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Re: A (Universal) Health Care Question
I started writing, and got very caught up, honestly at this point I don't care if no one reads it because writing it was very cathartic.
(proposals that lead to cost saving have a "cost-saving tag," those that lead to improved health care have an "improved health care" tag, and those that require more money have a "requires more money" tag)
The problem is complex, so is the solution. I think this is the "American" health care solution:
1) Universal, government-paid preventative health care: yearly check ups, screenings, etc. Health insurance companies have no market motivation to invest in your future health because such programs don't pay off for 20 or 30 years, and at that point you've changed jobs and therefore health insurance companies. But it does make sense for the government to invest in its people's health, and for you conservatives, our future working pool. It'll cost more now, but it'll pay off later. [requires more money] [cost-saving] [improved health care]
2) A universal insurance mandate for health treatment when you do get sick. You must have insurance, either privately or through an expanded government program (see #3). This allows us to spread the risk amongst those who currently don't feel the need to buy insurance (that is why I stress the plight of the poorly insured who are doing everything right over the unisured, many of whom are young, healthy, and dumb and just don’t want to buy it). Those who are “losing out” by being forced to buy insurance that they judge doesn’t make sense for them will make their money back when they get older, sicker, and have cheaper insurance because the next generation of healthy young idiots is also contributing to the insurance pool. [requires more money] [cost-saving]
3) Universal, government sponsored treatment implemented at the state level (because, after all, New York's needs are different than Kansas’, and because this system already seems to have some support with California and Massachusets doing so well) set up to compete with private insurance. If you want private insurance or it is provided by an employer, go ahead and take it, you can opt-out of the government program, and get a tax rebate or other financial return. If you want government provided insurance, you will be provided with it at an appropriate cost based on your income.
This "expanded medicare" program would have the following characteristics, which I feel would soon push the private sector to adopt similar principles because it would prove to be superior to their current system:
A)Price control at the level of providers. Diagnostic related groups pay physicians standard amounts for certain types of patients no matter how many tests are ordered, reducing the incentive for physicians to order unnecessary tests to stuff their own wallets. The optimal system is likely some mixture of pay-per-patient and pay-per-procedure. [cost-saving]
B) Incentives for physicians to treat chronically ill patients with multiple conditions, simply by paying more for it. Chronic conditions are America’s Number 1 health problem, we need to pay doctors to treat it. Health insurance companies don’t do it because it costs them too much. But the government should do it because, despite the cost, it’s the right thing to do. [requires more money] [improved health care]
C) Pay more for consultation and talking to patients. Doctors will spend more time with their patients if they are actually paid for it (right now the rates are dismal) rather than just paid for procedures. [requires more money] [improved health care]
D) Cut down coverage of pro-longed end of life care in Intensive Care Units, which right now make up most of our costs. Shift some of that money to palliative and hospice care. Essentially, you can’t spend three years brain-dead on a ventilator (just one year), but you can be allowed to die in peace in a hospice instead of poked and prodded in a hospital because your insurance doesn’t cover hospice care. If you don’t like this system, get private insurance that will keep you alive forever. This is one of those unfortunate concessions we must make to economic reality. [HUGE cost-saving]
E) Allow the government to negotiate with drug companies to get Americans cheap drugs by purchasing in bulk. Why should drug companies, who so loudly beat the free market drum, get this decidedly socialist advantage that is currently in place, where Medicare can’t negotiate on behalf of its patients. [HUGE cost-saving]
4) Standardized billing and accounting procedures for insurance companies. These must be heavily regulated to be standardized to reduce the confusion and administration of the current system. Yes, regulation reduces innovation, but there's not much innovation at the front-end of insurer-consumer and insurer-health care provider interaction, and the current hodge-podge system has led to ridiculous administrative burdens that can't be approached by even the worst government bureaucratic nightmare.
Furthermore, one of the most underrated difficulties with the current system is that it is so complicated no one understands their coverage. I work in the field and have no idea. Simple, readable insurance that can be understood by people can only be demanded at the government level would lead to a drastic improvement in health care. [GREATLY improved health care]
5) Aggressive government prosecution of insurance companies that attempt to deny coverage that is guaranteed, counting on the fact that consumers will be too busy, sick, or worried to complain. Legislation that increases these penalties to levels that companies can no longer consider "the cost of doing business." [improved health care]
6) Electronic Health Records. It’s about damn time. Mandated by 2015 (I think there already is some half-assed Bush mandate that really means nothing). A government-run, opt-in system for those who want it competing with smaller private health record firms to drive down costs and for those concerned about privacy and government involvement. Strong laws in place that absolutely no one can see those records except doctors. Eventually, this will save money by leading to decreased adminstriative costs and reduced errors, but it requires an up-front investment.
[requires more money] [cost-saving] [improved health care]
7) Mal-practice reform. Doctors order too many tests because they are afraid you will sue them if something bad happens . It drives up costs much more than the 4% figure John Kerry cited in the election (when Bush was pro-reform), which is only the portion of total health care spending that mal-practice insurance takes up. It needs to be balanced so that hospitals are still incentivized to cut down mistakes, but doctors don’t have to live in fear. Perhaps setting it up so that mal-practice awards come mostly from the hospital where it took place, so that the hospital is motivated to ensure its physicians make fewer mistakes (and hire good ones), and take some of that award money and make a pool that eases the insurance burden on a doctor that has made just one mistake. Health care will also improve as doctor's don't order unnecessary tests just to cover their ***. [cost-saving] [improved health care]
8) The American taxpayer should be paid back for all the free research and development he provides pharmaceuticals. This section is a bit long and a bit off the core topic, but nonetheless important, so please read if you have time: [HUGE cost-saving]
Currently, ideas are developed or basic science discoveries are made mostly by an academic physicians/researchers or small biotech start-ups. Drug company R&D budgets pale in comparison to their massive marketing budgets, and they rely on being able to buy up these discoveries. In the case of an academic, the discovery is owned by the university, but is quickly licensed back to the discoverer or a biotech company and developed. If developed successfully, it is eventually sold to a pharmaceutical company, who can run large clinical trials and make profits off of it. But a tremendous amount, in fact the majority, of the research was made possible by grants sent out by the government National Institutes of Health and financed by the American taxpayer. This is an underrated example of something that our government does well; in fact, I would put the military and scientific research as the two best examples of American government competence.
However, there are two problems. The first is a market failure created by an imbalance of risk. Most drugs don’t get anywhere. Thus, an individual or small biotech start up wants to sell their idea as quickly as possible because most likely that drug won’t make any money. But pharma, which has a massive drug portfolio, can absorb losses, and is the only entity with enough funds to run multiple large-scale trials, this drug is a sound investment. Thus, the same idea is worth less to the small company and more to big pharma, which is why they buy drugs on the cheap and gets tons of money in return.
The second is that the government asks for too little in return: essentially nothing.
These two issues can be addressed by a stipulation in all government research grants: if you develop any ideas resulting from this research and sell them to anyone, the government gets 5% of any eventual profits. This makes researchers and small biotechs negotiate for more; they still want to sell the drug ASAP, but by law pharma can’t pay a comparative pittance, it has to put its profits on the line. And it pays back the taxpayer for their investment. Don’t worry, pharma will be fine, it is the most profitable industry in the world and will continue to do what it does
I started writing, and got very caught up, honestly at this point I don't care if no one reads it because writing it was very cathartic.
(proposals that lead to cost saving have a "cost-saving tag," those that lead to improved health care have an "improved health care" tag, and those that require more money have a "requires more money" tag)
The problem is complex, so is the solution. I think this is the "American" health care solution:
1) Universal, government-paid preventative health care: yearly check ups, screenings, etc. Health insurance companies have no market motivation to invest in your future health because such programs don't pay off for 20 or 30 years, and at that point you've changed jobs and therefore health insurance companies. But it does make sense for the government to invest in its people's health, and for you conservatives, our future working pool. It'll cost more now, but it'll pay off later. [requires more money] [cost-saving] [improved health care]
2) A universal insurance mandate for health treatment when you do get sick. You must have insurance, either privately or through an expanded government program (see #3). This allows us to spread the risk amongst those who currently don't feel the need to buy insurance (that is why I stress the plight of the poorly insured who are doing everything right over the unisured, many of whom are young, healthy, and dumb and just don’t want to buy it). Those who are “losing out” by being forced to buy insurance that they judge doesn’t make sense for them will make their money back when they get older, sicker, and have cheaper insurance because the next generation of healthy young idiots is also contributing to the insurance pool. [requires more money] [cost-saving]
3) Universal, government sponsored treatment implemented at the state level (because, after all, New York's needs are different than Kansas’, and because this system already seems to have some support with California and Massachusets doing so well) set up to compete with private insurance. If you want private insurance or it is provided by an employer, go ahead and take it, you can opt-out of the government program, and get a tax rebate or other financial return. If you want government provided insurance, you will be provided with it at an appropriate cost based on your income.
This "expanded medicare" program would have the following characteristics, which I feel would soon push the private sector to adopt similar principles because it would prove to be superior to their current system:
A)Price control at the level of providers. Diagnostic related groups pay physicians standard amounts for certain types of patients no matter how many tests are ordered, reducing the incentive for physicians to order unnecessary tests to stuff their own wallets. The optimal system is likely some mixture of pay-per-patient and pay-per-procedure. [cost-saving]
B) Incentives for physicians to treat chronically ill patients with multiple conditions, simply by paying more for it. Chronic conditions are America’s Number 1 health problem, we need to pay doctors to treat it. Health insurance companies don’t do it because it costs them too much. But the government should do it because, despite the cost, it’s the right thing to do. [requires more money] [improved health care]
C) Pay more for consultation and talking to patients. Doctors will spend more time with their patients if they are actually paid for it (right now the rates are dismal) rather than just paid for procedures. [requires more money] [improved health care]
D) Cut down coverage of pro-longed end of life care in Intensive Care Units, which right now make up most of our costs. Shift some of that money to palliative and hospice care. Essentially, you can’t spend three years brain-dead on a ventilator (just one year), but you can be allowed to die in peace in a hospice instead of poked and prodded in a hospital because your insurance doesn’t cover hospice care. If you don’t like this system, get private insurance that will keep you alive forever. This is one of those unfortunate concessions we must make to economic reality. [HUGE cost-saving]
E) Allow the government to negotiate with drug companies to get Americans cheap drugs by purchasing in bulk. Why should drug companies, who so loudly beat the free market drum, get this decidedly socialist advantage that is currently in place, where Medicare can’t negotiate on behalf of its patients. [HUGE cost-saving]
4) Standardized billing and accounting procedures for insurance companies. These must be heavily regulated to be standardized to reduce the confusion and administration of the current system. Yes, regulation reduces innovation, but there's not much innovation at the front-end of insurer-consumer and insurer-health care provider interaction, and the current hodge-podge system has led to ridiculous administrative burdens that can't be approached by even the worst government bureaucratic nightmare.
Furthermore, one of the most underrated difficulties with the current system is that it is so complicated no one understands their coverage. I work in the field and have no idea. Simple, readable insurance that can be understood by people can only be demanded at the government level would lead to a drastic improvement in health care. [GREATLY improved health care]
5) Aggressive government prosecution of insurance companies that attempt to deny coverage that is guaranteed, counting on the fact that consumers will be too busy, sick, or worried to complain. Legislation that increases these penalties to levels that companies can no longer consider "the cost of doing business." [improved health care]
6) Electronic Health Records. It’s about damn time. Mandated by 2015 (I think there already is some half-assed Bush mandate that really means nothing). A government-run, opt-in system for those who want it competing with smaller private health record firms to drive down costs and for those concerned about privacy and government involvement. Strong laws in place that absolutely no one can see those records except doctors. Eventually, this will save money by leading to decreased adminstriative costs and reduced errors, but it requires an up-front investment.
[requires more money] [cost-saving] [improved health care]
7) Mal-practice reform. Doctors order too many tests because they are afraid you will sue them if something bad happens . It drives up costs much more than the 4% figure John Kerry cited in the election (when Bush was pro-reform), which is only the portion of total health care spending that mal-practice insurance takes up. It needs to be balanced so that hospitals are still incentivized to cut down mistakes, but doctors don’t have to live in fear. Perhaps setting it up so that mal-practice awards come mostly from the hospital where it took place, so that the hospital is motivated to ensure its physicians make fewer mistakes (and hire good ones), and take some of that award money and make a pool that eases the insurance burden on a doctor that has made just one mistake. Health care will also improve as doctor's don't order unnecessary tests just to cover their ***. [cost-saving] [improved health care]
8) The American taxpayer should be paid back for all the free research and development he provides pharmaceuticals. This section is a bit long and a bit off the core topic, but nonetheless important, so please read if you have time: [HUGE cost-saving]
Currently, ideas are developed or basic science discoveries are made mostly by an academic physicians/researchers or small biotech start-ups. Drug company R&D budgets pale in comparison to their massive marketing budgets, and they rely on being able to buy up these discoveries. In the case of an academic, the discovery is owned by the university, but is quickly licensed back to the discoverer or a biotech company and developed. If developed successfully, it is eventually sold to a pharmaceutical company, who can run large clinical trials and make profits off of it. But a tremendous amount, in fact the majority, of the research was made possible by grants sent out by the government National Institutes of Health and financed by the American taxpayer. This is an underrated example of something that our government does well; in fact, I would put the military and scientific research as the two best examples of American government competence.
However, there are two problems. The first is a market failure created by an imbalance of risk. Most drugs don’t get anywhere. Thus, an individual or small biotech start up wants to sell their idea as quickly as possible because most likely that drug won’t make any money. But pharma, which has a massive drug portfolio, can absorb losses, and is the only entity with enough funds to run multiple large-scale trials, this drug is a sound investment. Thus, the same idea is worth less to the small company and more to big pharma, which is why they buy drugs on the cheap and gets tons of money in return.
The second is that the government asks for too little in return: essentially nothing.
These two issues can be addressed by a stipulation in all government research grants: if you develop any ideas resulting from this research and sell them to anyone, the government gets 5% of any eventual profits. This makes researchers and small biotechs negotiate for more; they still want to sell the drug ASAP, but by law pharma can’t pay a comparative pittance, it has to put its profits on the line. And it pays back the taxpayer for their investment. Don’t worry, pharma will be fine, it is the most profitable industry in the world and will continue to do what it does
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