We've been talking about health care all week and I thought it would be interesting (especially since it has come up in comments) to cut and paste Last in Line's plan from a couple of years back so we could all comment on it. So without further adieu....here it is!
Based on my over 5 years of experience working in the health care field, and being a certified Paramedic in the state of Illinois, here is how my plan would work. Notice there is no cutting and pasting here from wikipedia.
The bottom line is that medicare IS the best system we have going right now in this country. IMO there needs to be more of a balance between medicare,private insurance, and co-pay.
Health care is one of the only industries where the government does not get the best rate for things. The company I work for gets better rates from Medica and UHG than the government does. Congress passed a law some time ago (not sure when) that stipulates that medicare cannot negotiate the price of anything while insurance companies can. I would reverse that so medicare IS allowed to negotiate for prices like everybody else.
Therefore I favor a medicare-style plan that EVERYBODY is on...sort of a National HMO if you will. 2 ways to go about this, and I’m not sure which way is the best...one way is to have hospitalizations covered 100%. Really expensive things like transplants and prescription drugs would NOT be covered under this. Everybody would have the option to purchase supplemental private insurance from insurance companies to cover such things based on their own or their families needs. The other way is to have all catastrophic things covered and have the option to buy private insurance for basic hospitalization or whatever else you want you and your family to be covered for. US companies would drop medical insurance as a benefit and they would get to keep that money for their own bottom line. Increase payroll taxes to pay for the plan.
Regarding co-pay, it is at about 20% now...increase it to 30% over a period of time...say 10 years or so…don’t implement that change right away all at once. Yes that will be painful to some people but no matter which way you go in this, somebody is going to get hurt and/or pissed off under any new plan. You have the option to buy private insurance from private insurance companies to help you out with co-pays.
In terms of implementing any new plan, the free market will determine the next great health care plan. When it will be successful will be when there is a market demand for it, sooner rather than later I bet. Maybe it will be something along the lines of what I typed. Maybe it will be some socialists wet dream, I don't know for sure. Whatever it is will come about because somebody has found a way to work with the free market and will allow people in the free market to sell services for a profit and the market has found that it is cheap, efficient, and is preferable to the current system. People have to want it, not be guilt tripped into accepting it (which is what I read when liberals tend to start spouting off on the subject). In other words, it can't be forced.
The main problem I still have is that US politicians and US government bureaucrats will be running the plan and the service we will receive and the implementation of the plan will be absolutely horrible and corruption just may rear its ugly head just a little, ya think? I mean, look at the areas that the government controls now – the post office, Department of Motor Vehicles, VA hospitals, Public Education…areas like those are horribly mismanaged with bureaucracies, corruption, overhead and waste as far as the eye can see, not to mention a poorly motivated workforce who all know it is impossible for them to get fired.
5 comments:
To clarify soemthing I wrote back then...I was speaking in terms of reimbursement when I said Medicare was the best system. Every day I work with practitioners in my field and it has gotten to the point where they prefer patients who are covered under medicare because they get reimbursement for their work in 2 weeks like clockwork from medicare. Insurance companies just throw the claims our practitioners submit to them into "review" for 45 or 60 days and we still have to deal with plenty of denials from the insurance companies.
As I have read more about medicare, especially the dollar amounts that it now requires with the baby boomers reaching 65 at record numbers these days, I just don't think we can pay for full universal health care.
Yeah, that was two years ago and things certainly have changed.
I think the dollar amounts might be sustainable if we have the citizens of this country paying less in health care costs and pumping more into our economy which, of course, means more taxes. I'm beginning to think and feel (!) that the primary reason why people are against health care is greed. The problem with this is they can't see that it is in their self interest to help fund health care for everyone.
By self interest, I mean whatever business they are in (mostly) is going to see increase revenue because people are going to have extra money. The government won't go bankrupt because they will see increased revenue from the 300 billion dollar cut in Medicare and increased tax revenue.
Health insurance companies have an inherent conflict of interest because their profit comes from insuring people who don't use health care. That is, they make money by not giving you what you're paying for. This is different from other insurance industries that pay nothing unless an accident happens.
With health insurance it's a given that you will get sick, you or your wife will get pregnant, you will need a flu shot, you will need a physical, etc. The only thing that's not certain is whether you'll have a terrible car accident or develop a catastrophically expensive medical condition.
Furthermore, the vast majority of health insurance is sold by one middleman, the insurance company, to another middleman, the employer, and not to the customer. That is, the insurance company sells the insurance plan to the executives of a company, and then provides the health care to a third party, the employee. The customer is the employer, not the employee. That means that, to keep getting paid, they have to please the company and not the employee. This is another inherent conflict of interest.
Some personal observations: I used to get health care though my employer. Every time I had some test or treatment the insurance company automatically rejected it. We'd resubmit it a second or third time and in every case they eventually accepted it.
Now we pay for health insurance directly. Since then not one thing has been declined (and the recent care has been a lot pricier). I don't believe is an accident. It's a business model.
So, the primary model for health care in America -- employer-based insurance -- is just plain wrong from an ethical business perspective. If your primary responsibility isn't to the person you're supposed to be serving, how can you possibly do a good job?
In the best possible light, health insurance companies are nothing more than useless middlemen. Middlemen with a lot of clout that put patients and care providers through a lot of needless and expensive hoops.
The most obvious way to squeeze inefficiencies out of the system is to eliminate the insurance companies, and go to a health care subscription model directly from providers. This is basically what last in line is talking about. It doesn't have to be government run (in fact, our "government-run" health care systems are nearly all administered by private companies), but it does have to be well-regulated, to prevent certain companies from skimming the best clients off, kicking you out if you get sick or change jobs, or banning people with pre-existing conditions.
What I just described is essentially the "government-run" option that the Democrats are proposing. Some insurance company (or companies) will get the contract to run the government's program to provide semi-direct care to subscribers.
Conservatives trust our government to run a half-trillion dollar defense department. Conservatives trust that cops like Crowley aren't abusing their authority when they arrest guys like Gates. Conservatives trust the government to monitor phone calls of suspected terrorists without court-approved warrants. But conservatives say they don't trust putting their lives in the hands of a government-run health care system.
You're already putting your lives in the hands of a government bureaucracy. You put guns in the hands of cops and authorize them to shoot people on sight. You trust that prosecutors and judges will fairly apply punishments like the death penalty.
To me the conservative thing would be to outlaw the death penalty to make sure some over-zealous or lazy cop or prosecutor didn't finger the wrong person because it was easier for them to get a conviction.
I trust some faceless government bureaucrat a lot more to provide my health care than I trust some faceless corporate exec whose bonus depends on getting a 30% rejection rate on health care claims made in their corporate health insurance section.
That is, they make money by not giving you what you're paying for.
Wrong. Just as auto insurance isn't about replacing your tires and oil, health insurance shouldn't be about your annual check-up. I don't call my home insurance provider when I need the house painted or re-roofed. The problem is the way we've structured health-insurance - and that is largely the way the govt has built the incentives (corporations can deduct the expense of providing health insurance but individuals can't).
I agree that health insurance shouldn't be tied to employment, any more than auto or home coverage is (which is to say not at all). It's a very good point you bring up - who is the real customer of the corporate health insurer: the individual/employee making a claim or the company/employer that pays the premiums? That disconnect results in perverse incentives.
But to make the change effective, people are going to have to stop expecting someone else to pay for their routine medical expenses (as many if not most insurance plans do). You have to sell that part first, otherwise you will never get people to agree to the rest of the program. I'm not holding out much hope for this of course.
That is, they make money by not giving you what you're paying for. This is different from other insurance industries that pay nothing unless an accident happens.
That's not quite accurate. All companies of any kind profit by giving you as little product for as much money as they possibly can. It's called "charging all the market will bear". It's also called, "I'm using this money to improve life for me, my wife, my kids. Yes, they are more important to me than you the customer are, get over that." They used to have a pithy phrase to describe this, "Caveat Emptor", but since nobody understands Latin anymore nobody cares I guess. Juris is right though, the real flaw in the parallel is that people expect health insurance to do things equivalent to your car insurer advising (or dictating to) you on where to get an oil change.
The customer is the employer, not the employee. That means that, to keep getting paid, they have to please the company and not the employee. This is another inherent conflict of interest.
Precisely, and that's exactly where most of the problems come from. Just as most of the problems concerning customer value/service, taking care of employees, etc. stem from the conflict of interest inherent in a company trying to please its customers and its stockholders both at once. The interest of the paying customer and the stockholder are almost perfectly diametrically opposed.
So, the primary model for health care in America -- employer-based insurance -- is just plain wrong from an ethical business perspective. If your primary responsibility isn't to the person you're supposed to be serving, how can you possibly do a good job?
Absolutely.
What I just described is essentially the "government-run" option that the Democrats are proposing. Some insurance company (or companies) will get the contract to run the government's program to provide semi-direct care to subscribers.
Those two sentences directly contradict each other.
By having an insurance company or companies (already noted above as having several inherent conflicts of interest) administer the contract in the government's name, you'll avoid the problems caused by precisely those same conflicts of interest? How does THAT work?
It works because you've added yet another layer of "inherent conflict of interest"? That's what getting government in on it does, you know. Instead of:
1. Conflict patient care v. provider profit, plus
2. Conflict patient care v. customer (employer who's payin the bill) satisfaction, plus
3. Conflict customer satisfaction v. stockholder satisfaction,
with all the problems those conflicts of interest cause, instead we'll solve #2 and #3 by eliminating the necessity for customer satisfaction entirely, because (whether satisfied or not) he no longer has the option to stop paying. It comes out of his taxes, if he stops paying he goes to jail. And in addition, just to make it better still, we'll add:
4. Conflict patient care v. politician satisfaction (who is in economic terms the new customer). What do the people making the decisions about how much money goes where, how do they define "good return on investment"? He/she gets reelected, the money people who fill his campaign coffers owe him favors, that's how. Notice anything about whether or not the patient's new leg actually fits in there? Me neither. You're just adding another layer of conflicting goals. The politician's and patient's goals may or may not be directly opposed (varies case by case), but they are at best incidental to one another.
And this is supposed to help matters how, exactly?
I guess my real question for most of the people pushing for all this is the same one my Chief used to constantly ask me when I was in the Navy:
If you can't take the time to do it right, how will you find the time to do it again?
Post a Comment