POL: Problem Solving - Health Care

[EagleFan]

Okay, enough of the political thread that end in name calling, how about a solid discussion of ideas for solutions....

I'm going to post an idea that I have for helping solve the current problem with Health Care. Please feel free to post your comments and opinions and to answer the poll than I have included about the idea.

If you answer that it will not work, please list constructive comments below on why and what proposed changes you would make to the idea. This is a work in progress and with the brains we have on this board (on both sides of the political aisle) we may be able to come up with something worthwhile.

I am probably just opening myself up to ridicule but if that is the case, so be it.



National Health Care:
All citizens are issued health care upon birth. This will be an HMO style health care that may have limited selections on where to get service but will be open enough to everyone.

There are several options within the plan...

1) The amount payed in taxes for this service will be based upon earnings. Those in the highest earning brackets should get the extra brunt of the tax (this is a society and all should help out). Those in the lower brackets will feel little to no affect on taxes.

2) Individuals can still opt for additional coverage through additional payments directly for insurance (these options open up the additional choices a person can have for where to go for coverage).

3) An idivual can "opt out" of the basic coverage which will give a small tax relief (but not entirely remove the cost of the extra tax, as I said this is a society and we need attempt to imrpove the whole of society sometimes over individualism).

4) The coverage will include medical, dental, vision and pharmacy. Copayments will be minimal for all areas.

5) Medical savings accounts will also be offered as another option similar to how they are now with one exception, a person will not be punished for over-estimating the amount of medical they may pay in one year (they will, however, be taxed on the money they did not spend and are refunded).



This idea probably didn't come out entirely as it exists in my head as I have a habit of attempting to shorten things when I type them and often miss the entire point.

If you are unsure of what I mean by things or want clarification ,please feel free to ask.

Not sure how far this thread will go but I figured I would give it a shot. I have been thinking about trying something like this for a while now to get a better feel of where everyone stands and to see what we can come up with on different issues.


Now for the customary statements...

poll to follow...

in before lock... ;) :D

[ISiddiqui]

I'd rather have a system somewhat more like a hybrid, where the government acts as the brokers for basic coverage for wide swaths of people (based on age, location, etc), having insurance companies bidding on those contracts. Of course extra health insurance can be offered by the employers.

[Leonidas]

Whatever America tries, they need to make sure it's as far from the English National Healthcare System as possible. There are a good many third world countries with better services than the NHS. When you have accountants and MBAs running your medical system for the sake of cutting costs inevitably your care goes to crap.

[gstelmack]

I don't think the answer is to remove choice (which is what involving the government will do), and I don't think lowering copayments will necessarily help (you need some way to discourage people from walking into a clinic and clogging it up for very minor issues).

I do think that the problems we have with the existing system are solvable. Insurance created the current mess, we need to work on fixing that mess. Make insurers start actually covering all medically necessary procedures. Stop offering different costs to different groups, since the POINT of insurance is to spread the costs out over a much larger group. Stop giving higher prices to uninsured, especially when those can pay immediately, thus meaning they have lower costs for your business; it drives me bonkers that I would be charged significantly more for a prescription than my insurance company would.

Heck, I think you fix that second one, and more people would be able to handle being uninsured.

I think where government needs to get involved is more on the price-fixing / gouging end of things, and coming down harder on white collar criminals (make it so fraud doesn't pay, rather than making it worth it even if you get caught). Keeping it "fair" if you will, rather than running the whole show.

[BYU 14]

One big step to cleaning this mess up would be to take the individual states out of the governing process and institute a wider "national" set of provisions. (I will post more on this later as I don't have time at the moment)

I will use Texas and their prompt payment act as an example. These regs were passed as an attempt to benefit insured's by holding Insurance companies to more stringent guidelines for processing claims (good in theory) with heavy fines and penalties levied against insurance companies when these time frames were not met. Where does this Money go? A large part goes to the Doctor's as well as the State Insurance commission. Two entities that probably need it less than needy families that can not afford insurance. How does that help the Insureds?

Insurance Companies, saddled with these extra costs do what? Raise premiums and though Texas has a cap on how much you can raise Premiums each year, when it happens year after year at the maximum level it still hurts the Insured in the pocket. In addition many Companies pulled out of Texas because they were losing their shirts. So from the Insurer's consumers now have a pricier product and less choice...How does that help the insured?

Because each State has this power, each State can do about anything it wants as long as a few minimum Federal guidelines are met and I feel this benefits nobody.

It's a complex issue that would take years to sort out correctly....

[EagleFan]

So if we add, or adjust:

- adjustable copays (if you go to the ER for something you have no reason to, and don't have a doctor's referral to do so, your payment is higher).

- taking states out of the picture (which I think is the right way to go anyway as it should be uniform).

- allow choice, which I was for in the original idea anyway just may not have communicated that well enough as there should be a system of choice for not only the HMO portion that is given you but you will still have the choice of added insurance.

- what I think should be mandated now anyway whioch is not allowing accountants to have any say on what is and isn't covered.



Granted, this isn't going to happen overnight which is why a working discussion such as this (or obviously preferrably on the level that can do something about it) is a must. The idea is not going to come about in one sitting (side not: I wish I could get my boss' boss to understand that with some of the large projects we are working on now as he has a habit of asking a question out of the blue about something not in the disuscion at a meeting and expecting an immediate answer before any research is done-- I made the mistake of thinking that was just meant as a seed to be planted for thought and discussion so I gave an initial answer once and he held me to that being the final outcome).

[EagleFan]

One bump to see if there are any other ideas out there...

[BrianD]

1 - I am not a fan of putting more burden on the rich and make them subsidize the healthcare for the poor. I would be ok with a flat tax having the same percentage for everyone.

2 - I'm not sure having government-provided health care with options to go beyond privately is the solution. The poor will only be able to make use of the government-provided care and the better doctors will work on the private side for more money. As it is now, the rich will get great care and the poor will get crappy care.

3 - One way to improve the healthcare system is to reform the legal system. Make malpractice lawsuits harder and make losing parties pay for at least some amount of the legal costs of the winning party. Lawsuits and payoffs to avoid lawsuits are causing some pretty high insurance rates for doctors and high hospital costs to cover the insurance.

4 - I agree that insurance companies shouldn't have to pay less for the same treatments. It makes no sense that they get a deal on procedures while uninsured people get gouged.

[albionmoonlight]

The burden of lawsuits on the system has been overblown. They are still a problem, and they should be fixed (more on that in a second), but the idea that we would all have affordable healthcare but for those big bad trial lawyers is simply false. The numbers do not support that.

That said, I am all for lawsuit reform because it would (1) save the system some money, (2) get rid of the "it's all the fault of lawsuits" bogeyman and maybe get people to start looking at other aspects of the system, and (3) maybe improve the reputation of my profession a bit.

Now, any reform will run into the problem of the pesky Seventh Amendment which (this is a simplified review) demands that the parties have the right to a jury trial in suits of this nature. So we can’t get rid of juries. We can, however, work around them a little bit.

One solution may be to force plaintiffs to first bring their claims in front of an independent board of medical experts. Those experts can make a liability finding and set damages. The plaintiff is then free to either bring the case in court or take the damages. If the result of the judicial process gives the plaintiff more money than she would have gotten otherwise, then she keeps the money. If, however, she ends up with less, then she and/or her attorney can be hit with sanctions for bringing a frivolous suit.

This system should keep the panels honest because they know if they go too low then people will always go to court instead. It will also prevent people from taking frivolous claims, however, because there is the danger of sanctions that does not now exist.

Most importantly, this introduces sanctions into the system, but does it in an objective way. One of the problems with the idea of "hit them with sanctions for bringing frivolous suits" is that there is no way to determine what is frivolous without (you guessed it) more proceedings. If we start to spend a lot of time and money to determine whether people are wasting time and money, we quickly lose the forest for the trees. The system outlined above will minimize that problem because a quick mathematical test will exist to determine whether a lawsuit is frivolous or not.

Someone with some knowledge of economics might be able to show why that either makes sense or is stupid. It makes sense to me.

Other quick points. If we make health care public, but then allow for private options, I see health care quickly becoming like education. People who can afford to send their kids to private schools, and the vast majority of public schools flounder. Now, you might argue that sucky health care is better than none at all, but I still think that one would need to address the fact that the public system would degenerate if left on its own.

Finally, I don’t know much about it, but I like the idea of forcing everyone to carry insurance. Keep the solution in the private sector, but force the risk pools to be large enough to actually absorb people’s costs. Right now, young healthy people take themselves out of the system, meaning that the risk pools of people with insurance is disproportionately unhealthy.

Oh, and though I quibble with the execution of it, I like the President’s instinct to start to de-link health care and employment.

[JonInMiddleGA]

You lost me as soon as you made a point of taking money out of my pocket & putting it in someone else's. After that, anything else you said became irrelevant.

[BrianD]

I didn't mean to suggest that legal system reform would magically fix the healthcare problem, but it does add to the problem. There is still more that needs to be done, but I'd like to see it start with legal reform. To me, that would be like working on two problems at the same time.

[albionmoonlight]

I didn't mean to suggest that legal system reform would magically fix the healthcare problem, but it does add to the problem. There is still more that needs to be done, but I'd like to see it start with legal reform. To me, that would be like working on two problems at the same time.

Cool. My statement wasn't directed at you. There are people who cite "lawsuit reform" as the panacea that will eliminate all ills in the healthcare system because they either (1) work for the medical or insurance profession and very conciously invoke "lawsuit reform" as a way of directing public calls to reform the system away from them, or (2) are normal people who figure that whatever it means, it will make a big complex expensive problem go away without forcing them to make any sacrifices.

It sounds like you and I basically agree. Lawsuit reform won't solve the problem, but it will help, and there is no good reason not to do it.

[Fighter of Foo]

People who generally don't agree with equality/fairness across income levels won't agree with any sort of national and/or subsidized health care plan. It's a large enough minority to prevent anything from getting done.

That being said, I can't support the federal government being in charge of just about anything given the general incompetence and retardation. At the state level, I think could work, and it reads similar (and is probably better) than what's being implemented here in Mass.

[BrianD]

Cool. My statement wasn't directed at you. There are people who cite "lawsuit reform" as the panacea that will eliminate all ills in the healthcare system because they either (1) work for the medical or insurance profession and very conciously invoke "lawsuit reform" as a way of directing public calls to reform the system away from them, or (2) are normal people who figure that whatever it means, it will make a big complex expensive problem go away without forcing them to make any sacrifices.

It sounds like you and I basically agree. Lawsuit reform won't solve the problem, but it will help, and there is no good reason not to do it.

Yes, I am annoyed enough by stupid lawsuits that I would love to see legal reform anyway...not just in medical areas. If that can also provide some help with the healthcare problem, I am doubly for it. It would also give us a good indication of just how much of the problem is left and help us decide how to deal with it. There are no magic bullets in this issue, so I am fine with taking partial steps that give added benefits.

People who generally don't agree with equality/fairness across income levels won't agree with any sort of national and/or subsidized health care plan. It's a large enough minority to prevent anything from getting done.

That being said, I can't support the federal government being in charge of just about anything given the general incompetence and retardation. At the state level, I think could work, and it reads similar (and is probably better) than what's being implemented here in Mass.

Two very good points here. I'm not willing to have my money taken away from me just to turn and give it to the poor. I am comfortable, but certainly not rich and I want to enjoy the fruits of my labor. Charitable giving still comes into play, but it wouldn't bring in anywhere near the funds that taxes would.

I also don't trust the government to handle anything like this. They have no real incentive to stay efficient and do this well. Private companies have the incentive since they go out of business if they do a poor job.

[Buccaneer]

That being said, I can't support the federal government being in charge of just about anything given the general incompetence and retardation. At the state level, I think could work, and it reads similar (and is probably better) than what's being implemented here in Mass.

Me neither. Go figure, huh?

[flere-imsaho]

You lost me as soon as you made a point of taking money out of my pocket & putting it in someone else's.

Well, there's a certain argument to be made that society as a whole benefits when those better off in society make some sacrifices to help those who, er... uh, I just realized to whom I was responding. Nevermind. :p

[EagleFan]

You lost me as soon as you made a point of taking money out of my pocket & putting it in someone else's. After that, anything else you said became irrelevant.

So you don't pay taxes at all?

Streamline the taxes and make the system work. It needs overhauled from the top down and Health Care needs to be a major part of that.

Help society as a whole and everyone wins.

[Desnudo]

The government contains most of the leading minds of our generation, so why not let them have a hack at this?

[JonInMiddleGA]

So you don't pay taxes at all?

Fine, I should have said "...taking more money ...[/quote]

Increase handouts & watch even more hands try to get in your pocket later

Fixed that last bit for you.

[BishopMVP]

Finally, I don’t know much about it, but I like the idea of forcing everyone to carry insurance. Keep the solution in the private sector, but force the risk pools to be large enough to actually absorb people’s costs. Right now, young healthy people take themselves out of the system, meaning that the risk pools of people with insurance is disproportionately unhealthy.

Oh, and though I quibble with the execution of it, I like the President’s instinct to start to de-link health care and employment.I completely agree with the legal reforms and the removal of employers from providing health care. That's an anomaly due to WWII wage caps (oh, unintended consequences!) that merely confuses by adding another layer of bureaucracy.

On the requiring people to carry insurance I'm not sold, seeing as I'm one of those young healthy people. I'm not against helping subsidize costs for elderly people or unlucky people but I see way too many people putting no effort into their own health to consider subsizing the inevitable health problems they'll have. I'm not gonna pretend I'm perfect (too much alcohol and red meat, not enough vegetables,) but at the same time I go running and lifting every day, eat fairly healthy, don't smoke and haven't seen the inside of a doctor's office or even the trainer's room since my last required physical in High School. I have a professor who loves to bring up a strawman and say that "putting down the fried chicken and running a mile won't solve America's health care problem", which I agree with - but it would probably go a longer way than any policy proposal enacted by the government.

So is there any possible way you could see to enact a system under required Universal Health Care that rewards people for making healthy lifestyle decisions, or would that be too hard to implement? Would the required bureaucracy/incentive to lie/potentially questionable ethics once we find out more about genetics/etc. be too great a challenge? Because the other two options are forcing one set of people to live healthier lifestyles or forcing the other set to subsidize the others short-sighted choices. The second, as unpalatable as it is to me, may fly politically; the first never would.