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