Studies have shown that care for the uninsured has little impact on premiums. Not a non-existent impact, but not enough that eliminating the problem would make a dent in the cost of healthcare. People who are uninsured tend to receive less care. If they are insured, they are going to receive more care, which will drive up costs.

Cost containment affects everybody. Here in Cleveland we have an excellent model of cost containment – the Cleveland Clinic. Best health care in the country and at a much lower price than the national average.

But the reason for this is that it is a very large organization with salaried doctors, lots of medical specialists, and a highly trained administrative support staff. It is therefore the antithesis of the model of the individual entrepreneur.

In a typical private doctor’s office, you will have the doctor, two nurses, a receptionist who doubles as appointments secretary, and four or five people in the back who’s sole duty is to deal with insurance companies. The doctor will also spend at least two hours of every eight hour day on the phone arguing with insurance companies. In the end it is a very inefficient way to run a business.

Cleveland Clinic has 2000 doctors and just 1400 insurance admins. The doctors rarely have to spend any time on the phone dealing with insurance companies. It is medicine that works.

However, if all doctors were required to accept the same level of payments that the Cleveland Clinic can accept, then they would rather quickly be forced out of individual practice and into ever larger group practices. And that would affect just about everyone. That is much more difficult to achieve.

How are you feeling? I want you to know that a group of us have introduced resolutions to change the GOP party platform in Texas. We have been nominated to the State Senatorial Convention as delegates and have interviewed to become delegates to the State Convention. We will change that crazy Texas GOP platform.

Maybe, maybe not.

First of all, the people without jobs already have healthcare. It’s called Medicaid. And if Medicaid means they have to wait a lot in waiting rooms for service, etc, no big deal, since the unemployed aren’t contributing to the economy.

But then we have all those people who are working … but don’t really make enough money to pay for insurance, and whose usually avoid needed primary care because a $75 office visit fee puts a serious dent in the monthly budget, and whose finances could be wiped out in an instant with any real medical emergency.

People say “there are free clinics” … sure, that is a great option for someone who has to work 40 or 50 hours a week at barely above minimum wage, and also get home to take care of kids. They have soooo much time to travel across town and sit around and wait for a free clinic to be able to see them. And societally, those workers having to miss work, either due to untreated illness, or even to having to take too much time to get medical care at an overswamped free clinic, has a cost that we all bear.

People say “if they get sick, they can go to the emergency room”. Yeah, that’s an efficient allocation of societal resources.

Not to mention the societal burden created whenever anyone has to declare bankruptcy.

The problem is that our current system causes a myriad of costs that get buried. Hell – even the “administrative costs” of insurance are vastly understated by just talking about the costs embedded in the insurance companies budgets … since hospitals and larger medical practices all end up having to dedicate a serious amount of administrative overhead time to fighting with insurers, filing and re-filing paperwork. And I can only guess how much having to deal with a patient who declares bankruptcy must be.

Overall societal costs are improved if we go to universal insurance. The alternative is just continuing to play chicken with healthcare system meltdown.