June 17, 2009

Government Health Care Won't Fly

By Frank S. Rosenbloom, M.D.

It is a common misconception that the free enterprise system is at fault for the current high cost of medical care in the US, a misconception that the current administration has no desire to refute. However, the government's regulatory and control practices are really at fault. Ever increasing and more punitive government and Medicare regulations set the standards for the actions of the private insurance companies. Sometimes, these can best be understood by analogy.


Let's look at the airline industry hypothetically as it would operate if the government had as much control over it as it does over health care. To see how complex Medicare is we can turn to over 130,000 pages of regulations and penalties and contrast that with the Federal Aviation Administration (FAA) regulations numbering about 1,000 pages.

We will first include some definitions so we can follow the convoluted story:

Pilots = physicians.

Flight Attendants = nurses.

The FAA (Federal Aviation Authority) = (CMS-Center for Medicare and Medicaid Services)

Flight Insurance Companies (FIC's) = Health Insurance Companies.

Airlines = hospitals and hospital corporations.

Airports = primary care provider's office.

Airplanes and flights =  medical care.

Primary Coordinating Pilot (PCP) = Primary Care Physician (PCP).

Flight Attendant Piloteers (FAP's) = Nurse practitioners (NP's).

Pilot Assistants or (PA's) = physician assistants (PA's)

Licensed Independent Pilots (LIPs) = Licensed Independent Pilots, (LIPs) I kid you not!

Future Flyer Tax = Medicare tax

Statement of Ground Transport Necessity = Letter of Medical Necessity

Suppose that pilots and the airlines were paid not by fees for tickets paid by passengers, but by flight insurance companies (FIC) or plans for the retired offered by the FAA.  FICs would charge those under age 65 a monthly premium of $500 to $1000 in case they needed to fly. Imagine also that the FAA imposed a "future flyer tax" each month on every passenger under 65, with the promise of unlimited flights and small co-pays for airport consultations and flights needed after age 65. Of course, that money would not be saved for the future needs of the persons paying now but would immediately be used to pay for the flight needs of current retirees.

The FAA would pay the flying fee of retirees to the pilots, NPs or FAPs and the airlines, but at a significantly discounted rate. These payments would be approved only when the passenger "needed" to fly, as determined by the FAA. However, if elderly passengers were near death they would be allowed seats as long as it was likely they would die before reaching their destinations. Paradoxically, pilots and airlines would get paid more for flying nearly dead passengers.

For a small co-pay of $20, passengers would be able to see a pilot, NP or FAP briefly in consultation. They would try to help passengers by exploring alternatives to flying, such as determining whether a bus or a car would be a better option. Perhaps if some passengers would just wait, or take an aspirin and a sedative, the urge to fly would pass on its own.

Passengers not in these plans would be charged high fees for just going to the airport and thousands of dollars for even short flights. Therefore, anyone who thought they were ever going to need to fly would join if they could afford to. Passengers who flew more often would be charged higher premiums due to their "pre-existing" flights. Further, the FAA would get the IRS involved to adopt restrictive tax rules. If employers paid for the flight insurance the premiums would be in pre-tax dollars but if individuals paid there would be a tax penalty. Therefore, in most cases employers would offer flight insurance which would eventually be considered an entitlement. Therefore, passengers would always be dependent upon either their employer or the government for their flying insurance. Dependence on the government after retirement would be more palatable if flyers were already used to being dependent on their employers for benefits not related to employment.

Whether a passenger "needed" to fly would be determined by the FIC or the FAA, or the FIC as an agent of the FAA, but not the passenger. Occasionally, passengers could fly on short routes, but would be refused permission to fly on any of the longer routes unless their flight was deemed "aeronautically necessary". Such passengers would have to endure several visits to the airport and short consults with a pilot, who would be required to submit paperwork to the FIC or, for retired passengers, the FAA, for pre-approval of flights. In some emergency cases a passenger would be allowed to fly immediately but authorization would be required before they were allowed to land. Special trap doors would be installed so that passengers who were not able to obtain the required authorization prior to landing could be "denied" by gently dropped them out of the plane. Whether they would be provided parachutes would be up to their FIC or, if applicable, the FAA.

The FIC or the FAA would be able to overrule the passenger, the pilot and the airline regarding a passengers' destination. Say a vacationing passenger wanted to fly from Chicago to Hawaii for a week lounging on the beach. The FIC (or the FAA for older passengers) could decide that this vacationing freeloader really did not need that long of a flight and that he or she would be routed to Galveston via Houston instead. The FIC could determine that a beach in Galveston would do just as well. Never mind that a hurricane is due in Galveston, since emergency accommodations would not be covered by the FIC.

So it's off the plane in Houston for our vacationer. The FIC pre-approved half the cost for a rental car to Galveston, but will not pay for the gas or tolls. While the return flight from Houston to Chicago will be covered, the rental car back from Galveston to Houston will not be unless a pre-authorization is received with a "statement of ground transport necessity" from the pilot, dated after the passenger arrived in Houston but before the passenger arrived in Galveston.

Some passengers would be in "Managed Flight Plans", in which FIC's or the FAA would pay much more money to pilots and airlines for not flying or flying passengers where they don't need to go. Bonuses would be paid to pilots who changed course en route, landing at closer, mystery locations. In some managed flight plans and in "capitated" plans, passengers would be assigned to a pilot, called the "primary coordinating pilot" (or PCP), who would be in charge of "managing" the flights of the passengers, called "capitated lives" (true term). Passengers would have to go where these planes were going or not fly at all. Some pilots, called "gatekeepers", would be stationed at the doors of airplanes pushing passengers away and would thereby get large bonus checks at the end of the year from the FAA or the FIP.

So, there you have it. Government over-regulated and managed health care makes as much sense as government managed flying. The situation will only get worse unless we prevent it. Happy flying!

Frank S. Rosenbloom, M.D. President of Oregon Right to Life. He blogs at summacontraprobus.blogspot.com
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