety of computer-related systems from small single embedded microprocessor based applications to some of the largest distributed heterogeneous supercomputing systems ever planned.
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3 Responses to Improving Healthcare

  1. Leona Knox says:

    The plan that ultimately became the Patient Protection and Affordable Care Act consists of a combination of measures to control health care costs and an insurance expansion thought public insurance (expanded Medicaid eligibility and Medicare coverage expansion) and subsidized, regulated private insurance. The latter of these ideas forms the core of the law’s insurance expansion, and it has been included in bipartisan reform proposals in the past. In particular, the idea of an individual mandate coupled with subsidies for private insurance, as an alternative to public insurance, was considered a way to get Universal Health Insurance that could win the support of the Senate. Many healthcare policy experts have pointed out that the individual mandate requirement to buy health insurance was contained in many previous proposals by Republicans for healthcare legislation, going back as far as 1989, when it was initially proposed by the politically conservative Heritage Foundation as an alternative to single-payer health care .


    • lewbornmann says:

      Agree. Since the basics of the ACA were initially proposed by conservatives, it demonstrates that politically motivation is considered more important than what is best for our nation.

      Prior to the Affordable Care Act, over 14 percent of Americans were without health insurance at any given time. This percentage is misleading in that the uninsured individuals continually changes and, in actuality, a higher percentage of the overall population has periodic lapses in coverage due to loss or change of employment. An even higher percentage fears loss of insurance resulting from problems at home or work. The ACA remains only a partial solution to the healthcare problem; some form of single-payer system should remain the eventual goal.


  2. Pingback: Legislative Insanity | Lew Bornmann's Blog

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