So, I hate complaining or complimenting without giving advice. What are the possible solutions to healthcare reform?
Objective:
Get as many people in America covered on healthcare as possible and get the costs as low as possible.
Bottom line. If you have $10 dollars to pay for a $12 item. You can't afford it. So, you have to either buy a $10 or less item or you have to get more money. I have some suggestions on how to do both.
Solutions:
1. TORT REFORM. Reduce the law suits to numbers that give compensation to people to make them whole or as close as possible. People make mistakes. If we continue to pay $10 million dollar law suites because a doctor makes a mistake, we will never solve this problem. The reality is that the patient gets about $4 million and the attorney gets $6 million of that $10 million, and WE pay for it all... not the doctor. Canada has passed laws in this area and it has made a huge impact on the costs of goods and on insurance costs. This is the biggest area of impact that we could make on the healthcare industry. BUT, the attorneys run our government. Good luck ever seeing tort reform at the level necessary. This would equal billions of dollars annually.
2. PPO Plans with deductibles at $2,000. Government subsidies for low income families paid in the form of medical stamps. Incentives for not using them. (there is more that ties this together - see #4). Insurance rates lower if they are not responsible for the first $2,000. Also, you could include a HSA Account to make it possible for people to put money in these accounts and invest it (helps economy as well) and build medical dollars for the future.
3. Government catastrophic insurance coverage to protect from medical bankruptcy.
4. Doctor and hospital rate posting in the facility and online. When was the last time you checked around with a few doctors for the cost of a procedure? When was the last time you checked to see if you could get lower medical tests (MRI's)? If all doctors rates and fees were posted and we had options to attend the different doctors, we could let supply and demand drive the prices down.
5. Shorten the food and drug standards on the length of time it takes to approve medicine. We have the highest price of drugs in the world and it is directly related to law suits and the food and drug administrations regulations.
6. The new bill penalizes doctors who's patients return for the same issues. I would require insurance companies to give incentives to doctors who don't have patients return for the same issues. One concern would be that doctors could become jerks so people wouldn't return with issues. Keep in mind item number 4 above.
7. Allow medical co-0ps. These would be risk pools that would reduce health care costs because of proactive health coordination.
8. Require healthcare penalties and rate increases for life style choices. Non medical related obesity (medical related would be due to thyroid or other issues), smoking, drinking, drug use, high cholesterol. You have to give incentives for the right behaviors. This would be fazed in to allow people to adjust lifestyle choices over time. If you are going to raise the cost of healthcare pools because of lifestyle choices, you should be required to pay more for coverage.
9. Eliminate HMOs. HMO's create an entitlement healthcare mentality that makes people believe they should go to the doctor for a sniffle. This drives costs up and insurance companies have to raise rates to pay for it.
10. Eliminate the government Cadillac plans. Government workers have the best insurance program in the country. It is not right that American people work, pay taxes, and the people in the government have better insurance than the people who are funding it. They need to have good healthcare plans but those plans need to be more in line with the average American. Most people in the U.S. have had their insurance plans reduced over the last 15 years. Government workers plans have improved over that same period. This is costing all of us more money.
Oh well, seems like these items would certainly lower our healthcare costs and would IMMEDIATELY lower insurance premiums and make healthcare more affordable. It wouldn't cost a fraction of the cost of the legislation that just passed.
You know, I wouldn't even mind paying a little higher taxes to help support subsidizing people who truly couldn't afford healthcare. I would have to think about how to structure it where they would have to be able to prove the hardship, but I think it could be done and I would be happy to help pay for it. It is the right thing to do.
There you go. Some ideas from an old jock country boy. Love to see your ideas. Post comments if you agree, disagree, or have better ideas.
11 comments:
I've got to say that I had no idea some of these things were included. I think all your solutions are well thought out and seem viable. This reform loses me at the point where we start being forced to have insurance or pay fines. I'm all for a government that protects people who can't protect themselves, or from others. I'm not for a government that is there to protect me from me. Lots to think about here.
Larry... like always I love the black/white no-BS you throw out there. Exactly what I've been trying to say to people for the last few weeks. I look forward to more blogs.
Well Put - Concrete Ideas. The single biggest problem I have with what the reform going through is it fails to tackle the underlying costs of healthcare at a high level. The mechanism that pays for healthcare matters little if we continue to see double digit percentage increases annually in the actual costs. Specifically giving people an incentive to curb healthcare costs seems like the best long term solution. If people are more aware of costs and have a mechanism (HSA) that is funded and grows tax free then it is a great benefit to stay healthy and reduce healthcare costs when possible.
I'm glad you are blogging on this. I forced myself to listen to Sean Hannity on the radio yesterday to try and ferret out some concrete reason why the bill was the same as Nazi germany and Stalin Russia but strangely felt like I was in one of those two countries with the amount of hate talk and incendiary comments. Still didn't get anything meaningful.
I think a key option for tort reform we should push is to have an independent medical panel review and validate any claims. Obviously baseless claims should be rejected outright and the cost should be forced to be paid by the lawyer him/herself not the client.
One important point to address in terms of "possible" cost reduction is that the actual $5,000 ER visit for a stitch might go down now that it doesn't also have to pay for the other 5 people in the room who are using the ER as the free clinic.
As treasurer at Maggie's school I see families and admin staff without insurance, see the impact of a doctor ordering a blood test and checking a box that results in them paying an extra $1,000 instead of the $75 they expected. Perhaps one option is also to force medical rates to be printed on those forms. I know Meredith has no clue what a test costs. She doesn't see that part. She just practices medicine and orders what she thinks is important. There are alternatives in many cases to tests if only she had insight into the price in a way that was simple.
Well, written and thought through, Larry. Thanks for sharing.
Larry, I look forward to the rest of the series. You have some serious blogging ahead of you!
Knowing you, I think we share some of the same feelings, both pro and con regarding this program. At the forefront is our ability to provide health care to those who cannot legitimately afford it, even if it is at some expense to us who can and have worked hard for it. The biggest concern is how this can be accomplished without it becoming another inflated entitlement program. And can this be done without a rise in our yearly taxes to the levels that are present in the countries that have socialized medical practice. Correct me if I am wrong, but in a couple of those countries, their yearly taxes are around 60% of their income.
Another concern is what will it do to the quality of our health care providers. If I'm going to medical school right now, looking forward to starting a practice with $300,000+ in loans and the government controlling my income and the ability to pay off those loans, why not become a veterinarian instead? My oldest daughter isn't ready to start med school yet, but that is the very question that she asked me the other day. She has been vacillating between the two careers for quite some time. What is it going to do to our work ethic as a nation if you can do enough to get by and qualify to receive every entitlement, or bust your gut to make a living in order that you live in the same manner as those who are not willing to put forth the effort? For those of us who are bullish in regards to our future and pride ourselves on our abilities to better ourselves, the choice is easy. But to the "fence riders" their decision might come just as easy, with a negative impact on our society as a whole.
I'm having a big problem with the elephant and asses mentality that permeates our government, and the inability of the masses to have a say in our future. You've made some very valid points in your blog, and without discrediting you and your thought process, these and many other points along these lines should have been brought into account long before a signature was ever put on a piece of paper implementing this document. What recourse do we have now to "rethink" and correct the problems that this bill will dump on us as a nation and our children and grandchildren who we will give this to?
One last point....in regards to your #8...there needs to be a OTHOL clause in this provision. That is a "Over-the-hill Offensive Lineman" clause!!
Keep writing and we'll keep reading!
In response to number 6: Doctors being penalized for patient's returning for the same issues is absurd! A majority of patients have chronic illnesses that are not resovled in one hospital visit (ex. People with liver failure, HIV, hepatitis, etc). Unless doctors are now supposed to be playing God I don't see how this is reasonable. Doctors are PRACTICING Medicine...and the real problem is with the pharmaceutical companies. There are probably multiple cures out there however due to the multi billion dollar drug industry cures will never be known in the "medical world", therefore patients are going to be returning for the same issues. Will a doctor be penalized because they are readmitting a patient who overdosed on heroine and is in a coma for a second time? This is ridiculous and whoever thought to put this in the bill has no medical knowledge.
Tiff,
The point #6 is not in the bill, this is my recommendation as a way to create higher comp for Doctors who have good results. The statement was a general one but would need to be much more specific in application.
I would create incentive programs for doctors for reducing repeat patients. I would not penalize if they had a single incident. It would be based on the geography and the tendencies in that area. It would also have actuary factors on historical frequency of high level diagnosis. This is actually being done in Grand Junction Colorado. This program has created one of the lowest health care cost programs in the country.
You don't set up unrealistic expectations that penalize doctors. But, you can create incentives that motivate doctors to take their time and get the diagnosis right. You NEVER expect 100% accuracy. You are right... it is "practice". But, you can create those actuarial percentages that are realistic. It is working in one hospital. I think it would be worth trying!
My daughter is going to be a doctor. I would not want penalties... only incentives for better pay for lower costs due to accurate diagnosis!
Love ya baby.
To further #6, Meredith was sharing a story about a patient who had a persistent wound issue. He was going to all sorts of specialists, had home nursing care coming out daily but nothing was getting better.
She felt like he probably wasn't following instructions at home so she had him come into the office for 2 weeks every other day and the nurse just washed his wound with soap/water, changed the dressing and it healed up. Not a lot of expense in having the nurse bill for a simple office visit but it fixed a systemic problem that was being treated with expensive care for 9 months (including a specialist at a hyperbaric wound treatment center). I'd hate to see this sort of common sense treatment get minimized tossed aside because it would be viewed as multiple treatments of the same issue by one doctor.
Just food for thought
Pat.
Sorry for the slow response on the last item. Under the format that I have heard they use in Grand Junction Colorado, this example would actually be rewarded. I don't know the details but my understanding is they have a certain amount of expected patient return that is expected and rewarded. So patient return is part of the model. What is penalized is doctors who fall outside of industry practice with return patients that should have been identified under normal medical practices. I think the system protects the fact that doctors are "practicing" medicine. They are testing new ideas and finding the best solution.
I wish I had more detail, but the interesting thing with this program is that it has one of the lowest healthcare costs in the country and doctors are being rewarded for their efforts. Seems like these kinds of results should at least be considered!
Oh, and the population is a diverse economy. HIspanic, Native American, White (multiple ethnic white), and a population that has moved from all over the US to live there.
This is one of the complaints of the cost reform in the US. We are too diverse and large numbers of issues come into play in medicine with genetics and family history.
They are overcoming this issue.
So, again, I think the example you gave would actually be rewarded in that system. It is the lazy practices and the get them in and out systems that would be penalized.
I will try to look to see if I can get more detail on this system. I heard it on NPR a few months ago when traveling.
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