The Greeks Bailout and Healthcare in the US – Podcast
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Podcast Session 25: The Greek Financial Bailout and Healthcare in the U.S. – An Attitudinal Perspective
By Scott McDonald
This is Scott McDonald and welcome to the Perfect Place to Put a Practice Podcast.
So, what in the world do the Greek Financial Bailout and the Healthcare Marketing in the U.S. have in common? Well, as a matter of fact – a great deal. If we were to reduce the problem in the Greek Financial Bailout to a single word it would be entitlement. After the recent “No” vote to accept the restructuring and austerity deal promoted by the European Union Creditor Nations like France and Germany on Greece displayed, Greeks by a large majority have come to believe that the other side is going to blink when it comes to “lowering the boom” on their party. When a nation owes more than 150% of its gross domestic product to other nations, there is simply no way that it can write its ship of state without outside help. This rate is entirely unreasonable and everyone knows it. Long and mandatory vacations have long been the norm in Greece. Generous retirement benefits are naturally expected. The percentage of Greeks even paying their taxes is below 20% of those required to pay. Enforcement is non-existent. It is a “given” that Greeks believe that while the other European nations have been doing the heavy lifting of their debt for 25 years, this pattern is going to continue. It is what they are accustomed to. It is what they feel they are entitled to.
What will the Greek economy do now that they have called the bluff of their creditors?
Let’s switch gears to Healthcare in the U.S. The “doc fix” is well understood by professionals that what the Federal Government (and many states) have done is to balance the budget regarding health benefits on the backs of doctors. They have figured that if they can continue to reduce the amounts of money paid to professionals while increasing the services they provide, everyone will be happy. Well, that is true until doctors come to realize that they are losing on every treatment they provide. Without tort reform, they are increasingly liable for treatments that go wrong even though it is not their fault. Therefore, there is a provider shortage that is strangling healthcare in some types of practices. This is much worse in some geographic areas than others. And with the advent of “outcome based” reimbursements, things are getting even stranger. I am sure that every single listener is aware that if patients are unhappy, offering them medication for pain will make the complainer go away while increasing the doctor’s patient satisfaction score.
What ties these topics together is the issue of “entitlement.” As soon as a majority of the nation comes to see healthcare as a right, the process is doomed. One little story illustrates the situation quite well. One welfare recipient I know found getting to the hospital was much more convenient if she could just call an ambulance. She knew what to say to the dispatcher that would get her in the front of the line. She had no problem morally for this practice. After all, “the hospital has a lot of money.” She was convinced that she had a right to a free ambulance whenever she wanted it, didn’t she?
Reality will someday hit this woman as the availability of ambulances becomes greatly reduced as more people catch on. Further, the ambulance company is going to ration its services at some time if they want to remain in business. My belief is that one can suspect gravity for only a short time. In the end, gravity is going to demand its due.
While I hope you understand what I am saying and agree, let me tell you why I have included this in my podcast. The current state of healthcare, just like the Greek economy, is unsustainable. It is not the way I want it nor is it the way that well-meaning politicians intended it. But reality can be denied for only just so long and results will happen regardless. And this is what I believe the future holds for healthcare as I have studied the trend lines of 30 years:
- Practices will have to become more entrepreneurial. The doctors are not going to entirely quit. Their practices will go toward those people who value their services because those people will pay. We have already seen the amount of negotiation practices of all types and hospitals will accept when people are willing to go outside the red-tape of regulations. The government and other regulatory bodies are going to scream about it but the market will ultimately decide that this is going to be what happens.
- Government mandates will become less effective as practices and patients do “work-arounds.” Yes, yes, we know that medical savings accounts are hated in current Washington. We are all familiar with government bodies who believe that they know best for everyone. But when people see their healthcare needs being ignored, they will either vote in new politicians or they will go under the table. The market always finds a way.
- Those who depend upon government largess are going to be hurt badly. It may appear that Medicaid and other public assistance programs will be around forever but they will not. It is not that the government will stop offering assistance to the poor. But the availability of providers on these programs will inevitably be reduced to the point of making them ineffective. There are a joke that in the old Soviet Union, one could get an abortion free of charge on demand. It just took 18 months to get an appointment. Actuarial tables I have seen indicate that the more free-food that is offered to children and adults, the worse the eating habits of that population becomes. There is assumption that the same thing is true with healthcare. One does not REALLY have to take care of one’s health if you can see a doctor for free who can “patch you up.” This is the deadly side of an entitlement society.
Therefore, my recommendation is to look beyond insurance programs toward locations that will offer services on demand to those who are willing and able to pay for them. This runs against the entire direction of government programs at this time but it represents an appeal to human nature. And you can never go wrong voting with human nature.
As to Greece, let’s use this a micro-macrocosm of what will eventually happen to America’s healthcare situation. Will Greeks really suffer for their decision? I see it as a metaphysical certainty. They will suffer because the things that they considered the backstop for their entitlement mentality are not going to be able to help them. I don’t wish this upon them any more than I hope that the poor in the U.S. can be saved by something for nothing. The law of the harvest is unforgiving.
This is Scott McDonald. Visit our web site at DoctorDemographics.com and learn about our products and services for professional practice.