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An analogy to help lawyer politicians understand healthcare and its financing


Editor's Note: Welcome to Medical Economics' blog section which features contributions from members of the medical community. These blogs are an opportunity for bloggers to engage with readers about a topic that is top of mind, whether it is practice management, experiences with patients, the industry, medicine in general, or healthcare reform. The opinions expressed here are that of the authors and not UBM / Medical Economics.

A lawyer politician spoke at one of our physician conferences. He passionately said he shared our concerns and burdens but then advocated that healthcare is a right. I spoke with him afterwards about his statement. I asked about his definition of healthcare, his understanding of economics, in the light of finite resources and unlimited need.  He had no answers but defaulted to political rhetoric that sounds good to voters but are more empty promises. In the end, they will only create more needs. After the conference I came up with a useful analogy to help those elected representatives better understand the situation and their effects on citizens.

Because all citizens live under the laws of cities, states and the nation, it was decided that legal representation was a right, not a service or privilege. Every citizen must be legally cared for and represented by counsel at every moment on demand.  To that end the government passed many progressive laws over time. “The elderly” and “the poor” were considered most vulnerable to laws (and large voting blocks), so Congress passed LEGALCARE and LEGALCAID to serve them. When that wasn’t enough, congress created the Legal Maintenance Organization (LMO) act. This too created more complexity and didn’t solve the problem. Legal crises existed and needed fast action so the congress passed the Legal Emergency Treatment and Labor Act (LEMTALA). This was yet another unfunded mandate that stated lawyers must be available within 30 minutes of client demand regardless of ability to pay. 

Lawyer-client communications are privileged by law, so that necessitates yet another act of congress, the Legal Information Privacy Act (LIPPA). Because lawyers were slow to computerize so the government could access their records for compliance, congressed passed the Legal Information Technology for Economic and Clinical Health Act (LITECH) to force all on the bandwagon. All legal communications were forced by the federal government onto computers and the internet.  There were many incidences of loss, hacking and theft, so the federal government now had its hands full in enforcement. The “privacy law” has now made privacy a thing of the past. 

The last straw was the Client Protection and Affordable Legal Act (CP-ALA). This act subsidized insurance companies and created huge mega law firms.  Solo and small personal firms were forced out of business for the sake of the efficiency and cost effectiveness of mega firms.

If that wasn’t enough, congress passed the Legal Access and CHIP Reauthorization Act (LACRA), and the Legal Incentive Payment System (LIPS).  This legislation took away the ability for lawyers and legal practices to bill their hourly rate but only submit their data to government for processing and payment determination based on the legal quality standard yet to be defined and constantly in development. That is, assuming it is not just another unfunded mandate.

Party politicians led the charge for LEGALCARE FOR ALL (L4A); to expand LEGALCARE as a so-called right for every American. Congress made self-paid legal care illegal to for all onto the government dependent system to make it, “fair,” and, “equal access for all.” Although this was unaffordable and unsustainable, party politicians tried to convince the American public that it was their “right.” It was yet another windmill quest to garner votes but it was just another emperor with no clothes.

There was no way for these mega firms to suit the unlimited needs of citizens made dependent on the government for their legal care. So the government did what it always does, make more laws by the axiom: “regulate it now, understand it never.” Then the government legalized LPs, legal practitioners, and LAs, legal assistants, to serve the people’s growing needs. These mid-level, bachelors and masters trained legal disciplines were licensed to do the job of doctorate lawyers. After all, there was need, and LPs and LAs were cheaper to train.  It really didn’t matter that they had half the training and lesser credentials than lawyers.  Who would know? Who would care? No one would get hurt, right? It would provide more access to legal care. After all, that is the lofty goal that justifies any and all means…

Through federal government progressive intervention over decades, lawyers and their staffs were conscripted progressively over time to serve the legal good of the people. After all, it was the right thing to do, even if no one had figured out how to guarantee unlimited access or pay for it. These circumstances assured high costs, high prices, legal care rationing, and thereby, reduced access and long waits for legalcare; this directly caused harm to clients. Now it was done and so personal legal care was more expensive and more scarce than prior to all the government intervention in the first place. 

This is indeed the case in healthcare. Perhaps now, we can talk sense and sensibility with the same set of facts to restore the healing patient-physician relationship through freemarket competition; direct primary care (DPC), direct patient care, true individual catastrophic insurance, hospital competition and expanded health savings accounts (HSA).

Craig Wax, DO, is a family physician and media host. 

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