eyekew

Bending the Curve: Redefining Health Insurance

Finally, a rational voice.

Everyone needs to have health insurance.; heath care via ER is not an option The playing field should be leveled by making employer provided insurance above a moderate policy taxable and giving those whose buy their own insurance an equivalent tax break/credit. Everyone ( including illegal immigrants) should be eligible to join a large affinity group which should be able to provide health insurance at rates no more than those of employer sponsored programs.

To ease the transition, those leaving or losing jobs should be able to keep their insurance at the same cost plus a minimal fee for administration. In general, alll insurance should be portable and available across state lines. Within a few years, everyone should be able to obtain insurance a reasonable rates; everyone would be covered and the problem of dealing with existing conditions eliminated.

In the transition, I would suggest that the appropriate role of government would be to provide re-insurance for insurance programs that end up with a disproportionate number of severely ill patients and to provide a subsidy on a sliding scale for those who truly cannot pay.

Somehow, medical societies and specialty groups need to step up and police the bad actors. Everyone knows who orders too many tests in their own facility, does inappropriate surgeries, etc., etc. However, the bad guys usually make more money, hire better lawyers and go on practicing egregiously bad medicine even after local medical groups try to get them to adopt better practices.

In general, how to promote good medicine w/o denying patients much outstanding medicine that may not be the accepted standard, is a real problem. Almost every significant advance in medicine went against the grain of standard practice for the time. (eg: how many decades did it take for H. Pylori to be accepted as a cause of stomach ulcers?)

Except in salaried groups, paying for outcomes is a nice goal, but not always realistic. How do you fairly compensate the truly outstanding physician who is willing to take on the really difficult, time consuming cases? He/she cannot see nearly as many patients, will have poorer outcomes, wil earn much less than someone who runs lots of patients through a superficial mill.

Bundling of services is also a problem outside of a salaried group. Docs will hang on to their patients. Those who might be better able to diagnose/treat will not be involved.

Medical IT is another conundrum. The potential is huge, but no one is talking about the major problem: legacy systems at every level that do not talk to each other. Once a task force establishes an open source protocol, lots of (hopefully, backward compatible) systems can be designed to take care of medical records, billing ( the same for all insurances and providers), etc.

Additionally, tort reform is a necessity. If you add the costs of defensive medicine and physicians malpractice insurance, the cost could be 10-15% of total medical costs. I would sugget a board analogous to a grand jury to award damages to anyone who sufers an untoward outcome. Someone with a disasterous outcome that is not malpractice is entitled to some recompense as well as those who have suffered from bad docs. Sueing should not be part of the process. Emotional rewards that go 66% (at the extreme) to the lawyers are anathema. Eliminate the tort system; establish reasonable compensation for functional loss, loss of income, etc. I bet the insurance companies might even come up with policies for those who earn huge amounts and allow those who wish buy insurance to double, triple, etc. the standard award.

I could go on, but it is tragic that rational solutions that solve problems, rather than promote a political imperative, are, in general not even on the table, not discussed

What Comprehensive Healthcare Reform Should Look Like

Many thanks for a relatively even handed blog amidst all the hyperbole.

There is a lot that needs to be out in the open. My biases are that everyone needs to be covered; and, there needs to be transparency as another commenter said.

One of the major problems is that Medicare and Medicaid underpay for services now (pay 75-95% of costs depending on type of visit, procedure, location); consequently, costs are shifted to the private insurers and even more to people who are not insured.

The only real cost saving that has been put forward is a 30% cut in Medicare. It is true there are savings to be had, but that mantra has been put forward for decades and not much accomplished. I'd like to see those savings materialize before making major changes.
I cannot see how those savings can be attained, while adding 73 million baby boomers to the current roles of a money losing system.

Nobody is talking about the illegal immigrants who make up 10-20% of the uninsured. Here is N CA, it is estimated 67% of the unreimbursed medical expenses are illegals. Since I accept the argument that everybody needs to get routine and preventative care from a practitioner, not an ER, those individuals would need to be covered as well.

Insurers need to accept all comers; insurance should be available across state lines; a realistic way needs to be found for stopping them from denying care, such that people die while families try to fight the bureaucracy. Initially, when they need to accept people with pre-existing conditions, there should be a mechanism to rei-insure for those that get a disproportionate number of high cost individuals.

A fair way to compensate people for untoward outcomes needs to be developed. That would allow people to be compensated w/o resorting to malpractice litigation. Defensive medicine is at least 10% of costs. The current system benefits mostly lawyers who take up to 60% (+ expenses) of the awards for the injured patients. I am not sure if the huge amounts paid for malpractice insurance are factored into the costs of defensive medicine. If not, there is more money to be saved.

Many more thoughts...no more time!

With It advances in medical record, etc, etc will help, there are currently a whole bunch of systems out there. The problem is many of them do not talk to each other. Before spending billions of $$ on IT, there need to be an accepted set of standards so that all systems that get tax benefits are guaranteed to be compatible with all the others.