Posted by Abby on January 21, 2000, at 14:33:03
I was purred on by Bradley's new
healthcare proposal and I'm watching the problems that Britain has been
having with the NHS, I have cobbled a few different ideas to come up
with my own.So here are some proposals which to me seem eminently reasonable but
have not shown up in any newspaper I have read. They are somewhat
similar to Bill Bradley's proposals. I readily admit that most of this was
stolen from the web site
produced by mental health professionals which I
hope you'll consider.
http://www.nomanagedcare.org/alternat.htmlHere goes.
1. Scrap Medicaid and Medicare.
2. Mandate that all citizens have private health insurance with a
minimum level of benefits. This should be debated. I personally would
not favor things like In-vitro fertilization treatment. It should include reasonable
parity in mental health. Yes, there has been tremendous abuse, but the
current standard of care in the public sector for those who suffer from
schizophrenia is appalling, and those individuals ought to have some
choice in where and how they get treatment. The costs of
manic-depressives who go bankrupt during a manic spending spree should
not be underestimated.3. The cost of this minimum private insurance would be 100% deductible.
People could have this level of insurance paid for by their employers,
but they would also have the right to ask for the money in their
paycheck--free of Social Security deductions. Thus employers who no
longer controlled the benefits package would not be able to gain access
to an employee's health records. This would benefit small businesses
who currently are at a huge disadvantage when contracting for health
insurance. Every individual would be in the marketplace making his own
decisions, and because everyone had to have insurance the risk would be
appropriately shared. Various levels of subsidy
would be provided depending on income level. The amounts should be
carefully graduated to ensure that there was always more benefit to
working than not.4. Anyone would be free to buy supplementary insurance above the basic
level to cover IVF or private hospital rooms, but in order to discourage
the kind of runaway healthcare inflation under indemnity insurance, such
Cadillac plans would not be tax deductible.
So, basically here's how it would work. After
thorough debate we, as a society, determine what
we think ough to be covered. Private Insurance
companies determine that insurance for all citizens
at a particular rate of coverage would cost some
amount. Let's say $3000. Children, young people,
old people everyone pays the same basic rate. It's
true that different parts of the country have different
costs, but at this level things need to be cherry-picked.
Except for a few exceptions where companies chose to
specialize in the care of specific populations
(see below), insurance companies would be required to
take all comers.
TYPES OF INSURANCE1. HMOs, both for profit and not, could compete for customers by
offering a package offering comprehensive care with only the basic
premium. Keeping HMOs around would also allow people to benefit from the
continuity of true managed care. It would keep open the option of
small, innovative systems like the Massachussets HMO specializing in
quadripelegics on Medicaid.2.Medical Savings Accounts with catastrophic insurance coverage. Poor
people should be given the money by the government; they would have control
over their health care.3. Modified fee-for service plans. Regional Boards, composed of a representative
sample of medical professionals ranging from academic professors to local pediatricians,
would determine reasonable fees for different
procedures. Based on the type of
procedure--triple bypass vs. psycotherapy, the amount paid out by the
insurance would either be the full amount of a "reasonable" fee or belowit. Regional Boards would publish this information, and doctors would
be free to charge more or to waive the difference between the insurance
payment and the reasonable fee. Altruistic souls could offer their
services on a sliding scale. Clinics with idealistic doctors in urban
areas serving poor people would be assured of a minimum income stream.Those opting for the third plan could also have a modified MSA; this
would be either limited in size or only partially deductible, but
someone who wanted something like vision therapy could use the MSA moneyfor that.
There would still be plenty of room for charitable fundraising etc.
or for local cities and towns to spend more.Internet databases, and, to a limited extent, paper ones would be
maintained and available to everyone. Doctors could discuss the
timeliness of the handling of payments by different insurers when
deciding which plans to accept. They would not be stuck with a
government bureaucracy.Patients could rate the different insurers and would be free to switch
on a periodic basis. My feeling is that people are more likely to fill
out online surveys than mail ones. There would also be
room for doctors to be evaluated. In our mobile culture many people no
longer know whom to trust etc. Patients, and perhaps even colleagues,
could, anonymously, if they wished, rate the quality of care given by a
particular physician. That way you would know when it might be worth
spendiing the extra money.
Anyway, it wouldn't be perfectly efficient, but I think it would work
better than the system we have now.
A solution to the problem of "drive-by hysterectomies" etc.
Depending on the age and health of a patient length of time he should
spend in the hospital following a particular operation varies. Many
young, otherwise healthy people could recuperate safely, if not
perfectly happily, at home but older people might die. One solution
would be to offer patients a cash sum which would be less than the cost
of a day in the hospital to leave earlier. They might spend the money paying a maid to make the house more comfortable.
One hopes that doctors would
counsel vulnerable patients to stay longer. Patients would be encouraged to
keep the costs down, and we could dispense with most of the utilization
review people.All of this should be coupled with aggressive public health measures
like
universal vaccination (religious convictions against excepted), adequate
TB management, and clean syringes. (I'd get one to inject juice into my
turkey) If more
people got the flu shot these winter epidemics would be significantly
reduced.I haven't solved the problem of prescription drug beneefits.
On the one hand you want people to be able to get
the prescription drugs they need. Right now in the
UK, though, they have rationing of some of the
newer cancer drugs depending on your region of the
country. One woman who bought a house two blocks
away from one NHS Trust which did provide the drug
which the doctor thought was the best for her
condition couldn't get it in her neighborhood,
because it was extremely expensive--$15,000 or more.
So, she offered to buy it herself. They couldn't
write a prescription. The only alternative would be
to go completely private and pay for everything herself
including all her doctors visits and chemotherapy.
Then there's the problem with prescription strength
doses of over-the-counter drugs. My Dad had some
dental work done. The dentist said he could prescribe
codeine, which my father declined, because it never did
anything for him in the past. (Interesting note:
codeine is either schedule II or III here, but in
many places you can buy it over the counter.) So,
instead my father got a prescription for ibuprofen.
He chose to save money by taking several of the
regular pills. (Prescription ibuprofen costs a lot
more.) Many people with drug benefits would have had
somebody else pay for the ibuprofen and would not
be at all cost conscious. So, there's a dilemma;
you want people to be sensitive to the cost, but
you don't want them to be so worried that they don't
get the treatment they need.Finally, the overall cost to the taxpayers. It probably would cost a fair amount. I'd like to
see pork spending cuts, but I don't have high hopes. Here are a couple
of ways we could save some money.
1. An end to federal subsidies for police in rural areas where there is
no crime.2. An end to the war on drugs. Legalize and regulate. Treat drug abuse
like the public health problem it is. Shut down the DEA, reduce the FBI
and reform the ATF. Clinton just gave the ATF more money, but they
obviously have too much if they can afford a WACO.Ending the war on drugs would save oodles of money. It would be good
foreign policy too. No more destabilizing of Columbia and other Latin
neighbors. Then there's the matter of expensive, macho raids. Moreover
all those mandatory-minimum sentences which put people behind bars for
20 years or more have, as I am sure you know, increased our prison
population exponentially. Keeping people in prison is expensive. Never
mind the gross infringement of civil liberties and private property
through asset forfeiture.
poster:Abby
thread:19352
URL: http://www.dr-bob.org/babble/20000112/msgs/19352.html