Health Care Destroyed: Lawyers Writing Rules for Health Care

While there is definitely a purpose and need for the legal profession, the fact that lawyers dominate elected office positions and governmental appointments puts them in the unique position of writing the rules that every profession and industry must follow including their own.

Unlike health care where there is no Constitutional mention or right, ever since the Supreme Court ruling in Gideon v. Wainwright (1963), there has been a right to an attorney in criminal proceedings if the person charged with a crime can not afford one.

How does the legal system handle this "right". In Massachusetts, at your arraignment, the judge asks you if you have already secured your own attorney. If you have not, the judge inquires about your income and assets. The judge then assigns you a court appointed attorney if it seems plausible that you can not afford an attorney. They actually authorize a specified amount of billable hours when they appoint the attorney. People who can afford an attorney, typically hire one because they want the best defense possible.

Who are court appointed attorneys? In Massachusetts, any practicing attorney may register and receive a modest amount of court appointed work at a below market fee structure. Attorney's who either have un-billable hours or those that want criminal court experience place their names on the roster. I do not know the specifics in other states and I am not proposing Massachusetts as the ideal model but merely to show how streamlined the process of providing legal care to the working poor and indigent is.

I remember very early on the pecking order of prominence as expressed to me by my grandfather; first was doctors, then lawyers and third was anything else. Doctors and lawyers used to be on relatively equitable footing with most practicing doctors and lawyers running their own professional practice and often creating some type of limited liability partnership to share work with other professionals.

The combination of Governmental bureaucracy (tax code, medicare, medicaid, etc.) and corporate cost management (third party payment of all types) has forced the base of health care and emergency care out of the free market where excellence and efficiency carry the financial rewards.

It has also forced many doctors into being employees not independent owner/practitioners. They have de-linked doctors from the market forces by which people select and pay for almost any other service. They have also burdened Doctors with an administrative paperwork nightmare and given them no relief from lawsuits that tend to treat the doctors as if they were defective car seats and the patients as if they were helpless healthy infants with full lives ahead of them.

The cure to the health care system requires removing routine health care and its economic model from those of emergency care and how we insure individuals from the costs of catastrophic care.

Returning most health care to a fee for service arrangement between a patient and a doctor of their choosing is the cure for much of what is wrong with the current system. Having patients make choices as adults with pocketbook consequences about their treatment is the best method of cost control. Eliminating all paperwork except medical records and a simple doctor-patient bill is they way to drive non-health care cost downward.

Having a stream-lined system similar to the current food stamp system for distributing health care funds directly to poor is a better way than what is proposed. Creating a simple system akin to the court appointed attorney system to ensure doctor availability to the poor.

Separating routine health care, to be paid directly or from a patient owned health care fund, from the insuring of individuals for costly catastrophic and emergency care.

Implementing tort reform to allow doctors to practice in a cost effective manner and begin to treat patients as having some responsibility in their own health care and reflecting that all disease can not be cured and eventually we all die. Why do people sue doctors at a far greater rate than they sue their lawyers? Are lawyers really that much more skilled or professional in their practices?

A final note, government incursion into health care has not interfered with the health care choices of the wealthy and those with golden insurance packages (a tax-free benefit), but it has simultaneously driven up costs for the typical American and limited their choices. The current health care legislation will drive up cost (and create debt for future generations), reduce our choices and drive all but the rich into a downward spiral of mediocre health care.

Should someone who earns $50,000 per year and pays $6,000 per year for health care, receive the exact same quality and quantity of health care as someone who does not work or is an illegal immigrant? Please note that someone earning $500,000 per year is not going to have their access to high end health care diluted even if they are paying more in taxes. The diminishment of health care as delivered will be born by the middle class.

The middle class can never benefit by class warfare and policies that reek of it are wrong, no matter whether supported by Democrats or Republicans.