On Wednesday, I noticed an editorial in the Chicago Tribune about some of the candidates' ideas about solving our health care "crisis". They break it down to the Republican-favored private-market approaches, basically tax breaks and incentives to help people to purchase insurance and pay for health care, and the Democratic-favored universal coverage plans. The title of the editorial is "Buy health insurance, or else?" It states that where the Democrats mostly differ is whether Americans should be "forced" to buy/carry health insurance, and if they refuse, what does the government do about it?

Health care is expensive, there is no doubt about that. Those with insurance don't really notice the cost levels as much, I'm convinced of that. I also know that, having run a health care business for 21 years now, a lot of the costs go to overhead management. We run at between 60 and 70 per cent overhead in a dental practice. A lot of our management consultants are preaching lowering overhead costs to about 50-55%, but as far as I can see, their favored approach is to raise revenues while leaving fixed costs, such as facility expense (rent, utilities, etc etc) and staff costs the same. Yeah, this lowers overhead, and increases the bottom line, but it makes dentistry more expensive, because to raise revenues, you've gotta raise fees and/or do more expensive procedures. So that doesn't really address the idea of containing health care costs in dentistry, only the relatively low income level of a lot of practicing dentists. (Believe it or not, most dentists aren't making a fortune, especially when you factor in all the stuff they've gotta pay for themselves and the fact that they start late (age 26) and have some pretty serious debt piled up to drag them down the next 10 years or so.)

So how do you lower health care costs in general? Dentistry is probably a good model, actually, because fees are not terribly high compared to procedures that take similar time and skill in medicine. But in medicine, a lot of specialists are paying more in liability insurance than most people make in a year. A six figure yearly premium is not unreal. That's a lot of medical services before that MD makes dime one. That's certainly an area where costs could be contained.

And everyone thinks about those batteries of tests that MD's order, in part because they need all the info they can get to make accurate diagnoses, and in part because they want to cover themselves medico-legally if they get sued. Well, I've noticed that a lot of people think that these are just scams to make more money - until it comes to their own treatment or that of their loved ones. Then, the more tests the better. I just don't see this part of medicine changing that much. "Unnecessary laboratory tests" would be nice to cut, but what's "unnecessary"?

Meanwhile insurance companies are building beautiful office buildings in most big cities, and their CEO's are making MILLIONS! I don't know too many MD's making a million a year. Are they overcharging? Perhaps, but we have to remember that they're in this racket to MAKE MONEY, not out of some altruistic desire to help people maintain their health. (Your doctors are the ones with that desire, in my opinion.)

Can costs ever be really controlled? Will medical fees stop going up? Well, I can't see how that will happen. I know that my fees will rise on January 1st. My staff costs will escalate, my fixed costs will go up, and so will just about every other expense. Unless our COSTS freeze in our offices, we aren't going to see fees drop.

So if you can't lower costs, how do you cover everyone affordably?

I don't have any answers, just more questions at this point...