To spend any time analyzing the reams of data about the best approach to solve Crisis Number Seventy-Three of our current administration, this one on health care reform, is to spend time in what historically is a futile effort. Everybody wants affordable health care of the highest quality available in an efficient manner. As my friend Chip likes to say of his current profession (not health care), "Cheap. Fast. Good. Pick two."
We have very good health care in this country, and it is relatively affordable when the economy isn't forcing people onto COBRA plans. Available health care for self-employed folks is out there for under $200 a month, excepting those with pre-existing conditions. The vast majority have good coverage. How to handle the outliers in this current system is an issue worthy of address, but a 'crisis' should involve missiles or bankruptcy. Quit bastardizing the English language, Washington. Now.
As for the efficiency, there is much that could be done. Most insurance companies are bureaucratic nightmares to negotiate one's way through, and these organizations do operate in a for-profit model, making for a lethal combination of wait times, phone calls and co-payments that turn people off of taking better care of themselves. It also overwhelms others so much that their best option (in their minds) is to demand a dummy-proof system so they don't have to think so much about what to do about their health care options.
The question this poses is simple: Should healthy people who have what they need be made to pay far too much for coverage to supplement those in lesser income situations or with more difficult medical histories? Without going too deep into the issues, the answer is yes, but only to the point of indemnifying providers (docs, nurses, etc) from the more absurd litigation. This alone would make health care more affordable and the process of getting it far more straightforward. This also would put tons of lawyers out of business, and this saddens only a few people, most of whom are related to said lawyers.
The answer seems more obvious after visiting Las Vegas. In the interests of research (and a friend's 30th brithday), I visited the town recently, hoping to glean an insight into how a town can function solely on the premise of debauchery. In doing so, I see a path to take for the current health care issues of America.
Watch the floor of a casino or club on any evening, and you'll see that security interrupts the flow of business seldomly and quickly. You'll note that 'social lubricants' are distributed free or very cheap by a systematic approach and the vast majority achieve what they came to do (enjoy themselves) while paying the costs that they allow themselves to pay. Anyone caught cheating in one place will be banned from all places, via networked information systems managed by the gaming board of Nevada.
The equivalent scenario in health care? Require all medical facilities to provide free trauma care, billed directly to the US Treasury, and make people pay retail for the rest. Physical needed? Go to any doctor licensed for such and his group will be paid (after co-pay) by your private insurance provider. All information will be tied via Social Security number to a confidential network that doctors can access to verify prescriptions, note past illnesses, view MRI's and X-rays of previous treatments and proceed accordingly with an honest and succinct patient history, regardless of where and when the patient has been into a doctor's office last.
Secondly, prescriptions are filled at a base insurance price (say, $20) whether or not insurance is presented by the patient. Specialists will be paid a base payment, then get the rest back from insurance.
Wait, you say. This sounds like the system we already have most of in place.
Exactly.
The market handles itself quite well. The 'greedy' drug makers keep extending lives and quality of those lives, while their customers invest in their stocks and make money for their retirement on them. Pfizer recently agreed to pay a $2.3 billion penalty for negligent advertising practices. Would they have to pay these fees out if attorneys and class action suits were not waiting around the corner? Would they have to resort to guerilla marketing techniques for pain medication if they didn't have a 8-digit line item for legal fees in their financial statements?
Tort reform.
The minute that frivolous lawsuits from opportunists cease, all health care costs will become more manageable. Doctor liability would drop, allowing that doctor's office to hire more people to process claims to insurance companies faster and more easily. Malpractice premiums dropping would be a sign that those providers have less frivolous claims to process, and could actually focus on getting the real bad doctors out of the business. Less people dependent on a flawed tort system means less money being suckled off the teat of our insurance premiums.
I agree that this sounds too simple. I agree that many, many lobby groups will laugh hysterically at my uninformed opinions. I also acknowledge that my government took over $1.1 billion of that Pfizer money as a fine, and I have no clue what they have planned to do with it, and medicine for my family will cost more because of it.
All that came to me in the Playboy Club at the Palms Casino, while watching a young lady with a bunny tail on her tailbone pour libations near a roulette wheel. You know why I saw this so clearly in such an odd place?
No lawyers present, and no place for someone to cheat.
All of the folks who played by the rules appeared to have a good time. The sloppy drunks and angry idiots were quickly removed. Even those who lost money (bad fortune is not illegal) seemed to believe it was a fair experience otherwise. Gambling is a bad corollary to draw in relation to health care, but changing a system that is extending lives daily without curing the illness of excessive lawsuits is doing just that.
Plus, the outfits people wear in those places makes me wonder if you can get an STD by being near these folks. Ugh.
Yet another post coming later today...
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Without getting into the terrible analogy between Vegas & health care which you already conceeded ("if only the mob had founded Blue Cross"), I'll keep my rebuttal short...
ReplyDelete1) What the hell is with the conservative line that if only there were no lawyers, everything would be great and cheap? Always sounds great until that same conservative has been wronged, then they are dialing up their lawyer faster then you can say "Larry H. Parker". Quips aside, I'll simply point to Texas, where tort reform may have resulted in lower malpractice premiums but no appreciable reduction in cost (or other benefit) to the consumer. And I have yet to see the remotely-definitive study that shows that the liability costs in the medical system (including "defensive" medicine) are anything more that a few percent.
2) Pfizer's massive settlement has nothing to do with lawsuits. It's because the idiots were aggresively marketing their products for off-label (that is, not tested-and-approved) uses, a huge no-no with the FDA. Seems pretty much a consumer protection issue to me.
3) What kind of insurance are you getting for $200/mo? What percent of the population could actually get that insurance? I know my "hyundai" HMO plan (OK, maybe "Dodge" plan) for three healthy young(ish) people costs around $850/mo (with employer covering about 35% and the gov't, via the tax deduction, covering another 25-30%).
4) You sort of mention in passing "pre-existing conditions" but that is the biggest problem for the self-employed and otherwise individually insured. Give them what we W-2 employees have, medical coverage with no fear of the pre-existing condition or rescission via risk pools. We do it for auto liability, for crissake! (And the point is universal *coverage*, not universal availability.)
6) Lastly, the funny part of all this is that the proposals for "reform" aren't very far off from what you describe: Nat'l Exchange for individual plans, keep your employer-sponsored plan, a *possible* Medicare option for a small part of the population, minimum coverage requirements, & cost subsidies for the poor paid for by taxes on the "cadillac" plans. With all the rheteric surrounding this whole thing, the fact is that no plan that has been seriously considered by Congress (which "single-payer" is not one of) doesn't really change much for those that are already covered, except perhaps to give you *more* choice now or down the road.