eyekew

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.